37TW «T %, <:< c-JCr-* ._ . >i .v. :—j,.;:;:;'^|j>'l: '. ^t): Surgeon General's Office Ua I I1 No ..£ .-r^/tf ■aaojGagagacQgaQQG-a go cocoon aft! NLM005801229 RETURN TO NATIONAL LIBRARY OF MEDICINE BEFORE LAST DATE SHOWN OCT 04 1984 FEMALE HYGIENE: A LECTURE DELIVERED AT SACRAMENTO AND SAN FRANCISCO, BY REQUEST OF THE STATE BOARD OF HEALTH OF CALIFORNIA. By DR. STOKER, JR. (Horatio), OF BOSTON, CONSULTING SURGEON TO THE CARNEY (GENERAL) HOSPITAL, AND TO ST. ELIZABETH'S HOSPITAL FOR WOMEN. REPRINTED FROM TUB JOURNAL OF THE GYNAECOLOGICAL SOCIETY OF BOSTON. BOSTON: JAMES CAMPBELL, Publisher, 18 TREMONT STREET, MUSEUM BUILDING. 1872. Female Hygiene. A Lecture delivered by Request of the California State Board of Health, at Sacramento, on the 28th April, 1871, and at San Fran- cisco, on the 25th May, 1871.* By Horatio Robinson Storer, of Boston. To a tired man, just preparing for a month's respite from constant and harassing care, by crowding that month's work in advance into the busy weeks preceding it, there came most unexpectedly Dr. Logan's kind request to add an Alp to the already too heavy burden. The very idea of preparing for delivery, under the auspices of the California State Board of Health, a lecture upon Female Hygiene in any way worthy the intrinsic importance of the subject, seemed like raising for the traveller a far more impassable barrier betwixt Boston and Sacramento than wonld once have been the dizzy heights, the floods, the wilderness, that intervene. I confess then, frankty, the reluctance with which I have assumed this task, and my conviction that in its performance I shall be found to fall far short of what you, perhaps, may think that you have the right to expect. I have undertaken it simply because, anticipating so much pleasure during my short stay in your State, it seems my duty to accept the opportunity now given me of endeavoring to make some slight return. No person can reach adult age without becoming impressed, often painfully so, by the belief that there are very different factors underlying the hygienic conditions of men and women ; inherent ele- ments, surely governing, and producing results that in the case of the gentler sex, to whom only we are now to give attention, are favorable under certain circumstances, extremely unfavorable under others; * Repriutcd from the First Biennial Report of the State Board of Health of California. 1 2 and then, disastrous not merely to the individual, but, in one way or another, to the wide circle of persons who may be within her imme- diate influence, and at times, however indirectly, to the whole coni- munitj*. The effects referred to, comparing the health of one man with that of one woman, or of any number of hundreds or thousands of the the first with an equal array of the other, are far greater, proportion- ately, in the case of the woman. That is to sny, while, First. "Women are naturally more exquisitely delicate in their, physical organization than men; more acutely sensitive to all emo- tional agencies; different in the very character of their intellect, as well as in its methods of thought, and far more spiritual (to use the term as expressive of a near approach to the source of all that is pure and angelic), and while, Second. Women are prone to a thousand physical ills and disturb- ances, many of them very severe, and some of them as j'et practically incurable, — the foundation, each and every one of them, at times, of mental disorder as well (in itself far more lamentable than the direst form of bodily suffering), — of which men practically and from their own personal experience, do know and can know comparatively nothing; Third. The health of women is much more liable to grave derange- ment from strictly hygienic cause than that of men. It is of this latter fact, and of this alone, that I have to speak to you. I shall point out some of its more prominent illustrations, and suggesting briefly what needs to be clone for relief, and for preven- tion, which is always so much better than cure, I shall have done well if my words prove to the people of your State, seed that in its fertile soil may bring the harvest quicker and more abundantly than can obtain in those icy and sterile older regions whence so many of you have come to this American Canaan. I shall have to speak very plainly, and must verge upon matters that, perhaps because they affect the best interests of society, are too often unwisely left to an unbridled imagination, wholly ignorant of the simplest laws of sanitary science. I shall trust, however, not to offend even the most delicate ear, and to carry conviction of the in- finite importance of what I shall speak of to each and every one of you. But it is possible that I may be asked, is it really true that women, like those treasures of finest workmanship whose value is enhanced just in proportion to their delicacy and fragility, are so prone, in 3 their very nature, to disease ; so wonderfully interwoven together of body with mind, through their intricate nervous organization, t'aat a mental shock or strain can occasion physical disturbance, and physi- cal derangement induce mental aberration or entire intellectual de- thronement, and so liable to confirmed invalidism, or an untimely taking off, as I have now stated? Does a, man make this inquiry, he can hardly have lived in the average domestic circle, awake to the anxie- ties that there ever press so heavily. In the old pioneer times here in California, such might have been possible. An enforced celibacy, or the enchantment of half-forgotten memories, heightened by distance in space and the longing for a brighter future, could perhaps have clad each dreamer's ideal with the richly glowing tints painters in Holland so loved to copy from their buxom sweethearts and wives. But the flushed cheeks and the sparkling eyes of those visions of eighteen hun- - dred and forty-eight were but the hectic hollow and the unnatural lus- tre of New England's consumptive ghosts, — the nut-brown maid, but the sallow victim of our central and southern malaria, — so many of whose hearts were then breaking from weary bereavement and the idle tales of a flippant, gossiping press, every word of which seemed aimed at some especial darling, far away as he was from all protect- ing influences, save the mighty one of pra}Ter. Is it a woman, on the other hand, who questions what I have said, of the comparative delicacy which so invests her, by Divine compen- sation, with a claim upon man's esteem, pity and reverence? Then, exception to her sex, epicene and valueless, alike morally and physi- cally monstrous, let her descend, devoid of every sense of shame, to those planes of competition with her grosser opposite, for which the unsexed women of the present day so clamor and strive. As broker, politician or professional person, these self-satisfying paradoxes ma}' succeed in gaining their daily bread. But, relinquishing thus that sweeter sphere for which Eve's daughters were created, no longer the partners but the rivals of man, they have lost, to all with a spark of what we still call chivalrous feeling, or a trace of respect for aught above what is purely material and utilitarian, almost as though they were the abandoned creatures of the streets, every claim upon what in their hearts they still so instinctively cherish and long for. This being so, and I know that my words must be felt to be true by all who hear me, I might proceed. And yet there is a something more that I ought, just at this point, to say. It may come to 3-011 with the better grace from a stranger than from one of jrour own people ; and if he has had at all commen- 4 surate opportunities for judging, his statement of the fact to which I am now about to refer, may carry more perfect conviction. In one of the latest issues of jrour medical periodical press, the asser- tion appears, that " Dr.------, of San Francisco, speaks of the much greater prevalence (of certain forms) of non-specific (or non-blam- able) local disease in women, in California, than in the Atlantic States, as a fact not only confirmed by his own experience, but by that of every intelligent physician with whom he has conversed upon the subject." I doubt if the above remark is perfectly borne out by the experi- ence of any number of those physicians who, previous to their settle- ment in California, had given as much attention to the study and care of sick women, as since their residence here. It will be observed that I am speaking now of " non-specific" disease,—that unattended by any imputation of shame. Woman is woman everywhere in the world. She may suffer unduly from goitre in Switzerland ; she may wholly escape pelvic cancer in Iceland, as of late seems to have been shown by the learned gynaecologist of that country, Dr. Hjaltelin.* She ma}r have peculiarities due to her race, as those special hypertro- phies of the breast and other parts of the bocty, that to Hottentot eyes are so ravishingly beautiful; or, as in the negress, she may be far more subject to fibroid tumors than the Caucasian; but there seems to be no reason that in California, now comparatively an old, sedate and well-governed community, there should be any redundance of a class of local affections, that in themselves are common everywhere, and dependent, for the most part, not upon climate, nor diet, nor dress, nor business emplo}Tment, but upon a neglect, in the single, of proper rest from fatigue, and in the married, of the simplest rules of conjugal courtesy. This is not a mere presumption of my own. It has been borne out by the study of California patients, during quite a number of years. I shall now present to you, more decidedly, other views regarding yourselves, upon a matter of even greater moment. A noted, but I think a little too hasty writer, a practitioner of your own State, put into print twelve years ago a statement that struck me at the time as very extraordinary. It was certainly very damag- ing to the reputation of j^our people, and, however limited the circle of unprofessional readers that it reached, it must have caused many a cheek to tingle with shame, many a one to flush with indignation, ' here in your midst. I have no doubt that the mental anxiety and anguish that it occasioned at a distance were simply incalculable. * Journal of the Gynaecological Society of Boston, March, 1871. 