WOMAN'S 
COMPLETE GUIDE 
T O 
BY 
M. E. DIRIX, M.D., 
Leetw •er on Physiology, Pathology and Hygiene of the Female System, and 
Author of a Popular Monograph on " Uterine Pathology." 
NEW YORK: 
W. A. TOWNSEND & ADAMS, PUBLISHERS. 
1S69. Entered, according to Act of Congress, in the year 1868, by 
W. A. TOWNSEND & ADAMS, 
In the Clerk's Office of the District Court of the United States for the Southern 
District of New York. 
Electrotyped by 
Smith & McDougal. TO TdTJT SJEJX, the most delicate and loveliest 
of God's Creation, these Contributions are 
respectfully dedicated by the Author. M. E. Dirix, M.D.: 
Dear Sir-It gives me pleasure to say, that, 
from a partial reading in manuscript of your volume, 
"Woman's Complete Guide to Health," I have no 
doubt of its great value and utility. 
Could it be multiplied and placed in the hands of the 
women of the United States, and were it by them carefully 
consulted and heeded, there can be no question but that 
a vast amelioration of distress and suffering, physical and 
mental, would ensue. 
I am, yours truly, 
H. H. McFarland, 
Park Congregational Church, Third Street, Brooklyn, N. Y. 
Oct. 30,1808. INTRODUCTION. 
These contributions have been written for the diffu- 
sion of useful knowledge among the public, and Women 
in particular. They have originated in the honest con- 
viction that they would meet a want that has long been 
felt. The treatises, monographs, memoirs and contribu- 
tions on diseases peculiar to Women are numerous, but, 
generally, and with only a very few, if any, exceptions, 
they are too specious in their character to be very useful 
to all mankind. Such works, it is manifest, reach only 
the few who are scientific, and their sphere of value, con- 
sequently, does not extend directly to women, who are 
immediately concerned, and of whose diseases they treat. 
Were there some such works adapted to common com- 
prehension, and consequently easy of use to all, consider- 
ate women who were aware of their contents, and of 
the information they convey in everything that relates 
to their health, would most naturally be desirous and 
anxious to study them, and the knowledge they would 
impart would be the means of preventing a vast and 
almost incalculable amount of suffering, physical and 
mental, witnessed, it is sad to say, amongst all classes 
of social life. A new era would in consequence dawn 
upon woman's existence. Thus truly conscious of the VIII 
INTRODUCTION. 
present state of medical exclusiveness, and of the manifest 
lack of information most women possess respecting their 
health and consequent welfare, the Author of this work 
has endeavored to remedy this very unsatisfactory state 
of things by issuing the present populai' contributions. 
They differ essentially in their form and aim from other 
works in the more beaten path of medical literature above 
alluded to. Their merit will be found to consist in im- 
parting to the public, and to women especially, as far as 
possible, peculiar useful and necessary knowledge in all 
that relates to their health and welfare ; a knowledge, as 
stated before, they had been unable to obtain. 
The object and intentions, then, of these contributions 
must be manifest and self-evident. From them, women, 
whether mothers, wives or daughters, may learn and 
judge, it is believed, the nature, causes, symptoms, etc., of 
the complaints to which they are mostly liable. This 
knowledge will enable them to compare symptoms, and 
by understanding them, indicate their most appropriate 
treatment; yet more, it will be the means of removing 
many doubts, perplexities and anxieties, which their ill 
health had awakened in themselves, their relatives and 
friends. 
In these contributions, finally, the reader will have a 
true and complete Guide to Health, differing essen- 
tially and widely from any and all reputed Women's Guides 
in existence. Herein, it is not too much to say, is a 
Mirror reflecting, so far as it has been intended, the 
actual and irrecusable state of health of those female INTRODUCTION. 
IX 
invalids who consult it, and, consequently, enabling them 
to discern what is a sympathetic manifestation of a dis- 
ease, and what are its " effects ''-from what actually does 
the disease itself arise, or the cause of such sympathetic 
manifestations. 
These contributions, thus designed as they are for 
general instruction, and for the sex especially, impose well- 
defined and particular obligations. Among the most im- 
portant of these obligations, are: First, to endeavor to 
make them worth reading, and to attract the reader's 
interest. To attain this result, it was necessary that tfiey 
should contain all that is useful and *practical, and 
exclude all uninteresting matter, while yet fulfilling the 
great object aimed at. Second, their style must be as 
plain, concise, comprehensible and unobjectionable as 
their special subject will permit. To effect this purpose, 
the Author has abstained from entering at any length into 
the physiological or healthy condition of his subject, and, 
consequently, he has dwelt but little on the pathological or 
diseased state of the subject or organ under consideration. 
The knowledge of both these subjects would offer but 
a small amount of practical interest to most of his readers. 
Finally, the Author has discarded from these contribu- 
tions, all materials of a purely speculative character; he 
has avoided as far as he could do so, making use of any 
technical phraseology which might have obscured, instead 
of enlightened, the intelligence of his readers. 
As to the general plan he has adopted, he would state, 
that the diseases treated of are not all the diseases to which X 
INTRODUCTION. 
women are peculiarly subject, but will be found to be 
those diseases to which they are most liable, and from 
which, also, their most acute and protracted sufferings 
originate. - Amongst the so-called diseases not included 
in these contributions, are some which, in the majority 
of actual instances, are really no diseases at all, but merely 
symptoms or the effects of some disease in a remote organ. 
As such, they have received ample consideration in differ- 
ent parts of this work, to which the Author would respect- 
fully refer his readers. 
Other diseases, which he has omitted to consider, are of 
so complicated a nature, would have necessitated such 
special and minute description, and are, moreover, of 
such a surgical character, as would require more space 
and time than the Author could well spare on an under- 
taking like the present. Besides this, it was not unrea- 
sonably feared, that the attempt to treat these more 
serious affections, in this connection, would not have been 
attended with any hope of success; in other words, it was 
apprehended that the presentation of these subjects could 
not without great difficulty, if at all, be made intelligible 
enough to the greatest number of his readers. Moreover, 
in the estimation of the Author, their consideration would 
have offered little, if anjq real interest and practical value 
or utility to the public generally. 
The diseases which are treated of in this work are the 
following, to wit: 
1st. Chlorosis, or " Green Sickness." 2d. Hysteria. 
3d. Amenorrhoea, or Retention and Suppression of Mens- INTRODUCTION. 
XI 
truation. 4th. Inflammation of the neck of the womb and 
its consequences, Ulcerations ; Hypertrophy; Induration, 
etc. 5th. Hypertrophied (morbid) Elongations of the neck 
of the womb, as a consequence of inflammation, etc., of the 
neck of the womb. 6th. The various Displacements of the 
womb. 7th. The Tumors of the womb. 8th. Inflammation 
of the mucous membrane of the vagina, or canal leading 
to the womb, Vaginitis. 9th. Leucorrhoea, both constitu- 
tional and sympathetic. 
The Author feels that these contributions, imparting, 
as they do, information of the most vital importance to 
health, and, consequently, to human happiness, should be 
read by all-by men and women alike. They are of direct 
concern to all fathers who wish the welfare of their chil- 
dren ; to husbands who have their own happiness and 
the happiness of their companions at heart; to young 
men having a regard for their future welfare; and to all 
women, whether mothers, wives, daughters or sisters; 
whether married or unmarried, old oi' young, rich or poor. 
In conclusion, it will be observed that the principles 
of treatment, upon which the diseases comprised in this 
work are based, have received but genera] consideration, 
and that, consequently, no special directions have been 
laid down, or prescriptions given, or any particular 
remedy recommended, which patients might have availed 
themselves of to treat and cure such diseases. The rea- 
sons for this restriction in a work destined especially to 
enlighten the female sex in relation to their own system, 
are the following, to wit: If my readers will attentively XII 
INTRODUCTION. 
and carefully study this book, they will not fail to notice 
that some of the diseases treated of therein are of a 
decidedly surgical character, and as such, these diseases 
require for their cure various medical applications, and 
other surgical means, which, it must be obvious, ladies 
cannot apply or adapt to themselves. 
Again, they -will notice that there are also diseases of a 
different nature, such as are mostly encountered in young 
ladies, which, at first, are of a purely medical nature. 
These diseases require early attention and judicious treat- 
ment. Should the first manifestations of these diseases 
remain unnoticed; should they be neglected, or injudi- 
ciously treated, and allowed to progress and become com- 
plicated, as unfortunately but too often happens, they 
invariably soon assume a much graver character, and as a 
natural consequence, will require to be treated upon surgi- 
cal principles. Let us, however, suppose, for argument's 
sake, that that disease from which such a young girl is 
suffering is, as yet, of a medical nature, and amenable to 
medical treatment, the question at once presents itself, 
could she cure herself ? 
This question I emphatically and unhesitatingly answer, 
No. The character of a disease, generally considered, is 
so varied, and on so many circumstances, such as 
individual constitution, etc., etc., that it is all but impos- 
sible to lay down any standard by which medicines might 
be administered with any hope of success ; in other words, 
a medicine may do good to one patient, yet may not bene- 
fit another, if actually it did not aggravate, even greatly INTRODUCTION. 
XIII 
injure the case. Such things are of daily observation and 
occurrence. Yet again-an objection of a very serious 
nature exists against the practice of recommending any 
mode or plan of medical treatment, and against writing 
prescriptions for popular adoption, which is this: that 
any failure (and failures innumerable would be experienced 
by a patient in the use of remedies so recommended), 
would be the occasion of the motives of the prescriber 
being at first doubted, misunderstood, then assailed and 
very uncharitably handled. Consequently, I cannot but 
repeat, that no disease has its own individual, unvarying 
standard, by which it might be successfully combated under 
all circumstances by one and the same medicine or series 
of medicines. On the contrary, medical treatment in such 
cases must depend on the nature of the disease, its causes, 
the constitutional peculiarity and antecedents of the 
patient, and any and all circumstances that may and do 
modify, in some respect or other, the character of such 
disease. 
But the Author would remark, that the sex to whom 
he addresses himself cannot but derive the greatest bene- 
fit from a careful perusal and attentive study of his work, 
because it will surely, unmistakably, give them the key to 
their sufferings. Once understanding thoroughly the 
nature, causes and symptoms of the disease from which 
they are suffering, they will be enabled to solicit from the 
proper quarters the treatment appropriate to their indi- 
vidual cases. The Author has frequently referred to 
authorities on the diseases peculiar to Women, thus giv- XIV 
INTRODUCTION. 
ing his readers the benefit not only of his own views and 
principles of treatment of said diseases, as sanctioned by 
his personal experience for nearly fifteen years, but also 
of those emanating from men of high standing in the 
medical profession, of eminent talents, and of great expe- 
rience, acquired through the ample opportunities enjoyed 
by them, to study and observe on a large scale in hospitals 
and dispensaries, the inexhaustible field of diseases inci- 
dent to the sex. 
An Appendix, containing numerous abstracts of cases 
typical of the various diseases treated of in this work, and 
derived from private practice has been added, enhancing 
greatly the interest, value and utility of the contributions. 
To the attentive perusal of these cases, as well as of those 
scattered throughout the book, the Author would respect- 
fully and particularly invite his readers. 
How far he has succeeded in fulfilling his most earnest, 
sincere and ardent wish to alleviate Woman's Suffer- 
ings, let the future speak. 
M. E. Dirix, M.D. 
Fourth Avenue, between Wyckoff and Warren Sts, 
Brooklyn, December, 1868. CONTENTS. 
CHAPTER I. 
PAGB 
GYNECOLOGY, OR THE DOCTRINE OF THE NA- 
TURE, DISEASES, ETC., OF WOMEN 21 
CHAPTER II. 
CHLOROSIS. 
Its Nature-Etiology, or Causes-Symptomatology, or Symp- 
toms-Diagnosis-Prognosis-Treatment25-34 
Case I.-Chlorosis in a girl eighteen years old, the result of the suppression 
of the menstrual function. Cured in four months treatment 34 
Case II.-Chlorosis in a young lady nineteen years old, the'result of displace- 
ment of the womb. Cure complete within a year of appropriate treat- 
ment 39 
CHAPTER III. 
HYSTERIA. 
Its Nature-Causes-Symptomatology-Hysterical Paroxysm 
-How it affects the Digestive Function-Respiratory 
Function-Circulatory Function-Function of the Liver 
and Kidneys-Nervous System-Cutaneous Surface-Spe- 
cial Senses-Function of Voluntary Motion-Sensorial 
Functions-Reproductive Function-Diagnosis of Hyste- 
ria-Table presenting the most striking differences and 
Analogies between Hysteria and Epilepsy-Prognosis of 
Hysteria-Treatment44-62 
Case III.-Hysteria, dependent on a uterine affection, in a married lady aged 
twenty-eight. The cure of the uterine affection effected the cure of the 
hysteria 62 
Case IV.-Hysteria, consequent upon uterine affection, in a lady aged thirty- 
five. Successful termination 64 XVI 
CONTENTS. 
CHAPTER IV. 
AMENORRHCEA. 
PAGE 
Retention of the Menses-Nature-Causes-A. Nervous Con- 
stitution-B. Organic Affections and Visceral Lesions- 
C. Mechanical Causes-Symptoms of Retention of the 
Menses-Suppression of the Menses-Nature-Causes- 
Symptoms-Diagnosis of Amenorrhcea in General-Prog- 
nosis-Treatment66-72 
Case V.-Retention of Amenorrhcea in a girl aged seventeen, from insuffi- 
ciency of physical development. Nature abides its time 78 
Cases VI-X.-Retention of the Menses in girls of various ages, from insuffi- 
ciency of physical development. Time their benefactor 74 
Cases XI-XIX.-Suppression of the Menses in persons of various ages, single 
and married, from various constitutional and accidental causes. Suc- 
cessful termination of the cases, with the exception of one 75 
Case XX.-Retention of the Menses in a young girl seventeen years old, 
from imperforate hymen. Successful termination of the case 77 
CHAPTER V. 
GENERAL REMARKS ON THE DISEASES OF THE UNIM- 
PREGNATED WOMB. 
Nature of the Diseases of the Womb-Parts affected and Varie- 
ties of Inflammation of the Womb-Sympathies of the 
Womb79-84 
CHAPTER VI. 
INFLAMMATION OF THE NECK OF THE WOMB, AND ITS 
SEQUEL2E, ULCERATION, HYPERTROPHY, INDURATION 
AND ELONGATION OF THE NECK. GENERAL REMARKS. 
Existence, Frequency and Importance of Inflammation and Ul- 
ceration of the Neck of the Womb-Varieties of the Neck 
of the Womb-Erosion, or Excoriation-Ulceration-Gran- 
ular Ulceration-Fungous, or Cock's-comb Granulation 
-Hypertrophy and Induration of the Neck of the Womb, 
consequent upon Inflammatory Ulceration-Hypertrophy 
or Engorgement-Induration-Elongation-Recognition CONTENTS. 
XVII 
PAGE 
by the Profession of the Existence, Frequency and Import- 
ance of Inflammation and Ulceration of the Neck of the 
Womb-Statistics in testimony of its Frequency85-103 
Case XXI.-Partial Prolapse, dependent on inflammatory ulceration of the 
neck of the womb, the cause of previous miscarriage, in a married 
lady. The disease of the womb not discovered by a preceding practi- 
tioner. Complete cure 89 
CHAPTER VII. 
ETIOLOGY, OR CAUSES OF INFLAMMATION AND ULCERA- 
TION OF THE NECK OF THE WOMB. 
Predisposing Anatomical Causes of Inflammation and Ulcera- 
tion of the Neck of the Womb-Predisposing Physiologi- 
cal Causes-1. Menstruation, 2. Conception, 3. Parturition 
-Constitutional Causes-Liability of the Sex to Inflamma- 
tory Affections of the Neck of the Womb103-115 
CHAPTER VIII. 
SYMPTOMATOLOGY, OR SYMPTOMS OF INFLAMMATION AND 
ULCERATION OF THE NECK OF THE WOMB. 
Anatomical Symptoms-Character of Vaginal Discharges of Con- 
gestion of the Neck of the Womb-Of Vaginal Discharges of 
Inflammation and Ulceration-Of the bloody Vaginal Dis- 
charges-Local or Subjective Symptoms of Inflammation 
and Ulceration of the Neck of the Womb-Extension of the 
Inflammation, etc., to the Vagina and Vulva, productive 
of Itching of the Vulva, or Pruritus Pudendi-Extension of 
the Inflammation, etc., to the Rectum and Bladder- 
Hemorrhoids or Piles, in consequence-Prolapsus Ani, in 
consequence-Pain and its Seat in Inflammation and Ul- 
ceration of the Neck of the Womb-A. Character of Pain 
in the Back-B. Character of Pain in Ovarian and Hypo- 
gastric Regions-Dynamic, or Functional Symptoms of 
Inflammation and Ulceration of the Neck of the Womb-- 
Menstruation as a Functional Symptom-A. Pain expe- 
rienced during Menstruation-B. Periodicity of Menstrua- 
tion-Duration of Menstruation-Quantity of the Menses XVIII 
CONTENTS. 
PAGE 
-Impregnation as a Functional Symptom-Uterine Iner- 
tia as a Functional Symptom-Sexual Congress as a Func- 
tional Symptom-The Breasts as a Functional Symptom 
-Sympathetic or Constitutional Symptoms of Inflamma- 
tion and Ulceration of the Neck of the Womb-Sympa- 
thetic Affection of Digestion-Of the Intestinal Canal-Of 
the Liver and Kidneys-In the Organs of Respiration- 
Of the Circulatory System-Of the Function of Nutrition 
-In the Cerebral System-In the Organ of Vision-In the 
Organ of Hearing-Of the Spinal System-Pains, Distress- 
ing Sensations, etc., in the Pelvic and other Regions-Sym- 
pathetic Affections of the Skin, or Hyperesthesia-Of the 
Nervous System-In Sleep-Summary of Symptoms.. .115-169 
Case XXII-Menorrhagia, the result of extensive inflammation and ulcera- 
tion of the neck of the womb. Repeated miscarriages, etc., in a mar- 
ried lady. Complete recovery 119 
Case XXIII.-Severe Itching of the Vulva, the effect of granular inflamma- 
tion of the neck of the womb, in a lady of thirty. Ultimate cure 123 
Case XXIV.-Repeated Miscarriages, dependent on extensive inflammation 
and ulceration of the neck of the womb, etc-, in a married lady. The 
treatment recommended declined 135 
Case XXV.-Seven consecutive Miscarriages, the result of inflammation and 
ulceration, and elongation of the neck of the womb, etc., in a manned 
lady. Complete cure 136 
Case XXVI.-Extensive Ulceration of the Neck of the Womb in a married 
lady ; no hindrance to impregnation, or to the preservation of a tolera- 
bly good health. Exceptional case 143 
CHAPTER IX. 
DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF INFLAMMA- 
TION AND ULCERATION OF THE NECK OF THE WOMB. 
Diagnosis-Differential Diagnosis in relation to Leu- 
corrhcea-to Weight, Dragging and Bearing-down Pains 
and Sensations-to Pain in the Back and other Pains-as 
to the Ovarian Pains-to Symptoms emanating from the 
Rectum and Bladder170-176 
CHAPTER X. 
PROGRESS OF INFLAMMATION AND ULCERATION 
OF THE NECK OF THE WOMB 177 CONTENTS. 
XIX 
CHAPTER XI. 
PAGE 
TERMINATION OF INFLAMMATION AND ULCERA- 
TION OF THE NECK OF THE WOMB 178 
CHAPTER XII. 
PROGNOSIS OF INFLAMMATION AND ULCERATION 
OF THE NECK OF THE WOMB 180 
Case XXVII.-Extensive Uterine disease in a married lady, not discovered 
by former medical advisers. Premature death, after a long life of suf- 
fering, from a curable but neglected disease. Inside life of a lady of 
wealth 182 
CHAPTER XIII. 
TREATMENT OF INFLAMMATION AND ULCERATION OF THE 
NECK OF THE WOMB. GENERAL REMARKS. 
Remarks on the Use of the Speculum-On Topical Applications 
-On Constitutional or General Treatment-On Vaginal 
Injections189-202 
CHAPTER XIV. 
HYPERTROPHIED ELONGATION OF THE NECK OF THE 
WOMB. GENERAL REMARKS. 
Nature-Causes-Diagnosis-Symptoms-Treatment203-297 
Case XXVIII.-Hypertrophic Elongation of the Neck of the Womb in a mar- 
ried lady, twenty-three years old, the probable cause of sterility and 
of her ill health. Cured after three months of treatment 207 
CHAPTER XV. 
DISPLACEMENTS OF THE WOMB. GENERAL REMARKS. 
Nature and Frequency-Anteversion of the Womb-Retrover- 
sion-Prolapsus and Procidentia-Causes of Displace- 
ments-Any Influence which increases the Weight of the 
Womh-which diminishes the Supports of the Womb- XX 
CONTENTS. 
PAGE 
which pushes the Womb out of place-which displaces 
the Womb by Traction-Symptomatology of Uterine Dis- 
placements-Course, Duration and Termination-Prog- 
nosis-Treatment-Pessaries, their Use and Abuse209-223 
CHAPTER XVI. 
TUMORS OF THE WOMB. GENERAL REMARKS. 
Nature of Fibrous Tumors and Fibrous Polypi-Nature of 
Mucous Polypi-Etiology, or Causes of Uterine Tumors- 
Symptomatology, or Symptoms of Tumors of the Womb 
-Course, Duration and Termination of Tumors of the 
Womb generally-Prognosis of Uterine Tumors-Treat- 
ment of Tumors of the Womb224-232 
CHAPTER XVII. 
INFLAMMATION OF THE MUCOUS MEMBRANE OF THE 
VAGINA, OR CANAL LEADING TO THE WOMB : VAGINI- 
TIS. GENERAL REMARKS. 
Nature of Vaginitis, or Inflammation of the Vaginal Mucous 
Membrane-Etiology, or Causes-Symptomatology, or 
Symptoms-Diagnosis, or Discrimination-Prognosis- 
Treatment233-238 
CHAPTER XVIII. 
LEUCORRHCEA, OR WHITES. GENERAL REMARKS. 
Nature-Etiology-Constitutional or General Causes-Local 
Causes - Diagnosis-Prognosis - Treatment-Conclusion. 
On the Indifference of Women in respect to their Health, 
and the present System of their Education239-250 
APPENDIX. 
Numerous Abstracts of Cases derived from Private Practice, 
etc254-315 
Card from the Author 343 WOMAN'S COMPLETE GUIDE TO HEALTH. 
CHAPTER I. 
GYNECOLOGY, OR THE.DOCTRINE OF THE NATURE, DISEASES, 
ETC., OF WOMEN. 
At the close of the last century the various diseases 
peculiar to women, their causes and true nature, were 
but very imperfectly understood. Their existence was 
overlooked, because their symptoms were obscure and 
their diagnosis impeded by various causes, such as 
social habits, religious customs, superstitions, etc. Con- 
sequently, the medical treatment of these diseases was 
necessarily inadequate, irrational, and of an empirical 
character, as it did not rest upon any scientific basis. 
Owing to various influences, in addition to the reasons 
above alluded to, these affections remained unchanged 
and permanent, thereby increasing greatly the suffer- 
ings they entailed. These sufferings, in many in- 
stances, were so acute, intense, and agonizing, as to 
render the invalid's existence a burden unendurable, 
if they did not, in consequence, actually carry her to a 
premature grave. The " Opprobium Medicorum," or 
the disgrace of the medical profession, never, perhaps, 22 
woman's complete guide to health. 
was more legitimately applied to any disease, than to 
the diseases peculiar to women. 
But this state of medical ignorance could not exist 
forever. Progress is the universal law-the law of 
nature. The science of medicine, like other branches 
of human knowledge, goes onward in its march, and 
could not fail of bringing to light new materials tend- 
ing to alleviate the sufferings of mankind. Progress, 
for a century or two past, has been heralded in every 
science and art. In no science or art was improve- 
ment so imperatively demanded, or so absolutely ne- 
cessary, as in medical science. In time, and gradu- 
ally, medical science attained its due share of univer- 
sal progress. In some of its departments, this pro- 
gress was great, immense, unparalleled in medical his- 
tory ; in others it was at a stand still, or moved at a 
very slow pace. Gynecology, one of the most import- 
ant and interesting branches of medical science, seemed 
doomed to remain, comparatively, without any sensi- 
ble improvement till within a very recent period. 
Toward the middle of the nineteenth century, or as 
late as twenty years back, the diseases peculiar to 
women received, however, something of the attention 
they really deserved; and before long, their import- 
ance was recognized to be greater than that which had 
hitherto been accorded to them. And the growing 
interest that this new field of investigation subse- 
quently awakened among some of the most eminent 
professional men, could not fail to be productive of 
the happiest results. 
Thus the existence of the diseases of women re- 
ceived full acknowledgment. Light, where darkness 23 
GYNECOLOGY. 
previously existed, was thrown upon their causes and 
true nature, and hence, what in the remotest periods of 
medical science were regarded as idiopathic affections of 
some organs, were now recognized to he sympathetic dis- 
turbances, or merely "effects" of disease in the icomb. 
Moreover, thus was established definitively, Gynecol- 
ogy, as a special branch of medical science. It is 
considered as such at the present day, if not by the 
profession generally, at least by the most discerning 
part of it. 
If, then, the class of suffering women is yet very 
large (much larger than is generally supposed-their 
frequency and the degree of suffering seeming to in- 
crease with the progress of society), it cannot be said 
that the medical science of the nineteenth century, and 
Gynecology, in particular, is still at fault. Certainly 
not. The great delicacy that surrounds all woman's 
ailments, the excessive scrupulousness of some of their 
medical advisers, and the great indifference, if not ut- 
ter and culpable neglect of others, to inquire minutely 
and conscientiously into the exact state of health of 
their patients, are some of the main reasons why so 
little relief is obtained by this class of sufferers. 
It is by comparing woman wdien sick with woman 
when in health, that the true cause of her ill-health 
could always be ascertained with accuracy, and with 
little, if any difficulty. If this method were adopted, 
one would not witness daily medical treatment directed 
to fantastic diseases, or to symptoms-in other words, 
to the effects instead of to the causes of the disease. 
Thus, women are treated for diseases of the stomach, 
liver, kidneys, heart, lungs, throat, etc.; yet, in most 24 
woman's complete guide to health. 
instances, these diseases will be found, oh due inves- 
tigation, to be, in reality, no diseases at all, but merely 
the sympathetic reactions or the symptoms of one dis- 
ease, namely, a disease of the womb. This is now so 
evident, that often, after many years of suffering and 
treatment without benefit, the womb is, at last, made 
the object of investigation, and is finally recognized, 
both to be the only organ diseased, and, consequently, 
the primary cause of all the late sufferings. It is then 
made, in consequence, the object of treatment, and 
being ultimately cured, all the sympathetic manifesta- 
tions alluded to above soon disappear, and the suf- 
ferer recovers at last her long-lost and almost hopeless 
health. CHAPTER II. 