5 " In no place of civilization," it was said in eighteen hundred and fifty-eight, by this gentleman, " do the causes [of ill health among women] exist or prevail to the same extent as in California." These causes, the writer referred to went on to state, were chiefly the ''yielding to the seductive allurements of sexual dissipation. This applies," he said, " equally to the unmarried and married; and so general is it," he continued, " that I believe I am correct when I es- timate two in every three females, who have reached the age of fif- teen, to be victims of this dissipation." * The above statements I cannot but believe to have been exagger- ated, even so long ago as eighteen hundred and fift}'-eight, however unintentional it may have been on the part of their author to convey a false impression. Were they made by any one, of the California ladies of eighteen hundred and seventy-one, he would at once be branded as a disreputable person. The paper, however, from which they are quoted bears intrinsic evidence of having been very hastily prepared ; and in this fact there must be allowed to exist a sufficient measure of excuse, were such thought necessary. The report opened with the following remark, which should be borne in mind when the charges that it made are taken into consideration : "■ During the past twenty-four hours," such is the admission of its writer, " I have thrown together these facts and reflections in an exceedingly rude shape." It must not be forgotten, moreover, that plrysicians, dealing as the}' have necessarily to do, with so much of vice and wretchedness, may easily lose sight of what is good in the world about them, over- borne as it were by their enforced contemplation of its opposite. With conversations that I have had with my friend, upon whose statements I am commenting, since reaching San Francisco, I am satisfied that he made them in good faith, and it is my desire to relieve him, so far as possible, from the grievous false position toward the community and the profession he has by some' been thought to occupy. The immediate effect of the paper seems to have been singularly unfortunate. Not only was the better portion of the public disgusted, but its confidence lessened in that profession, one of whose members had so seemed to malign it. Could ladies consult a physician, if their most innocent ailments were to be made the object of so uncharitable suspicion or comment? Could husbands endure to be * Report on Obstetrics and the Diseases of Women, by R. Beverly Cole, M. D., of San Francisco. Transactions of the Third Session of the Medical Society of California, 1858, p. 133. 6 supposed always the brutes a vivid imagination would portray them ? Besides all this, it is more than probable that what appeared so great an act of indiscretion had no little to do with the torpor and temporary death that soon fell upon the State Medical Society of California, then in its earliest infancy. Many physicians felt that their experience had been misrepresented, and that the publication under the stamp of the society, — for the paper referred to was printed in its Transactions, — of what might thus be thought to have been indorsed by them, was a decided and permanent injury to their prac- tice, from which it might take many years to recover. It was cer- tainly a fearful blow at the progress of gynaecology, — that beneficent science to whose reyelations the world owes an ever-increasing num- ber of women's lives that otherwise were untimely sacrificed. Let us hope that the present year, signalized as it is by the first formal recognition upon your own ground of the members of the American Medical Association by their brethren of the Pacific Coast, and by the establishment of the State Society upon a far firmer basis than it had in that early time, may mark a turning-point in the reciprocal rela- tions of the profession and your community; the one pursuing their arduous and so often unpleasant duties with greater zeal and enthu- siasm than ever before, the other bestowing a freer confidence and reaping therefor a commensurate reward in better health and pro- longed lives. I have spoken, you will perceive, very plainly upon this topic, bas- ing my right to do so, as I have said, upon personal observation of many Californians, during my score of years in practice. They have been women in every class of society; some of them rich and some of them poor, — married and unmarried; some of them returning home to the East for a permanent residence, others temporarily visit- ing their friends, and still others coming solely for the purpose of seeking advice and treatment. Their diseases have been the same in type, — covering, as all these affections do, everywhere in the world, a vast range of differential peculiarities, — as those of their sex in other parts of our country. Certainly, they have been no worse ; cer- tainly, they have afforded me no ground for suspicion that the people of California, at the present day, lack more than usually the moral sense. And again, granting that the influence of the old times was not wholly lost, when, in the scarcity of women here, a stray bonnet or slipper is said to have 'been publicly worshipped, and when the over- land journey or the trip around the Horn was attended by peculiar 7 danger to a woman's good name, and that a dozen years ago your State was still a frontier country, and under circumstances in many respects exceptional; it was not, however, so very much more so than many distant or isolated portions of the Union at the present time. I happen to be familiar, from personal study upon the spot, with the diseases of w-oman as they prevail in several parts of the British Provinces and in our extreme South-west, and am constantly seeing patients from other parts of the country, very many of them sent by physicians with whose own experience, as detailed to me in person or by letter, I am also acquainted. From these data, again, I am forced to the same result. You may have here in California an undue preponderance of deaths in men from aneurism, — you may have still, as in your earlier history, more than your share of fatal wounds, — but I cannot grant, as regards the morality of your women, unless I count those poor creatures from across the sea, inaptly termed " celestials," that they are one whit worse, at least so far as one can judge by the character of their diseases, than their Puritan Eastern cousins. " Female Hygiene." There's a world of thoughtful meaning con- tained in these simple words. With the discussion of womanly char- acteristics, physical or mental, we have nothing now to do. Over- written or understated, we may take them all for granted. In some points inferior to man, in others far above him, woman is in all of them governed by wholly different laws. AVhile his physical life scarcely varies, from the cradle to the grave, save in its steady growth, culmination, and as steady decline, hers is a constant series of changes, from childhood to maidenhood and maturity; and as this period again is shortened to a term of but thrice ten 3-ears, the wife becomes aged while her companion may be still in his prime. Whether married or single, her life in its physical aspect is like the tides of the sea, ever ebbing and flowing in obedience to laws that, explain them as we may, are yet among the darkest mysteries over which the Creator has thrown his veil. The renewal of life, again by its transmission to offspring, and the physical changes undergone My the mother in supplying her child with its earliest food, — these all mark critical epochs in woman's history, each with its own host of diseases and dangers, all of which may to a certain extent be pro- vided against, and all of which, in their general sanitary relations, deserve attention at your hands. It were foolish to say that these are topics too abstruse for study, too sacred for discussion. If they were better understood, far more 8 infants would be born living, — and I here put aside all cases of crim- inal interference, which, according to evidence adduced by the Presi- dent of your State Board of Health, Dr. Gibbons of San Francisco, is probably now as prevalent in California as in the Eastern States ; far more children, especially girls, would be reared to maturity; far more women live to old age ; far more marriages be happy ; far fewer excuses or temptations exist for divorce. What subject, therefore, more practical, or more worthy the attention of a State Board of Health, to whose watchful care not a citizen but that may owe all that he holds most dear ? Very little has as yet been written concerning the subject of Female Hygiene that is at all philosophical or satisfactory; and the crudest notions prevail in the community, alike with regard to the causation of invalidism in women and the best means of its prevention. It has been stated by the author upon whose views concerning the character of your population I have taken the liberty of commenting, that much of the ill health prevailing among the women of one of your cities, San Fraiicisco, — over and above what he explained so unpleasantly, — is attributable to the effort required in climbing its hills. This, how- ever, even allowing for their former greater steepness, would apply with almost equal force to a residence anywhere in an uneven country, — to the dames of Albany, Boston and Quebec, of Valletta, Rome and Edinburgh. Fatigue of the kind referred to may, it is true, aggravate such diseases when already established from other causes, but mountaineer maids are fully as healthy as those of the lowlands ; and, so far as regards the influence of participation, within any