CHLOROSIS. 
Chlorosis is an affection mostly peculiar to women, 
and of comparatively frequent occurrence. It is char- 
acterized by discoloration and paleness of the skin, 
and more particularly of the face. This discoloration 
and paleness of the skin, moreover, assumes a yellow- 
ish-greenish hue of a greater or lesser proportion, 
according to the progress of the disease, from whence 
the affection has been called " green-sickness." 
I.-NATURE OF CHLOROSIS. 
Chlorosis is an affection of girlhood, just as the 
period of puberty approaches; and is, consequently, 
mostly observed in girls from thirteen or fourteen to 
nineteen or twenty years old, and unmarried. It be- 
comes an extremely rare affection in girls approaching 
twenty-five, and after this age; and it is just as rare 
in the married. If a state seemingly chlorotic, has, 
perchance, been observed under these circumstances, 
this state should be considered in its true light, viz.: 
that of a state of anaemia, symptomatic of some abnor- 
mal state of the womb or its appendages. This seems 
also to be the view taken on the subject by Dr. Bec- 
querel, of France. A lady is actually under my treat- 
ment for a retroversion of the womb, having existed 26 
woman's complete guide to health. 
for the last three years. Her symptoms are an obsti- 
nate constipation, want of appetite, weakness, etc. 
But the most striking of her symptoms is pallor of the 
face-so much so, that her state might well give occa- 
sion to be considered as one of chlorosis. Yet she is 
merely anaemic through the abnormal condition of the 
digestive organs, the effects of the displaced womb 
pressing against the rectum, and producing thus a 
mechanical obstruction to the free motions of this 
organ, the rectum. 
What the real nature of this disease is, is still an 
unsettled and open question. Some authorities, Dr. 
Bedford and others, for instance, suppose that it is a 
disease of the vascular system, and that its principal 
element consists in a decrease, or diminution in the 
richness of the blood, or rather of its red globules. 
Others, on the contrary, as Eisenmann, of Wurtzburg, 
and Becquerel, consider it a disease of the nervous 
system, and although they recognize the diminution 
of these red globules in the blood to be one of the 
main elements of the disease under consideration, yet 
they do not consider it to be the essential disease-all 
the disease. But, this part, the speculative part of a 
subject und?r consideration, has been excluded from 
this work, and, consequently, I am not called upon to 
clear up these conflicting opinions. Let the simple 
statement of the fact suffice. 
IL-CAUSES OF CHLOROSIS. 
The causes that operate in developing the disease 
are seldom known or discovered. These causes are 27 
CAUSES AND SYMPTOMS OF CHLOROSIS. 
various and very numerous; they may operate sepa- 
rately, or, to a certain extent, collectively. A resi- 
dence in humid, damp places; exposure to sudden 
changes of atmosphere; close confinement in over- 
heated, ill-ventilated, and ill-lighted apartments; se- 
dentary habits, are among them. 
In France this disease is very common in girls work- 
ing in manufactories. Impoverished diet, and conse- 
quently, the inevitable derangement in the digestive 
and intestinal organs ; delicate and weak constitutions 
give rise to it. Such are some of the causes that may 
operate in developing this disease. It may, moreover, 
occasionally date its origin from functional derange- 
ment-in other words, from absence or irregularity 
of the menstrual function, or some structural lesion 
of the womb. Finally, moral causes, such as pro- 
tracted grief, anxiety or fatigue, disappointments, un- 
requited love, etc., may also contribute in developing 
chlorosis. 
III.-SYMPTOMATOLOGY, OR SYMPTOMS OF CHLOROSIS. 
Chlorosis usually develops itself slowly and almost 
insensibly. It is rare that it develops itself with any 
degree of rapidity. As before stated, it is character- 
ized by discoloration and paleness of the skin, and 
more particularly of the face. This discoloration of 
the cutaneous tissue is one of the most striking and 
constant symptoms of chlorosis; it is also one of the 
earliest. When the disease is well developed, it is 
manifested by numerous symptoms. There is impaired 
appetite and longing for unnatural food. This state of 28 
woman's complete guide to health. 
the digestive organs is probably one of the causes of 
the obstinate constipation which is so generally pres- 
ent in this affection, if not occasioned by displacement 
of the womb. There is disturbed circulation, as indi- 
cated by a very variable pulse, palpitation of the 
heart, and general feeling of coldness. The nervous 
system is considerably involved in this disease, and 
very remarkably so. The female passes many sleepless 
nights, and in consequence becomes restless, depressed 
in spirits, complains of headache, lightness or vertigo, 
throbbing of the temples and ears, and other hysterical 
phenomena, according to the particular constitution of 
the girl so affected. The menstrual function, in cases 
of this affection, is usually deranged. This function 
may continue with regularity, but then the character 
of the menstrual blood will be changed; or the func- 
tion may cease altogether, constituting amenorrhcea, a 
disease to be considered hereafter. 
Such are some of the symptoms that may be said 
to characterize chlorosis in its earlier or incipient 
stage; but these are soon followed by others which 
clearly indicate that other organs-the womb, for in- 
stance-are morbidly affected, and have complicated 
the case. 
IV.-DIAGNOSIS, OR DISCRIMINATION OF CHLOROSIS. 
The history of the patient's ill-health, and a thorough 
and cautious examination of all the symptoms com- 
plained of, will generally enable the practitioner to dis- 
criminate chlorosis from any other disease. DISCRIMINATION OF CHLOROSIS. 
29 
The affection with which chlorosis may be easily 
confounded is anaemia; yet, the non-identity of the 
two affections is well founded. It is, then, not only of 
importance, but also of practical utility, that the dis- 
tinction between these iwo affections should be well 
understood; the more so, as their treatment neces- 
sarily varies very materially. Consequently, I think 
it will be acceptable to my readers to point out next 
the chief differences between the two affections, and 
in so doing, will mainly adduce the arguments so 
clearly stated by Drs. Becquerel and Bodier, of Paris, 
and Dr. W. A. Hammond, of New York. 
CHLOROSIS. 
CAUSES. 
1st. Chlorosis is especially an 
affection peculiar to women, and 
in the majority of cases occurs 
between the ages of fifteen and 
twenty-five; it is very rarely 
met with in persons beyond 
that age. 
2d. The causes of chlorosis, 
for the most part, are unknown, 
or are directly associated with 
some powerful shock to the ner- 
vous system. Moral emotions, 
disappointments, and severe 
mental exertion, favor the de- 
velopment of chlorosis. Resi- 
dence in large cities, and a se- 
dentary life, likewise predis- 
pose to it. 
ANJEMIA. 
CAUSES. 
1st. Anaemia is an affection to 
which both sexes are subject, 
and in no wise connected with 
age, but is just as liable to oc- 
cur at one time of life as an- 
other, if the causes are set in 
operation. 
2d. Anaemia may be induced 
by insufficient aeration of the 
blood, and by the action of de- 
leterious vapors and gases in 
the atmosphere. It is, hence, 
apt to occur in persons who are 
forced to remain long in crowd- 
ed apartments, or who are ex- 
posed to emanations of a pois- 
onous character. Miners and 
others, cut off from a due sup- 30 
woman's complete guide to health. 
ply of light, become anaemic, or 
etiolated, as the condition is 
called when it arises from a de- 
ficient amount of light, Long 
continued exposure to humid- 
ity may also produce it. The 
blood also becomes depraved 
by insufficient alimentation, or 
by the ingestion of food bad in 
quality, and by various other 
diseases and cachexies, too long 
to mention. In short, any acute 
or chronic disease, if sufficiently 
prolonged, in which the diet 
has been restricted, or in which 
the body has been subjected to 
exhausting discharges, is almost 
always followed by more or less 
well-marked anaemia. 
3d. Anaemia, on the contrary, 
can be directly traced to some 
one of the causes mentioned 
above. It is rather a sequela of 
some well marked morbid con- 
dition, than a disease itself. 
SYMPTOMS. 
4th. In anaemia, the eviden- 
ces of mental or nervous de- 
rangement are never prominent, 
and when they are present, are 
simply such as are directly the 
result of a deficient amount of 
blood in the brain. They con- 
sist, therefore, of headache, ver- 
tigo, and attacks of syncope. 
3d. Chlorosis either comes on 
suddenly, after a severe mental 
shock, or occurs gradually from 
derangement of the nervous sys- 
tem, or arises without any very 
palpable cause. 
SYMPTOMS. 
4th. The symptoms of chlo- 
rosis are such as very markedly 
show its non-identity with anae- 
mia. In the first place it is, in 
the early stages especially, char- 
acterized by disturbances in the 
nervous system. The character- 
changes, the individual be- 
comes morose, melancholic, or 31 
DISCRIMINATION OF CHLOROSIS. 
subject to various whimsicali- 
ties of disposition, of temper, or 
of appetite: headache, vertigo, 
noises in the ears, neuralgia, 
palpitation of the heart, and 
nervous derangements of the 
stomach or bowels occur. There 
is usually indisposition to either 
physical or mental exertion, and 
there are generally pains at the 
points of attachment of certain 
muscles, and at various spots 
along the course of the spine. 
Sometimes there are choreic 
movements, or various hysteri- 
cal manifestations, and occa- 
sionally epileptiform convul- 
sions. 
5th. Finally, the discolora- 
tion of the skin, consisting of a 
yellowish-green hue, and the 
paleness of all the mucous mem- 
branes, exists often from the very 
beginning of the disease. De- 
rangements of the menstrual 
function, dysmenorrhoea, or 
painful menstruation, or ame- 
norrhoea, are usual concomi- 
tants, and sometimes occur early 
in the course of the affection. 
Leucorrhoea is also a frequent 
accompaniment. 
There is never in pure anaemia 
the perversion of character, and 
the suddenly-acquired likes and 
dislikes which are such notable 
features in chlorosis. Neural- 
gic pains and nervous derange- 
ments of the viscera are seldom 
met with, and are never such 
marked symptoms as they are 
in chlorosis. There may be pal- 
pitation of the heart, owing to 
the debility of the organ and 
the poverty of the blood. 
5th. The color of the skin is 
altogether different in anaemia 
from that which prevails in 
chlorosis. Instead of being a 
yellowish-green it is pallid or 
doughy, more or less intense 
according to the degree to which 
the diminution of the essential 
elements of the blood has 
reached. 32 
woman's COMPLETE GUIDE TO HEALTH. 
V.-PROGNOSIS OR FUTURE PROGRESS AND TERMINA- 
TION OF CHLOROSIS. 
Chlorosis is a manageable disease. If chlorotic 
patients are submitted in time to proper medical 
advice, if their health has still remained vigorous, 
although greatly tried under the influence of the dis- 
ease, and .if no complication of a serious character 
accompanies it, it may safely be predicted that the 
case will terminate happily. If, on the contrary, 
the case has been neglected, mismanaged, and the 
patient's health decidedly broken down, and has 
otherwise become seriously complicated with other 
diseases, it may turn out to be a hopeless one. The 
complications alluded to just now, are : a. Hemorrhage 
from the nose, the eyes, the ears, the nipples, the 
lungs, the stomach; ft. Ulcerations of the stomach, 
etc.: c. Lesions of the spinal cord. The deaths which 
have and do occur in chlorosis are from hemorrhage 
from one or more of the organs above enumerated, 
and from ulceration of the stomach. 
VI.-TREATMENT OF CHLOROSIS. 
The treatment of chlorosis requires caution and 
good management, such as a physician alone can sug- 
gest. Chlorotic patients should enjoy frequent and 
active exercise in the open air, and nutritious and 
highly digestible diet, this to consist in all those arti- 
cles of food which are best calculated to enrich the 
blood. But as the subjects of chlorosis are generally 
so greatly debilitated, it is essential that their food TREATMENT OF CHLOROSIS. 
33 
and exercise should be adapted in proportion to their 
actual and growing strength. They should take fre- 
quent baths, both general and local, in fresh or salt 
water, the temperature of the water to be so gradu- 
ated as will best suit their strength and the benefit 
they derive therefrom. Lastly, a no less important 
means of treatment, is the removal of any and all 
causes, physical, functional or moral, that may have 
been productive of the disease. 
If chlorotic patients have been inhabiting ill-venti- 
lated or ill-lighted apartments, for instance, these 
should be changed for more suitable quarters, and in 
the construction of them, the laws of health have 
received some consideration. Dr. Forbes Winslow, 
in his work recently published, on Light and its Influ- 
ence on Life and Health, shows the inestimable value 
of light as a hygienic agent. He also very forcibly 
demonstrates that living in direct sunlight, or in build- 
ings to which, during portions of the day, the direct 
rays of the sun have access, is necessary to the enjoy- 
ment of complete health, and to the attainment of the 
highest degree of mental and physical development. 
" Not only," says he, " is the reflected and polarized 
light which alone visits the pent-up dwellings of large 
towns, incompetent to discharge the stimulating func- 
tions performed by the solar beam, but it is supposed 
to exert positively deleterious effects upon the organ- 
ism." He then goes on enumerating and classifying 
the pathological (morbid) phenomena which have been 
chiefly noted in persons living in badly-constructed 
houses containing but few windows, in factories and 
holds of ships, and in those who have long been im- 34 
woman's complete guide to health. 
mured in prisons, as well as in the denizens of narrow 
streets and confined courts, garrets or cellars. Among 
all these classes of persons are found to be prevalent 
the severer kinds of chlorosis and other forms of anse- 
mia, showing an impoverished state of the blood. 
But one subtle and well-established mode of the 
action of light upon the organism has been omitted 
by Dr. Winslow. I allude to the well-known fact, 
that sunlight, by its stimulating effect, very considera- 
bly increases the action of the lungs, as it does of 
other organs. Inhalation and exhalation are more 
vigorous, the exchange of carbonic acid (the gas we 
expire) for oxygen (the gas we inhale) goes on more 
rapidly, the circulation is quickened, and doubtless 
the repair- of the tissues is thus facilitated, etc. 
Such is, in short, the treatment of one of the most 
remarkable diseases that " young girls " may be 
exposed to. 
As an illustration of the principles that should be 
the guide in the treatment of Chlorosis, I take from 
my note-book the following two very interesting cases : 
Case I.-Chlorosis in a girl eighteen years old, the result 
of the suppression of the menstrual function. Cured 
in four months' treatment. 
In 1860, I was requested to see a servant girl stay- 
ing with a family whose acquaintance I had formed 
some years previous, on account of this girl's ill 
health. The history of the case is this : In the latter 
part of November, 1858, the girl left Ireland for the 
United States, and arrived in New York on New 
Year's eve. While in Ireland, she had enjoyed good, CASES OF CHLOROSIS. 
35 
even robust health in every respect. She began to 
menstruate at 14 years, without trouble, and continued 
to do so regularly till she left her home, within a week 
of her last courses. The voyage lasted nearly five 
weeks, and, consequently, she should have been unwell 
while on ship ; but from some cause or other, unac- 
countably to herself the menstrual function failed to 
appear. 
She arrived in New York, as I said before, the eve 
of the 1st of January, 1859, apparently in as good 
health as usual. Her courses, which she expected 
would certainly come on in January, again failed to 
appear. Shortly after her landing here, she went into 
service. Some time later, her health, which up to 
that period had always been excellent, became im- 
paired ; she gradually lost her appetite, her strength 
and her former aptitude for work. She grew low- 
spirited and ill-humored, her bowels became consti- 
pated and she began to complain of headache, light- 
ness in the head, amounting occasionally to actual 
vertigo. All these symptoms had come on gradually, 
and before a year had expired, other symptoms ap- 
peared. She became pale, emaciated, exceedingly 
nervous, and talked of returning home. Within this 
year, also, she had changed service several times, her 
employers discharging her because " she was not up 
to her work." 
When I first saw her, her state was truly pitiable. 
It was a genuine case of chlorosis, and it had made 
considerable progress. Her pallor was great and gen- 
eral, her face exhibiting the yellowish-greenish hue 
so characteristic of the disease. She complained, 36 
woman's complete glide to health. 
moreover, of palpitation of the heart, and also of flut- 
tering ; of general weakness, great nervousness ; of an 
obstinate constipation, which induced her to take large 
doses of castor oil and salts. Her condition, indeed, 
was such that it required a very exceptional and chari- 
table family to keep her even for a week, and conse- 
quently she had been employed to take care of a sick 
elderly lady. She had received medical advice in 
almost every family she had served, but she had at no 
time derived any benefit from medicines that had been 
given her. This girl was of a better family than the 
average of Irish servants ; she was intelligent, and 
seemed to have watched remarkably well the march 
and progress of her ill health. Having inquired in 
relation to her menstrual function, she said that she 
had not seen anything since she left Ireland, and 
added: "I do not know that it has anything to do 
with it, but my back feels at times so weak and lame ; 
I feel a heavy weight across my hips and a dragging 
towards my legs, that makes them tremble under 
me." On inquiring still further, I was told that she 
had the whites : sometimes they were thin and copious, 
at others, thicker, and not quite so profuse; but she 
could not tell what particular cause produced an 
increase or decrease of the secretion. 
Such was the history and gravity of the case with 
which I was to be entrusted. Before proceeding, I 
would crave my reader's further indulgence for one 
moment only, in order to recapitulate her long history 
of suffering. This girl left Ireland in excellent health, 
menstruating regularly. On her arrival here, her health 
was still good, but her menstrual function had been CASES OF CHLOROSIS. 
37 
suppressed. This suppression had gradually been 
followed up by symptoms characteristic of chlorosis, 
and ultimately by symptoms characteristic of some 
affection of the womb. She had received medical ad- 
vice, and been treated, but had not in the least been 
relieved from her distress. 
Doubtless, the treatment that this truly patient 
patient had received, had been directed mainly to her 
chlorotic state, regardless of any other abnormal con- 
dition she might have been laboring under. In other 
words, the treatment, in my opinion, had been direct- 
ed principally to the " effect," instead of the " cause," 
of her disease. The chlorotic state of the girl was the 
" effect," and the diseased condition of the womb, 
whatever and wherever located, was the " cause" of her 
affection. Lastly, this cause, or the condition of the 
womb, it was imperative should be ascertained, in 
order that the appropriate treatment might finally be 
resorted to. 
I prescribed for the patient with the understanding 
that, within two weeks, I should be allowed to examine 
the state of the womb. After some hesitation, she 
appointed a day within the time demanded. On the 
appointed day, I made, in the presence of the lady of 
the house, the examination requested, and I found the 
lower part of the vagina in a lower state of tempera- 
ture than usual; but this state of temperature increas- 
ed considerably on reaching higher up towards and 
around the neck of the womb. The neck of the womb 
was normally situated, tender on pressure, and some- 
what increased in size. The mouth of the womb was 
so small that its location could only be ascertained 38 
woman's complete guide to health. 
through a slight indentation. The womb itself was 
increased in bulk, and rather sensitive on external pal- 
pation. The very small aperture of the mouth of the 
womb, or some obstruction within its neck, had most 
likely been the impediment to the escape of the 
menstrual blood, which had in consequence remained 
shut up in the cavity of the womb, and increased with 
every menstrual period. The indication seemed to 
point to the letting out of this accumulated blood in 
the womb ; and to this end I inserted the very smallest 
tent of elm-bark I could shape, about three quarters 
of an inch long, into the mouth of the womb, and as 
high up its neck as it would go, and left it there for 
twenty-four hours. 
This proceeding was ineffectual, and on extracting 
the tent, it was perceived that it had not expanded in 
the slightest degree. No bad effects having otherwise 
resulted, I inserted in the same way the smallest 
sponge-tent I could procure. I extracted this tent 
early next morning; it was followed for several days 
by a moderate flow of blood, and by a dribbling of 
blood for several days more : all the effects of the di- 
latation of the neck of the womb soon subsided. I 
then gave general instructions as to diet, exercise, 
baths, medicines, etc., for the promotion of her courses. 
The girl felt a general relief following almost imme- 
diately the emptying of the womb of its long-accumu- 
lated blood. 
She menstruated a month later, and continued to do 
so regularly for some time afterwards. She com- 
plained only of some slight sickness just before men- 
struating-a circumstance that had not accompanied CASES OF CHLOROSIS. 
39 
her former menstruation, but the difficulty seemed to 
be slight, since she paid little attention to it. In the 
mean time her health had improved gradually since 
the return of her courses, and improved more rapidly 
afterwards. All this change, from a wretched state 
of health to nearly as good a health as she ever en- 
joyed before, was effected in four months from the 
time I took charge of this case. 
I have given this case in all its details, because it is 
an interesting and instructive one, as to the treatment 
to be pursued in all similar cases, and because it is 
but an example of nearly a dozen others of the same 
nature, that I have met with in practice between the 
the period of 1856 to 1867. 
The following case occurred in the higher rank of 
society, where, I should remark, such cases are oftener 
found than in any other station of life. 
Case II.-Chlorosis in a young lady of nineteen years old, 
the result of displacement of the ivomb. Cure complete 
within a year of appropriate treatment. 
In 1863, I was requested to see Miss B , at her 
parents' residence in New York. On my arrival, I 
found a young lady reclining on a lounge, propped up 
and duly supported with numerous cushions, shawls, 
etc. The first glance I cast upon the invalid on 
approaching her lounge almost appalled me. It was 
neither life I contemplated, nor was it quite death. 
The history of the case was given me by the mother, 
and is as follows: Miss B was then in her nine- 
teeth year. She began to menstruate at fourteen 
without any difficulty, and continued to do so regu- 40 
woman's complete guide to health. 
larly for over a year. When she was nearly fifteen 
years old, she was sent to one of the boarding-schools 
in New York to finish her education. At that time 
she was delicate and slender, but her constitution 
showed vigor. She was very prepossessing, had a 
beautiful complexion, large dark eyes, with long silken 
eyelashes, her eyebrows were black and well-delin- 
eated. She was lively, cheerful and happy in disposi- 
tion, and, to crown the whole, was endowed with great 
intelligence. The parents, as may be imagined, had 
built great expectations upon their darling; she was 
an only child, and a daughter, too ; consequently she 
was indulged in all her wants, caprices or whims. 
She had scarcely been a year in school, when her 
menstrual function, from being regular, became irregu- 
lar as to time, at first, and subsequently, also, irregular 
as to quantity and quality of the menstrual flow. No 
apparent cause could be assigned for this change. 
From this period, also, her health became impaired, 
and failed gradually, until it aroused the solicitude of 
her parents, who took her home to be nursed and 
treated by the family physician. She had been thus 
over one year and a half in her boarding-school, and 
was in her seventeenth year. At the expiration of 
another year, the state of health of this once lovely 
and blooming girl, instead of having improved under 
treatment received, and the careful, tender and unceas- 
ing nursing of her devoted mother, was miserable 
beyond expression. The family physician was under 
the impression that all resulted from " constitutional 
weakness," and had treated her accordingly. Of 
course, he had signally failed to improve in the least 41 
CASES OF CHLOROSIS. 
the girl's state of health. He withdrew his attendance 
at the end of that year, saying that the case was be- 
yond possible recovery, and that all that science could 
have accomplished had fairly been brought into requi- 
sition. The parents, out of respect to this old prac- 
titioner, their family adviser for some twenty years, 
did not consult any other medical man, neither had 
this family friend at any time advised them to 
do so. The moral of this and of all such cases of 
neglect of duty on the part both of physicians and 
parents, I respectfully submit to the consideration of 
the public. 
Thus when I saw Miss B in 1863, she had been 
nearly a whole year without medical attendance, and 
was, as I remarked before, in her nineteenth year of 
age. The symptoms hi the case were nearly all those 
we have seen complained of in the preceding case. It 
■was chlorosis in a very advanced stage. Her features 
were excessively pale, pinched and almost transparent, 
and on very close examination and in a good light only, 
could be perceived the slightest greenish-yellowish 
hue that it is possible to imagine. The lids of her eyes 
seemed also slightly puffed, and the same puffiness or 
oedema occasionally appeared on her feet. But the 
symptoms that now mostly attracted my serious atten- 
tion, were those which Miss B described herself. 
She experienced, she said, in the lower part of the abdo- 
men, a sensation or feeling of pain as if occasioned by 
a heavy load, which at times worked as if it would 
descend lower, and escape from her person. The back 
and lower limbs were so weak and gave her so little 
support, that she was unable to walk for any length 42 
woman's complete guide to health. 
of time across her room. After that she had to lay 
down again and rest. She had occasionally a thin, 
white vaginal discharge, not very profuse, she said, 
but she thought that when she had it most it con- 
siderably increased her weakness. Her courses ap- 
peared at longer or shorter intervals, every five or 
six weeks, and two, three and four months had 
elapsed before their appearance. The blood was 
variable, sometimes very pale and small in quantity. 
The nervous and moral systems were greatly shaken, 
as w'ell may be imagined. I met the painful, anxious, 
and shall I add, the avowedly hopeless questions of 
the parents with but little encouragement. I only told 
them, «that I had taken it for granted from the start 
of my practice, that wherever there is life there may 
be hope, and alluded to the result of the first case 
described in this chapter, also to a few others of the 
same type. 
From this day I attended Miss B , and saw her 
daily. A fortnight later she had gained a little in 
strength, and her nervousness grew somewhat quieter. 
There seemed also to be a look about her from which I 
augured wrnll. Two or three weeks later still, or five 
weeks from the commencement of my attendance, 
Miss B had gained so much in strength, and her 
nerves became so much stronger, that I had become 
anxious to make a more thorough examination, and 
to attack the enemy in his stronghold, for such I con- 
sidered the womb to be in this case. I knew that I 
should find this organ displaced, etc., and that here 
lay the foundation of the great irregularity of her 
courses. Having thus explained to the mother what I CASES OF CHLOROSIS. 
43 
suspected to be the cause of her daughter's ill health, 
and my duties in this respect, and having obtained 
Miss B 's consent, I made the surgical examination. 
I found the hymen intact, but so dilatable as to admit 
of manipulation without any great difficulty. The neck 
of the womb was found only a short distance from the 
threshold of the vagina, perhaps a distance of about 
an inch, or three-quarters of an inch. It was very 
mobile, receding from the touch, tender, sensitive 
and somewhat larger than normally ; its surroundings 
rather dry and of a low temperature. The mouth of 
the womb was so small that its location could only 
be identified by a slight depression. Here then was 
a case of displacement or falling of the womb. The 
indication was to replace the organ and to maintain 
it when replaced. It would be interesting to detail 
the treatment pursued and the progress of this truly 
critical case. Suffice it to say, however, that within 
six weeks of treatment, the organ lost its tendency to 
fall down, and remained finally in its natural position. 
From this time the case progressed rapidly, and in 
less than a year of the commencement of all treat- 
ment in this case, Miss B was entirely restored to 
her former good health, and looked, said the once 
more proud and happy mother, as pretty, if not pret- 
tier, than before. 
In 1865, just as Miss B had recovered her 
health, her father failed in business, and removed 
with his family to one of the Western States, where, 
with the debris of his former fortune he had bought 
a farm, and consequently, I regret to say, I have not 
heard from the family since. CHAPTER III. 
HYSTERIA. 
Hysteria is also a disease mostly peculiar to wo- 
men, and is a disorder of very frequent occurrence. 
Its subjects are generally women between the ages of 
puberty and the cessation of the uterine functions. 
I.-NATURE OF HYSTERIA. 
It is a disease consisting of a morbid excitement of 
the nervous system, showing itself in occasional con- 
vulsive paroxysms and diversified functional disorder. 
It is, moreover, characterised by the extreme diversity 
and changeableness of its symptoms, which come 
rapidly, and as rapidly disappear, occur singly or in 
groups, with every possible variety of association, and, 
though often presenting an alarming aspect, are al- 
most never really dangerous, being a mere ebuhition 
upon the surface of life, while its depths are undis- 
turbed. As an affection per se, or independently, it is 
not so frequently met with in practice, as it is in a 
dependent or connected condition with some lesion or 
affection of the womb or its functions, and, as such, 
hysteria is no longer considered a disease, but a mere 
symptom, " the effects" of disease of the womb. 
That this form of the disease, viz., hysteria, depend- 
ent upon, or connected with some derangement of the 
womb, or its various functions, is more frequently met 45 
NATURE OF HYSTERIA. 
with than chlorosis, is a fact pretty generally acknowl- 
edged. Dr. Landouzy, the author of a very able 
Treatise on Hysteria, which was crowned by the Acad- 
emy of Medicine, Paris, made the autopsy of thirty- 
nine persons affected with hysteria, who had died of 
some other affection, and found that in twenty-nine 
some structural disease of the womb or its annexes 
existed. Further, from observation in hysterical wo- 
men during life, resulted the important fact, that out 
of twenty-seven cases, disease of the womb was recog- 
nized in twenty-six instances. "This," he remarks, 
" is certainly, as far as it goes, very strong, if not con- 
clusive testimony in favoi' of the connection between 
hysteria and an abnormal state of the sexual organs, 
whether from structural lesion or functional derange- 
ment." From my own observations of this affection, 
I have come to the same conclusion as Dr. Landouzy. 
Further, I am free to say, that those cases I have met 
with, so far, were all connected with some form or 
other of disease of the womb, and that in curing this 
latter affection, the hysteria or hysterical phenomena, 
which were all very promiscuous in the cases treated, 
disappeared without having received the slightest at- 
tention on my part. 
" The subject of hysteria," observes Dr. Hewitt, of 
London, " occupies a sort of neutral ground ; for al- 
though it is, as a rule, perhaps, to be looked upon as a 
general affection, there can be no doubt that between 
diseases of the generative organs and hysteria, there 
is in many cases a very close connection, and it is im- 
possible, in reference to treatment, practically to sepa- 
rate them." 46 
woman's complete guide to health. 
IL-ETIOLOGY, OR CAUSES OF HYSTERIA. 
An unusual degree of excitability, or mobility of the 
nervous system, constitutes a predisposition to hys- 
teria. This is sometimes received by inheritance. 
Parents affected with severe nervous diseases are apt to 
have hysterical children. "Whatever impairs the energy 
and increases the excitability of the nervous system 
may have the effect to create a disposition to hysteria, 
where it does not exist: sedentary habits, confinement 
to an impure air, living in hot rooms, and sleeping in 
hot beds, too much indulgence in sleep, vicious prac- 
tices in the young, and the premature forcing, by light 
and imaginative reading in early life, of the emotional 
part of the character, have a strong tendency to gene- 
rate hysterical constitutions. The difference in the 
education and subsequent habits of the two sexes has 
a powerful effect in confirming their respective natural 
tendencies in relation to hysteria. The boy is strength- 
ened against it by free exercise in the open air, the 
man by the invigorating influence of his bodily and 
mental struggles for a livelihood or pre-eminence. 
In woman, the predisposition which she derives 
from nature is too often fostered by confinement in 
girlhood, and by a pernicious system which affords 
her, in opening womanhood, at once the leisure and 
the means for the indulgence of the feelings and the 
imagination, at the expense of the hardier mental quali- 
ties. The debility of convalescence from acute and 
exhausting diseases, as well as that which follows ex- 
cessive depletion, encourages the approaches of hy- 
steria. Among its exciting causes may be ranked CAUSES OF HYSTERIA. 
47 
every thing capable of producing a strong impression 
upon the nervous system. Startling sights and sounds, 
astounding intelligence, surprise, terror, anger or 
vexation, jealousy, grief, and disappointment, espe- 
cially of the affections, are apt to induce the first symp- 
toms of the disease; and, when the morbid state of 
the system has become established, to provoke the 
paroxysmal attack. The imitative principle is a 
powerful cause, and instances are frequent in which 
the sight of one woman in hysterical convulsions has 
thrown others, previously exempt from the disease, 
into similar paroxysms. Still more frequently exciting 
causes are probably various morbid states of the sys- 
tem, which serve as sources of irritation to the nervous 
functions. Thus, the origin of hysterical attacks has 
been traced to the retrocession of cutaneous eruptions 
and the checking of habitual discharges, as the men- 
strual flow, for instance. Lastly, disease of the ali- 
mentary canal, and of the womb and its appendages, 
are among the most frequent exciting causes of hys- 
terical phenomena. " There is," says Dr. George B. 
Wood, "undoubtedly a strong connection of some 
kind between hysteria and the condition of the sexual 
organs of woman. Most women experience at one 
time or another of their lives, symptoms at least ana- 
logous to the hysterical, at the catamenial periods." 
"Further," says he, "the office of reproduction in 
women is a most complicated and important function, 
which, in order that its several operations may be sus- 
tained in due harmony, requires the constant over- 
sight and interference of the nervous system. This 
must, therefore, be in a condition of excitability, capa- 48 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
ble of answering quickly to the calls that may be made 
upon it, and by consequence peculiarly liable to be dis- 
turbed by morbid causes. Hence the more frequent 
occurrence of the disease in women, and at that age 
when the functions of the womb are in full vigor. 
Disorder of the womb may give rise to hysterical symp- 
toms, just as intestinal disorder is known to do." 
III.-SYMPTOMATOLOGY, OR SYMPTOMS OF HYSTERIA. 
The extreme diversity and changeableness of the 
symptoms that characterize hysteria, have occasioned 
it to be called, very appropriately, Protean, or Prote- 
an-like. The following sketch of the symptoms of this 
disease I have condensed from Dr. G. B. Wood's ex- 
cellent Treatise on the Practice of Medicine. 
The morbid phenomena of hysteria are very apt to 
cluster, forming paroxysms, which occur at irregular 
periods. In some, these paroxysms constitute the 
chief signs of the disease ; the health being tolerably 
good, and sometimes almost perfect in the intervals. 
In others, there is scarcely ever complete exemption, 
even through a long course of years; and the parox- 
ysms are merely exacerbations of a never-ceasing dis- 
order. In most, the slightest causes are sufficient to 
occasion some disturbance, and, though the inter-par- 
oxysmal symptoms are not constant, they are very fre- 
quent, and often the source of great discomfort. Per- 
haps the best view' of the disease can be obtained by first 
fixing attention upon the paroxysms, and then passing 
in review the most prominent of the phenomena con- 
nected with the derangement of the several functions. SYMPTOMS OF HYSTERIA. 
49 
The hysterical paroxysm is often preceded, for a 
longer or shorter time, by various distressing sensa- 
tions and nervous irregularities, which become at 
length more than the nervous centres can tolerate, and 
relief is sought in violent muscular disturbance, and 
a more or less complete loss of consciousness. But 
frequently, also, these phenomena come on suddenly, 
without any premonition whatever, under the influence 
of occasional exciting causes, especially those of a 
mental character. The patient is sensible of distress 
at the epigastrium, or oppression about the chest, or 
perhaps has the feeling as of a ball ascending from 
some point in the abdomen, usually the left side, to the 
throat; loses the ordinary expression of countenance, 
which is replaced by a vacant stare ; becomes agitated ; 
falls if before standing; throws her limbs about con- 
vulsively ; twists the body into all kinds of violent con- 
tortions ; beats her chest; sometimes tears her hair, 
and attempts to bite herself or others; and, though a 
delicate woman, evinces a muscular strength which 
often requires four or five persons to restrain her effec- 
tually. The jaws work with a sort of grinding motion, 
the chest heaves, the heart palpitates tumultuously, 
the carotids throb, the features become flushed and 
swollen, and the patient now and then utters inarticu- 
late sounds or cries. Sometimes, instead of the con- 
vulsive movements, there is a tetanic rigidity of the 
muscles, and the body is thrown back into an arch, or 
the limbs are stiffly contracted; and not unfrequently 
there is a mixture of the two conditions. The spasms 
often relax for a time, and are again renewed ; and this 
may occur repeatedly during the paroxysm. There is, 50 
woman's complete guide to health. 
during all this time, an apparent want of conscious- 
ness, which, in some cases, is real and complete, but 
often is only partial; the patient having a confused 
knowledge of what is said and done about her, and 
being able to recall the incidents of the paroxysm im- 
perfectly after it has passed. The features are seldom 
greatly distorted; and, though there is, to a consid- 
erable extent, an absence of expression, there is yet an 
indefinable appearance as if the inner life were not 
sympathizing with the outer violence, and as if there 
was something unreal in the whole show. After a 
variable continuance, the convulsions subside, con- 
sciousness partially returns, and the patient, some- 
times breaking out into a fit of laughter or sobbing, 
sometimes falling into a quiet state resembling sleep, 
gradually returns to her ordinary condition, though 
with feelings of fatigue and soreness, occasionally with 
temporary cataleptic stiffness, or partial palsy of some 
part of the body, and not unfrequently with a copious 
flow of colorless urine. All these symptoms, however, 
at length disappear; and then the patient experiences 
great relief, often feeling better than for a long time 
previously ; as if the morbid excitability had exhausted 
itself, and given place, for a time, to a healthy state of 
the nervous system. 
The duration of the paroxysm varies from fifteen 
minutes to several hours, and sometimes it continues 
for two or three days, though with remissions of the 
convulsions, and intervals, if not of consciousness, yet 
of calm stupor. In many instances, there is a rapid 
succession of convulsions, the patient being quite con- 
scious in the intervals; and in this condition, with 51 
SYMPTOMS OF HYSTERIA. 
longer or shorter respite, the affection may continue 
for many days or weeks. The paroxysm, however, 
varies exceedingly in character and intensity. Some- 
times it consists simply in feelings of abdominal or 
pectoral distress, with troubled breathing, sensations 
as of choking in the throat, bursts of weeping or of 
laughter, and slight twitchings of the muscles, not 
amounting to convulsions, and without loss of con- 
sciousness. Sometimes the prominent sensation is that, 
before alluded to, of the globus hystericus, as of a ball 
in the abdomen, rising to the epigastrium and the 
throat, and probably owing to spasmodic constriction 
of the intestinal tube and of the oesophagus. Another 
variety of the'paroxysm is that of quiet coma. The 
patient lies perfectly motionless, with the eyes closed, 
apparently without consciousness, and incapable of 
being roused by the loudest sounds, shaking, pinching, 
etc., to which she seems to be quite insensible. The 
respiration is sometimes so feeble as hardly to be per- 
ceptible, the surface is cool, and bystanders are apt 
to think that the patient is dead ; but the pulse, so far 
as has been observed, is always perceptible, and the 
countenance, though calm and motionless, wants the 
sunken aspect of death, and is rather as of one sleep- 
ing. This comatose state sometimes continues for one, 
two, or three days. 
The occurrence of the paroxysms is usually quite 
irregular, at intervals varying from a day, or less than 
a day, to months, depending partly on the degree of 
accumulated excitability in the nervous system of the 
patient, partly on the variable incidents which may 
disturb her physical or mental equability. There is 52 
woman's complete guide to health. 
one circumstance, however, which tends to give a 
periodical character to the nervous symptoms. They 
are very apt to be worse about the menstrual period, 
and some women have a regular hysterical paroxysm 
at that time. Such is the character of what is called 
a "hysterical fit, or paroxysm." 
I will now proceed to pass in review the most promi- 
nent of the phenomena connected with the derange- 
ment of the several functions. These are : 
First, the Digestive Function. There is frequently 
difficulty of deglutition. The patient cannot swallow, 
or thinks she cannot swallow, and the attempt is at- 
tended with strangling sensations. The stomach is 
variously disordered: craving, deficient or depraved 
appetite, desire for strange articles of food, various 
dyspeptic sensations, flatulence, spasmodic pains, and 
vomitings-sometimes excessive and obstinate, are 
among the occasional gastric symptoms; and yet 
digestion goes on. The bowels are usually disposed 
to flatulence and constipation. There is then rumbling 
and various other sensations, giving much annoyance 
and great trouble to hysterical patients. Sometimes 
attacks of violent intestinal spasm come on, so char- 
acteristic of the affection as to have received the name 
of hysterical colic. The constipation will sometimes 
continue for weeks if not cared for. Occasionally, there 
is diarrhoea. Another abdominal affection is acute 
pain and excessive tenderness upon pressure, which, 
co-existing with distention, and a frequent pulse, have 
sometimes been mistaken for signs of another disease, 
and led to corresponding treatment. 
Secondly, the Respiratory Function. The function SYMPTOMS OF HYSTERIA. 
53 
of respiration, as seen above, suffers also. The larynx 
may be the seat of various irritations, in some in- 
stances modifying or suppressing the voice ; in others, 
giving rise to spasms of the glottis, which, for a time, 
completely obstruct the entrance of air into the lungs, 
and yield only on the approach of asphyxia. A hard, 
dry, sonorous cough, sometimes occurring in convulsive 
paroxysms, like those of whooping-cough, is another 
symptom. Great oppression of the chest, with labored 
breathing, is not uncommon; and dyspnoea, with a 
sense of constriction, bearing a close resemblance to 
the paroxysms of spasmodic asthma, is every now and 
then noticed. Deep sighs, yawnings, and hiccough 
are frequent hysterical phenomena. 
Thirdly, the Circulatory Function. The circulation 
in hysteria suffers scarcely less than the other func- 
tions mentioned above. Palpitations of the greatest 
violence are very frequent, alarming the patient with 
the fear of organic disease of the heart. The pulse is 
generally irregular, being at one time very frequent, at 
another time perhaps slower than is natural, and al- 
most always easily disturbed by slight causes. 
Fourthly, the Function of the Liver and Kidneys. 
The liver and kidneys are liable to suffer, and almost 
all the functional disorders incident to the biliary and 
urinary organs may be looked for in this complaint. 
Both secretions may be deficient, excessive, or vari- 
ously altered. The urine is sometimes exceedingly 
copious, and in some rare cases has been almost or 
entirely suppressed. 
Fifthly, the Nervous System. The nervous system in 
this disease exhibits, above all others, a proneness to 54 
woman's complete guide to health. 
derangement. This system is really the very seat and 
throne of the disease (if not the symptom), and in its 
various ramifications are displayed almost all the fan- 
tastic vagaries of this curious affection. Of the gen- 
eral nervous phenomena, pain of one kind or another 
is among the most frequent. Neuralgia is very often 
a purely hysterical affection. Headache is very com- 
mon, and sometimes almost insupportably violent. A 
frequent form of it is that denominated clavus hystericus ; 
a fixed pain in one spot, generally over the eye. But 
it is often also more or less diffused, and is liable to all 
the diversities incident to this affection from other 
causes. Pains in the chest are very frequent, espe- 
cially on the left side, under the mammae. In this 
situation they are sometimes very severe and obsti- 
nate. The bust itself is occasionally acutely painful, 
giving rise even to the suspicion of cancer, and caus- 
ing great distress on this score. All or some of these 
pains, or painful sensations, more or less acute, are 
felt in the abdomen, the spine, the urinary and sexual 
organs and the extremities, such as the joints; but it 
would take considerable time to notice each of these 
organs, and for practical purposes, the bare allusion to 
the possibility of these pains extending to the sexual 
organs being mentioned, it is, I think, sufficient. 
Sixthly, the Cutaneous Surface. The skin is mor- 
bidly sensitive, and thus affords indeed a common 
symptom of hysteria. Pressure on any part of the 
body will often occasion much apparent uneasiness. 
This tenderness is peculiarly apt to be evinced by the 
skin in the vicinity of the spine. One of the most 
common complaints by hysterical patients is of gen- SYMPTOMS OF HYSTERIA. 
55 
eral and vague discomfort, of sensations in various 
parts of the body which they cannot describe, or feel- 
ings of soreness, uneasiness, and aching in the limbs, 
which induce a constant restlessness, and disposition 
to motion. 
Seventhly, the Special Senses. The special senses 
frequently suffer in hysteria. Intolerance of light and 
sound, perverted vision, even loss of vision, noises of 
various kinds in the ears, and derangements of the 
senses of smell, taste, and touch are not uncommon. 
Eighthly, the Function of Voluntary Motion. This is 
notoriously perverted. The characteristic convulsions 
of hysteria have already been spoken of. The muscles 
sometimes contract rigidly as in tetanus. Instances 
every now and then occur in which permanent contrac- 
tions take place with deformity of the limbs, and even 
distortion of the body; it is not so very rare to meet 
with hysterical paralysis. 
Ninthly, the Sensorial Functions. These are greatly 
disturbed. Attention has been already called to the 
headache, noises in the ears, and perverted vision of 
hysteria. Vertiginous sensations are very common. 
Sleep is often greatly disturbed. The patients are 
exceedingly liable to spells of causeless low spirits, 
with various marks of nervous disorder, which are 
popularly called the vapors. Occasionally the spirits 
are equally without cause excessively elated. Patients 
will at one time burst into tears or sobbing, at another 
time into giggling or laughter, and in either case with- 
out any assignable reason. The temper is apt to be 
impatient, capricious and whimsical. Slight causes 
excite anger, and bring on convulsions or other nerv- 56 
woman's complete guide to health. 
ous paroxysms. Occasionally the cerebral functions 
are so much deranged that the disease amounts to in- 
sanity. This shows itself in a great variety of modes. 
Sometimes the patient is obstinately silent, hides her 
head under the bedclothes, refuses to show her tongue, 
to take her medicine, etc. Sometimes, on the contrary, 
she is talkative, and tells of strange sights that she 
has seen, or incidents in which she has been con- 
cerned, both equally unreal; she sings, perhaps, or 
dances. 
Tenthly, the Reproductive Function. The derange- 
ment of this function I consider of the utmost impor- 
tance, and to understand it thoroughly, is to possess 
at once and unmistakably the key to most of the 
causes of hysteria that are met in practice. So com- 
mon, indeed, is disorder of the womb, that it has given 
its name to the complaint. It is of daily observation, 
that in the great majority of cases of hysteria, we dis- 
cover, upon examination of the womb, some one or 
other of the many abnormal conditions and lesions to 
which this organ is so liable-from inflammation, abra- 
sion or ulceration of its neck to the more serious and 
complicated abnormal states of the womb itself, such 
as inflammation of its mucous membrane or of its sub- 
stance, and the abnormal growths and tumors to 
which this inflammatory state may give rise, as well 
as to the divers displacements of the womb conse- 
quent upon the inflammation and tumors just al- 
luded to. 
The above sketch, incomplete as it is, will give my 
readers a fair idea of the strangest of the diseases to 
which women are subject, which, from its symptoms, DIAGNOSIS OF HYSTERIA. 
57 
almost without number, has very appropriately re- 
ceived the name " Protean." 
IV.-DIAGNOSIS OF HYSTERIA. 
It is of the utmost importance, not only to be able 
to recognize the hysterical paroxysms, but also to be 
familiar with the irregular phenomena of this disease. 
These often so closely counterfeit other more danger- 
ous affections, that there is great liability to error of 
diagnosis and consequent serious mistakes in practice. 
That affection with which the hysterical paroxysms 
are most Hable to be confounded is epilepsy. In 
order that the parallel between these affections may 
be well understood, I have thought it advisable to 
annex here a table giving the most striking differences 
and analogies which may exist between them. 
HYSTERIA. 
1. Is, in general, a trivial af- 
fection. 
2. Is a disease of the nervous 
system, and may be idiopathic 
or symptomatic. 
3. The hysterical paroxysms 
generally come on less sudden- 
ly, or, if sudden, have an ob- 
vious cause. 
4. There is no loud cry at 
the outset; the features are sel- 
dom distorted, and foam seldom 
appears at the lips ; the pupils 
EPILEPSY. 
1. Is an affection of a more 
serious character. 
2. Is a disease of the brain, 
and may be idiopathic or symp- 
tomatic. 
3. The epileptic paroxysms 
find the patient comparatively 
unprepared, the attack being 
sudden. 
4. Is ushered in by a sudden 
cry ; frightful distortion of the 
features; permanent dilation or 
contraction of the pupil; a 58 
woman's COMPLETE GUIDE TO HEALTH. 
change upon exposure to the 
light; the face, though flushed, 
is usually of a bright red; the 
respiration is less embarrassed; 
there is throughout the parox- 
ysm an appearance as of a con- 
cealed will obscurely mingling 
with the causes of the phe- 
nomena, and sometimes an ob? 
vious degree of consciousness; 
there is an absence of deep 
coma after the subsidence of 
the convulsions; and, finally, 
the hysterical laughter and sob- 
bing are, when they occur, quite 
characteristic. 
5. In the intervals between 
the paroxysms, the face of the 
hysterical patient of any stand- 
ing has usually all the appear- 
ance of health, both in its phy- 
sical character and its expres- 
sion. 
6. The prognosis as to ulti- 
mate recovery is favorable. 
livid turgescence of the face; 
the foaming at the mouth ; the 
small quantity of air admitted 
into the lungs in respiration ; 
the comparative brevity of the 
convulsive portion of the fit, 
and the profound coma which 
attends the convulsions, and 
continues for some time after 
they have ceased. 
5. In the intervals between 
the paroxysms, the epileptic 
patient, under similar circum- 
stances, almost always exhibits 
the marks of the disease in a 
peculiar physiognomy. 
6. The prognosis as to ulti- 
mate recovery is unfavorable. 
I have already observed that hysteria is apt to 
counterfeit other dangerous affections. For instance, 
it may counterfeit inflammation of the brain, apoplexy, 
palsy, laryngitis, asthma, organic disease of the heart 
or gastritis. In all these cases, it is in general only 
necessary to bear in mind the distinguishing features 
of hysteria, to be able to recognize it in its disguise. 
The superficial character of the affection, which often RESULT AND TREATMENT OF HYSTERIA. 
59 
shows itself to an experienced eye in the midst of the 
greatest apparent violence ; its fickle, shifting ten- 
dency, the want of correspondence between the vio- 
lence of the functional disorder and the usual evi- 
dences of organic disease, the frequent intervals of 
apparent health, the tendency to causeless laughter 
and weeping, the want of an expression of deep dis- 
ease upon the countenance, the frequent normal state 
of the skin and pulse and the fitful character of the 
latter when excited, and, lastly, the very frequent 
presence of tenderness of one or more of the vertebras, 
are signs which can scarcely fail to prevent mistake, 
at least in all ordinary cases. 
V. PROGNOSIS OF HYSTERIA. 
The ultimate result of hysteria, as I said when treat- 
ing of its diagnosis, is generally favorable. 
VI. TREATMENT OF HYSTERIA. 
The treatment of hysteria may be divided into that 
required for the paroxysm and for the relief of the 
prominent symptoms, and into that calculated to cure 
the disease by correcting the cause of irritation, and 
changing the irritable condition of the nervous sys- 
tem. To effect the latter is unquestionably the pro- 
vince of the physician, and the case should instantly 
be trusted to his care. To him it is due to investigate 
carefully all the circumstances of the case, whether 
the affection is due to functional derangement of the 
womb, in the form of some of the menstrual aberra- 60 
woman's complete guide to health. 
tions constantly observed in practice, or to some 
organic or other derangement of this organ, or whether 
the hysteria is due to or originates from an anaemic 
state of the system. As to the paroxysms, and while 
expecting the medical adviser, the friends of the hys- 
terical patient may give such assistance as it is in 
their power to give. The patient may be placed in 
bed, her dress loosened, and so much restraint used 
as to obviate personal injury. It is scarcely possible 
to coerce every limb or muscle, nor is it desirable to 
do so ; for the convulsions are to be looked on, rather 
as a safe outlet for the excessive irritation of the nerv- 
ous centres than as in themselves hurtful. To rouse 
the patient, cold water may be sprinkled or dashed 
upon the face, and some one or other of the usual 
stimulants applied lightly to the nostrils, such as 
camphor, ammonia, burnt feathers, or the inhalation 
of chloroform, if this can be superintended by an 
intelligent person. It will sometimes be advisable to 
speak in a decided tone, in the presence of the patient, 
of the necessity of shaving the head, or of giving her 
a cold shower-bath, should she not be soon relieved. 
Strong mental impressions have a powerful influence 
over the disease, and sufficient consciousness often 
remains during the apparent coma to appreciate ob- 
servations of this kind. 
It does not follow, because such a mental impression 
may prove useful, that the patient has been counter- 
feiting illness. It acts by replacing one impression by 
another more powerful for a time. The sedative influ- 
ence of fear may allay, as I have known it to do, the 
excitement of the nervous centres; perhaps a strong 61 
TREATMENT OF HYSTERIA. 
impression upon the emotional centres may act revul- 
sively within the cerebro-spinal cavity, by calling off 
irritation from those which govern the convulsive 
movements. The patient may herself often do much 
in controlling the tendency to the hysterical paroxysms 
by a determined exertion of her own will. 
Respecting the diet and hygiene of hysterical pa- 
tients, little can be said of a special nature which would 
not equally apply to most of the affections to which 
women are subject. Let there be regular habits, plain 
and simple, but nourishing diet, avoidance of mental 
excitement or effort, free exercise in the open air, 
general baths, with assiduous frictions of the cuta- 
neous Residence at a watering place will 
often be beneficial, not only on account of the thera- 
peutical action of the water, but on account of the 
novel and regular mode of life there enjoyed. If the 
mental faculties have been exercised at the expense of 
the physical, a careful avoidance of all sources of men- 
tal excitement should be perseveringly guarded against. 
The object aimed at should be to develop the physical 
energies, to cultivate the activity of the locomotive 
apparatus, and to restrain, as much as possible, the 
exercise of the mental faculties. 
The sexual tendencies frequently shown in this affec- 
tion require to be kept in subjugation. Matrimony, I am 
aware, has occasionally been recommended as a cure, 
in cases of hysteria, where, at the same time, a very 
strong sexual inclination existed. In such cases it 
may be allowed, and may do good. There are cases, 
however, where slight hysteria is not attended with 
any very strong sexual inclinations, and others where 62 
woman's complete guide to health. 
the hysteria is complicated with or dependent upon 
some abnormal condition of the uterine organs. Under 
such circumstances, marriage should not be thought 
of or encouraged. It will have very little, if any, cu- 
rative effect. Marriage, indeed, in these latter cases 
had better-in definitive cases it really ought to be 
postponed for a while, until such time as the abnormal 
state of the womb, and its nervous manifestations, or 
the hysterical phenomena, have been entirely cured. 