rea- sonable bounds, in the enjoyments of social life, there may be as much exposure to chill and over-fatigue in attendance upon the sober lecture or prayer-meeting as at the concert or ball, — as much mental and physical self-indulgence in the solitude of the cloister cell as in the haunts of gayety and pleasure. From the inherent excessive delicacy of woman's organization, there exist a vast amount and as vast a variety of disease peculiar to herself, over and above those ordinary illnesses to which she is liable in common with man, but which themselves are liable to be simulated, masked and increased* in virulence by the very influence of her sex. Take consumption, for instance. The sedentary life of women and their comparative seclusion from active out-of-door exercise, even in girlhood, render them more prone than men to a disease so dependent upon a low condition of constitutional vigor. But, in addition to this, it is found that while in men, making allowances for alternations of temperature and atmospheric moisture, and differences in diet, garb 9 and exercise, the lungs perform weekly, monthly and yearly, a certain average of work, —in woman the case is very different; there being with her what has been termed an accessory respiratory organ, one of whose duties it is to serve at regular intervals as an outlet of the car- bonaceous waste, which, during the intervening periods, is in the main disposed of by the lungs ; that is to say, in her the function of the lungs is a constantly varying element, witljin bounds which in themselves are liable to variation through disease, while in man it is always one and the same. In her, therefore, allowing for man's greater exposure to wet and chill while attending to his daily labor, the pulmonary system is far more liable to disturbance, derangement and local death. And so, again, with gastric disease. In man, dyspepsia and the group of morbid affections of which this is but a symptom are usually the result of some lesion, more or less severe, and more or less per- sistent, of the stomach itself. In women, upon the contrary, the periodical changes which are regularly taking place within one por- tion of her visceral economy are liable, in case of any derangement, to make themselves felt, through the reflex influence of her nervous system, upon the other organs in their neighborhood, just as is so fre- quently seen, as the distant result of a healthy physiological process, namely, the nausea, and at times excessive vomiting, of gestation, which occurs long before the stomach can have felt any appreciable pressure from the organ primarily affected. And so, also, with regard to the brain and nervous system. While women, like men, are subject to insanity from organic cerebral dis- ease, and to paralysis following upon apoplexy and similar causes, and to convulsions, as the result of injury or exhaustion from hem- orrhage, they present also a host of mental aberrations, that may be of the most general and terrific character, of paralyses the most com- plete, and spasmodic seizures the most distressing; all of which'may be purely functional, from distant and often trivial irritations, whose existence is often unsuspected. There is scarce a class of diseases, indeed, to which flesh is liable, that I might not in the same manner show to be more common in women than in men; and it will be seen, when their special and peculiar affections which so often underlie all the others, are also taken into consideration, that Female Hygiene is a much more impor- tant subject than might at first have been supposed. Such being the case, you will permit me briefly to call your atten- tion to the actual frequency and causation of the special affections to which I have alluded. In doing so I shall reproduce certain views 10 that I have elsewhere presented for the thoughtful consideration of medical men: — ib There are honest men in our profession who deny the frequency of these special diseases. Having eyes they see not, and even if they saw, they could not understand; this being from no wilful fault of their own, but in consequence of defective training or erroneous methods of observation. There are others, equally honest in their purpose, who are deterred from making the necessary investigation, from a twofold timidity : fear of the ridicule of their fellows and of being misunderstood by their patients. There are others still, who, from jealousy, natural incompetency, the love of mischief, or ingrained malice, would keep from the laborer his most satisfying recompense, by stigmatizing the records of his cases as false or overdrawn, and as imaginary the diseases that they represent. •' It is to the honest sceptic, the still incredulous general practitioner, of whom the number is constantly growing less, that I now speak. No information on the subject is required by those whose duties lie more particularly among women. The evidence of statistics is( not worth much, since pelvic examinations are seldom made during life, or after death, of perfectly healthy women, or those in reality considering themselves sucli; but I venture no risk in asserting that the frequency of organic disease — and by this is meant noteworthy and important organic disease — is greatly underrated. Probably two out of every three women in New England, and the same remark applies to other parts of the country, require occasional treatment. Pelvic disease in women covers a range of lesions, vast in number and of very differ- ing character. Identical symptoms may represent diseases intensely divergent. Antagonistic symptoms may represent an identity of disease. Graily Hewitt well has it, that the organs referred to have a life of their own, to a great extent independent of, while they so strongly control, the life, mental and physical, of the woman who car- ries them within her. A hundred cases side by side, and no two of them identical. Such is the experience of every gynaecologist. Since 1 entered the profession, and this is perhaps what no other man living can say, I have never once prescribed for a married woman with any, the slightest, pelvic symptoms, without a careful personal examination ; and while, in a small proportion of cases, there was found so healthful a local condition that it was possible to dismiss the pelvic region from all participation in treatment, in scores upon scores of other cases, where not the slightest suspicion had existed on the part of the patient that there was here any cause for anxiety, there was detected the grave, effective and real exciting cause of the 11 distant or apparently constitutional disorder previously recognized. It is a great mistake to suppose that the presence or character of every form of organic disease can be determined from its symptoms, or that such are always present where the disease exists. I have repeatedly found cancer in its advanced stages, when there had never been lan- cinating pain, metrorrhagia or foetid discharge. Yet one or all of these are generally supposed necessary to the presence of malignant disease. We may have displacements sufficient to produce sterility, and yet apparently perfect health; infra-mammary pain, reflex in its causation, mistaken for cardiac or pulmonary disease; the most profound melancholy, supposed of religious origin, sending a patient to an insane asylum perhaps, when it is all owing to a pruritus de- pendent upon ascarides, but which the patient supposes a device of Satan for ensnaring her soul,—just as I have known a married woman, who had forgotten herself during the temporary absence of her husband for a week or two, commit suicide a few moments after- wards from remorse. We constantly see pelvic mistaken for intes- tinal inflammation, uterine fibroids for impacted scybala, and so forth, simply for the reason that the necessary measure of physical examination had not been resorted to, a neglect which, in affections of any other part of the body, would be, by ordinarily good physicians, pronounced malpractice. '.' In advocating tactile exploration before essaying even medical treatment in cases that are probably pelvic in their character, it will be noticed that I advise it, Unreservedly, in the instance of married women. For the unmarried, on the other hand, it should be reserved for cases whose pelvic character is evident, or where ordinary treat- ment has failed. If no local disease is found, a load of anxiety is lifted from both the physician and patient. If it is discovered to be present, doubt has been removed and the treatment is made decis- ive. These are matters purely of common sense. Thoughts of sex are the last that enter a pure mind when invalidism is present, and the more sensibly practical the physician, the greater his success and the more sure his reputation. " It is strange that our younger men complain that the profession is more than full, when there is everywhere, in city and country alike, a wealth of legitimate and lucrative employment as yet almost un- opened, awaiting the zeal of the special worker ; the surest key, more- over, to the best general family practice. ki Granting that female diseases are more frequent than has been supposed, for he who seeks cannot but find, many are yet puzzled as to their causation ; and these not merely mothers, who do not readily 12 understand how young girls can so often become the subjects of dis- placements and local inflammations, but physicians, who see in it all, as Dr. Nathan Allen, of Massachusetts, has done, a proof that our women are degenerating into barren shadows of their former selves, physically unable to become the mothers of men.