CASES OF HYSTERIA. 
Among the cases of hysteria whose history I took 
down more or less fully at the time I saw them, are 
the following: 
Case III.-Hysteria dependent on an affection of the 
womb in a married tady, aged twenty -eight. The cure 
of the affection effected the cure of the hysteria. 
In 1859 I was requested to see Mrs. E , of New 
York, aged twenty-eight, a mother of one child five 
years old. The history of the case, as given to me, is 
as follows : Mrs. E married in the twentieth year 
of her age; had always been a delicate girl, and of a 
rather nervous temperament, yet enjoyed good health. 
She complained at that period of a little uneasiness 
and sickness two or three days preceding her menstrua- 
tion, but it passed off as soon as the menstrual flow 
had fairly commenced. Her only child was born a 
year and a half after marriage. The confinement had 
been a long and fatiguing one, and she made a slow 
recovery. Her health, however, was not any longer CASES OF HYSTERIA. 
63 
the same ; it lacked former strength, and she began to 
experience a general malaise that she could neither 
understand nor express. A little over a year from the 
birth of her child she miscarried, for no reason that 
she could assign; the miscarriage was followed with 
some hemorrhage-bleeding continued more or loss 
for five weeks, and she remained an invalid for quite 
a period. 
From the period of this miscarriage she dated all 
her sufferings. Gradually, symptom after symptom 
appeared, and her health rapidly grew worse ; her ner- 
vousness was great, and one day she was found lying 
on the floor, in her own room, in convulsions. She 
complained of a number of the symptoms described in 
this chapter; the fits set in every now and then, nor 
could she tell what gave rise to them. She had been 
attended first by her family physician, afterward by 
two others, in succession, but no benefit had been de- 
rived from the treatment pursued. It is all but certain 
that these physicians considered the hysteria as the 
disease instead of a symptom, for they all prescribed 
for Mrs. E without ever having inquired in rela- 
tion to the performance of the functions of the womb. 
Hence, their failure. When I called, Mrs. E had 
just had an attack of the paroxysm, and it was pass- 
ing off, as shown by her laughing, sobbing, and grasp- 
ing at her throat, alternately. Finally, she became 
quiet, and the whole trouble ended by a copious urin- 
ary secretion. 
I prescribed for her, but requested, preliminary to 
any further attendance on my part, that I should be 
allowed to make an examination of the womb and its 64 
woman's complete guide to health. 
appendages, and appointed the day. Consent was 
given. I made the examination, and was fully con- 
firmed in my supposition of the existence of dis- 
ease of the womb, and in referring all Mrs. E 's 
sufferings to this affection. The most prominent and 
unmistakable local symptom she had complained of, 
was that she experienced great distress in sexual inter- 
course, which threw her nearly every time into convul- 
sions. It had this effect several times. She now re- 
mained under medico-surgical treatment for nearly 
nine- months, when the womb and its neck were per- 
fectly restored to their normal condition. No fits had 
occurred within the last three months of the treat- 
ment ; her courses were regularly performed and with- 
out any difficulty. She gradually improved in health, 
and was finally as well as she ever had been before. 
Case IV.-Hysteria, consequent upon an affection of the 
womb in a lady of thirty-five. Successful treatment. 
In 1862, I was consulted by Mrs. McC , then 
visiting a sister in New York, from one of the Western 
States. Mrs. McC was thirty-five years old, a 
mother of three children, the last ten years old. She 
had for the previous eight years been subject to hys- 
terical fits, more or less severe. Her health had been 
very poor during that period. She had been most of 
this long time under the care of her family physician, 
but with little, if any, improvement in the state of 
her health. For two years prior to my seeing her, the 
attacks had come on so often that hardly a week ex- 
pired without her having two, or even three of them. 
The causes which, in her opinion, called these attacks CASES OF HYSTERIA. 
65 
into operation were threefold : great vexations in her 
household avocations, too frequent intercourse in suc- 
cession, and in a short time, which was also usually 
followed by a slight bleeding, and, lastly, the periods of 
her courses. These had so far been regular, but they 
lasted too long, say from eight to ten and twelve days, 
and the menstrual flow was increased and exhausting. 
She complained bitterly of soreness in her back, across 
her hips, of shooting pains in the region of the womb, 
and of a weakening leucorrhcea. If my readers will 
take it for granted that this lady was, moreover, labor- 
ing under many of the symptoms of hysteria, they will 
have a pretty good idea of the case, and will save my 
entering into a tiresome repetition of those symptoms 
already repeated several times. 
Mrs. McC acceded to my request for permis- 
sion to examine the womb. I requested it as being 
imperatively demanded, preliminary to the adoption 
of any treatment. In the examination, among other 
abnormal conditions, I found the neck of the womb in 
a wretched state. I cannot better compare its condi- 
tion than to a large bleeding piece of raw beef. She 
was three months under a steady medico-surgical treat- 
ment. Her improvement in health was so unquestion- 
able, that she protracted her stay till she should be 
entirely well. And I had the satisfaction to send this 
lady home five months later, entirely cured from her 
disease, and of its effect, hysteria, while her health in 
all other respects was as good as she could desire it 
to be. CHAPTER IV. 
Amenorrhcea is an affection exceedingly common 
among women. This term has been applied to desig- 
nate an absence of the menstrual function. It is a 
disease that may occur from the age of puberty to the 
critical age at a later period. It is divided into- 
First, Retention of the Menses. A condition of the 
system in which the function has never appeared. 
Second, Suppression of the Menses, which is that con- 
dition in which, having been established, it became 
from certain causes arrested. 
Wishing to impart, as far as possible, correct infor- 
mation in relation to amenorrhcea, I think it best to 
treat of the nature, cause, and symptoms of both re- 
tention and of suppression of the menses, individually, 
and to consider what I have further to say upon the 
subject as occupying common ground, in other words, 
as being referable to amenorrhcea in general. 
I.-(1.) RETENTION OF THE MENSES-ITS NATURE. 
This is, as I said before, that condition of the sys- 
tem in which the function has never appeared. It is, 
consequently, an affection of early girlhood, and of 
those girls in whom the ovaries, which are necessarily 
AMENORRHCEA. CAUSES AND SYMPTOMS OF RETENTION OF MENSES. 
67 
connected with menstruation, have not attained their 
full development, the physical appearance of the girl 
presenting all the characteristics of the child ; there is 
an absence of that fullness and embonpoint which mark 
womanhood. 
ETIOLOGY, OR CAUSES OF RETENTION OF THE MENSES. 
The causes that may operate hi the development of 
amenorrhoea by retention, in young girls, may be said 
to be generally of a constitutional character, which 
predispose the person to such a difficulty. The fol- 
lowing are some of these causes : 
a. A nervous constitution, weakly or cachectic con- 
stitution, a lymphatic, flabby constitution, a robust 
or plethoric constitution. 
b. Constitutional causes may be owing to organic 
affections and visceral lesions in other parts of the 
body, such as consumption, chlorosis, scrofula, etc. 
c. And, lastly, constitutional causes which have re- 
ceived the name of mechanical causes, may bring the 
affection we are considering into existence; such as 
atrophy of the womb or ovaries; deficient develop- 
ment, functional weakness, entire absence of the 
womb, imperforate mouth of the womb, imperforate 
hymen, occlusion of the vagina, stricture of the neck 
of the womb. 
SYMPTOMATOLOGY, OR SYMPTOMS OF RETENTION OF 
THE MENSES. 
The symptoms, or chain of symptoms, which char- 
acterize retention of the menses, depend on the causes 68 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
that may or may not have produced it, as also on the 
peculiar system of the individual. Consequently, they 
are so various, and extend over such a large field, that 
to attempt their description would be entering a laby- 
rinth without issue. What I may say in this connec- 
tion, however, is, that some of the symptoms that may 
be met with in retention of the menses, have been de- 
tailed in the chapters on Chlorosis and Hysteria, and 
that many others will be described at some length, 
when I come to speak of inflammation and ulceration 
of the neck of the womb. In retention, however, oc- 
casioned by mechanical obstruction, there is one symp- 
tom, the symptom of all symptoms, that for obvious 
reasons, should be well understood by mothers, daugh- 
ters, and the public alike. I allude to the enlargement 
of the abdomen in this affection from the accumula- 
tion of the menstrual fluid contained in the womb. 
This latter organ becomes increased in size, and sev- 
eral symptoms, simulating pregnancy, develop them- 
selves. It also gradually compresses the rectum, the 
bladder, the pelvic nerves, impeding stool and the 
urinary emission, and causing a number of symptoms, 
local and others, to be mentioned in other parts of 
this work. 
(2.) SUPPRESSION OF THE MENSES-ITS NATURE. 
Suppression of the menses is that condition in which 
having been once established, the menses become 
from certain causes suppressed. It may develop itself 
slowly and gradually, or it may be brought about sud- 
denly. It occurs in the most sound and healthy con- SUPPRESSED MENSES-THE CAUSE. 
69 
stitution, as well as in those of very different consti- 
tutions. 
(3.) ETIOLOGY, OR CAUSES OF SUPPRESSION OF THE 
MENSES. 
This affection may arise from innumerable causes. 
The various constitutional causes that may occasion 
retention, and which were detailed in the first section 
of this chapter, may also operate, after menstruation 
has been established, to bring about suppression. 
Other causes, such as inhabiting low, badly lighted, 
cold, wet and insalubrious dwellings or apartments ; 
extreme changes of temperature ; the improper and 
always injudicious use of cold baths, washes, injec- 
tions at the period of the expected courses, or while 
menstruating, which, I should say, is one of the most 
frequent, and certainly most powerful cause of sup- 
pression of the menses ; the requirements of fashion 
and gallantry, in consequence of which, dashing 
women sometimes expose themselves half covered to 
the air, and at other times load themselves with un- 
necessary garments ; sudden exposure to the fresh 
night air, still heated, sweating, on leaving ball rooms 
or other places of amusement when unwell, and 
indulging at the same time in cold drinks or ice 
creams ; the being seated upon a damp cold place, a 
stone, or bench, or steps ; too stimulating food, or 
insufficient and unwholesome nourishment; a seden- 
tary mode of life, like that of the seamstress, or exces- 
sive exercise, like that of dancers, singers, servants ; 
change from the country to large cities ; admission to 70 
woman's COMPLETE GUIDE TO HEALTH. 
hospitals, convents, working-houses, manufactories or 
boarding-schools ; fatiguing journeys, etc. ; all these 
may produce suppression of the menses in young girls 
and others. I would also add, the abuse of drugs in 
domestic practice, such as emetics and purgatives, for 
correcting certain anomalous conditions of health, or 
to bring on " the thing." Among the married, more- 
over, complete abstemiousness or sexual excesses ; 
various abnormal conditions of the womb or its appen- 
dages, brought about and inherent to the marriage 
state, such as confinements ; all these may likewise 
occasion the suppression we are considering. Moral 
causes, such as violent emotions of the mind, vehe- 
ment anger, terror, sudden joy, intense grief, revolting 
sights, fright, etc., or any other cause which abruptly 
shocks the system, etc., may induce the affection. 
(3.) SYMPTOMATOLOGY, SYMPTOMS OF SUPPRESSION 
OF THE MENSES. 
The symptoms which follow suppression of the 
menses are nearly all those we may expect to meet 
with in retention, with this notable difference, that the 
symptoms of suppression are rather of an acute and 
often inflammatory character. Consequently, we may 
meet with very serious and dangerous conditions in a 
patient laboring under a sudden suppression of her 
menses. For instance, she may be attacked by con- 
gestion and inflammation of the lungs, the braiil or 
the womb, this latter especially, and other organs, or 
she may be attacked by serious hemorrhages from 
the lungs and stomach. Any or all of these conditions DIAGNOSIS AND RESULT OF AMENORRHCEA. 
71 
may be attended with more or less fever and vascular 
repletion, as shown by a flushed countenance, en- 
gorged eyes, full and vigorous pulse, heat of the sur- 
face, headache,, dizziness, pain in the limbs, and gene- 
ral languor. 
II. DIAGNOSIS OF AMENORRHOEA IN GENERAL. 
The existence of amenorrhoea is known by the evi- 
dence of the fact. Still, that which has particularly to 
be ascertained, is the causal condition, whether of 
retention or of suppression. If of a mechanical char- 
acter, its true nature, location, and extent has to 
be ascertained. And to do this, a physical examina- 
tion must be resorted to. The fact of a patient being 
a virgin should cause a deference, but not forbid 
an examination indispensable to a correct understand- 
ing of the cause of a condition that may destroy 
her life. 
III. PROGNOSIS OF AMENORRHOEA IN GENERAL. 
As regards the final result and progress of amenor- 
rhoea, it differs considerably, and depends entirely 
upon the causes of the irregularity. As a general 
rule, we are safe in considering the prognosis of amen- 
orrhoea as favorable, provided the affection is not 
complicated with, or depending upon, some serious 
organic difficulty. As to the mechanical causes of 
amenorrhoea, these are mostly easily overcome, and 
the case progresses satisfactorily to the end. 72 
woman's COMPLETE GUIDE TO HEALTH. 
IV.-TREATMENT OF AMENORRHOEA IN GENERAL. 
In the treatment of amenorrhoea, it is of particular 
importance to ascertain whether it is owing to consti- 
tutional or accidental causes ; in other words, whether 
it is an independent or symptomatic condition. Since 
amenorrhoea, apart from any organic or mechanical 
cause is, in my opinion, mostly a symptom, it becomes 
absolutely necessary to treat the disease-the cause, 
of which amenorrhoea is a symptom or effect. 
Let us suppose amenorrhoea to depend upon some 
affection of the womb or of its appendages, such as 
inflammation and ulceration of its neck, or upon some 
form or other of the various displacements to which 
the womb is subject, or to any abnormal growth, 
tumor or polypus within the cavity of the womb ; all 
these abnormal conditions will have to be remedied 
before we may expect to cure amenorrhoea. As to 
any other of the many causes that may lead to the 
suppression of the menses, checked perspiration, ex- 
posure to cold, cold drinks, mental emotions, etc., all 
or any of these causes may promptly or gradually 
receive relief by the employment of suitable rehiedies. 
And, to repeat, amenorrhoea, as well as any other 
affection to which women are subject, and much more 
so, for that matter, should promptly, without delay, 
and before other difficulties arise to complicate the 
case, be submitted- to a judicious and trusty medical 
adviser. CASES OF AMENORRIICEA. 
73 
CASES OF AMENORRIICEA. 
Among other cases that I have met with in private 
practice having special reference to the affection I 
have endeavored to describe, are the following : 
Case V.-Retention, of amenorrhoea, in a girl aged seven- 
teen, from insufficiency of physical development. Nature 
abides its time. 
In 1860 I was requested to prescribe for a young 
miss, seventeen years old, who complained of head- 
ache ; dizziness; general restlessness and lassitude; 
palpitation of the heart, and flushes in the face, while 
the rest of the body remained rather cool. She had 
not yet menstruated, and the mother requested me to 
give her daughter something to bring on her courses. 
On looking casually at this young lady, it at once 
struck me that she showed, as yet, little of the appear- 
ances of womanhood, or so much as is generally re- 
marked in girls of her age. She was slender, delicate, 
child-like. Her constitution was decidedly scrofulous, 
and the cut of her dress, in front, denoted, without 
special local examination, the total absence, or nearly 
so, of her breasts. I informed the mother that her 
daughter was still a child; that the time she should 
menstruate had not come yet, but was at hand. Nev- 
ertheless, that nature was not inactive, as best shown 
by the troubles of the girl, above detailed, but that 
nature bides its own time, and that I respectfully de- 
clined coercing it by prescribing medicines, and thereby 
satisfying the mother, perhaps to the injury of her 
daughter's health. I gave, however, general instruc- 74 
woman's complete guide to health. 
lions as to the proper diet and exercise, and requested 
the mother to bring her daughter back within six 
months if the state of her health was not more satis- 
factory than it then was. On or about the first of the 
seventh month thereafter, the girl menstruated, and 
continued to do so regularly for about a year, when I 
lost sight of her. The inauguration of the girl's men- 
struation immediately improved her health, while it 
relieved the premature and over-anxious solicitude of 
her parent. 
Cases VI.-X.-Retention of the menses in girls of various 
ages from insufficiency of physical development. Time 
their benefactor. 
From 1856 to 1867 I was consulted on five different 
occasions, beside the above case, by mothers, in refer- 
ence to the tardy menstruation of their daughters. 
These girls, of whom the youngest was but fifteen and 
the eldest eighteen years old, in most instances pre- 
sented that lack of physical development I described 
in the preceding case ; while all were troubled almost 
similarly, with more or less variations, according to 
their individual constitutions; some being affected 
with slight hysterical symptoms, some others showing 
marks of incipient chlorosis. In every instance the 
case was conducted safely through by prescribing pa- 
tience, trust in nature, and the use of means best 
adapted to aid nature in giving the girl a physical 
vigor which would enable her, through the proper 
growth and development of the organs, to perform the 
physiological or natural offices of her sex. CASES OF AMENOERHCEA. 
75 
Cases XI.-XIX.-Suppression of the menses in persons 
of various ages, single and married, from divers consti- 
tutional and accidental causes. Successful termination 
of the cases, zvith one exception. 
In the same period, to wit, from 1856 to 1867,1 was 
consulted in nine different instances, in reference to 
suppression of the menses. Six of the nine persons 
were young girls from fifteen to twenty-five years old, 
and three were married ladies ; one being nineteen, one 
twenty-one, and tlie other twenty-four. In all of them 
the menstrual function had taken place in due time, 
and had continued for a time, of more or less duration. 
The girl of fifteen menstruated only six times regularly. 
In all, menstruation failed to appear at one of its ex- 
pected returns. In three cases, the suppression de- 
veloped itself gradually, the patients, individually, 
being unable to tell the active cause of the suppres- 
sion, or that which might have brought it about. In 
the remaining six, the suppression was accidental and 
sudden, and was brought on in the following manner : 
In two of the six cases (who were sisters) the suppres- 
sion of the menses had been brought on by exposure to 
the fresh air, a very cold winter night, on coming from 
a ball given by one of the militia regiments in New 
York, while they were still heated and perspiring from 
the last round of dances they had gone through. One 
patient attributed the occurrence of the suppression 
to a great fright she had one day while crossing 
Broadway, by finding herself suddenly caught, as it 
were, between two stages coming in opposite direc- 
tions, from which situation she only escaped un- 76 
woman's complete guide to health. 
hurt by the timely and dexterous management of a 
police officer, usually on duty at that place. Another 
patient drank ice-water, immoderately, it is believed, 
one very hot summer day, while returning, heated, from 
an excursion in the country. Another patient, in order 
to be what she termed " all right " for an expected 
dancing party, foolishly took a cold foot-bath, the third 
or fourth day of her courses. And lastly, one of the 
six persons was caught in a sudden thunder shower, 
which drenched her thoroughly before she could reach 
shelter. All six were actually menstruating, or on the 
eve of its commencement, or of its termination, when 
the incident occurred. 
The symptoms in these cases, as may be surmised, 
were various. It would take considerable time and 
space to describe them individually, even incompletely. 
•For all practical purposes, let it suffice to give here a 
summary of the same, and to refer my readers to the 
affections so far treated of, to wit: chlorosis, hysteria, 
and amenorrhoea which we have been considering. A 
good idea will thus be obtained of the symptoms com- 
plained of by the patients, which are now the subject 
under consideration. The three patients, in whom the 
suppression of the menses had been gradually brought 
about, were the subjects of some of the constitutional 
diseases mentioned in the preceding pages, and their 
sufferings were more or less those of chlorosis, and 
partly of hysteria. In the remaining six the symp- 
toms were about like those described under the differ- 
ent affections we have been considering, but all were 
more or less acute; some attended with fever, others 
with considerable congestion, and even two with in- CASES OF AMENORBHCEA. 
77 
flammation of the lungs; besides, of course, all the 
symptoms belonging to these various and special dis- 
eases. The treatment pursued in these nine cases of 
suppression of the menses, was successful in all but 
one, who died three years subsequently to the suppres- 
sion of her menses, of consumption. She was one of 
the three girls who were the object of some constitu- 
tional diathesis. 
Case XX.-Retention of the menses in a young girl of 
seventeen years old from imperforate hymen. Successful 
termination of the case. 
In 1863 I was requested to call on a family in New 
York city in reference to the state of health of a young 
lady, from the country, seventeen years old, a school- 
mate and friend of the daughter of the house. The 
young lady, of a delicate and very prepossessing ap- 
pearance, having seemingly all the attributes of a 
young girl just budding into womanhood, complained 
of severe headache, flushes in the face, and considera- 
ble nervousness. Her courses had not yet appeared, 
and after a good deal of hesitation, she complained of 
heat, heaviness, dragging, and of the presence of a 
tumor that occasionally appeared and disappeared 
again,' the location being pointed out by the index. 
The answers to a few questions in reference to the pres- 
ence of this tumor, gave me reason to suspect some 
abnormal condition of the genital organs, perhaps an 
imperforate hymen. After having explained to the 
friends of the young lady w'hat I suspected to be her 
condition, and the duties it imposed upon me, I with- 
drew, promising to call again in two days. I called as 78 
woman's complete guide to health. 
promised, and in the presence of a third person, I made 
a physical examination, and discovered, what I had 
rightly surmised, an imperforate, or an unopened hy- 
men. The treatment consisted in the division of the 
hymen, and, consequently, allowing of the escape of 
about half a pint of blood, which had accumulated 
gradually, for some time, behind the vulvar closure. 
Three weeks sufficed to restore this young lady to 
perfect health. CHAPTER V. 
GENERAL REMARKS ON THE DISEASES OF THE UNIMPREG- 
NATED WOMB. 
In strict compliance with the plan adopted in this 
work, and announced in the preface, I should proceed 
to the consideration of the diseases of the non-preg- 
nant womb, without entering upon any especial de- 
scription of its anatomy. I believe, however, that it 
would increase the interest and the better understand- 
ing of what follows, if a breach of the promises made 
were allowed, in favor of that most remarkable organ 
of woman's system, the womb. 
What then is the womb ? It is a pear-shaped, or a 
hollow, truncated, rounded and elastic organ, poised, 
as it were, in the middle of the pelvis, between the 
bladder and the rectum. The length of this organ is 
from two and a half to three inches ; its width, at its 
largest part, is an inch and a half, more or less; the 
thickness of its texture is about an inch, and its cavity 
is between two and two and a half inches long. The 
interior of the organ is lined in its whole length with a 
mucous membrane, the prolongation of that of the va- 
gina, or the canal leading to the womb. The womb is 
divided in two distinct parts, the body or upper and 
largest part, and the neck, or the lower or most con- 
tracted portion, in which is situated the opening of 
the organ, or mouth of the womb. These two distinct 80 
woman's complete guide to health. 
parts are greatly dissimilar in their peculiarities, 
which renders a separate consideration of the diseases 
of the two parts necessary, both for convenience and 
for facility of comprehension. 
Having said enough, however, for all practical pur- 
poses, I proceed to my task. 
I.-NATURE OF THE DISEASES OF THE WOMB. - 
The womb is equally liable to become diseased with 
any other organ of the system. Circumstances do 
exist, in truth, which render the womb, and especially 
its neck, more subject to be morbidly affected than 
any other organ with which I am acquainted. The 
diseases of the womb are various ; so are the causes 
that produce them. It will be safe to say, however, 
that, in the majority of cases, the diseased states of 
the womb, either have for cause inflammatory action, 
or in their progress become complicated by inflamma- 
tion, so that inflammation forces itself constantly upon 
the notice of the gynecologist, as the key-stone of the 
arch upon which rest his knowledge and usefulness. 
I believe that it will be no less safe to say, that the 
connection which I just now stated to exist between the 
nfajority of diseased states of the womb and inflamma- 
tory action, is recognized pretty generally by the pro- 
fession, at least by those who have taken pains to 
inquire into the complaints incident to the sex. 
The diseases of the womb which have no such ori- 
gin as inflammation, are mostly those which are stated 
in the Preface to be of so complicated a nature, or of 
such a surgical character, that their consideration, in 81 
DISEASES OF THE WOMB, ETC. 
a work like the present, was not deemed advisable. 
Consequently, the diseases into which I intend to in- 
quire, are those which, as I said in opening this chap- 
ter, do arise from inflammation, or in their progress 
become complicated with it. 
II.-PARTS AFFECTED AND VARIETIES OF INFLAMMA- 
TION OF THE WOMB. 
I have already stated that the womb is divided into 
two distinct parts, and that for both convenience and 
facility of comprehension, a separate consideration 
of the diseases of the two parts is necessary. The 
first division, then, will concern exclusively the body 
of the womb, and its mucous membrane. I would, 
therefore, state that the parts of the body of the 
womb which may be affected by inflammation, are 
first, its mucous membrane, and, second, its substance. 
Morbid action may limit itself to either one of these, 
though it rarely does so strictly, one usually to a 
greater or less extent complicating the other. Thus, 
if the inflammation is limited to the mucous membrane 
of the body, the disease is called corporeal endome- 
tritis, or, plainly, inflammation of the mucous mem- 
brane of the body of the womb. If the inflammation 
is limited to the texture or substance of the organ 
itself, the disease is designated as corporeal or par- 
enchymatous metritis, or inflammation of the womb 
proper. 
Inflammation of the body of the womb and of its 
mucous membrane, is mostly caused by the act of 
parturition and abortion, and as such, will not be con- 82 
woman's complete guide to health. 
sidered here. Another reason why inflammation o£ 
the body of the womb should be excluded from con- 
sideration in this work, is, that very frequently the 
above inflammation is the result, by extension, of the 
inflammation that attacks the neck of the womb. 
Moreover, to describe the symptoms of inflammation 
of the body, which are mostly those to be described 
when I shall come to treat of inflammation of the neck, 
would subject myself and my readers to a repetition 
of a long train of symptoms, much alike in both forms 
of the inflammation. It is generally conceded, too, 
that inflammation of the neck of the womb is much 
more frequently and primarily met with in practice 
than in any other part of the organ. This brings me 
to the consideration of the second division of the dis- 
eases of the womb, viz., those affecting exclusively the 
neck of the womb, together with its lining mucous 
membrane. And as I attribute a very great impor- 
tance to this disease, and for the reasons I shall soon 
explain, I shall postpone its full consideration to the 
next chapter. 
III.-SYMPATHIES OF THE WOMB. 
The womb is the sensitive centre of many affini- 
ties and sympathetic reactions, through its acknowl- 
edged intimate relation with the other organs of the 
body, this connection being transmitted, secondarily, 
through the sympathetic system of nerves. An illus- 
tration of this sympathy of the womb with other or- 
gans, is remarkably well shown in pregnancy, the 
very first symptom indicating this condition being an SYMPATHIES OF THE WOMB. 
83 
irritation in the stomach, producing nausea, even 
vomiting, occasionally of rather an obstinate charac- 
ter. Is it then surprising that when the womb is 
morbidly affected, the disease should react upon the 
organs at a distance from its site, as those of the 
chest, for instance, and that, consequently, we meet 
with a combination of symptoms emanating from the 
stomach, lungs, heart, liver, etc.,-all organs, as already 
stated, under the control of the sympathetic system of 
nerves ? 
Authorities on the diseases of women express them- 
selves unanimously in relation to this sympathetic 
reaction of the womb upon other organs. Thus Pro- 
fessor Von Scanzoni, of Wurzburg, remarks : " Of all 
the organs of the human body, the womb is unques- 
tionably one of those whose diseases are characterized 
by the most varied symptoms, and cause in the dif- 
ferent parts of the economy the most diverse troubles, 
alike subjective and objective." In his clinical lec- 
tures on the diseases of women and children, Profes- 
sor Bedford, of New York, expresses his views as fol- 
lows : " There is scarcely an organ which is not, to a 
greater or less extent, through the agency of the 
nerves, in alliance with the womb ; and it is through 
this agency alone that we can explain why remote 
parts are almost always affected in both organic and 
functional diseases of the womb, whilst the patient, 
in many instances, experiences but slight pain in 
the womb itself. This is what constitutes the stum- 
bling-block in the treatment of affections of the womb ; 
the pain in the head, the disordered stomach, the 
uneasiness in the back, etc., which are but the conse- 84 
woman's complete guide to health. 
quences of some derangement of the womb, being 
regarded as the disease. Remedies are applied to 
the head, stomach, etc., the patient experiences no 
benefit, and the practitioner derives no credit. The 
disease, in the meantime, is progressing insidiously, 
and often results in the destruction of health." " I 
think," observes Dr. Wm. H. Byford, of Chicago, Ill., 
" there is no doubt, and I speak after an observation 
of a large number of unmistakable cases, that the 
unimpregnated diseased womb does produce grave 
and even fatal disorders in other parts of the organ- 
ism by its reflex or sympathetic influence, while the 
organ itself is not suspected to be the original cause 
of the wide-spread disorder." 
To conclude, I would observe, that although gyne- 
cologists do agree as to the existence of the sympa- 
thies of the w.omb, and call upon the nervous system 
to explain the fact, I still think that the existence of 
this faculty so universally recognized, has not been, as 
yet, satisfactorily explained. CHAPTER VI. 
INFLAMMATION OF THE NECK OF THE WOMB, AND ITS 
SEQUEL2E ; ULCERATION, HYPERTROPHY, INDURATION AND 
ELONGATION OF ONE OF ITS LIPS. GENERAL REMARKS. 
If there is any disease to which I would most ear- 
nestly call the attention of my readers, it is that which 
is the object of the present chapter. Its importance 
is hardly equaled by any other disease, and the better 
it is understood, the greater will be the relief derived 
from it in the future. Of all the diseases peculiar to 
women, inflammation of the neck of the womb is the 
disease to which they are the most subject; it is the dis- 
ease of all, whose consequences are most to be appre- 
hended. It is the affection from whose focus radiate, 
like the rays of the sun, innumerable sympathetic 
manifestations, under whose influence woman's health 
becomes impaired, flags, and ultimately breaks down. 
It is the affection which, if not seasonably checked or 
cured, may be, and generally is, the source, sooner or 
later, of numerous anatomical changes and compli- 
cations in the womb and appendages, of a much graver 
nature, having all an increased unfavorable influence 
upon her already deranged state of health, and is not 
unfrequently the indirect cause of premature death. 
Thus this affection is the cause, of more than 
seventy-five per cent, of all woman's sufferings, what- 
ever her age or social standing. In the unmarried, 86 
woman's complete guide to health. 
most of the severe forms of dysmenorrhoea, or painful 
menstruation, which resist the ordinary modes of 
treatment, and are merely palliated by the habitual 
but very pernicious use of narcotics, spirituous stimu- 
lants and quack nostrums ; and most of the cases of 
inveterate vaginal discharges; anaemia, mental de- 
pression, loss of rest, spinal irritation, chlorosis, 
hysteria; under its Protean manifestations, may all 
be occasioned by this affection. Consumption may 
be said to constitute one of the dangers to which 
this form of disease indirectly exposes those whom it 
attacks, owing to the extreme general debility which 
it so often occasions. In the married, moreover, it is 
the most frequent cause of morbid pregnancies : it is 
also one of the causes of sterility, both in originally 
sterile and in previously fruitful women, and the suc- 
cessive miscarriages, false conceptions and premature 
confinements that occur with some women in the first 
few years that follow marriage, and of non-dilatation of 
the neck of the womb during labor, of puerperal me- 
tritis, internal inflammation of the womb, hemorrhages 
after labor, and lastly of the abortions that occur in 
child-bearing women. 
Even after the cessation of menstruation, inflamma- 
tion of the neck of the womb and its sequela, ulcera- 
tion, may persist, and be the principal cause of that 
agonizing backache of which elderly women sometimes 
complain, which resists every means of treatment 
unless its true cause be discovered and removed. As 
an illustration of the occasional existence of this back- 
ache in elderly women, my readers are referred to 
Case XLVIII., in the Appendix. Lastly, observe that INFLAMMATION OF NECK OF WOMB. 
87 
inflammation and ulceration of the neck of the womb 
are generally so intimately connected with each other, 
that it will be proper to consider these two morbid 
conditions as one affection. Consequently, my readers 
are invited to-keep this circumstance constantly in 
their minds. 
I.-(1.) EXISTENCE, FREQUENCY AND IMPORTANCE OF 
INFLAMMATION AND ULCERATION OF THE NECK OF 
THE WOMB. 
Of all diseases of the womb, inflammation of its 
neck is the most common form met with in practice : 
it is, in fad, the key-stone to Gynecological Science, and 
unless the phenomena which it occasions be recognized and 
taken into consideration, all is doubt, obscurity and decep- 
tion. The inflammation may commence anywhere in 
the mucous membrane that covers or lines the cavity 
of the neck, or it may attack the substance of the 
neck itself. The inflammation may be limited to one 
of these regions ; it is, however, seldom so confined, 
but generally extends to the whole neck, and may, in 
certain circumstances, extend to the whole organ. The 
inflammation may also exist for some time in the neck 
of the womb without giving rise to any very serious ana- 
tomical changes. However, as the mucous membrane 
lining and covering the neck of the womb, and espe- 
cially that portion of the membrane which is near the 
mouth of the womb, appears to be peculiarly liable to 
ulcerative action, the consequence is, that the existence 
of inflammation, in the majority of instances, is soon 
followed by the manifestation of the ulcerative process. 
When the inflammation and ulceration are as yet 88 
woman's complete guide to health. 
localized, as it were, within the cavity of the neck of 
the womb, as they are very frequently observed to be 
in practice, a circumstance of some importance as I 
wish my readers to remember, ocular examination of 
the organ will not reveal any evidence of its existence, 
if this examination be resorted to in a careless man- 
ner, or by a practitioner not au fait of diseases of the 
womb. I cannot better illustrate the inefficiency and 
unsatisfactory result of such examination, than by a 
comparison. Suppose, for an instant, that a person 
should be attacked with some troubles in the throat- 
an inflammation, an abscess or ulcer, and that for its 
relief he sought medical advice. The physician, in- 
stead of making the proper examination by looking in 
this patient's mouth and throat, and depressing his 
tongue, might satisfy himself by merely looking at his 
neck and dismiss him with a prescription. But could 
it be supposed for a moment that the result of such 
examination would be satisfactory to both physician 
and patient ? 
It is in all respects the same in relation to the ex- 
amination of the diseases I am considering. Thus, 
instead of simply looking at the exterior surface of the 
neck, which will show nothing, we separate gently 
and sufficiently the lips of the neck of the womb, and 
enough will be revealed to satisfy the most rigid 
diagnosis ; that is to say, this proceeding will satis- 
factorily show the affection of the mucous mem- 
brane within the cavity of the neck, whatever its 
character. To close this article, I will relate the fol- 
lowing case, illustrating the above remarks in relation 
to inefficient or careless examinations in diseases of 89 
CASES OF INFLAMMATION OF NECK OF THE WOMB. 
the womb. It is one out of a great number of similar 
cases I have met with in practice. 
Case XXI.-Partial prolapse, dependent on inflamma- 
tory ulceration of the neck of the womb, the cause of 
previous miscarriage, in a married lady. The disease 
of the womb not discovered by a preceding practitioner. 
Complete cure. 
In 1857,1 was consulted by Mrs. Y , aged thirty, 
in reference to her state of health, which had been 
steadily declining for the last five years. She had 
been married seven years, had miscarried in her first 
year of marriage, but had subsequently given birth to 
two children, the last now three years old. Her health 
was good before she married, and she dated her ill- 
health from the time she miscarried. She complained 
of " dragging-down pains," of pains in the back, of oc- 
casional severe headache, often accompanied with diz- 
ziness, of a thick yellowish vaginal discharge,impaired 
appetite, scanty menstruation, and great nervousness, 
all well-marked and characteristic symptoms of an 
affection of the womb. I informed Mrs. Y that 
her ill-health was probably caused by some abnormal 
state of the womb, and that in order to judge rightly 
of its true character, an examination of the organ was 
necessary. This suggestion was at once rejected: 
there was no occasion for an examination, she said; 
it was preposterous. The lady's eloquence was great 
on the subject; there was nothing the matter with her 
womb, she knew it; she had only very recently under- 
gone an examination, and the doctor had told her that 
there was no disease of her womb at all. As this hap- 90 
woman's COMPLETE GUIDE TO HEALTH. 
pened in the very commencement of my practice in 
New York, and at a period when I wras an apprentice 
in tire English language, I was little prepared to sus- 
tain successfully my argument against the opinion so 
decidedly given by the doctor, backed as he -was by 
such an eloquent opponent, and therefore I led Mrs. 
Y to suppose that she had carried the point, by 
not urging the examination. What, then, was my sur- 
prise, when a few weeks later, Mrs. Y called at my 
office, and spontaneously requested an examination. 
I found the neck of the womb much lower than usual 
(partial prolapsion), engorged and painful to the touch. 
No ulceration was visible externally : on separating 
the lips, however, the cavity of the neck presented 
unmistakable evidence of the existence of extensive 
ulceration. From the opened mouth issued a profuse 
mixture of a viscid, bloody, muco-pus secretion. Here 
was sufficient cause for Mrs. Y 's ill health. Sub- 
sequently she came under treatment, and six months 
later was declared free from all disease, her health 
having in the mean time been entirely restored to its 
former standard. Such cases as the above are fre- 
quently met with. Any practitioner who makes the 
treatment of affections of the womb a specialty, will 
meet with them almost daily. See Case XXVII., for 
one somewhat similar to the above. 
(2.) VARIETIES OF THE ULCERATIONS OF THE NECK OF 
THE WOMB. 
Ulcerations of the neck of the womb, like ulcera- 
tions on any other part of the body, generally con- VARIETY IN ULCERATION OF NECK OF THE WOMB. 
91 
sidered, are divided into the benign, the malignant 
and the specific, and further into acute or inflamma- 
tory and the chronic. To describe at any length the 
different forms of ulcerations that are met with in 
practice, would not be in keeping with the plan of 
tliis work. It would require too much time and 
space that might be better employed for the interest 
of my readers. For all practical purposes, let it be 
sufficient to state briefly in what the ulcerations of 
the neck of the womb mostly met with consist. They 
are the following, viz.: 
First. Erosion or Excoriation of the Neele of the Womb. 
This is the simplest form of ulceration. In itself, 
it has not much practical importance except from the 
developments it may assume. Thus, if abandoned to 
itself, it nearly always degenerates into deep ulcera- 
tions of long duration, which soon injure the entire 
organism if not cured. This form of ulceration is 
quite easily removed by injections of suitable reme- 
dies. 
Second. When the erosion just noticed is for a 
certain time left to itself, or when it is for a long time 
submitted to the deleterious influence of exterior 
causes, as, for instance, repeated confinements ; sexual 
excesses; neglect of local ablutions, etc., it is trans- 
formed into profound ulceration, accompanied by loss 
of substance, and other morbid alterations in the 
womb, as well as in its surrounding organs and tissues, 
from this period exercising their baneful influence 
upon the patient's hitherto tolerably good health. 
It would be folly to expect a cure of this ulceration, 
as well as of any of the following, by medicated injec- 92 
woman's complete guide to health. 
tions. In these cases, nothing short of the cauteriza- 
tion of these ulcers, with one or other of the different 
caustics to be considered hereafter, wTould at all avail 
for their cure ; and simple injections of luke-warm 
water, or castile soap and water, are resorted to, for 
the purposes of cleanliness, and to carry off the acrid 
secretions dependent upon these ulcerations, and of 
the cauterization for their cure. 
Third. Granular Ulcerations. This is a more severe 
form of the ulceration just considered. Of the above 
ulcerations, the second and third types are never 
cured spontaneously. Left to themselves, they con- 
tinue to spread, and become covered with excrescences, 
better understood by the term "proud flesh," and 
other morbid growths, which will constitute the next 
type of ulceration. 
These ulcerations, moreover, keep up a constant 
congestion of the womb or its neck, and neighboring 
tissues, and exercise, consequently, very injurious in- 
fluence upon the general economy. The granular 
ulcerations, furthermore, are distinguished by the 
obstinacy with which they resist all the different means 
employed against them, and much patience and perse- 
verance are necessary, on the part of both physician 
and patient, in order that the treatment adopted may 
be crowned with success. 
Fourth. Fungous or Cock?s-cornb Granulation. In a 
more advanced stage of the granular ulceration just 
described, there are seen, forming upon their surface, 
particularly in the neighborhood of the mouth of the 
womb, certain fungous excrescences, more or less large, 
of a livid red color, very full of blood-vessels, from ULCERATION OF THE NECK OF THE WOMB. 
93 
whence this form of ulceration is designated as fun- 
gous or cock's-comb. These excrescences are often 
very close together, and are ordinarily the seat of a 
very abundant purulent secretion, exerting an inju- 
rious influence upon the patient's health. Moreover, 
they bleed at the least touch ; the mere attrition of the 
walls of the vagina, as well as sexual congress, often 
produces very copious hemorrhages. See cases in Ap- 
pendix. These hemorrhages will especially take place 
at the time of menstruation, when these excrescences 
seem to partake of the congestion of the womb, to 
which I shall have occasion hereafter to allude. Such 
ulcerations resist with even more obstinacy than the 
granular ulcerations the remedies employed against 
them, but with time, perseverance, and the removal by 
excision of the most luxuriant of these fungous 
growths, converting them thereby into the form of 
granular ulcerations described under the third class, 
we soon obtain the desired cure. 
Other forms of ulceration of the neck of the womb 
occur, but those that have been just described are 
those usually met with in practice, especially the first 
three types. It is also generally in their chronic stage 
that they come under observation. They demand, on 
the part of the practitioner, the utmost study, care and 
reflection. I fully agree with Professor Von Scanzoni, 
in his remark upon this subject, as follows : " The dif- 
ferent forms of ulcerations not only present sensible 
differences in their symptoms and progress, but they 
also demand varied methods of treatment." 94 
woman's COMPLETE GUIDE TO HEALTH. 
IT.-HYPERTROPHY, INDURATION, AND ELONGATIONS OF 
THE NECK OF THE WOMB, CONSEQUENT UPON IN- 
FLAMMATION AND ULCERATION. 
Inflammatory ulceration of the neck of the womb 
may remain unchanged and unprogressive in its 
dition. In the course of time, however, it is frequently 
followed by very important pathological or morbid 
changes in the structure, size and form of the neck. 
The limit of these contributions allow but a rapid con- 
sideration of these changes, as follows : 
(1).-HYPERTROPHY OF THE NECK OF THE WOMB. 
One of the first changes which inflammatory 
ulceration of the neck of the womb may produce 
in its progressive tendency, is a state of hyper- 
trophy, also called engorgement. Hypertrophy is that 
state of a part in which the nutrition is performed 
with greater activity, and which on that account at 
length acquires greater bulk. In this state, then, the 
neck of the womb is found enlarged, swollen, and con- 
gested, but perfectly soft and elastic. 
This hypertrophic or engorged condition of the neck 
of the womb, is almost of general occurrence, and 
varies very much. In virgins, and in women who 
have had no children, for instance, the neck of the 
womb does not enlarge to any great extent, nor is this 
particular condition very frequently met with among 
them. But in women who have borne children, the 
hypertrophy and induration are much more commonly 
met with, and, owing to the greater vascularity and 95 
INDURATION AND ELONGATION, ETC. 
vitality of the tissue of the womb, inflammation read- 
ily extends to the structure of its neck. It is, con- 
sequently, not only more frequently followed by indura- 
tion, but when this condition does occur, it is nearly al- 
ways much more extensive than in virgins, or even than 
in sterile women. It is in these child-bearing women, 
moreover, that the neck of the womb occasionally en- 
larges to a very great extent; and I am not guilty of 
exaggeration when I state that in at least three in- 
stances, I have seen the neck enlarged, or nearly so, 
to a good-sized fist. Lastly, if this state of hyper- 
trophy remains limited to the cavity of the neck and 
its orifice or mouth, this condition may exist for some 
time, even a number of years, perhaps, without any 
other morbid change taking place. 
(2.)-INDURATION OF THE NECK OF THE WOMB. 
Occasionally, the inflammatory hypertrophy of the 
neck of the womb, as described in the preceding para- 
graphs, undergoes another morbid change, that of 
Induration. This is a certain hardness which super- 
venes in an inflamed part, owing to a change of nutri- 
tion in that part, or, in other words, an effusion of 
plastic lymph may take place in the structure of the 
inflamed hypertrophied neck of the womb, and become 
more and more organized. Thus, the neck is not only 
hypertrophied, but it is also indurated. At first, this 
induration is evidently of an active inflammatory na- 
ture, as I have had occasion to observe in at least three 
or four instances. This inflammatory nature of the 
induration is indicated by the great heat of the neck 96 
woman's complete guide to health. 
of the womb, its vivid redness, and the pain produced 
on pressure. 
In the course of time, the inflammatory character of 
the induration, above alluded to, partially subsides, 
and the neck becomes the seat of a chronic state of 
hypertrophy and induration. It is in this particular 
condition of the neck of the womb, namely, that of 
Chronic Hypertrophy, that patients mostly present 
themselves for treatment, and in rare instances only, 
the induration, as just described, is met with as a com- 
plication of the affections of the neck. Finally, the 
induration and hypertrophy are generally confined to 
the neck, but sometimes they pass on to the body of 
the womb, then, obviously, also the seat of inflamma- 
tion. This is a serious complication, as it is much 
more difficult to restore the body of the womb to a 
healthy condition when it is thus modified, than it is 
to overcome inflammatory hypertrophy in the neck. 
Fortunately, however, the induration seems most fre- 
quently to limit itself to the neck, notwithstanding the 
anatomical continuity of the two regions. 
• 
(3.)-ELONGATION OF THE NECK OF THE WOMB. 
Another morbid change which the neck of the womb 
may undergo when hypertrophied, is that of Elonga- 
tion of one or both of its labia. But the consideration 
of this particular subject I shall postpone, and com- 
plete it in another part of this work. MEDICAL RECOGNITION OF INFLAMMATION, ETC. 
97 
III.-RECOGNITION BY THE PROFESSION OF THE EXIST- 
ENCE, FREQUENCY AND IMPORTANCE OF INFLAMMA- 
TION AND ULCERATION OF THE NECK OF THE WOMB. 
The existence, frequency, and importance of inflam- 
mation and ulceration of the neck of the womb, are, at 
present, almost universally recognized by the medical 
profession. On the continent of Europe, among those 
most prominent in recognizing the disease under con- 
sideration, I may mention the following, to wit: Dr. 
James Henry Bennett, of London, and to him the pro- 
fession, and the public as well, are indebted for having 
first directed attention to this branch of medical sci- 
ence. He stands thus justly in the foremost rank of 
modern gynecologists. His name and fame, in this 
relation, will remain imperishable. Dr. Charles West, 
of St. Bartholomew's Hospital, and Dr. Tyler Smith, 
the Physician-Accoucheur to St. Mary's Hospital, both 
of London, have also recognized the existence and fre- 
quency of inflammatory ulceration of the neck of the 
womb. Dr. James Whitehead, of Manchester, who 
was one of the earliest in the field, and whose labors 
and researches place him high in the profession, Dr. 
James T. Simpson, the eminent and celebrated profes- 
sor of Edinburgh, who has for many years taught and 
demonstrated the correctness of Dr. Bennett's views; 
Drs. Montgomery, Evory, Kennedy, Beatty, Tilt, Rig- 
by, Michel, all eminent gynecologists, have recognized 
and treated surgically, the disease under consideration. 
I mention, also, the celebrated professor, of Wiirtz- 
burg, Dr. F. W. Von Scanzoni, who truly remarks that 
" The frequency and the consecutive influence which 98 
woman's complete guide to health. 
ulcerous affections of the neck of the womb exert 
upon the whole organism, render an attentive study 
of the subject necessary to all gynecologists." In 
France, the existence and frequency of the uterine 
affections, and the necessity of treating them on sur- 
gical principles, have been generally recognized for 
more than twenty years ; in short, ever since Dr. Lis- 
franc's lectures. France, also, reckons among its great- 
est gynecologists, Drs. Jobert de Lamb all, Valleix, 
Becquerel, Boys-de-Loury, Huguier, and many others 
too numerous to mention. On this side of the Atlan- 
tic the disease is recognized by such men as the eru- 
dite professor of obstetrics in the New York Medical 
College, Dr. B. Fordyce Barker, whose interesting and 
always instructive obstetric and gynecological clinics 
I was happy to enjoy for nearly three years, and Dr. 
Meigs, of Philadelphia, who holds a very high position 
among obstetric and uterine authorities in the United 
States. In his work, on Acute and Chronic Diseases 
of the Uterus, Dr. Meigs very judiciously remarks: 
" We should cure a much greater number of leucor- 
rhoeas, if we would not misinterpret the disorder, call- 
ing that a vaginal which is really a cervical malady, 
and vice versa. * * * * We repeat, the serious cases 
of leucorrhoeas are cases of disease of the cervix; but 
a vaginal injection for inflammation of the canal of the 
neck is simply ridiculous. The albuminous leucor- 
rhoea is a sign of inflammation of the cervix, in which 
is included the canal, with its copious muciparous ap- 
paratus. It is as much a surgical disease as an ulcer 
of the legs; as an anthrax, or conjunctivitis. When 
the surgical disorder is cured, the sign disappears. MEDICAL RECOGNITION OF INFLAMMATION, ETC. 
99 
Hence our desire to express the opinion that such leu- 
corrhoeas are to be held as acute or chronic inflamma- 
tions of the canal of the neck, and ought to be treated 
accordingly." Dr. Gunning S. Bedford, of New York, 
the very talented professor of obstetrics, and the au- 
thor of the well-known clinic for the diseases of wo- 
men and children, in the Fourteenth Street Medical 
University, and other distinguished practitioners in 
America, too numerous to mention, all recognize the 
existence, frequency, and importance of uterine affec- 
tions, and the necessity of their surgical treatment. 
Finally, Dr. Bennet, in 1856, received a letter from 
Dr. D. S. Stewart, " Surgeon Hon. E. I. Co's Depot, 
Warley," containing the following passage : " A long 
and extensive experience among native families in 
Calcutta, from the highest to the lowest classes, 
fully satisfied me that the particular affections which 
you have so ably described and brought to the notice 
of the profession, are of immense frequency, and that 
the plan of treatment which you so ably advocate is 
the only right one." Dr. Stewart's testimony has been 
thoroughly corroborated by the experience of Dr. Scott, 
formerly physician to the Hospital for Native Women 
at Madras, and later practising at Ootacamund. Dr. 
Scott has frequently informed Dr. Bennett that he has 
found these diseased conditions to be quite as frequent 
among the native women at Madras as he (Dr. Bennet) 
has done in Paris and London. 100 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
IV.-STATISTICS IN TESTIMONY OF THE FREQUENCY 
OF INFLAMMATION AND ULCERATION OF THE NECK 
OF THE WOMB. 
Although the reading of statistics may be tedious 
and unattractive, I yet think that a glance over the 
following records, investigations and researches made 
in testimony of the frequency of inflammatory ulcera- 
tion of the neck of the womb, may exceptionally 
afford some interest, and consequently wrould crave 
the indulgence of my readers that I may present 
them. 
Dr. Bennett, already mentioned, examined three 
hundred women presenting uterine symptoms, at the 
Western General Dispensary, of which two hundred 
and twenty-two, or nearly three-fourths, presented 
ulceration. Dr. West, of St. Bartholomew's Hospital, 
London, although not attaching as much pathological 
value to this ulceration as Dr. Bennett and others, 
gives, however, corroborative testimony to its fre- 
quency in his Croonian Lectures in 1854, " on the 
Pathological Importance of Ulceration of the Cervix 
Uteri." At the Middlesex and St. Bartholomew's 
Hospitals, he examined two hundred and sixty-eight 
patients, and found ulceration in one hundred and 
twenty-five, or nearly one-half. 
In a second series of investigations instituted in 
St. Bartholomew's Hospital, he examined forty women 
on the day of admission into one of its wards, and 
found thirteen presenting ulceration in a more or less 
marked degree. And in a third series of investiga- 
tions in relation to this subject, he examined carefully 101 
STATISTICS OF INFLAMMATION OF THE WOMB. 
the uterine organs of sixty-two women who died in the 
wards of St. Bartholomew's Hospital of other than 
uterine disease, and he found that in seventeen of 
these existed ulceration. " Within the past five years," 
observe Drs. E. E. Marcy and F. W. Hunt, of New 
York, on this subject," we have had occasion to make 
a large number of specular examinations in women 
suffering from uterine diseases, and in at least thirty 
per cent, of these cases we found either granulations 
or ulcerations of the cervix." 
My own individual experience would lead me to 
conclude that of all the women who have come under 
my special observation, and presented characteristic 
symptoms of chronic and confirmed uterine affections, 
from fifty-five to sixty-five per cent, presented ulcera- 
tion. Dr. D. Stewart, first-class staff surgeon, and 
late Professor of Midwifery in the Medical College of 
Calcutta, sent, in 1856, to Dr. Bennett, a memorandum 
drawn up for him by one of his late associates in the 
Calcutta Medical School, Baboo Madoosudun Goopta, 
of the appearances observed in these parts in the post- 
mortem examination of fifty native Indian females 
whose deaths occurred in hospital from other casual 
diseases. In fifteen cases out of these fifty, there was 
inflammatory ulceration, and in many the ulceration 
was noticed as extensive. I would remark, 'that the 
discrepancy that exists in the figures of the above 
statistics is not so great as would appear from a 
rapid survey of them. However, a percentage more 
accordant with the real facts and actual experience 
might be arrived at if these investigations were made 
with no preconceived ideas, conscientiously, and with 102 
woman's complete guide to health. 
the careful determination to gain the truth, by all 
investigators. Particularly I think this would prove 
true, if these investigations were made among women 
of the same class and at the same stage of their 
uterine affections. It will be admitted, that women 
of the lower classes of society can ill afford, for 
obvious reasons, to suffer any length of time from a 
disease that so seriously undermines their health. 