* Such a view I consider mistaken. It might be shown that women are just as fruit- ful, provided they let themselves be so, as were the dames of a by-gone age. " A great deal has been written about the causes of what has been termed the physical decline of American women, — an expression that conveys a false idea. I acknowledge the frequency, both pos- itive and comparative, of ill-health among our women, but believe that a large portion of this is remediable, provided its causation were properly understood. " Some of the elements of this computation have been fully appre- ciated : such as the effects of parturition, over-lactation, unbridled indulgence, undue mental and moral excitement, exposure to chill at certain critical periods, violent or prolonged muscular efforts, over- fatigue, excessh'e or unequal pressure from the clothing or from apparatus resorted to as remedial, and irritation from disordered function or abuse of other organs, as violent retching during vomit- ing, excessive constipation, etc. " The same is true of the disproportionate development of the ner- vous as compared with the muscular system,— the result of an over- stimulating social atmosphere, prematurely entered. Increasing the ill conditions thus begun, come the influence of constrained and faulty positions long continued, whether standing, sitting, or recum- bent ; the use of high-heeled shoes, and of faulty leverage in dress, in addition to the faulty pressure therefrom already pointed out; while beyond this, and by no means least, there lie the reflex and sym- pathetic disturbances of the nervous system, produced by anterior, posterior and downward pressure upon the pelvic plexuses, from dis- placements or hypertrophies of the pelvic organs, or outgrowths from them. , " Other observers have attributed much of the infirmity observed, to the domestic appliances of modern civilization, such as the tier upon tier of lofty staircases characteristic of our city palaces ; the furnace heat, heavily charged with gaseous poison, which makes of the dwelling a forcing-house, devoid generally of the great essentials of such, namely, sunshine and moisture; and the so universal barbarities in diet, only * " The Law of Human Iucreaso," Quarterly Journal of Psychological Medicine, April, 18G8. 13 excelled by the haste with which the vile meals are swallowed. A craving for over-medication, or too active or constant medical treat- ment, is no unnatural consequence, and there can be no doubt that many of the means taken to cure disease in reality induce it or give rise to worse; such, for instance, as an indiscriminate and careless resort to sea-bathing, mineral springs, electro-galvanism and calis- thenics. Inheritance plays, too, its part, and just as the taint of twin births often descends from parent to child, so, no doubt, does a ten- dency to many forms of local organic disease. " The sewing machine, that compound of blessing and curse to woman, adds to the list of influences causative of disease, not only acting in several of the ways suggested, by the long-continued and constrained position and fatiguing of the pelvic muscles, but in another, not generally sufficiently appreciated, by which a mental and dangerous disquietude is originated and enhanced by the unintentional auto-stupration. " There are causes, however, beyond and above these, recognized, a part of them, by a few who have seldom dared to breathe above a whisper what they yet know to exist. Several of them have, been re- ferred to by another authority, in an article remarkable for the bold- ness with which it was presented to the community, and its plain language.* Every word of the following extracts from the " Knick- erbocker Magazine " will be acknowledged to be true. The writer is first speaking of the diseases of women resulting from criminal abor- tion, — an offence to whose study and prevention I have myself given .a great deal of attention: — " ' The health of the mother,' remarks the gentleman, 'suffers ma- terially from the violence done her system and from the shock to her nervous sense. Whether it is effected by powerful drugs or by mechanical and instrumental interference, the result is deleterious to the animal economy. The organs are often seriously lacerated, punc- tured, irritated or inflamed, producing temporary disease which threatens, and not unfrequently destroys, life, and also, when appar- ently cured, leaves the organs cicatrized, contracted, maimed, in distorted shapes and unnatural positions, in a state of subacute inflammation or chronic congestion, for all after years a source of pain and weakness, and a fruitful origin of neuralgia, disabilities and miseries. Be assured this is no exaggeration, for we cannot recall to mind an individual who has been guilty of this crime (for it must be called a crime under every aspect), who has not suffered for many years afterward in consequence ; and when the health is finally * Knickerbocker Magazine, January, 1860. 14 restored, the freshness of life is gone, and the vigor of mind and energy of body have forever departed. Languor and listlessness have become a second nature by habit.' " What is true of the premature arrestment of pregnancy applies with equal force to the effect of measures for its prevention. Upon this point the authority referred to is equally direct in his remarks: — " ' An overweening desire for luxury,' he says, ' for dress, fashion, or from simple indolence, — sometimes from a desire, which may be laudable, not to produce children to inherit constitutional disease, — induces many to take various precautionary measures against concep- tion. We have heard clergymen state " that a man should control the size of his family, as much as a farmer his flock, and that he should not have a larger stock than he can house and feed; that this was in the power of any one; that the lower classes were overrunning with children, and the poorer the parents the more prolific they became." Yes, and the more healthy and vigorous ! It is these women who do not pretend to guide the course of events, or make the laws of nature conform to their wishes, who are in health and actually doing the work of the world ; while the wise in their own conceit are sufferers, invalids, and useless. The laws of nature and the necessities of our existence, implanted by an overruling Providence, cannot be contra- vened without detriment to the S3'stem. Local congestion, nervous affections and disabilities are the direct and indisputable result of the vicious means commonly employed by the community, who are so ignorant on all these matters, and who are, in fact, substituting for one imaginary difficulty, in prospect, a host of ills that will leave no rest or comfort to be found.' " The same unsparing hand points to the frequency and evil conse- quences of a certain selfish habit in women which is, as I myself have elsewhere shown,* while itself often the result of some sympathetic neighboring physical excitation, and so not a vice, yet an important element in the causation of other local disease. Unattended by the special source of exhaustion accompanying the habit in the male, it induces nervous irritation rather than prostration, attaining often an intensity of indulgence undreamed of by anxious friends or the attend- ing physician. " I have not referred to the influence, whether direct or by inheri- tance, of the various forms of the loathsome specific diseases, for their frequency and their virulence in the female are far less with us than many alarmists would fain represent, — less, there is reason to believe, than obtains abroad. Western Journal of Medicine, August, 1867. 15 " Beyond and above all that has been said, it must not be forgotten that while, through the influence of the introduction of anaesthesia and the progress of obstetrical science, the pangs and perils of parturition have been lessened, and the chance also of its subsequent evils, as vesico-vaginal fistula, crural and other embolism, and pelvic inflamma- tion, and while an increasing self-control in the masses has practically subjected Venus to Minerva, and while the restlessness of the age has endeavored to introduce into public and private life a third sex, that of masculine women, — there are causes still effective in inducing ill- health in our women which have been only indicated, and never as yet carefully studied. Such are long betrothals, attended as they so often are by hope realized and yet deferred, — for the physiology now taught in our schools gives the knowledge of much that were better then dispensed with ; the too prevalent custom of avoiding lactation, lest it interfere with the requirements of fashion ; and the fact, a very im- portant one in this connection, that, thanks to improvements in sanitary science, the sickly children that in former times used to die in infancy are now many of them raised. The delicate girls that at puberty were mown down by phthisis as grass before the scythe, now many of them live to become wives and mothers, in their turn begetting frail and invalid offspring. " I do not believe with certain authors that the healthy woman is the physical equal of the man in every respect; but I do believe that, while a host of pelvic aches and ills have grown into existence as the result of a change from the age of Force to that of Reason, there were in the old times behind us, that we are wrongly taught were golden, deaths without number from pelvic causes unsuspected, ovarian dropsies supposed ascitic, local organic hypertrophies, out- growths and degenerations misnamed affections of the liver, and all sorts of disease from oversight or neglect by the physician, special in their causation, and wrongly designated as by the providence of God." * From the above it will have been perceived that the whole subject of Female Hygiene is yet in its infancy ; that the causes of ill-health may lurk undetected, the very possibility of their existence even not being appreciated; that formerly, as now, there were hosts of bed- ridden patients who might have been restored to society as active laborers for the common good, and of deaths that might have been postponed or prevented; that still there constantly occur the most serious errors of diagnosis, and consequently of treatment, trifling ailments being thought severe maladies, and the gravest affections * Journal of tho Gynaecological Society of Boston, July, 1869, p. 39. 