They consequently avail themselves at the earliest 
opportunity of the care and treatment they receive in 
hospitals, dispensaries, etc. On the other hand, wo- 
men of the better class have their uterine troubles 
looked into only after they have exhausted e,very 
means beside the proper means which, wealth can 
bestow, to assuage their sufferings ; only when they 
can no longer postpone the investigation on account 
of the duties they owe to their husbands, their chil- 
dren, their family and friends, or to themselves; 
only when, in short, the disease has been allowed to 
go unchecked and has made rapid progress in its mis- 
chievous tendencies. Then, as a dernier resort, they 
submit to a uterine investigation. Is it then astonish- 
ing that, in private practice, the percentage of women 
presenting ulceration of the neck of the womb is so 
much higher than the percentage in hospital practice. 
Again, the above statistics demonstrate the existence 
and frequency of inflammatory and ulcerative lesions of 
the neck of the womb in almost all parts of the world ; 
in the far East, and well as in the more civilized coun- 
tries. Still further, its existence and frequency is just 
as wrell noticed in the dead as in the living. CHAPTER VII. 
ETIOLOGY, OR CAUSES OF INFLAMMATION AND ULCERATION 
OF THE NECK OF THE WOMB. 
The causes which may occasion inflammation and 
ulceration of the neck of the womb are very numerous. 
They are divided into Predisposing Anatomical Causes, 
Predisposing Physiological Causes, and Constitutional 
Causes. 
I.-PREDISPOSING ANATOMICAL CAUSES. 
For all practical purposes, it is sufficient to state, in 
relation to the predisposing anatomical causes of in- 
flammation and ulceration of the neck of the womb, 
that it is on account of its peculiar structure, acknow- 
ledged to be the most vascular part of the uterine 
organ, that it is rendered prone to inflammatory ac- 
tion. According to Professor Bedford, of New York, 
the very position of the neck of the womb necessarily 
predisposes it to inflammatory action, it being situated 
in the most dependent portion of the trunk, and its 
veins unsupplied with valves. These two circum- 
stances necessarily tend in a greater or less extent to 
arrest the circulation, thus inviting congestion in one 
or other of its forms. 104 
woman's complete guide to health. 
II.-PREDISPOSING PHYSIOLOGICAL CAUSES. 
These predisposing physiological causes implying 
the knowledge of the different functions of the womb 
at its various epochs of uterine life, it is necessary, for 
the purposes stated in the design of this work, to 
state somewhat fully in what these functions consist, 
in order that deviations from their physiological or 
healthy character may be made clear and palpable to 
the intelligence of my readers. The functions are : 
1. Menstruation; 2. Conception; 3. Parturition. 
(1.) MENSTRUATION. 
Throughout its entire period of vital activity, the 
non-pregnant womb has this important function to 
perform-Menstruation. This act of menstruation is 
preceded, accompanied and followed by determination 
of blood to the said organ, whose importance or hem- 
orrhagic nature is more or less great. The conse- 
quence is a certain degree of passive congestion, which 
is, as may be presumed, always greater in the neck of 
the womb, on account of its greater vascular character 
than any other part of the organ. "When inflamma- 
tion exists, this congested condition of the organ, it is 
easily conceived, often extends over a much more 
lengthened period, both before and after menstruation, 
and is necessarily greatest in the most vascular part 
of the organ, to wit: in the neck and its lining mucous 
membrane. 
The periodical return of menstruation takes place, 105 
CAUSES OF INFLAMMATION OF WOMB. 
iii the great majority of women, about every fourth 
week, and continues generally for four or five days. 
The consequence is, that the congestion or determina- 
tion of blood to the womb, as before noticed, must 
last with most women from seven to ten or twelve 
days. So that during one-third or one-fourth of each 
month, the womb of a menstruating woman, and 
especially its neck, is physiologically in that condition 
which, throughout the whole physical economy, im- 
mediately precedes inflammation, viz.: a state of con- 
gestion. When, therefore, it is considered that the 
arrest of a secretion from a congested organ is one 
of the most frequent causes of inflammation, and how 
very many causes there are that can arrest or modify 
the menstrual flux, it need not be a source of surprise 
that inflammation should occur in the womb and 
its neck apart from physical lesions. With some 
women, moreover, the womb seems to be naturally a 
weak organ. This peculiar delicacy of the organ is 
indicated by the difficulty with which menstruation is 
at first established, by its irregularity during the first 
years, by its scantiness or abundance, by the frequent 
presence of leucorrhoea before and after menstruation 
-an indication of congestion of the uterine system-• 
and by the existence of pain either for the first few 
days, or for the entire period. These peculiarities 
of menstruation, although apparently morbid, are evi- 
dently natural with some women, and quite compatible 
with the absence of disease of any kind. They char- 
acterize a tribe, as it were, of the human race, a class 
of women who are more liable than others, in the 
course of human life, to inflammatory affections of the 106 
woman's complete guide to health. 
womb, and to all the accidents to which these diseases 
give rise. 
Menstruation, I have before remarked, is liable to 
be modified through many causes. It may be pre- 
vented, diminished, increased, or suddenly arrested by 
a host of mental, social or morbid pathological causes ; 
and whenever this is the case, the natural congestions 
above averted to may become morbid, and thus give 
rise to inflammation. This accounts for virgins being 
so frequently attacked with the disease under con- 
sideration-a fact which clinical observations abun- 
dantly and daily prove. I refer, on this subject, to 
cases in Appendix. In the married state, the neck of 
the womb is necessarily exposed to another fruitful 
source of inflammation, even when conception does not 
take place. The natural congestion and excitement 
which accompany intercourse, may if too frequently 
renewed, give rise to inflammation; and the same re- 
sult may be occasioned directly by physical contusion 
of the womb itself. In some women, the womb ap- 
pears to be so extremely sensitive, that inflammation 
follows intercourse nearly immediately, even when the 
bounds of discretion have not been overstepped. 
Owing to the operation of these latter causes, many 
young women are attacked with inflammation and 
ulceration of the neck within a few days or weeks after 
marriage ; and when such is the case, they mostly re- 
main sterile. See in this connection cases in Ap- 
pendix. 
If they do conceive, successive abortions or miscar- 
riages generally take place ; and this will frequently be 
found the explanation of the repeated abortions which CAUSES OF INFLAMMATION OF THE WOMB. 
107 
sometimes occur during the first years of married life, 
and prove so embarrassing to the practical accoucheur. 
(2) CONCEPTION. 
When conception takes place, other causes of in- 
flammation come into action. A new life dawns on 
the generative organ. Instead of remaining in a qui- 
escent condition, merely disturbed at periodical inter- 
vals by the menstrual congestion, the womb assumes 
a high degree of vitality, becomes the seat of a most 
active nutrition, rapidly increases in size, and the en- 
tire organ becomes one of the most, instead of one of 
the least, vascular in the human economy. The neck 
of the womb participates in the change; it becomes 
turgid, swells, softens, and its entire structure is modi- 
fied by the exaggerated organic activity which per- 
vades the womb. Pregnancy may thus itself be con- 
sidered a predisposing cause of inflammation of the 
neck of the womb. A careful investigation of the 
morbid conditions of pregnancy will prove, and has so 
proven to me in many instances, that inflammation 
and ulceration of the neck frequently exist during that 
state; but it is supposed that in these cases the in- 
flammatory disease generally originates antecedently 
to conception taking place, and is merely increased by 
the changes which occur in the vitality of the womb. 
(3) PARTURITION. 
Parturition is another very frequent cause of the 
inflammatory ulceration of the neck of the womb, as 108 
woman's complete guide to health. 
might be presumed a priori. This is owing to the 
neck being the part of the womb the most exposed to 
laceration and contusion during parturition. The 
neck may be lacerated more or less extensively during 
the most natural labor. In a rapid confinement, a 
strong contraction (ordinarily called "pain") or a suc- 
cession of strong contractions propelling the child with 
great force against the imperfectly dilated mouth of 
the womb, will lacerate the neck, under circumstances 
otherwise the most favorable. These, observations 
apply still more strongly to the mucous membrane 
lining the cavity of the neck. The lesions just referred 
to mostly occur in first confinements, and disappear 
promptly, cicatrization taking place with rapidity in 
the majority of women, no doubt under favorable 
physiological or natural influences. But if these 
physiological influences should prolong their duration, 
and assume a morbid pathological character ; if rem- 
nants of the conception are left behind in the womb, 
they may give rise, by their decomposition, to an irri- 
tative foetid discharge, and it is easy to understand 
that these lesions, instead of healing, will almost in- 
evitably become the seat of inflammation and of sub- 
sequent ulceration. Married women who have had 
children, and who have escaped the danger of child- 
birth, are not only exposed subsequently to all the 
various causes of inflammation which have already 
been enumerated, but are more liable to their opera- 
tive action than unmarried, or than women who have 
never conceived. The reason of this is, that with 
these women certain changes take place in the womb, 
rendering it more vascular, and endowing it with 109 
CAUSES OF INFLAMMATION OF THE WOMB. 
greater vitality than at any time previous to concep- 
tion. This remark applies even more to the neck than 
to the organ itself. The more vitalized state of the 
neck in women who have conceived, accounts also for 
induration and hypertrophy being more frequently a 
concomitant and result of inflammatory ulceration in 
them, than in women who have never been pregnant. 
In more advanced life, when menstruation is ceas- 
ing, the extreme and lengthened congestion of the 
womb, which often accompanies the irregularities that 
occur in the menstrual secretion, may be considered 
as predisposing to inflammation of the neck. This 
congested condition of the womb will sometimes per- 
petuate itself for years after menstruation has finally 
ceased, more especially if the neck is the seat of in- 
flammatory disease. In other instances, it gradually 
gives way, and the womb falling into a state of atrophy, 
any inflammatory affection of the neck that may ex- 
ist, spontaneously disappears. See in this respect an 
exceptional case (XLVIII) in the Appendix. The 
various predisposing causes of inflammation which 
have been enumerated, are all connected with func- 
tional arid physiological states of the womb. This 
exaggeration or morbid modification leads to the de- 
velopment of inflammation under the influence of all 
the ordinary .efficient causes of inflammatory disease, 
and more especially of those w'hich act upon the 
womb. 
Inflammation of the neck may also be the result of 
the extension of the inflammation of the vagina, what- 
ever produced the latter; or it may occur spontane- 
ously, like other inflammations, without being trace- 110 
woman's complete guide to health. 
able to any particular cause. It may arise from the 
direct exposure of the womb to the air, to friction; 
to external violence, as in complete falling of the 
womb, to acrid and corrosive leucorrhoea, induced by 
some other disease of the womb ; from irritating vagi- 
nal injections, pessaries, self-abuse, chronic and ob- 
stinate constipation, hemorrhoids, too great muscular 
efforts, such as a long, fatiguing walk, climbing some 
high hill or mountain, ascending and descending high 
staircases, severe jolting on horseback, or in coaches, 
from dancing, running, jumping, falls, sneezing, cough- 
ing, vomiting, lifting or carrying weights, dandling 
children in the arms, etc. It is not unfrequently met 
with when tumors are developed in the walls of the 
W'omb, and is often the concomitant both of large 
polypi originating in the cavity of the womb, and pass- 
ing through the neck by means of a pedicle, and of the 
small vascular polypi that grow from the contour of 
the mouth of the womb, or from the parietes of the 
cavity of the neck. 
Thus the frequent existence of inflammatory ulcera- 
tion of the neck and its cavity, under the circumstances 
above enumerated, may be easily accounted for. When 
a tumor has formed in the womb, the latter, along with 
its neck, becomes developed and vitalized, as in preg- 
nancy, and consequently predisposed to take on in- 
flammatory action ; and polypi, whatever their charac- 
ter, irritating the tissues with which they come in con- 
tact as they escape from the mouth of the womb, 
cause the mucous membrane with which it is lined to 
inflame and to ulcerate. The preceding considerations 
explain how it is that inflammation of the neck of the 111 
CAUSES OF INFLAMMATION OF THE WOMB. 
womb is of such frequent occurrence. Finally, by ad- 
mitting the important pathological fact, that inflam- 
mation of the womb and inflammation and ulceration 
of its neck, are, in the majority of cases, the real 
causes of morbid changes in the womb and symptoms, 
we only bring the womb within the pale of the laws 
that regulate diseases in the rest of the human econo- 
my. In the history of diseases of all the animal struc- 
tures and organs, we find inflammation playing the 
principal part. Thus is it with the brain, the lungs, 
the liver, the kidneys. Take away from a treatise on 
the diseases of any of these organs all that relates to 
inflammation and its sequela, and how small a space, 
comparatively, would the remainder occupy. 
Inflammation of the neck of the womb, as already 
remarked, is exceedingly common ; so common, indeed, 
that the very great majority of women who apply for 
relief when laboring under symptoms denoting an 
affection of the womb, will be found, on careful exam- 
ination, to be suffering from its existence. Leucor- 
rhoea, dysmenorrhoea, menorrhagia, irritable womb 
and falling of the womb, are generally considered 
independently of any such origin, but in reality, in 
nineteen cases out of twenty, when confirmed, they are 
the immediate result of inflammatory disease of the 
neck, and are only to be effectually treated by attack- 
ing the primary disease to which they owe their exist- 
ence. Leucorrhoea, more especially when chronic, and 
persisting during the entire interval of menstruation, 
is nearly always the result of inflammation and ulcera- 
tion of the neck of the womb ; but a large- proportion 
of the generally reputed functional diseases of the 112 
woman's complete guide to health. 
womb will also be found, if submitted to severe scru- 
tiny, assignable to the same cause. Most of the more 
intractable cases of dysmenorrhoea and menorrhagia 
which are met with in practice, are the result of local 
inflammation. 
III.-CONSTITUTIONAL CAUSES. 
Among the constitutional causes of inflammation 
and ulceration of the neck of the womb, may be enu- 
merated plethora, or that state of health expressed 
by "full habit," and the various constitutional pecu- 
liarities, such as the chlorotic, the scrofulous or stru- 
mous, and the cachectic diathesis. In patients who 
are the subjects of one or other of the peculiar con- 
stitutions above referred to, the womb is, generally, of 
a very delicate organization, throughout life. This 
renders them more liable, all other things being equal, 
to an inflammatory affection of the womb. It is con- 
sequently, of the highest importance to take into con- 
sideration these different constitutions in the treat- 
ment of the various affections to which the womb is 
subject. 
In conclusion, the very great number of causes 
which have been considered in the preceding pages, 
will, I fear, but give my readers a most inadequate 
idea of the very great number which may produce and 
kindle up an inflammatory action in the womb and in 
its neck. Dr. By ford well remarks upon this subject, 
in which I entirely concur, that " there is no mucous 
cavity in the body that is subject to so many causes 
of intense excitement, arising from the nature of its LIABILITY TO AFFECTIONS OF THE WOMB. 
113 
functions, from its accidents and abuses, as is that of 
the cavity of the female genital canal. Hence it is 
not wonderful that this cavity is very much more 
frequently the seat of disease than any other mucous 
cavity in the human body." 
IV.-LIABILITY OF THE SEX TO INFLAMMATORY AFFEC- 
TIONS OF THE NECK OF THE WOMB. 
From the dawn of menstruation until a very advanced 
period of woman's existence, the neck of the womb may be 
attacked by inflammation and inflammatory ulceration. 
The young and old, the unmarried as well as the mar- 
ried, those who have given birth to children as well 
as the childless, the rich as well as the poor, every 
class of society, all are liable to it. There exists, how- 
ever, a remarkable difference in the greater or less 
liability of certain classes of society to affections of 
the womb. Women inhabiting the country, for in- 
stance, seem and are less exposed to the disease than 
are those of city life. Again, among the latter, the 
higher classes are much more subject to it than are 
the lower classes. Why this influence of city life is 
not universal, and does not fall with equal force on all; 
why the lower classes enjoy, comparatively at least, a 
greater immunity from this special affection, are ques- 
tions of easy solution. The causes which conspire to 
the frequent production of functional and organic de- 
rangements of the womb are numerous, but operate 
very unequally under different circumstances. The 
married state, with its various consequences, and often 
unrestrained requirements, together with the numer- 114 
woman's complete guide to health. 
ous excitements of city life, consequent upon balls, 
parties, the opera, and the liability to colds imposed 
by these amusements, are so many unfavorable influ- 
ences constantly exhibiting their destructive results in 
the women of our fashionable circles, the womb being 
in all cases the organ upon which these influences re- 
act, and through it upon their nervous system. The 
poorer classes, on the contrary, less impressible, 
are less exposed to, and suffer less from the nervous 
excitements just alluded to ; their frugal habits and 
constant exercise in the open air, have rather a whole- 
some and strengthening influence upon their wombs, 
and, as a consequence, an invigorating effect upon 
their nervous system. Their immunity from diseases 
of the womb, however, as I stated before, is only com- 
parative : their measure of suffering follows from ex- 
posure, and the influences usually attendant upon 
dependence and poverty. 
Inflammation and inflammatory ulceration, it is an 
acknozvledged fact, never disappear or are cured spontan- 
eously ; but if not checked by appropriate treatment, have 
a great tendency to perpetuate themselves indefinitely, 
owing partly to the structure of the womb, and partly 
to menstrual and other influences. Under these cir- 
cumstances, inflammation of the womb or its neck, is 
sooner or later followed by changes or lesions of a 
much graver nature, such as hypertrophy, induration, 
elongations of the neck of the womb, polypoid, fibrous 
tumors, and other morbid growths, with the various 
displacements of the uterine organs. Some of these 
changes, hypertrophy and induration, have been con- 
sidered in the preceding pages, others will be con- LIABILITY TO AFFECTIONS OF THE WOMB. 
115 
sidered hereafter. The existence of a large amount of 
diseases of the womb, unrecognized and left to them- 
selves, is undoubtedly a remote cause of death. Dr. 
Bennet remarks very truly on the subject: " Inflam- 
matory diseases of the womb and of its neck, are 
essentially debilitating affections, through their reac- 
tions on the functions of digestion and nutrition. 
When, therefore, as so generally occurs, they are not 
treated, they gradually induce a state of debility and 
anaemia, and of deficient vital energy, which may ren- 
der the female unable to resist the attack of intercur- 
rent'disease, to which she becomes an easy prey." 
I will close this sketch of the causes of the affec- 
tions of the womb, by adducing the remarks on this 
topic of Dr. James Whitehead, of Manchester, to wit: 
" Disease of the womb entails an incalculable amount 
of distressful suffering, leading often to abortion, un- 
fruitfulness, and not seldom to fatal consequences. 
It is equally prevalent among the high and among the 
lower orders of society, so far as my experience extends, 
and is so commonly met with, that scarcely less than 
one half of all married women, between the ages of 
twenty and forty-five, besides others differently cir- 
cumstanced, are constantly suffering under its influ- 
ence." CHAPTER VIII. 
SYMPTOMATOLOGY, OR SYMPTOMS OF INFLAMMATION AND 
ULCERATION OF THE NECK OF THE WOMB. 
The symptoms indicating the existence of inflamma- 
tion and ulcerative inflammation of the neck of the 
womb, are divided into-1. Anatomical symptoms; 
2. Local or subjective symptoms ; 3. Dynamic or func- 
tional symptoms; 4. Sympathetic or constitutional 
symptoms. 
I.-ANATOMICAL SYMPTOMS. 
The anatomical symptoms consist in those changes 
and lesions which take place in the appearance, form, 
and structure of the neck of the womb, as appreciated 
by physical examination, and consequently are of no 
great, if of any interest to the generality of my readers. 
I may, therefore, abstain from entering into their de- 
scription, and take into consideration the more impor- 
tant secretions, or vaginal discharges with which the 
changes and lesions above mentioned are attended. 
These vaginal discharges, called the " Whites," "Leu- 
corrhcea," or " Weakness," so commonly met with in 
women/are of the greatest importance, as leading 
symptoms, and, consequently, should be well under- 
stood. Many women, who have no disease whatever woman's complete guide to health. 
117 
of the organs of generation, have, however, a vaginal 
discharge, as has already been stated, for a few days 
before and after menstruation, when the womb is in a 
state of physiological congestion. 
The " vaginal discharge of congestion" consists in a 
white, milky, creamy fluid or mucus, and has no 
other importance. But the secretion from the inflam- 
ed and ulcerated state of the neck of the womb is 
quite different in character from the one attendant on 
mere congestion. 
The " vaginal discharge of inflammation and ulcera- 
tion, " from whatever part of the neck of the womb it 
is secreted, is purulent. The pus secreted and dis- 
charged may be thick, and of a yellow healthy color, 
or it may be thin and sanious, according to the state 
of the ulceration. It may be secreted scantily, or in 
abundance. It may be mixed with a good deal of 
mucus (the secretion of congestion) or remain uncom- 
bined. When secreted scantily, and unmixed with 
mucus, it is often absorbed, so as not to appear at all 
externally. If this is the case, a patient may suffer 
from extensive ulceration, and yet have apparently no 
discharge. In the Appendix, this condition will be 
well illustrated. Many cases will there be spoken of, 
where this discharge existed, but was neither noticed 
or complained of by the patients. 
When the purulent secretion is very abundant, or 
when it is mixed with a large quantity of mucus, which 
circumstance would indicate considerable congestion, 
more or less reaches the external parts, and the pa- 
tient is said to have the " Whites." When the dis- 
charge is purely purulent, it is generally thick, yellow, 118 
woman's complete guide to health. 
and seldom very abundant. However, the amount of 
the morbid secretion in inflammation and ulceration 
of the neck of the womb, is sometimes considerable. 
It then appears externally in large quantities. See in 
illustration cases in Appendix. 
The discharge is sometimes tinged with blood. 
This occurs more especially after any effort or exer- 
tion, or after intercourse ; but it may take place at any 
time, and without any appreciable cause. In some in- 
stances, the exudation of blood, in more or less abun- 
dance, will occur regularly for a week or more after 
each menstrual period, or even during the entire inter- 
val of menstruation. Among my patients, I have met 
with several presenting one or other of these anoma- 
lies. Generally speaking, this exudation of blood sel- 
dom appears in large quantities, and is nearly always 
mixed with the other mucoso-purulent secretions. 
Sometimes, however, pure blood escapes, and severe 
hemorrhage may take place under these circum- 
stances. It is generally pure unmixed blood, but in 
small quantities, which is observed after sexual con- 
gress, and its presence at such a time may be always 
considered a very important symptom, indicating the 
existence of an ulcerated surface within reach, that is 
to say, on the external surface of the neck, liable to be 
bruised and injured by pressure. 
The lengthened sanguineous discharges that not un- 
frequently follow laborious confinements and miscar- 
riages, lasting without intermission for weeks, and 
even months, and proving so intractable to treatment, 
are nearly always connected with and caused by ulcera- 
tive affections of the neck of the womb and its cavity 119 
CASES OF INFLAMMATION OF THE NECK, ETC. 
in a state of great vital activity. As an illustration of 
the above statements, I append the following case, in- 
teresting in more than one point: 
Case XXII.-Menorrhagia, the result of extensive in- 
flammatory ulceration of the neck of the zvomb. Re- 
peated miscarriages in a married, lady. Complete 
recovery. 
On the 20th of January, 1859, I was requested to 
call on Mrs. D , a lady about thirty years old, who 
had come to New York to attend a sick sister of her 
husband. Mrs. D miscarried a very few days after 
her arrival, and, as she thought, in the commencement 
of her seventh month of pregnancy, and had, since said 
miscarriage, seven weeks previous to my visit, a con- 
tinuous bloody discharge more or less abundant. 
After having tried the means generally resorted to in 
similar cases, without improvement, I made an appli- 
cation of the acid nitrate of mercury to the ulcerated 
neck, after which all flooding stopped, and did not 
recur again. The neck of the womb was quite inflam- 
ed, engorged, and considerably ulcerated, extending 
externally over the upper lip, and within its cavity ; 
the ulceration being, moreover, of a very vascular 
character. On inquiry, Mrs. D informed me 
that, as a general thing, she enjoyed pretty good 
health. She was stout, and of full habit. She mar- 
ried five years previous, but had not given birth to 
any children. She miscarried at the end of her sixth 
month after marriage and pregnancy, without being 
able to assign any apparent cause for it, unless it wras 
the sanguineous discharges with which she commenced 120 
woman's complete guide to health. 
to be troubled after a few months from marriage. 
These bloody discharges occurred mostly after inter- 
course, yet would occasionally take place after great 
exertion; but under all these circumstances, and at 
such times, they seemed to have been only of a very 
slight character, and were considered of no importance 
whatever. Her miscarriage was followed with flooding 
for some six weeks, when it ceased. Since that mis- 
carriage, she lost much more blood after intercourse, 
or after considerable exertion, than before. In this 
state of things, and about a year and a half after her 
first miscarriage, she became again pregnant, and I 
met her five weeks after her second miscarriage, under 
the circumstances as stated above. The patient fol- 
lowed up the treatment so auspiciously commenced for 
some six weeks, and then returned home. She there 
persevered in following up the treatment, calling once 
a week upon me, and shortly afterwards she was en- 
tirely cured of her affection, and of all her symptoms 
which had characterized the disease ; symptoms which, 
on inquiry, Mrs. D acknowledged had existed for 
some time past, but said she had paid little or no at- 
tention to them. In the beginning of November, 1864, 
I was informed that Mrs. D had had a fortunate 
pregnancy, and had been delivered of a strong and 
healthy boy. 
JI.-LOCAL OR SUBJECTIVE SYMPTOMS. 
" Les symptomes sont le cri des organes souffrants." 
(Symptoms are the outcry of suffering organs.)- 
Broussais. 121 
LOCAL SYMPTOMS OF INFLAMMATION. 
Local symptoms are those symptoms appreciable by 
the patient alone, and are furnished by the extension 
of the inflammation of the womb or its neck to the 
surrounding- organs or tissues, to wit: to the vagina 
and vulva; to fhe rectum and bladder;-by pain 
and its seat. 
(1).-EXTENSION OF THE INFLAMMATION TO THE VAGINA 
AND VULVA, OR EXTERNAL ORGANS. 