16 but imaginary disease; that w-hile some of the old causes of illness have been lessened or removed by the advancement of science, new ones have risen with that of a progressive civilization; and that feeble children, who formerly would have been lost, are now reared. While a certain proportion of these prove hearty and strong, others of them, becoming the feeble mothers of a puny progeny, die early or linger into a wretched old age. Do you ask me now to what practical result do these facts tend ? Ask rather the judge on the bench, and he will tell you of causes innumerable wherein they have given character to the puzzling suit. Is it a divorce that is sought? "Incompatibility of temper" too often means an enfeebled body, no longer responsive to the claims Of passion, — a mind perturbed by melancholy or jealous to the bounds of madness, — all from some simple physical disturbance that might or might not by care have been prevented. Is it a thief, or a drunk- ard, or a murderess — though the result of the late trial at San Francisco * shows that there is a limit to which such a defence can be permitted to be made — that has come before him for sentence ? Ten chances to one there exists a morbid craving for wrong-doing, an in- controllable impulse, in itself a symptom of physical disease, and most likely more marked than at other times at certain critical phys- iological periods. Or ask the clergyman, the comforter, to whom so many women un- lock the secrets of their hearts. You shall learn of sorrows borne long in silence, and of physical and mental sufferings, to which death would be a pleasure, of whose existence the world does not dream. You shall be told of conflicts that have shaken faith, and of despair that has driven to suicide. They rested, nine in ten of them, upon a physical cause. Do you put the question to the insurer against death? He will reply, if he understands the true meaning of those tables upon which his success depends, and more distinctly than has lately been done by Mr. Alexander Delmar, of New York, that all the averages, the sim- plest expectations of life, are fundamentally different in women as compared with men, and that the greater liability in the one sex to decease by accident or intentional homicide cannot safely balance the evil chances attending parturition, lactation and the climacteric. And if you ask the undertaker, he will confess that many a fair maid and many a gentle mother has he coffined and borne away to her mingling with dust, of whom he bad heard it whispered, " This might not have been." * That of Mrs. Fair, for the murder of her paramour. 17 Come now to the physician for his opinion ; and if he be a thoughtful man, who believes that in order to remove the effects of a cause you must reach that cause itself, you will gain from him some useful hints. Childbirth, he would tell you, should always be attended by the most competent nurse and the most skilful physician that can be obtained. A perfectly natural and physiological process that, in the large proportion of cases, progresses favorably without any aid, it is yet liable at any and every time, and under any and all circumstances, to the most terrible complications, during which a moment's delay or the slightest ignorance may prove fatal. Hence the necessity of approved attendants. An anaesthetic, he would say again, goes far in childbed, when properly given, to increase the safety of both mother and child, as does also, afterwards, the process of suckling. Turning the breasts for a few months to their appointed use relieves organs long furnished with an excessive supply of blood, and lessens many a chance of sub- sequent ill-health and disease. Infants, you would be told, should be allowed a certain amount of air and exercise. If treated at first more like animals and less like reasoning creatures, the mother's pride might suffer, but it would be more than compensated by a lasting joy in after years. Girls, little and great, should be far more educated in body than at present, far less in mind. Proud, as every New Englander, of our system of common schools, I yet believe and acknowledge that many a delicate girl has been utterly ruined in body and mind by the men- tal overwork to which she has been subjected. Ambitious, for that runs in the New England blood; quick of perception, for that's a quality that comes from its clear atmosphere ; spurred ever to attempt beyond one's strength, for such is the effect of our unrestful life, which must have the experience, bitter and sweet, of an old-fashioned year in each twenty-four hours, — is it a wonder that they early bloom and early fade, so many of them grown women at sixteen, old women at forty, wishing themselves out of the world at the very age life ought to be most comfortable at ? I do not here exaggerate. Study of this matter, as a member of the Boston School Committee in former years, led me to suspect what since then, in practice, I have constantly found to be true. And as for the teachers of these school maidens, a very large proportion of them early find themselves invalids, with overstrained nervous sys- tems and frail bodies, which act and react abnormally, the one upon the other. To stimulate a girl's brain to the utmost, during the ac- 18 cess of puberty, is a positive loss to the State. There's likely to be one less healthful parent of a sound and vigorous offspring. I shall not discuss the question of whether girls should best be edu- cated at home or away ; at boarding schools, academies, seminaries, colleges, or whatever the title of their distant place of abode. In some respects the same points would be found to obtain as with that other education which takes these tenderlings from the mother's watchful protection, to the mill, the shop, or the service of strangers. The hygienic risks and those to morality are, in number and impor- tance, nearly equal in both cases ; they are but too apt to go hand in hand. The terrible instincts, that a chance word or look may awake into activity, never again to be put at rest, — which, for the world's good, cause yet its greatest dangers, — are there always and every- where. Happy she who, till the day of her change of name, never becomes conscious of their existence. From the dawning of that day, however, — nay, from the time it is first looked forward to, — a host of hygienic questions troop upon the stage. The amount and the character of intimacy that is advisable, or even safe, so far as health is concerned, between young people who are affianced ; whether marriages, in a sanitary light, are best made early or later in life ; the advantage of pregnancy within the first year or two of wedlock ; the care that should be taken of the woman during gestation, parturition and the puerperal state; the fearful risks of miscarriage, to life and to subsequent health, even where complete recovery seems for the time to have taken place ; the so-called social evil, and the specious arguments by which the devil would tempt his victims to make its toleration seem a positive safeguard to the virtu- ous portion of the community, — these are all matters with which you have clearly to do, but to which I shall only refer. They are each of them of public importance, for of isolated instances the whole social communism consists. The extension of sanitary knowledge, and the demand its increase creates for a class of more highly educated phy- sicians, who shall neither pander to the demands of vice, or of that sophistical pseudo-reason which now seeks politically to emasculate our mtm and to unsex our women, will by degrees set all these knotty questions at rest. You have close at hand, in the territory so near — the gynaecological peculiarities of which I have just come to you from studying-7-the old social problem that so vexed the students of Female Hygiene in David's time. And yet, the openly avowed concubinage of Utah scarcely differs in some respects from that stealthily indulged in by a certain proportion of every civilized people that ever existed since the 19 world began. In the one case there is present a partial freedom from shame, based upon an avowed self-dedication to a religious impulse — in the other, fear of exposure ; but then, in this, there may be ig- norance that another shares the conjugal esteem — while in that, its open fractional subdivision begets, instinctively and inevitably, ail manner of heart burnings. Each state has, in its way, its mental frets, its physical ills; each in its way furnishes material for the profoundest study to the medical scientist. Gymnastics, now-a-days, bring on disease, and are appealed to to cure it in women. Dress— as ever since the days it first suggested itself to Eve — still adorns or deforms its wearer, still delights her mind ; it may make, or it may cure, one or another form of disease. Enforced position, long continued — as at the piano, the business desk or at the counter — may mar, it but seldom makes, a perfect form. Horseback riding, so beneficial to some, at certain times or for certain indications, may at others, or under other circumstances, inflict irrep- arable injury. Sea-bathing, to some a tonic, is to others the worst of dangers. The voluptuous warm bath may cause, indulged in too fre- quently or incautiously, as perfect ruin to the health as slavery to opium or alcohol; and these, first taken for the relief of pain, and perhaps by the advice of a physician, may prove — they often do — a flight of steps descending to an early grave, or, far worse, to a pro- longed death in life. But let me stop here, for I fear that I may uncover miseries that perhaps were better hid, at least till the community more fully appre- ciate the value of what they already but partially know concerning Female Hygiene. Before they can do this, men must first value, bet- ter than ever yet has been done, woman herself. Not as a voter; her best franchise is through that of her husband. Has she none? Few women on earth, whether young or old, who may not marry, and marry well, if they but live a perfectly beautiful, loveable life. Not as the rival of man. For partnership she was created — not for identity of work or of purpose. Not as the object of passion alone. The state and its every citizen must value her as one entitled to the tenderest care and sympathy, without whom the world would be a wretched place, but who bears its heaviest burdens ; whose hours of pain are tenfold — nay, a thousandfold — those of man; and this, not to mention the agony of childbirth, of whose exquisite poignancy he knows absolutely nothing, and which, were it not wrong to do so, might justly be said to approach more closely than can any other experience of mortals, the physical portion of the Passion upon the Cross. Does she seek sympathy, it is her due; or confess to suffering, 20 she is to be believed; or exhibit nervous disturbance, it is far more difficult to bear than mere pain would be; or at times seem capri- cious, unreasonable, or a severe and cruel despot? A fortunate wom- an she is, if her temper has never been tried, if her powers of mental endurance have never been overtaxed, if the angel within her has never been slighted or openly denied. What seems vice in woman, man alone is often to blame for. Where this is not the case, as often it is but disease. As I said to you at the outset, itrs the most delicate things that are the most precious. The very evil chances that so preponderate in the case of the health of the gentler sex should caution you to guard its members from every harm, with a more anxious care, a closer watchfulness, —appreciating the fact that every wise or kind act that men can do for the safety of the health of women is done in reality, and in the sense of simplest self-interest, well understood, for them- selves. Such, gentlemen of the California State Board of Health, and such, gentlemen and ladies of the community, is the highest lesson that I can teach you, — the fundamental law of Female Hygiene. The attention of the Profession is invited to the following Table of Contents of Volume V., of Tbe Journal of tlie GynBscolos as a specimen of the valuable material of which the Journal is composed. CONTENTS OF VOL. V. PROCEEDINGS OF THE SOCIETY:— ^^ Forty-eighth Regular Meeting. Fibrous Parietal Tumor in the Process of Spontaneous Discharge by o Enucleation................................................... Q Delayed Narcotism................................................ The Local Treatment of Endometritis............................... 7 Pregnancy following the Treatment of Endometritis................... 9 Permanent Organic Lesions from Local Treatment.................... 10 Death during Anaesthesia from Sulphuric Ether....................... 12 Forty-ninth Regular Meeting (Annual Meeting). President Lewis' Address........................................... 18 Dr. Chas. T. Jackson's Remarks on the Discovery of Anaesthesia--- 20 Vote of Thanks to the President and Secretary....................... 20 Fiftieth Regular Meeting. Multilocular Ovarian Cyst................_•......................... 66 Factitious Suits for Malpractice..................................... ^8 Gynaecology of Iceland........................................... 73 Treatment of Tympany by Lobelia.................................. 74 Hydrocele of the Round Ligament.................................. 75 Fifty-first Regular Meeting. Miscarriage from Disease of the Foetus.............................. 77 Fatal Case of Horse Shoe Pessary within the Bladder................. 78 Congenital Atresia of the Vagina................................... 79 Local Rest........................................................ The Sulpho-Carbolatcs as Gynaecological Agents..................... 84 Fifty-second Regular Meeting. Dr. Scott's Letter, acknowledging the Society's Resolutions............ 130 Nitrated Charcoal for applying the Actual Cautery................... 132 Pneumatic Aspirator, for the Detection and Discharge of Collections of Pus.......................................................... The Still Prevalent Ignorance of Differential Diagnosis............... 136 Puerperal Mania............................................ Hydrate of Chloral................................................ Fifty-third Regular Meeting. Ovariotomy, the Abdominal Wound Being Intentionally Left Open.... 144 Detect;on of Criminal Abortion..................................... i51 4 Contents of Vol. V. PAGE Gross Violation of the Code of Ethics of the American Medical Associa- tion .......................................................... 151 Operation for Pelvic Abscess........................................ 1 55 Cesarean Section.................................................. 1 57 Fifty-Fourth Regular Meeting. Treatment of Chronic Inversion of the Uterus. Dr. Gross's Letter.... 194 Uterine Neuralgia, as Occasioned by Malaria or Anteflexion, or their Concurrence..........................-^...................... 196 The Importance of Exploratory Sections for Abdominal Diagnosis...... 199 "Womb Splitting" .............................................. 204 Evanescent Polypi................................................ 204 Contemporaneous Abscess of both Vulvo-Vaginal Glands.............. 2u5 Osseous Degeneration of the Uterus.................................205 Death from Sulphuric Ether........................................ -07 Pseudo-Uterine Specialism...................................,......208 Fifty-fifth Regular Meeting. Cellulitis from a Horse Shoe ressary................................ 212 Perinephritic Abscess complicating Ovarian Disease................... 213 Exploratory Abdominal Section, for Renal Tumor.................... 214 Long Retention of a Blighted Ovum without Putrefactive Change...... 215 Chronic Labial Abscess............................................ 217 Displacements, and their Faulty Delineation in the Text-Book3....... 218 The Tolerance of the Peritoneum of Operative Injury................ 219 Puerperal Mania and its Rational Treatment.......................... 222 Regular Menstrual Irregularity..................................... 224 Digitalis in Hemorrhage after Abortion.............................. 225 Decease of Sir James Y. Simpson, before the Obstetrical Society of London....................................................... 226 Fifty-sixth Regular Meeting. Retro-Uterine Hematocele ...............................-......... 258 Tubercular Nephritis of both Kidneys............................... 259 Quill Sutures in Amputations....................................... 200 Fifty-seventh Regular Meeting. Starch as a Vehicle for Injections................................... 262 Hydronephrosis................................................... 264 New Vaginal Showering Syringe.................................... 265 California Wines.................................................. 266 Spring Ligator......,............................................. 267 Fifty-eighth Regular Meeting. Flooding from Retained Placenta after Abortion...................... 321 Loomis' Forceps.................................................. 32.5 Use of the Tampon................................................ 324 Gallic Acid....................................................... 325 Fifty-ninth Regular Meeting. Cundurango....................................................... 328 Modification of the Winged Catheter................................ 328 Retroflexion with Endometritis and Pelvic Adhesions, treated by a novel Method....................................................... 330 The Evils of the Neglect r»f a. Thorough Examination................. 331 5 Contents of Vol. V. PAQl ORIGINAL CONTRIBUTIONS: — Both. — The Ultimate Pathology of the Various Types of Pulmonary Disease....................................................... 22 Mayer. — The Relations of the Female Sexual Organs to Mental Dis- ease. Part IV............................................... S3 Gerocld. — Uterine Neuralgia, as Occasioned by Malaria or Ante- flexion, or their Concurrence.......... ........................ 39 Cutter. — The Use of Iodoform as a Neurotic...................... 43 Traylor. — Displacements, and their Faulty Delineation in the Text- Books........................................................ 46 Mack. — Case of Ovariotomy....................................... 87 Weber. — Puerperal Mania........................................ 92 Beech. — Twin Compound Conception with Miscarriage, and Delivery of an Extra-Uterine Foetus through the Abdominal Walls......... 103 Mayer. — The Relations of the Female Sexual Organs to Mental Dis- ease. Part V................. . ............................ 107 Storer. — Upon the Question of the Propriety of Operating for Malig- nant Ovarian Disease.......................................... 158 Blxby. — Peritoneal Retro-Uterine Hematocele...................... 167 Cutter. — Retroversion of the Uterus............................... 174 Van Db Warker. — The Detection of Criminal Abortion. Part II.... 229 Mayer. — The Relations of the Female Sexual Organs to Mental Dis- ease. Part VI................................................ 245 Cutter. — Retroversion of the Uterus (Concluded)................... 271 Mayer. — The Relations of the Female Sexual Organs to Mental Dis- ease. Part VII............................................... 296 Storer. —"Outline History of American Gynaecology. Part III.......334 Cox. — Reflex Insanity............................................ 347 Van Db Warker. — The Detection of Criminal Abortion. Part III... 350 EDITORIAL NOTES: — Protest by the Councillors of the Mass. Med. Society to the American Med. Association, at San Francisco............................. 49 Cundurango...................................................... C2 " Dear Old Harvard".............................................. 123 Our Western East................................................ 188 Rest............................................................. 192 Malaria as a Gynaecological Element................................. 