When the neck of the womb is inflamed, the con- 
gestion and inflammation very frequently extend more 
or less to the vagina, or canal leading to the womb; 
when severe, it occasions swelling and great tender- 
ness of this organ, rendering sexual congress, or any 
other manipulation tending to cleanliness by washing 
the parts, or with a view to appropriate medical 
treatment, painful and distressing, indeed almost im- 
possible. The inflammation occasionally extends still 
lower to the external parts, and is often, under such 
circumstances, accompanied by a very distressing 
symptom, intense itching. This itching has been gen- 
erally described as a disease per se, and may be oc- 
casionally so met with; but if clinical observations 
can be trusted, this itching is in reality nearly always 
connected with inflammation of the neck of the womb, 
extending downwards to these parts. Should this 
itching of the external organs be considered as an in- 
dependent disease, instead of as a symptom of disease 
of the womb, and consequently be allowed to run its 
course, and the means of treatment be only applied to 
the external organs, there will be but little chance that 
it will be cured, however energetic the treatment 122 
woman's complete guide to health. 
adopted for its relief. On tlie contrary, it disappears, 
or is easily subdued, once the inflammation of the 
womb has been removed. Well do I remember my 
failure in two cases of pruritus pudendi, or itching, 
that presented themselves in my practice a few years 
back, for which I prescribed, according to custom, 
medicated injections and fomentations. I failed, I say, 
just as one or two other physicians who had been con- 
sulted before me had failed, till one of the patients 
complained of other symptoms, which unmistakably 
characterized a morbid affection of the womb. To 
this affection I immediately directed my treatment, 
and it was not long before I had the pleasure to be in- 
formed by my patient that the itching which had so 
tormented her, had disappeared, and without any 
effort on my part to subdue it, since my attention had 
been paid exclusively to the affection higher up. Be- 
fore this patient was well cured of her troubles, I had 
already shaken off my shyness in relation to physical 
examinations, and the second patient also was soon 
relieved of her miseries. From this time, I never have 
prescribed for any patient complaining of this itching 
of the external organs without a thorough preliminary 
examination, and I have succeeded in relieving and 
curing these cases in the shortest time it could possi- 
bly be done. I would further remark, that, under all 
similar circumstances, such examination should be re- 
sorted to. It will be a saving of time, money, and, 
before all, of misery. I insist here that women, when so 
affected, should be courageous enough to solicit such 
preliminary step to be made before they allow them- 
selves to be prescribed for. To proceed otherwise, is, 123 
CASE OF PRURITUS PUDENDI. 
on the one hand, prescribing in the dark, for what is 
unknown, and consequently it is justly failing to make 
a suitable return for the trust that will benefit but one 
party; and, on the other hand, the ignorance is as 
great, the anticipated relief is not obtained, things are 
allowed to progress, and the patient's state of health, 
even life itself, are made wretchedly miserable. I 
could here adduce several cases where this itching of 
the external organs was the prominent symptom for 
which the patients were urgent in seeking relief. Let 
the following suffice at this place, and let the Appen- 
dix be consulted for others there related. 
Case XXIII.-Severe case of Pruritus Pudendi, the effect 
of granular inflammation of the neck of the womb, in a 
lady of thirty. Ultimate cure. 
In the latter part of May, 1863, I was consulted by 
Mrs. O , a very refined and educated lady, on ac- 
count of an intense itching, which had troubled her for 
nearly a year. Mrs. O married six years before, 
and had three children. Before her marriage, and 
until the birth of her third child, her health had been 
good in every respect. Her third confinement was 
long and tedious, and her delivery was effected instru- 
mentally. Her recovery was slow, and her health had 
since changed very much from what it used to be. 
Symptom after symptom gradually appeared, and the 
state of her health the day of consultation was as fol- 
lows : Nervous prostration, pallor of countenance, in- 
tense itching of the external organs, which had been 
troubling her severely for the year past, notwithstand- 
ing all the medicated injections and washes she had 124 
woman's complete guide to health. 
resorted to on the recommendation of her family phy- 
sician. This itching was not continual. She was free 
from it for a day or so, once in a while; but when- 
ever it returned, it became intense, unbearable, mad- 
dening almost, and the furious scratching she could not 
help resorting to, rendered this state of things consider- 
ably worse ; she had then to keep in her room. She 
was most urgent to receive relief from this unbearable 
affection, forgetting all else. On inquiry, she acknowl- 
edged the existence of a thick yellow discharge, of rather 
a foetid and acrid character ; of pains in the back, and 
of a host of other symptoms, indicating functional 
derangement; of impaired digestion, and of morbid 
nervousness. Her family physician treated her for 
nearly a year, without at any time inquring in rela- 
tion to the performance of the functions of the womb, 
and without ever soliciting an examination of the parts 
affected. Later, however, he solicited and obtained 
leave for such examination ; but he did not extend his 
examination further than the external parts. This ex- 
plains his failure to relieve his distressed patient. On 
examination, I ascertained that the itching was but 
the " effect " of a granular inflammation of the neck 
of the w'omb, which had involved, by extension, the 
external organs. After five weeks of treatment, Mrs. 
O began to improve, and wras declared cured of 
her affection of the womb at the end of the sixth 
month of treatment. Her health had steadily im- 
proved, and the itching, which had made her so 
wretched for a ■whole year, disappeared, before the 
third month of the treatment pursued. 125 
INFLAMMATION OF RECTUM AND BLADDER. 
(2.)-EXTENSION OF THE INFLAMMATION TO THE REC- 
TUM AND BLADDER. 
Inflammation of the neck of the womb, when severe 
and chronic, not unusually extends to the rectum and 
to the bladder and urethra, or at least exercises a 
morbid influence over these two organs. The vascu- 
lar system of the three pelvic viscera, the bladder, 
womb and rectum, is so intimately connected, that it 
is all but impossible for one of these to suffer much 
from long-continued inflammation, without the other 
feeling more or less the effects of the disease. 
The rectum, or lower bowel, is, indeed, generally 
affected in chronic disease of the womb. This clini- 
cal fact is explained not only by the vascular connec- 
tion of the rectum with the womb, as above stated, but 
by the physical pressure exercised on the former by 
the diseased and enlarged womb. If the body of the 
womb is inflamed and enlarged, it falls backwards, so 
as to rest with its entire weight on the rectum. If the 
neck of the womb is enlarged and indurated, as it fre- 
quently is, it is generally thrust back mechanically, 
so as to press on the rectum, the body of the womb 
remaining in situ, or being carried forward. In either 
case, the pressure on the rectum is attended with the 
same distressing results as when the body of the womb 
is retroverted or thrust backwards, and presses on 
the rectum. The contents of the rectum meeting with 
a physical obstruction to their passage downwards, 
accumulate above, and keep the upper part of the rec- 
tum permanently distended. Their passage is also 
generally attended with great pain (tenesmus), espe- 126 
woman's complete guide to health. 
daily if they are solid, owing to the contents of the 
rectum having to lift the inflamed and indurated neck 
of the womb that obstructs their exit. The body of 
the womb, however, being infinitely more painful and 
sensitive when inflamed than the neck, the pain, when 
an evacuation is produced, is, of course, so much 
greater. The combined action of the causes enume- 
rated and others, in the course of time, appear to de- 
stroy the natural contractility of the rectum, and, as a 
necessary result, to induce obstinate constipation. 
Indeed, constipation, from want of sensibility and contrac- 
tile power in the rectum, is one of the characteristics of 
chronic inflammation of the womb and of its neck. 
Hemorrhoids, or piles, and prolapsus ani are not un- 
frequent complications of the disease under considera- 
tion, owing to the operation of the causes that have 
just been enumerated, viz., obstinate constipation and 
the straining which it occasions; as also secondary 
congestion and irritability of the rectum, impeded cir- 
culation, dilatation and relaxation of the bowel and of 
its mucous surface. The attacks of piles occur most 
frequently at the period of menstruation, when, as my 
readers are aware, the pelvic irritability and conges- 
tion are at the greatest height. These attacks are 
often very frequent and very severe, and add greatly 
to the discomfort of the patient. 
As to the bladder, the anatomical connection that 
exists between it and the womb, renders it almost 
equally liable with the rectum to suffering, secondarily, 
when the neck of the womb is the seat of inflammatory 
disease. The bladder and urethra may become congested 
and, irritable, giving rise to pain, accompanied by a fre- PAIN AND ITS SEAT. 
127 
quent desire to pass water: Ute patient is often obliged to 
get up several times in the night, in order to empty the 
bladder; and there are cases in which the water can 
scarcely be retained for more than half an hour at a time, 
owing to difficulty in its excretion, and to heat and scald- 
ing in the urethra as it passes. See cases in Appendix. 
These symptoms occur with the greatest intensity 
during the menstrual periods, when, generally speak- 
ing, and to reiterate the assertion, the inflammation 
of the womb becomes exacerbated. As the inflamma- 
tion subsides during the interval of menstruation, the 
dysuria diminishes, and the (vesical) irritation of the 
bladder becomes endurable. 
In relation to the reciprocal sympathies between the 
womb and the bladder, as just noted, Dr. W. F. Mont- 
gomery makes the following judicious remarks : " It is 
familiar to us all, that in -the human female there is an 
intimate reciprocal sympathy between the womb and 
bladder, and other parts of the urinary apparatus; so 
that, under a variety of circumstances, when the 
former organ is the seat of any anomalous action, or 
is brought into a state of exalted sensibility, whether 
from natural or morbid causes, the latter is not only 
liable, but very apt to sympathize, and suffer corre- 
spondingly." 
(3).-PAIN AND ITS SEAT. 
One of the chief causes, undoubtedly, which tend- 
ed to keep the profession at large in ignorance of the 
frequent existence of inflammation of the neck of the 
womb, and its sequela, ulceration, was, that the disease 128 
woman's complete guide to health. 
very often exists without (jiving rise to pain or uneasiness in 
the region affected, and that when pain is experienced, it is 
often at a distance from the seat of the morbid action, in 
regions that are perfectly healthy. Extensive inflamma- 
tory and ulcerative disease of the neck of the womb 
may, indeed, be present for years without giving rise to 
pain, or to any well-marked local symptoms; the only 
evidence in such cases, of its existence, especially to a 
superficial observer, being functional derangement of 
the womb, and the general sympathetic reactions. The 
pain occasioned by inflammation and ulceration of the 
neck of the womb is seldom felt in the region of its 
seat, but in one or both of the ovarian regions, in 
some part of the lower back, and, in nine cases out of 
ten, it is the left ovarian region alone, or both, which 
is the seat of pain. A characteristic of this ovarian 
pain is, that it is circumscribed in its seat, does 
not radiate over other regions, is of a dull, aching, 
constant, circumscribed character, and its existence in 
the left ovarian region, is all but pathognomonic of in- 
flammatory affection of the neck. 
The pain in the back is of the same dull, aching 
character. It is sometimes scarcely perceptible, only 
amounting to what patients may call a " weakness," 
excepting perhaps after fatigue. In many instances, 
however, this pain in the back is very severe, and may 
be perfectly agonizing, incapacitating the patient for 
any exertion. She feels, she says, as if her back were 
broken, and she can neither stand nor sit erect with 
comfort. When there is pain in the region of the neck, 
it is experienced in the region of its seat. This pain DYNAMIC OR FUNCTIONAL SYMPTOMS. 
129 
generally radiates all over that (lower abdominal) 
region. 
These three pains may exist conjointly or sepa- 
rately. They are produced alike by inflammation 
without ulceration, and by inflammation with ulcera- 
tion. They are, however, much more marked when 
there is ulceration, more frequently severe and much 
more constant. The uninterrupted persistence of one 
or of all these pains, even when slight, is an impor- 
tant feature in their character. They are always pres- 
ent to a certain extent; yet they may be better after 
rest, and in the intervals of the menses, and worse 
after fatigue and at the menstrual period. In addi- 
tion to the above-named pains, which peculiarly char- 
acterize inflammation and ulceration of the neck of the 
womb, there are often other pains present, to wit: in 
the hip, in the groin, and down the thigh, and in other 
regions supplied with the sympathetic system of 
nerves, etc. As I have stated before, a dull, aching 
pain seems to be the characteristic form in which suf- 
fering manifests itself in the sympathetic system of 
nerves. 
Ill-DYNAMIC or functional symptoms. 
By functional symptoms, we understand the two 
great functions of the womb, viz. : 1. Menstruation ; 2. 
Impregnation. Inflammation, both acute and chronic, 
nearly always modifies the functions of the organs 
which it attacks. The functions of the womb, as 
might thus be anticipated, are generally more or less 
disordered by the existence of an inflammation and 
ulceration of its neck. 130 
woman's COMPLETE GUIDE TO HEALTH. 
(1.)-MENSTRUATION. 
An affection of the neck of the womb seldom exists 
for any length of time without unfavorably modifying 
menstruation. Owing, however, to the great varia- 
tions that exist, physiologically, in healthy women, as 
to the pain, periodicity, duration, and amount of the 
sanguineous discharge, it is impossible to establish any 
precise standard, applicable generally, by which we 
may judge of the state of menstruation in any given 
patient, with reference to the existence or the non- 
existence of inflammatory disease of the neck of the 
womb. It may safely be asserted, notwithstanding, as 
a general rule, that, under the influence of inflammation, 
menstruation usually becomes painful, anomalously scanty 
or abundant, and irregular, both as to periodicity and 
duration. 
These variations not being incompatible with health 
within certain limits, their existence does not neces- 
sarily indicate a state of inflammatory disease; but 
we are warranted in suspecting the presence of inflam- 
mation, whenever menstruation, previously easy, be- 
cumes laborious and irregular, or whenever its natural 
difficulty becomes much increased. In a word, the 
existence or non-existence of morbid symptoms in con- 
nection with menstruation, must be ascertained by the 
analysis of the entire uterine life of the patient, and 
by comparison of the present with the past. It is 
with herself only, when in health, that we can com- 
pare her, if diseased. 
The pain experienced during menstruation, when 
the neck of the womb is inflamed and ulcerated, is 131 
DYNAMIC OR FUNCTIONAL SYMPTOMS. 
greatest for the first few hours, or for the first clay or 
two, like the physiological menstrual pain. Unlike 
the latter, however, it often persists with great severity 
during the entire period, and for some time after. 
Occasionally it is agonizing and continued, so much 
so, as to confine the patient to her bed, and to render 
sleep impossible for days and nights. It is then nearly 
always accompanied by nausea and sickness, and by 
some degree of general febrile reaction. The pains are 
of the same nature as those felt during the menstrual 
interval, which were noticed a few pages back. These 
pains are, generally speaking, alike intense and constant, 
but diversified by occasional colicky pains in the womb. 
The entire lower abdominal region is tender, painful in 
these extreme cases, and often so sensitive as scarcely 
to bear the pressure of the bedclothes. The great 
increase of pains occasioned by inflammatory ulcera- 
tion of the neck of the womb during menstruation, is 
owing partly to the congestion that accompanies men- 
struation, referred to before, distending the more than 
usually sensitive tissue of the neck and body of the 
womb, and partly to temporary exacerbation of the 
local inflammation. In patients thus suffering, there 
is evidently at each monthly period a revival and an 
extension of the local inflammation. A large propor- 
tion of the cases of severe dysmenorrhoea, generally 
supposed to be merely functional, are undoubtedly 
cases of this description. 
The periodicity of menstruation is very frequently 
modified by the existence of the local inflammation. 
The menses either return too frequently, or are retard- 
ed in their manifestation. Thus, instead of appearing 132 
woman's complete guide to health. 
every four weeks, they appear every three weeks, or 
even more frequently, or are delayed from a few days 
to several weeks, or even months. The influence of 
the affection under consideration, in retarding the ap- 
pearance of the menses after parturition, is very re- 
markable. When the neck is thus affected, the return 
of the menses is often retarded for two, three, or four 
months, although the patient be not nursing. 
The duration of the menses is also morbidly modified 
by the local disease. It may be either increased, last- 
ing two or three times as long as in health, or dimin- 
ished in the same ratio. It is most frequently, however, 
diminished. The flow of blood sometimes ceases for a 
day or more, to return again for a longer or shorter 
period. Occasionally, also, it appears to be prolonged 
for several days by a sanguineous exudation from the 
ulcerated surface. This is proved to be the case by 
cauterization of the ulceration putting a stop to the 
discharge. See Case XXII. 
The above remarks apply also to the quantity of the 
menses. This may be increased or diminished, but is 
most frequently of the latter character. These changes 
in the amount of blood excreted during menstruation, 
are apparently the result of extreme congestion, oc- 
casioned by an anomalous determination of blood to 
the womb, under the influence of local irritation. The 
womb thus congested, may be unable to relieve itself 
of the blood that distends it, or may, on the contrary, 
pour it out too freely. The quantity of blood lost 
may be so great as to constitute flooding. This more 
especially occurs when the neck is the seat of very 
vascular ulcerations. 133 
DYNAMIC OR FUNCTIONAL SYMPTOMS. 
The morbid congestion of the womb that generally 
accompanies and follows menstruation in inflammatory 
ulcerations of the neck, exercises an unfavorable influ- 
ence on the disease. In most instances, the inflamed 
and ulcerated surface is found more tumified, more 
irritable, more angry-looking than usual on the first 
examination, after menstruation has ceased, and some- 
times it takes a week or more to bring the diseased 
parts into the state in which they were before the 
menses set in. When this is the case, it may really be 
said that the patient suffers a relapse every month or three 
weeks, and that there is in each month only ten or four- 
teen days available for treatment. Occasionally, on the 
contrary, even in the most severe cases, menstruation 
does not appear in the slightest degree to interfere 
with the curative process, which progresses during its 
presence as rapidly as at any other time. 
(2.)-IMPREGNATION. 
Menstruation is a function preparatory only to im- 
pregnation, its office being periodically to prepare the 
womb to receive, retain, and nourish the product of 
conception. Reflection alone might lead to the con- 
clusion that inflammatory and ulcerative disease of the 
neck of the womb must modify, more or less, this, the 
principal function of the womb ; and experience shows 
that such is really the case. Inflammation of the neck 
of the womb is by far the most frequent cause of ster- 
ility, both in originally sterile and in previously fruit- 
ful women. The great majority of originally sterile 
women present, on consultation, some obscure inflam- 134 
woman's complete guide to health. 
matory affection of the neck, which can nearly always 
be traced to the period immediately following mar- 
riage, and in some to a period antecedent to marriage. 
When women, in the prime of life, who have previ- 
ously been fruitful, suddenly stop childbearing, with- 
out any evident cause,-if their general health fails, 
or if they present the slightest symptoms suggestive 
of disease of the womb, the existence of inflammation 
of the neck may be at once suspected. Some women, 
however, have so great a susceptibility to conception, 
that inflammatory disease of the neck, however exten- 
sive, does not appear to prevent it. When impregna- 
tion takes place under these circumstances, the preg- 
nancy is generally painful and laborious, and fre- 
quently terminates in abortion. In quite a number of 
instances I ascertained the local disease to be all but 
invariably the cause of the successive abortions that 
occurred with some women in the first few years that 
followed marriage. It is also one of the most frequent 
causes of the abortions that occur in childbearing wo- 
men. This cause of sterility may be removed by cur- 
ing the inflammatory affection to which it owes its 
origin. Clinical observations fully bear out these 
statements. In 1858 I met, among other cases of 
miscarriages, the two following, in which occasion was 
afforded me of examining the state of the womb, and, 
consequently, I was enabled to ascertain the presumed 
cause of the abortions. 135 
CASES OF REPEATED MISCARRIAGE. 
Case XXIV.-Repeated miscarriages, dependent on ex- 
cessive inflammatory ulceration of the neck of the womb, 
etc., in a married lady. The treatment recommended 
declined. 
I was summoned to Mrs. V. F., a well-educated and 
very refined lady, twenty-eight years old, to attend 
her in her sixth miscarriage. A fortnight later, when 
she had somewhat recovered her strength, for her last 
miscarriage had been attended with a good deal of 
flooding, much more so than former ones, I took the 
opportunity, in the course of a conversation between 
Mrs. V. F. and some of the members of the-family, in 
which she expressed deep regrets for her reiterated 
misfortunes, and hinted how welcome would be the 
coming of a child, to inquire respecting the lady's 
health previous to her marriage and subsequently to 
it. She informed me that she enjoyed tolerably good 
health before she married, six years before ; that she 
miscarried five times in succession, at different periods 
of her pregnancy, and that she knew not, nbr suspected 
any causes which led to this, unless it were, as she 
had been made to believe, her extreme nervous sus- 
ceptibility. I informed her that her miscarriages were 
undoubtedly referable to some abnormal state of the 
womb; that her actual state of health and repeated 
misfortunes demanded that an examination of the 
organ should be had, and that a treatment should be 
adopted according to the state in which the womb 
should be found; that the removal of any affection of 
that organ would certainly be the removal of the cause 
of her repeated miscarriages, and would also be the 136 
woman's complete guide to health. 
means of her ultimate restoration to perfect health. 
The examination was consented to, and as might have 
been expected, I found inflammation and ulceration of 
the neck of the womb, in a high state of activity; it 
was hypertrophied, lowered, and considerably deviated 
from its normal situation. But though this lady had 
consented to afford me the opportunity of ascertaining 
the state of the womb, she had not the courage-or, 
perhaps, from motives of false delicacy, did not accept 
the only chance that could restore her health by re- 
storing the diseased organ, and thus realizing the un- 
utterable and almost lost hope of becoming a mother. 
Case XXV.-Seven consecutive miscarriages, the result 
of inflammatory ulceration and elongation of the neclc 
of the womb in a married lady. Complete cure. 
A second case offered itself only a short time later 
than the above. It was that of Mrs. E , a lady in 
good circumstances, married nine years, but still child- 
less at thirty-two. She had, during these nine years, 
seven miscarriages: her first pregnancy came to a 
premature termination in the middle of the eighth 
month; her second, at the commencement of the 
ninth, but both children bore marks of having been 
dead for some time. Her other miscarriages happened 
at different periods between the third and fifth month 
of pregnancy, and it was at her eighth, in the com- 
mencement of her third month of pregnancy, that I 
was sent for. 
Having recovered from the effects of her last mis- 
carriage, Mrs E gave me the history of her past 
and present troubles. She would have enjoyed excel- CASES OF REPEATED MISCARRIAGE. 
137 
lent health but for the abnormal state of her courses. 
Her first menstruation had been attended with con- 
siderable distress and sickness, and had continued so 
ever afterwards. After her marriage, the condition 
of her courses became still worse, while her health 
became also impaired. She had officiously been made 
to anticipate that her marriage would improve her 
condition; an advice which I am aware is not very 
uncommonly given, and certainly most willingly ac- 
cepted. Her strong constitution and nerve-power 
resisted for some time, with more or less success, the 
morbid influence that was undermining her health, 
but she had at last to give up the struggle, and it was 
in this state of health, and at the time of her eighth 
miscarriage, that I saw her, a picture of great suf- 
fering. 
In due time, I solicited an examination of the womb, 
and I found the genital organs hot, humid and very 
relaxed, the neck of the womb excessively retroverted, 
painful, and its posterior lip greatly elongated. The 
mouth of the womb gave evidence of ulceration, but 
how extensive was not ascertained, on account of 
difficulty in adapting the instrument, and bringing 
the neck, deviated as it was, within its focus. 
Could it be doubted for one moment that all Mrs. 
E 's suffering was referable to her disease, and 
that the latter was also the cause of her repeated mis- 
carriages ? Her affliction had undoubtedly had its 
starting point from the very dawn of her womanhood, 
in the form of severe dysmenorrhoea. We have seen 
its consequences afterwards. 
Anxious to recover her health, and hopeful of yet 138 
woman's complete guide to health. 
giving her husband a token of her love, she agreed to 
the proposed treatment, which she scrupulously fol- 
lowed up until all vestiges of the affection had disap- 
peared. When she called last, her health was better 
than it had ever been since she commenced to men- 
struate ; she was preparing to visit Niagara Falls with 
her husband, and that was, I regret to say, the last I 
heard from Mrs. E . 
While on this subject, I should reproach myself for 
neglect if I did not give my readers the benefit of Dr. 
James Whitehead's experience in all that relates to 
morbid pregnancies and abortions, which he obtained 
through a series of indefatigable inquiries and obser- 
vations in thousands of subjects, wflio presented them- 
selves at the Manchester Lying-in Hospital, with 
which he is officially connected, for assistance in their 
confinement, as wTell as for relief in all cases of diseases 
peculiar to women. " The causes of abortion," he 
remarks, " are generally referred to accidents, as falls, 
blows, over-exertion, wrant, mental perturbation, and 
the like ; but in many cases thus accounted for, the 
exciting agency appears so very trifling, that were 
such influence equally injurious upon every individual 
upon whom it is exercised, the full term of utero- 
gestation would rarely be accomplished. Some women, 
even of delicate frame-the womb being in a normal 
condition-wilt endure in an extraordinary manner 
during pregnancy, hardships and privations of the 
severest description; fatigue, starvation, grief and 
cruelty, disease, external violence and a variety of 
pernicious practices pursued with criminal intention, 
without in any way interfering with the well-being of DR. JAMES WHITEHEAD'S TESTIMONY. 
139 
the foetus. Hence may be reasonably inferred the 
existence of a potent predisposing cause in many so- 
called accidental miscarriages. But in more than 
three-fourths of all the abortions which happen, no 
accidental or other appreciable cause can be assigned 
by the patient for the occurrence. 
" This fact was ascertained by statistical inquiry of 
several thousands of patients seeking relief at the 
institution. When further interrogated respecting 
their own or their medical attendant's opinion on 
the subject, the event was for the most part vague- 
ly referred to that state of the system popularly 
denominated an " inward weakness "-a convenient 
expression by which an important and extensive 
class of diseases are summarily disposed of, whose 
real nature is as little understood as the practice 
adopted for their relief is unscientific and empirical. 
This term refers, generally speaking, to one leading 
symptom, namely, "leucorrhoea," or the "whites," 
the existence of which was so constant in those cases' 
of abortion for which no known cause could be as- 
signed, as to lead to the suspicion that the condition 
upon which this phenomena depended was that also 
which commonly interfered with the favorable con- 
tinuance of utero-gestation. Having, by the evidence 
of a number of observations, arrived at a conviction 
upon this point, I was not long in adopting the only 
procedure liable to afford the necessary information 
respecting the nature and seat of the lesion with which 
leucorrhoea was commonly associated." 
Accordingly, Dr. Whitehead instituted several series 
of inquiries, whose results I will state as briefly as 140 
woman's complete guide to heaettt. 
possible. His first series of inquiries extended to 
two thousand patients ; they formed the subjects of 
investigation concerning the actual prevalence of leu- 
corrhoeal complaints during pregnancy. Of these two 
thousand cases, eleven hundred and sixteen had the 
whites at the time the inquiry was made, and a con- 
siderable number more had suffered under similar 
ailment at some former period. In nine hundred and 
thirty-six of these eleven hundred and sixteen cases, 
or eighty-three per cent., the discharge bore undoubted 
evidence of the presence of pus, or of sanies, and, in 
some instances, it was more or less mixed with blood; 
of these nine hundred and thirty-six cases, five hun- 
dred and forty-four, or fifty-eight per cent., had pre- 
viously miscarried. The discharge in the remaining 
one hundred and eighty cases was said to be colorless, 
and thirty-one of these had previously miscarried. 