251 Criminal Abortion.................................................255 Counting the Gains................................................ 306 The Gynaecological Atmosphere..................................... 310 From Worse to Better............................................. 813 A Mole Trapped................................................... 317 Squaring the Circle; or, The Changed Relations of the Harvard Medical School to the Uni- versity .......................................................370 Dr. B.'b Advice; or, Still further Improvement that the Profession expects made in that 8chool.......................................................372 6 Contents of Vol. V. PACK Which Wins ? or, An Endeavor to ascertain whether a certain Member of tho Medical Faculty is practically President of the University................. 377 Filing Right; or, A Recognition of the Power of the National Association to Direct American Medical Education............................ .....881 Good Wishes, and their Practical Fulfilment towards Gynecologists.... 382 -------------------<■«»>-------------------- THE JOURNAL OF THE GYNECOLOGICAL SOCIETY OF BOSTON, A Monthly Journal, DEVOTED TO THE ADVANCEMENT OF THE KNOWLEDGE OF THE DISEASES OF WOMEN. edited by WINSLOW LEWIS, M.D. HORATIO R, STORER, LI.D. GEORGE H. BIXBY, M D. TERMS: Five Dollars a year, in advance. Single numbers, ITifty cents. Specimen numbers sent fbr Twenty-Five cents eaoh. Sent THREE MONTHS on trial for ONE DOLLAR. NOW REAI>Y, Volumes I, II, III, IV., V., NEATLY BOUND IN CREEN CLOTH. Prico, $2.50 por Voluma. Uniform Covers, for Binding, for sale to subscribers, at fifty cents each, PUBLISHED BY • JAMES CAMPBELL, MEDICAL AND SCIENTIFIC BOOKSELLER, 18 Tremont Street (Museum Building), Boston, Mass. ApyxBTuxicxirrft. NOW COMPLETE, WITH LETTERPRESS DESCRIPTIONS, PHQTOCftElAP: OW TH1 DISEASES OF THE SKIN, T-AJKZEiT FBOM LTF33, itxdu thi •crsmnmoiBKioB or HOWARD F. DAMON, M. D. FIRST BBRUB Wo. 1.—Chronic Eri«o>, No 8.—llerpea (Zoator). Ko. 3.—Impetigo. Wo. *•—Ecthyma. No. S.-Uupla. Wo. O.-ltupla i*ni«Ur). second series. Wo. 1.—Alopecia Clrcomacrlpta. w. • _ii„.,i. J Areata, (acalp).i Wo. ».-Alopecl« J i.cjntl.o, (face). I Wo O.-Herpei Irla. Wo. 4.— — elrclnatna et Irla* Wo. S.-IchthToals congeallal, (ana a). Wo. •.- -- -- CUsahe). vol llerpea Ot*>- THTBD BERTEB. Wo. 1.—flarpea etrclaataa el Tti Wo. »•—Eci»m» Marginal! clnataa. Wo. 8.—Zoator Sacralls. Wo. 4.-Llrhea Syphiliticum. Wo. S.—Lichen Syphilitica* Cairaibam. Wo. O^Llckea Byphllltleua Ananlataa. FOURTH SERIES. Wo. 1.—SJyphllodennaTobcrcoloaaDlaaeaalaata Wo. ».—arphllodcrma Tukartulata CoaXerta ot Corymlioia, Wo. O.-Itnplu Syphilitica Tel Froanlaeae. Wo. 4-Vlcui Syphilitica. Beaallaaarls. Wo. 5.-1 lcua ayphlllUeas aerplflaoaa*. Wo. O.-KolU SrphOUUea. PEIOB Per Number, consisting ef Tws Photognphs, without Letterpress,..... Per Series, " "Six " M ...... Photographs) complste, (24 Photographs with Letterpress description,) put up In t seat Portfolio, • . The Tubllsher takes great pleasure in announcing to the profession the completion of this valuable series of Photographs of Skin Diseases. Numerous attempts have been made abroad to Illustrate with accuracy, by the means or colored photographs and chromolithographs, cutaneous diseases; in some oases a very fair repre- sentation lias been given, but in every case the photograph has been poor, and the details of the disease da* $1.00. 3,00. 12.00. dJopeusary, hospital, and private practice, and that of other physicians. The following opinions are from gentlemen of large experience, and well known as practical Demutologista: I have carefully examined Dr. Damon's Photographs of Diseases of the Bkla, and, la my opinion, they art wellsulted to aid the student In the itudy of Dermatology. gnjLfl DTJBKEE M D Bo a to y, August SO, 1867. M Baaooa Btbsbt, Bostox, Aagut M, ;M7. Dr. Damos : Dear Sir,—The Photographs yon hare shown me of some Diseases of the Skin, arc admirably taken. Thty would be useful aids to the student of Dermatology. Very truly, CHjLaLB8 oopjxjh, m. D. NOTICES FROM THE MEDICAL PRESS. From the New York Medical Record. January 15, 1868. .,»_»■ " The first two plates of this series which we have received are line specimens of Art." From (he Medical and Surgical Reporter, J'hiladelphia, February 8, 1868. ___ .„..«« ■ "They are very artistically executed, and display, with unmistakable clearness, the various dermic leotoni.» From the St. lAtuis Medical and Surgical Journal, May 10,1868. tm^^mm. to «•«*• thii eh*** *aa •« We do not hesitate to advise all who turn their attention to Skin Diseases to procure this cheap and efficient help." 49- For sale by all Medical Booksellers, or sent by mall, postage froe, on receipt of price. JAMES CAMPBELL, Publisher. 18 Trement Street, Eo*ton, lfa§$. PHYSIOLOGICAL AND THERAPEUTICAL ACTION Bromide of Potassium and The Bromide of Ammonium ON MAN AND ANIMALS. IN TWO PARTS* EDWARD H. CLAUSE, M.D., 7 . ROBERT AMORY, M.D., „ , S Lecturer on the Physiological Action of Drug*. In the Professor of Materia Medico in Harvard University, ^ Medical Department of Harvard University. Part I. The Physiological and Therapeutical action and value of the Bromide of Po- tassium and its kindred Salts. By Prof. Edward II. Clarke. Part II. Experiment! illustrating the Physiological and Therapeutical action of Bromide of Potassium and Ammo- nium on Men and Animals. By Robert Amort, M.D. ONE VOLl'SIE. lOrao, CLOTH". SI.GO. BOOKS LATELY PUBLISHED. DISEASES OF THE WOMB. UTERINE CATARRH FREQUENTLY THE CAUSE OF STERILITY. New Treatment. By H. E. Gantillon, 1I.D. ramphlet, 8to. pp.64.....................*0M A CONTRIBUTION TO THE TREATMENT OF THE VERSIONS AND FLEX- IONS OF THE UNTMPREONATED UTERUS. By Epiiraim Cutter, M.D. Twenty Ulna* rations, ramphlet, 8vo. Cloth,..............•»• THYROTOMY FOR THE REMOVAL OF LARYNGEAL GROWTHS. MODI- FIED. By EpnitAiM Cutter, M.D. Illustrated. Pamphlet, 8vo, ..-•••• JSO Sent by mail, postage pre-paid, anywhere in the United States on receipt of price. JAMES CAMPBELL, [Publisher, 18 Tremont Street, Boston, Mass. The Gynaecological Record: A BOOK of blank forms, intended as an aid to the busy practitioner in recording "* * Gynaecological cases; with an appendix of blank leaves, and tables for the ready analysis of the contents of the book. Prepared by Joseph G. Pixkiiam, A.M., M.D., &c. Approved by the Gynaecological Society. One volume, quarto, half bound in leather. Price, $2.50. EXTRACT FROM THE PREFACE. "This book is intended to aid the busy practitioner in making detailed and systematic records of cases occurring in his Gynaecological practice. Its scope will be obvious on inspection. Blank forms are fur nished which can be filled out with comparative little labor. As the same method and order of examina- tion is preserved in each case, a proper basis for comparison is secured; and the minuteness of detail re- quired to fill out the forms, renders the physician less linble to overlook points of interest. Under the head of" History " is supposed to be given the patient's own account of her clinical life previous to date, so far as otherwise not brought out. The diagrams will serve the purpose of illustrating the case. On the one representing the anterior aspect of the body, may be given the outline of any tumor, area of tender- ness, &c; on the other, the relative position of the several pelvic organs, as seen on a median section. The tables for the analysis of cases are few in number and simple in their plan." •' The forms are very carefully brought out, and will be of great advantage. They will terve not only as a record, but as a complete reminder of what to observe in these cases, and will add much to the accuracy of the diagnosis, and consequently to the success of the treatment."— MedicalanU Sur- gical Reporter, Dec. 24,1870. 41 It seems to us to fill most of the requirements, and we cordially recommend it." — New York Med. ioal Journal, Jan., 1871. •'The bookis neat, and neatly gotten up."—Low- eet ami Olterver. ' If these cases be well selected and carefully kept, even should only one book be tilled by each practitioner, it would make a contribution to Gyn- ecology which, before many jears, would enable us to settle dehnitely many points in the natural his- tory and therapeutics of uterine diseases which are now mobt obscuro and unsettled."— Medical l\mts. "We note with pleasure the use of diagrams with each blank, representing, in outline, tnVanterior aspect of the abdomen, and n section of t heSelvia." — Boston Medical and Sum*™i t~.---« r FEMALE HYGIENE: A LECTURE DELIVERED AT SACRAMENTO AND SAN FRANCISCO, BY REQUEST OF THE STATE BOARD OF HEALTH OF CALIFORNIA. 6 By DR. S TOREK, Jll. (IIo.it atio), OF BOSTON, CONSULTING SURGF.OX TO TIIF. CARNEY (GENERA!,)] itOSPITAL, ANI> TO ST. ELIZABETH'S HOSPITAL FOR WOMEN. REPRINTED FROM THE JOURNAL OF THE GYNAECOLOGICAL SOCIETY OF BOSTON. BOSTON: JAMES CAMPBELL, Publisher, 18 TREMONT STREET, MUSEUM BUILDING. 1872. PRICE, TWENTY-FIVE CENTS. A SPECIAL MEDICAL JOURNAL. THE JOURNAL OF THE GYNAECOLOGICAL SOCIETY OF BOSTON, .1 Monthly Journal, devoted to the Advancement of the Knov/tili/'' of the, DISEASES OF WOMEN. Edited by WINSLOW LEWIS, M. D.; HORATIO R STORER, M.D., LL.B.; GEO. H. BIXBY, M.D. Terms, $5 a-year, in advance. Single numbers, 50 cents. Half-yearly Volume, $2 50. The Journal will be under the editorial management of the officers of the Society, and no pains will be spared to render it creditable to the source from whence it emanates, and to the profession to which it looks for support. While devoted to the awakening of a greater interest in the knowledge of the Diseases of Women, the .Journal will yet not wholly ignore matters of general medical and surgical bearing, inasmuch as it is upon general principles that all success- ful specialties and especialties must rest. li is impossible, however, now that general practitioners are so universally beginning to appreciate the importance, comfort, and pecuniary advantage ot a thorough knowledge of the diseases of women, for these to occupy any longer. in genera! or special journals, a subordinate place. IX COMMKXCIXU THE ISSUE OF ASKCOXI) YEAR OF THE GYXvECOLOGH'AE .TOITRXAL. the Publisher would, call attention to its peculiar recommendations to practitioner of Medicine and Surgery. 1st. It is the only journal ever yet published exclusively devoted to the Diseases of Women 2d. It presents, every month, an extended report of discussions upon these diseases, by gentlemen skdled in their treatment: and. as is well known, there is more to be learned from the perusal of such discussions, affording as they do diverse experiences concerning a given topic, than from a formal treatise by the most learned physicians in the profession. M\. It is not a mere n--cast of articles taken from the current medical journals, which ar<> already supposed to be upon the table of every active physician. 4th. Its editorials are always fresh, pointed, terse, and effective; of that character, indeed. which made the London Lancet for so many years, w hile under the charge of the elder Wakley, the leading medical journal of the world. ;">th Tht Journal of a Scientific Society is the more likely to view the medical events of the day from a hiifli and dignified stand-point—without, however, fonrotting that to effectually clear a new path, and to remove obstacles in the way of progress, blows are frequently neces- sary, and that they must be heavy, vigorous, and conclusive. lith. The unexpectedly large circulation in every part of the country that it has already attained may be considered an indorsement of its excellence. Each Number -will contain the transactions of the Society at its regular meetings (two each month \ Original Articles, Editorial Notes, Book Reviews, &c, &c. Kach number will consist of not less than SIXTY-FOUR PAGES, OCTAVO, PRINTED TV LARGE TYPE, ON THINK: T'APER, and it will be the aim of the publisher to make it fully equal in appearance to anything of the kind in the country. NOW READY. Volumes L, II., III., IV,, and V., neatly bound in Cloth. Price, $2.50 each. ' It is edited by active, thinking, and liberal men, and published in a stvle that will command the approbation of all critics. The half-year forms a volume replete with instruction and one that is worth much more than the money it costs to every physician.-'__Philadtlvh'i Medical and Surgical Reporter. March 5. 1870. JAMES CAMPBELL, Publisher, Boston, Mass. LIST OF THE MEDICAL WORKS PUBLISHED BY JAMES CAMPBELL, BOSTON, MASS. *♦* Copies of any of the within named books aent free, by mail, anywhere in the United States, on receipt of the price. PHYSIOLOGICAL AND THERAPEUTICAL ACTION AND VALUE OF THE BROMIDE OP POTASSIUM AND THE BROMIDE OF AMMONIUM, Illustrated by Ex- periments on Man and Animals. In two parts. By Edward H. Clarke, M.D., Prof, of Materia Medica in Harvard University, and Robert Amory, M.D., Lecturer on the Physiological Action of Drugs in the Medical Department of Harvard University. Part I. The Physiological and Thera- peutical Action aud Value of the Bromide of Potassium and its kindred Salts. By Prof. Edward H. Clarke. Part II. Experiments illustrating the Physiological and Therapeutical Action of Bro- mide of Potassium and Ammonium on Men and Animals. By Robert Amory, M.D. One volume. 18mo, cloth, - ................$1.50 DISEASES OF THE WOMB. UTERINE CATARRH FREQUENTLY THE CAUSE OF STERILITY. New Treatment. By H. E. Gantillon, M.D. 8vo, pamphlet, pp. 54. .60 A CONTRIBUTION TO THE TREATMENT OF THE VERSIONS AND FLEX- IONS OF THE UNIMPREGNATED UTERUS. By Ephraim Cutter, M.D. Twenty illustra- tion!. 8vo, pamphlet,.................50 THYROTOMY FOR THE REMOVAL OF LARYNGEAL GROWTHS. MODI- FIED. By Ephraim Cutter, M.D. Illustrated. 8vo, pamphlet,........50 THE DETECTION OF CRIMINAL ABORTION AND THE STUDY OF ' FO3TI0IDAL DRUGS. By Ely Van DeWarker, M.D. Illustrated by pulse tracings with the Sphygmograph. 8vo, pamphlet,...............50 PHOTOGRAPHS OF THE DISEASES OF THE SKIN. Taken from life, under the superintendence of Howard F. Damou, M.D. Photographs, complete (24 Photographs, with letter-press description), put up in a neat portfolio,..........12.00 Each Photograph, without letter-press,.........-•••.50 SURGICAL CLINIC OF LA CHARITE. Lessons upon the Diagnosis and Treat- ment of Surgical Diseases, delivered in the month of August, 1865, by Prof. Velpeau. Collected and edited by A. ltegnard, Interne des Uospitaux, revised by the Professor. Translated by W. C. B. Fifield. M.D. Ouo volume. 16mo, cloth,...........1.50 HAND-BOOK OF THE DISEASES OF THE EYE. Their Pathology and Treat- ment. By A. Salomons. M.D.. Fellow of the Massachusetts Medical Society; former Oculist in Government Service at Vechnhizeu, Holland, etc. One volume, 16mo. Colored plate. English Cloth,....................1.50 METHOMAN1A ; A Treatise on Alcoholic Poisoning. By Albert Day, M.D., Super- intendent of the New York State Inebriate Asylum. One volume, 16mo. Pamphlet, .40. Cloth, bevelled boards,..................60 THE PHYSIOLOGY OF WOMAN, AND HER DISEASES FROM INFANCY TO OLD AGE. Including all those of her critical periods — Pregnancy and Childbirth—their causes, symptoms, and appropriate treatment; with hygienic rules for their Prevention, and for the Preservation of Female Health. Also, the Management of Pregnant and Parturient Women, by which their pains and perils may be greatly obviated. To which is added a Treatise on Woman- hood and Manhood, Love, Marriage, and Hereditary Descent; being the most approved views of modern times. Adapted k» the instruction Of females and professional reading. In three books. Complete In one volume. By C. Morrill, M.D. Author of sundry Medical Essays, Lectures on Popular Physiology, etc. Ninth edition. One volume, 12mo. Cloth, ...... 1.50 VERATRUM VIRIDE AND VERATRIA; A Contribution to the Physiological Study of. With Experiments on Lower Animals, made at La Grange Street Laboratory. 1889. By Robert Amory, M.D., and S. G. Webber, M.D. One volume, 16mo. Pamphlet, .50. Cloth, - .75 NITROUS OXIDE; Physiological Action of, as shown by Experiments on Man and the Lower Animals. By Robert Amory, M.D.. of Longwood. Mass. Illustrated by pulse tracings with the Sphygmograph. 8vo, pamphlet, pp. 31,...........50 TWO CASES OF CESOPHAGOTOMY FOR THE REMOVAL OF FOREIGN BODIES; with a History of the Operation. Second edition, with an additional Case. By David W. Cheever, M.D.. Adjunct Professor of Clinical Surgery at Harvard University; Surgeon to the Boston City Hospital. One volume, 8vo. Cloth,...........125 THE HISTORY AND PHILOSOPHY OF MARRIAGE; or, Polygamy and Monogamy Compared. By a Christian Philanthropist. One volume, 16mo. pp. 256, • - • 1.25 DISEASES OF THE EYE; A Treatise on. For the use of General Practi- tioners. By H. C. Angell, M.D., Oculist and Aurist. One volume, 12mo. English Cloth, - • 3.00 CONTRIBUTIONS TO DERMATOLOGY. Eczema, Impetigo, Scabies, Ecthyma, Rupia, Lupus. By Silas Durkee, M.D., Consulting Physician, Boston City Hospital. 8vo, pamphlet,......*............ i.jjq PHYSICIAN'S REGISTER, for Office or Hospitol Practice. An imperial 8vo book of Blank Forms, similar to the book used in the Dispensary, for recording the date, name, resi- dence, age, and disease, with a large blank space for remarks. Price, $1.50. 25 cents extra when sent by mail. HISTORY OF MODERN ANESTHETICS. By Sir James Y. Simpson, of Edin- burgh. A Reply to Dr. Jacob Bigelow's Second Letter. Reprinted from the Journal of the Gynss- cologlcal Society of Boston. May, 1870. 8vo, pamphlet,..........29 THE PRACTITIONER: A Monthly Journal of Therapeutics. Edited by Francis E. Anstie, M.D., F.R.O.P., Senior Assistant Physician to Westminster Hospital. Terms of subscri^ (Ion, $4.00 per year, in advance. Medical Monographs, CONSISTING OK Original Essays on Special Subjects, Reprints, and Translations from the German and French. THE FOLLOWING ARE NOW EEADY FOR DELIVERY: PHYSIOLOGICAL AND THERAPEUTICAL AC- TION AND VALUE OF THE BROMIDE OF POTASSIUM AND THE BROMIDE OF AMMONIUM, Illustrated by Experiments on Man and Ani- mals. In two parts. By Edward II. Clarke, M. D., Prof, of Materia Medica in Harvard University, and Robert Amort, M. D., Lecturer on the Physio- logical Action of Drugs in the Medical Department of Harvard University. Part I. The Physiological and Therapeutical Action and Value of the Bromide of Potassium and its kindred Salts. By Prof. Edward II. Clarke. Part II. Experiments illustrating the Physiological and Therapeutical action of Bromide of Potassium and Ammonium on Men and Animals. By Robert Amory, M. D. One volume. 16mo, cloth, ........... $1.50 DISEASES OF THE WOMB. UTERINE CA- TARRII FREQUENTLY THE CAUSE OF STERILITY. New Treatment. By II. E. Gaxtu.lon-, M. D. 8vo. pamphlet, pp. 54,......50 A CONTRIBUTION TO THE TREATMENT OF THE VERSIONS AND FLEXIONS OF THE UNIMPREGNATED UTERI'S. By Ernu.vi.u (Ytteh, M. I). Twenty illustrations. 8vo, pamphlet, .50 THE DETECTION OF CRIMINAL ABORTION AND A STUDY OF FCETICIDAL DRUGS. By Ely Van De Warker, M. D. Illustrated by pulse tracings with the Sphygmograph. 8vo, pamphlet, . .50 THYROTOMY: FOR THE REMOVAL OF La- ryngeal GROWTHS, MODIFIED. By Ephraim Cutter, M.D. 8vo, pamplilet,...............50 insr peepaeatioit. NEW TREATMENT OF VENEREAL DISEASES ' AND OF ULCERATIVE SYPHILITIC AFFECTIONS BY IODOFORM. Translated from the French of Dr. A. A. Izard. THE PASSIONS IN THEIR RELATIONS TO HEALTH AND DISEASES, LOVE AND LIBERTINISM. From the French of Dr. Bourgeois. Others will be announced, as subjects of special interest to the Profession may arise. For sale by all Booksellers. Sent free, by mail, anywhere in the United States, on receipt of the price. JAMES CAMPBELL, Piiblislier and. Bookseller, Boston, Mass. K B3¥ V' J? J* » • ■> ■> LI1 00560122 1 >,> :>» 6 » 3>~X>* > >> ;» >> •> ► ;» JSO> ,^> *> •,'$> »^ * ^ \" \ ,,, ;> >> > * y 5^> s> . > •: *> * ~Jm >yy jm> 169595954515��451��8609016