In other words, out of two thousand patients, eleven 
hundred and sixteen had the whites, and of this num- 
ber, five hundred and seventy-five had miscarried. 
In another course of inquiry, extending to three 
hundred and seventy-eight cases of abortion, examined 
principally with a view to obtain a correct statistical 
average of the prevailing causes thereof, it was ascer- 
tained that two hundred and seventy-five cases of 
abortion were referable to disease of the neck of the 
womb, and one hundred and thirteen to accidental or 
other agencies. 
On a former occasion, he further remarks : " Whilst 
employed upon a course of inquiry of the present 
character (he alludes to an investigation made in 
reference to the history of menstruation, and extended DR. JAMES WHITEHEAD'S TESTIMONY. 
141 
to upwards of two thousand cases), I was struck with 
the constancy with which leucorrhoeal affections ex- 
isted previous to the occurrence of abortion, and by 
the fact that the discharge was invariably accompa- 
nied by a certain well-marked train of local and con- 
stitutional disturbances, and sometimes with evidence 
of disease of specific character. On submitting these 
cases to specular examination, the source of the dis- 
charge and the cause of suffering appeared to be at 
once revealed, disease of the lower part of the womb 
being found to exist in almost every instance. That 
this lesion of structure constitutes the true morbid 
pathological seat of leucorrhoea and of all its associated 
phenomena, as well as a very frequent cause of disas- 
trous events during pregnancy, is further corroborated 
by the beneficial effect of the treatment adopted when 
this w'as especially directed to the affection of the 
womb." 
These observations, coming as they do, from a prac- 
titioner of so high repute and experience as Dr. 
Whitehead is so legitimately considered to be, and 
presenting facts so clearly stated, and of such absorb- 
ing interest in more than one respect, and, moreover, 
so fully corroborating my more limited experience 
on this particular subject, are such, that I make no 
apology for having laid the above statements before 
my readers in extenso. 
In France, Dr. Cazeaux, a most eminent obstetrician, 
and others, examined a large number of cases of preg- 
nancy, with a view to determine the frequency of 
ulceration in this condition, and found ulceration to 
exist in a very large proportion of the cases examined. 142 
woman's COMPLETE GUIDE TO HEALTH. 
(8).-UTERINE INERTIA, OR INERTIA OF THE WOMB. 
Inertia of the womb, or the diminution or absence 
of the sexual feelings, is another important functional 
symptom of inflammation and ulceration of the neck 
of the womb, as also of inflammation of the womb gen- 
erally. This symptom is frequently met with,-indeed, 
may be said to be generally present, when the disease 
is severe, and is often one of the first indications of 
the existence of the affection under consideration. It 
is sometimes carried to such an extent, as not only to 
be attended with an entire absence of all natural 
Sensations, but so as to inspire feelings of disgust, if 
not of loathing, and that independently of any physi- 
cal pain. • The cause of this change in the feelings of 
the patient being misunderstood, or even unsuspected, 
great unhappiness often ensues in married life. The 
change is attributed to loss of regard and affection, 
whereas, it is solely the result of physical disease. 
This is more likely to occur, as my readers will 
readily perceive, when the subjective or local symp- 
toms are obscure or absent, as is so very frequently 
the case, and when the disease of the womb only 
manifests its existence by thus modifying its func- 
tional vitality, and by debilitating and impairing 
the general health. As the inflammation subsides 
under appropriate treatment, the womb gradually re- 
turns to a natural physiological state, and this return 
is one of the most satisfactory and conclusive indica- 
tions of a radical cure having taken place. In some 
exceptional cases, so far from inertia of the womb be- 143 
SEXUAL CONGRESS. 
ing the result of inflammation, the sexual feelings are 
increased and exaggerated. 
(4).-SEXUAL CONGRESS. 
When the neck of the womb is inflamed and ulcer- 
ated, sexual congress is often painful. The pain may 
be either experienced at the time, for a few hours 
after, or on the following day. Sometimes general 
weakness, or mental depression only, is subsequently 
experienced. Not unfrequently, although there may 
exist extensive inflammatory ulceration, and enlarge- 
ment of the neck, no pain is experienced; such women 
live with their husbands, just as usual, without incon- 
venience ; and impregnation, under such circumstances, 
is not altogether of unfrequent occurrence. 
Sexual congress may be and is quite often, under 
the disease in question, followed by a discharge of a 
few drops of blood, or even by considerable flooding- 
a circumstance to which due reference has already 
been made. As an illustration to the above remarks, 
I append here the following case : 
Case XXVI. - Extensive ulceration in the neck of the 
icomb in a married lady ; no hindrance to impregna- 
tion, or to the preservation of tolerably good health. 
Exceptional case. 
In 1859, I was consulted by a German lady of good 
standing, of this city, aged thirty-eight, on account of 
the non-appearance of her courses for the last three 
months, and the possibility of it indicating pregnancy. 
The lady and her husband contemplated shortly a 144 
woman's complete guide to health. 
visit to Germany, and a pregnant state would preclude 
the possibility of going. On examination, I found 
the neck of the womb considerably enlarged, congest- 
ed, sensitive, and retroverted; the mouth of the 
womb presented one mass of livid, luxurious, fleshy 
ulceration, and the vagina throughout presented signs 
of the extension of said congestion to its walls. She 
was pregnant. This state of the neck, apart from its 
actually greater excited state of congestion and inflam- 
mation, dependent on pregnancy, must have existed 
for some time past. Yet though, according to the 
history as given by this lady, she had given birth to a 
child about every fifteen or eighteen months, for the 
last ten years (she was now with her eighth child); 
she had never miscarried; had no subjective or local 
symptoms of any importance, if we except a slight 
permanent vaginal discharge, which she had never 
minded ; there had been no difficulty or any thing un- 
usual in relation to sexual congress, or other func- 
tions of the womb ; she had only complained of a few 
sympathetic symptoms, which, on her part, had never 
received the slightest consideration. Consequently, 
she had never doctored on their account. She was in 
due time delivered, and made subsequently a safe voy- 
age and return from Germany. At the present time, 
December, 1865, this lady is still in the same state of 
general health as I noticed in her in 1859, except that 
she has been blessed since with another child. As yet, 
no doctor has been called upon to attend to her 
affection. 
This case is exceedingly interesting in more than 
one respect. It shows how extensive disease of the TAIN ANT) SWELLING OF THE BREASTS. 
145 
neck of the womb may be, and yet not interfere in the 
least with any of the various functions of the womb, 
which have successively been under consideration ; or 
its existence be manifested by any of the leading char- 
acteristic local or sympathetic symptoms, if we except 
the discharge, and an occasional slight impairment of 
her appetite-symptoms which were, as has been seen, 
so trifling as to be hardly noticed. Indeed they were 
altogether disregarded by the patient. Lastly, it ap- 
pears how long and extensive such inflammation and 
ulceration, as this case presented, may be in operative 
action, without decided detriment to the general 
health. But her case, my readers will observe, is a 
very exceptional one indeed. 
(5).-THE BREASTS. 
Another functional symptom in inflammatory disease 
of the neck of the womb, which is occasionally met 
with, is sympathetic pain and swelling of the breasts. 
These may become enlarged, irritable, and preternatur- 
ally sensitive, or they may only become so before and 
during menstruation. There may be hardness and 
tenderness to the touch, and the areola round the nip- 
ple may increase in size, and become darker, as in the 
first stage of pregnancy, the sebaceous glands also 
enlarging and becoming prominent. The left breast, 
I ought to observe, is the one mostly so sympatheti- 
cally affected. 146 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
IV.-SYMPATHETIC OR CONSTITUTIONAL SYMPTOMS; 
ALSO CALLED SECONDARY SYMPTOMS. 
When the womb or its neck is diseased, there are 
generally present, independent of any of the local 
symptoms described in the preceding pages, a greater 
or lesser number of sympathetic or constitutional 
symptoms, which are, by every authority, considered 
of the highest scientific importance. These sympa- 
thetic symptoms are th more important, because the 
attention of the medical attendant is, at first and most 
frequently, if not exclusively, called rather to the sym- 
pathetic than to the subjective or local symptoms, or to 
the original cause of any of these symptoms. Dr. 
William H. Byford, of Chicago, very judiciously re- 
marks on this subject, " that the secondary or sympa- 
thetic diseases distress patients most, and the. fact of 
their mentioning no other troubles, may, without in- 
quiry, mislead us into the belief that they are inde- 
pendent affections." 
The constitutional reactions or sympathetic symp- 
toms are produced by the following organs, systems, 
etc., to wit: 1. Organ of digestion; 2. Intestinal tract; 
3. Liver and kidneys; 4. Organs of respiration; 5. 
System of circulation; 6. Functions of nutrition; 7. 
Cerebral system ; 8. Organ of vision ; 9. Organ of hear- 
ing ; 10. Spinal system ; 11. Pelvic pains, etc.; 12. The 
cutaneous tissue; 13. The nervous system; 14. And, 
lastly, sleep. DIGESTIVE ORGANS AFFECTED. 
147 
(1).-SYMPATHETIC AFFECTION OF THE ORGAN OF 
DIGESTION. 
The influence of inflammation and ulceration of the 
neck of the womb on the functions of digestion, is, 
perhaps, the earliest, the most marked, important and 
common of all the sympathetic reactions, and the ex- 
tent to which these functions become morbidly modi- 
fied, varies very considerably in different individuals, 
although the intensity and duration of the disease 
may otherwise be the same. With some, digestion is 
merely weakened; but with the majority it soon flags, 
and gradually becomes more and more disordered; a 
host of morbid symptoms supervening. Indeed, the 
dyspeptic, gastralgic symptoms frequently assume 
such an intensity as entirely to obscure all others, com- 
pletely misleading both the patient and her medical 
attendant with reference to the real nature of her suf- 
ferings. The appetite may be diminished, but is quite 
frequently exaggerated. In the latter case, there is 
generally a continual sinking, or craving for food, 
which nothing appears to satisfy. Nausea is not 
unfrequently present, and is occasionally followed by 
vomiting, either of the contents of the stomach, or of 
some glary matters, occasionally of bilious fluid. 
There is often great straining and retching, with but 
slight ejection, the ejection consisting mostly of gas. 
These attacks of nausea and vomiting are periodical, 
coming on at intervals, and are especially present 
during the menstrual period. The ingestion of food 
is often followed by a sense of weight, fullness and op- 
pression at the pit of the stomach, and in the chest, or 148 
woman's complete guide to health. 
by a sensation of a foreign body in the throat. It may 
also be followed by the eructation of wind, with which 
the stomach is very often much distended, or by the 
return into the mouth of tasteless or acid fluid, or of 
partly digested food, etc. This gaseous development 
in the stomach is a very common, uncomfortable, and 
occasionally a most severe and distressing symptom 
in affections of the womb, and the more nervous per- 
sons are the more severe and distressing is its pres- 
ence in the stomach. If the stomach should become 
unable, through some cause or other, say the irregular 
action of its muscular fibres, to get rid of this gaseous 
accumulation, spasms, cramps, pain or colic, some- 
times of the most severe character, may be its inevit- 
able consequence. There is frequently pain in the pit 
and region of the stomach, in the chest, and under- 
neath the left breast, in the region of the heart. This 
is of the same dull aching character to which I have 
referred on several occasions, as characterizing pain 
in organs supplied by the sympathetic nerves. There 
is also often considerable cutaneoas sensibility in the 
regions where the pain exists, which is nearly always 
increased by pressure. At times the patient can 
scarcely bear the pressure of her corsets. There is 
likewise heaviness and headache. The headache 
may be frontal, above the eyes, or at the upper part 
of the head-a very common form of headache, and 
often bitterly complained of. Patients describe it as 
being of a dull, heavy, burning and very distressing 
character. 149 
THE INTESTINAL CANAL AFFECTED. 
(2.) SYMPATHETIC AFFECTION OF THE INTESTINAL 
CANAL. 
The sympathy of the intestinal canal with the womb, 
when affected, is no less marked, and probably ranks 
next in frequency to the stomach. A liability to con- 
stipation is frequently complained of. The bowels 
have apparently no natural tendency to move. Con- 
stipation, in many instances, terminates or alternates 
with diarrhoea, lasting for several days. Diarrhoea 
often exists alone, and its character varies consider- 
ably. It may be watery, profuse, weakening (see 
Case XLVI. in Appendix), and is often attended with 
dysenteric symptoms. Occasionally it seems to be 
excited or aggravated by certain articles of food. 
The irregularity of the bowels, in the absence of any 
reasonable cause, is quite characteristic of some affec- 
tions of the womb. This irregularity, moreover, is 
mostly observed at or near the period of menstrua- 
tion. It may last throughout the courses, or only for 
a day or two before. Finally, there is occasionally 
considerable gas developed in the bowels, producing 
distention, noises, and other motions, all of the great- 
est annoyance to patients. For those irregularities 
of the bow'els occasioned by the displacement, or the 
extension of inflammatory action of the womb and its 
neck, my readers are referred to the local or subjec- 
tive symptoms 
(3.) SYMPATHETIC AFFECTION OF THE LIVER AND 
KIDNEYS. 
The functions of the liver often participate in the 
depraved state of the digestive system. The secretion 150 
woman's COMPLETE qUIDE TO HEALTH. 
of bile may be deficient or it may be too abundant, 
owing to sluggish secretion or to anomalous activity. 
Sometimes the morbid state of the biliary functions 
assumes a very prominent feature in the history of the 
case, so much so as to obscure all other symptoms. 
The patient is seized at intervals with severe bilious 
attacks, characterized at first by pain in the right 
side, radiating to the back and shoulders (these pains 
have frequently subjected women to be treated for 
inflammation of the liver); a yellowish tinge of the 
skin, with bilious headache, and subsequently by the 
vomiting and purging of bile in large quantities. 
These attacks appear to be irregular in their mani- 
festation, with entire absence of fever, but are nearly 
always connected with menstruation, immediately 
after it, or one, two, or three weeks subsequently. 
In the latter case, though the vomiting and purging 
are thus deferred, the pain in the side and the other 
premonitory symptoms generally commence with, or 
soon after, the menstrual epoch. In affections of the 
womb, the urine is morbidly modified in various 
modes. The condition most frequently observed is 
the existence of large quantities of salts. There is 
often pain in passing water, and great difficulty of 
excretion, or even complete retention. These symp- 
toms, and more especially retention, re-occur with the 
greatest intensity during the menstrual epochs, wdien, 
generally speaking, the .inflammation of the womb 
becomes exacerbated. As the inflammation of the 
neck of the womb subsides during the interval of 
menstruation, the difficulties in the secretion of urine 
diminish, and the irritation of the bladder becomes 151 
AFFECTION OF RESPIRATORY ORGANS. 
endurable. The desire to void urine is very frequent, 
and as the urine passes along the urethra, it gives 
rise to a sensation of heat and scalding. Further 
details have been given in this relation, when speak- 
ing of local symptoms, to which I respectfully refer 
my readers. 
(4.) SYMPATHETIC AFFECTION IN THE ORGANS OF 
RESPIRATION. 
The pains felt in the region of the stomach, pre- 
viously noticed, often radiate to other regions. Severe 
pains may then be experienced underneath the ster- 
num or extending all over the chest. These pains are 
sometimes so severe as to interfere with the action of 
the lungs, and to render respiration difficult and pain- 
ful. Under these circumstances, several other symp- 
toms may be experienced ; and first, a sense of con- 
striction or tightness, as if a full breath could not be 
taken. This constriction is, in many cases, almost 
permanent; in others, it is paroxysmal, mild or ex- 
ceedingly intense in its attacks, recurring daily or at 
longer and irregular intervals. Second, by coughs-a 
no less common, annoying, and often distressing 
symptom. The cough may be of a dry, short, hack- 
ing character, scarcely noticed by patients, although 
painful enough to the bystanders ; it is the most com- 
mon of coughs. Occasionally it is sonorous, hard and 
apparently distressing. The cough, in other instances, 
is of a paroxysmal nature : patients, after having been 
comfortable for some hours, are suddenly seized with 
a fit of coughing, lasting for several minutes, it may 152 
woman's complete guide to health. 
be for hours, until the sufferers appear exhausted by 
fatigue. Attacks of these coughs often take place in 
the morning just when the patient is leaving bed, aTid 
last for many hours. 
As is seen above, there is a great diversity in the 
character, of the cough. Other diseases, from a com- 
mon catarrh, bronchitis, pleurisy, pneumonia, heart 
disease, tubercular deposit and others produce it, and 
consequently, cough, in the absence of any other well- 
marked home-symptom, cannot lead us to suspect 
disease of the womb until a thorough examination of 
the chest shall have informed us of its healthy con- 
dition and the absence of any affection of which cough 
is a characteristic symptom. 
Third, by aphonia or loss of voice. This loss of 
voice is very often noticed, lasting, in some instances, 
for days. The patient can speak only in whispers, 
and with considerable effort; in others, it is of shorter 
duration, and often suddenly disappears. See Case L. 
in Appendix, where the above observations are well 
illustrated. Fourth, by disturbances in the action 
of the heart. The heart may be perfectly free from 
organic disease, and yet patients will suddenly, with- 
out the slightest cause, complain of distressing sensa- 
tions, as palpitations, or of fluttering and irregular 
action; these palpitations are occasionally of a very 
violent character, with a sense of fullness and suffoca- 
tion. The presence of these thoracic pains, dyspnea, 
cough, aphonia, palpitations and other chest symp- 
toms, is nearly always a source of great anxiety to 
the patient and her friends, leading them to fear the 
existence of diseases of the lungs and heart, particu- 153 
AFFECTION OF THE CIRCULATORY SYSTEM. 
larly if these diseases have existed in their families. 
If the careful examination of the lungs and heart 
demonstrates the integrity of these organs, we are 
warranted in considering the pains, and the other 
chest symptoms just described, as merely sympathetic. 
Consumption may be said to constitute one of the 
dangers to which this form of disease of the womb 
indirectly exposes those whom it attacks, owing to 
to the existence of that general debility which it so 
often occasions. 
(5).-SYMPATHETIC AFFECTION OF THE CIRCULATORY 
SYSTEM. 
The connection between the circulatory system and 
the affection of the womb, is so well delineated by Dr. 
Byford, and agrees so well in every respect with my 
own experience upon the subject, that I do not hesi- 
tate to transfer his remarks to these pages. He says : 
" The circulation and its organs are very often de- 
ranged to a distressing degree. Palpitation of the 
heart is troublesome, and patients are apt to think 
themselves the subjects of disease of the heart. We 
are often consulted solely with reference to this symp- 
tom, it having absorbed the attention and awakened 
the apprehension of the sufferer to such a degree that 
her other inconveniences are forgotten or over- 
looked. These palpitations are sometimes attended 
with pain in the region of the heart, which occasion- 
ally shoots up to the left shoulder, and down the left 
arm to a greater or less distance; the distress being 
so great as to amount almost to angina. The palpita- 154 
woman's complete guide to health. 
tion is worse during nervous excitement. It occurs 
generally in paroxysms. We meet with instances in 
which it oftener occurs after lying clown at night than 
at any other time. Sometimes it seems to be in- 
creased during digestion. The sensation of palpitation 
does not seem to be at all commensurate with the in- 
creased excitement of that organ, and vice versa. I 
have observed instances in which the patient com- 
plained of violent palpitation, while the pulse and 
heart, as far as I could judge, were not at all disturbed. 
In such cases, we might say that the sensitiveness of 
the heart was increased, until its ordinary motions were 
perceived by the patient. Indeed, the pains and in- 
creased irritability of the organs supplied with the great 
sympathetic nerves, seem to result from increased sus- 
ceptibility or sensitiveness, instead of organic changes. 
There is also sometimes a sensation of throbbing, as 
though the blood was passing through the arteries in 
increased quantities, and wTith increased force in some 
parts of the system. This occurs mostly about the 
head, sometimes in the hands and feet, and occasion- 
ally inside the head, apparently in the brain ; also 
about the genital organs. Great irregularity of dis- 
tribution of the blood is often observable, the hands and 
feet being uncomfortably cold, and continuing in that 
state for twenty-four hours at a time. In connection 
with cold extremities, the head is apt to be hot, or 
warmer than is natural. This heat of the head may 
also be present when the feet and hands are of the 
common temperature. 
" Heat about the head and face is sometimes almost 
constantly present in certain patients and is the source AFFECTION OF THE CIRCULATORY SYSTEM. 
155 
of great annoyance to them. It is apt to be caused by 
any thing that excites the person. It is greatest and 
frequently exclusively located on the top of the head. 
I do not think that this sensation of heat arises from 
any other cause as frequently as from the disease un- 
der consideration ; and I am sure it is one of the most 
common symptoms in such disease. There is also 
great heat complained of in the back of the head in 
many instances. Sometimes it extends along the 
spine, affecting the whole or only sections of it. Burn- 
ing in the lower back and loins is very common. 
Flashes of heat and flushes of color in the face and 
head, and even in other parts of the body, are very 
common and annoying occurrences. The power or 
nervous energy of the heart may be impaired to such 
an extent as to render the patient liable to faintness 
on the application of very slight causes-anger, fear, 
surprise, or even the more tender emotions overcom- 
ing the patient very readily." 
Inflammation and ulceration, if limited to the neck 
of the womb alone, seldom give rise to any febrile re- 
action. Sometimes, however, patients become rather 
feverish towards evening, but even this is rare. Prac- 
titioners unacquainted with the history of affections of 
the womb, would never for a moment suspect that the 
pale, languishing, debilitated women, by whom they 
are probably consulted for weakness, have been re- 
duced to a state of anaemia by an inflammatory disease 
of the womb, or of its neck, still in active existence. 
Although the pulse be seldom accelerated by fever, it 
is generally modified in other ways. Thus, it is often 
miserably small and feeble, quick and irregular. WOMAN'S COMPLETE GUIDE TO HEALTH. 
156 
When this is the case, the pulse partly reflects the 
debilitated state of the system, and partly a direct 
sympathetic reaction from the womb, on the central 
organ of circulation. 
To conclude, I would state what I have before said 
upon the subject, that it is partly owing to the ab- 
sence of fever, which generally characterizes inflam- 
matory diseases in other regions, that inflammation of 
the neck of the womb has passed unobserved until 
so very recently. 
(6.)-SYMPATHETIC AFFECTION OF THE FUNCTION OF 
NUTRITION. 
The functions of digestion, respiration and circula- 
tion, being those which control assimilation and nutri- 
tion, cannot long be in a morbid state without the 
general nutrition becoming impaired. The patient 
loses flesh, becomes emaciated, pale, sallow, languid, 
and weak ; falls, in a word, into a more or less marked 
state of anaemia. Indeed, anaemia, the result of de- 
praved nutrition from sympathetic reaction, is so gen- 
eral in this form of disease of the womb, that it may 
be said to characterize it in its advanced stages. And, 
on the other hand, as is well known, anaemia exercises 
considerable influence in the production of various 
nervous disorders. 
Dr. 0. Landy, of Paris, has shown and illustrated 
by various cases the forms of nervous disorders caused 
by an insufficiency of the amount of blood in the sys- 
tem, or by an alteration in the qualities of that nutri- 
tious fluid. According to Dr. C. E. Brown-Sequard, 
the various forms of insanity, paralysis of sensibility 157 
AFFECTION OF THE CEREBRAL SYSTEM. 
or motion, neuralgia, and almost all the convulsive 
affections, from chorea to epilepsy and catalepsy, are 
among the often-observed effects of anaemia, whether 
due to a loss of blood, or to other causes. 
(7.)-SYMPATHETIC AFFECTION IN THE CEREBRAL 
SYSTEM. 
The principal sympathetic cerebral symptoms in 
affections of the womb, are intense headache, great 
depression and lowness of spirits, and groundless ter- 
rors experienced not only in the night, but even during 
the day. 
The headache may exist in any part of the head, 
but it is principally observed, as before referred to, at 
the summit, and over the forehead. The pain at the 
summit, patients compare to a heavy weight pressing 
on it, or to a disagreeable burning sensation. These 
headaches very frequently extend not only over all the 
scalp, but to the skin and deep-seated tissues of the 
face. Intense darting burning pain is often felt in the 
eyeballs, or deep in the sockets of the eyes, with or 
without " flashes of light from the eyes and in the 
ears, the sufferer may have then a " ringing in the 
ears." The same pain is often felt in the nose, or 
along the dental nerves, not unfrequently accompanied 
by the most acute twitches and spasms of the facial 
muscles, and thence patients have been treated for 
neuralgia of the face or tic-douleureux. The extension 
of the pains along the dental nerves very often consti- 
tute those severe cases of odontalgia or toothache, 158 
woman's complete guide to health. 
that scarcely any thing can soothe or drive away, till 
the dentist has been called upon, and some tooth or 
other has been extracted. 
The mental depression experienced by the patient 
subjected to inflammation of the womb, is often ex- 
treme, and not unfrequently is accompanied by delu- 
sions or hallucinations and by the fear of insanity. This 
mental depression is always greatest at the menstrual 
epoch, and may be carried to a great extent, being 
attended by irresistible weeping for hours and days 
together, independent of any other hysterical manifes- 
tation. A very truthful picture of these " depressions 
of the mind " is drawn by Dr. Hugh L. Hodge, of 
Philadelphia. " The patient," says he, " is low-spirited 
and desponding ; loses her interest in the common 
business of life, performs her duties with an effort, and 
finds it requires an exertion to turn her thoughts away 
from herself. Gradually she loses her interest in her 
friends and society, preferring solitude as more con- 
genial to the state of her mind and heart. This state 
often becomes very distressing; nothing withdraws 
the patient from her own morbid sensations ; she is 
desponding and melancholy, prefers death to life, and 
even meditates seriously as to the value of life under 
such circumstances ; for to her the future promises to 
be like the past. She expects, perhaps even desires, 
nothing better, and is almost ready in despair of com- 
fort, to rush upon the untried realities of another 
world. These extreme cases are comparatively rare, 
but minor cases of mental indifference or despondency 
are exceedingly frequent. On recovery, such patients 
often say, 1 a cloud has been removed from my mind 159 
AFFECTION OF THE CEREBRAL SYSTEM. 
' a load taken from my heart; ' ' my head is cleared; ' 
' the confusion of thought has vanished ; ' ' my natural 
interest in my husband, my children, my duties, has 
returned.' " 
This mental depression, as well as the .other ail- 
ments and morbid sensations, I have noticed so far, 
are always greatest at the menstrual epoch, and may 
be carried to a great extent, and be attended by irre- 
sistible weeping for hours and days together, inde- 
pendent of any other hysterical manifestation. In 
some instances, slight general debility, with great low- 
ness of spirits and languor during menstruation are 
nearly the only indications that the patient presents 
of the existence of the inflammation of the womb from 
which she is suffering. The " languor " alluded to, is 
called by the patient " weaknes-s," and is one of the 
most common symptoms in affections of the womb. 
It is also expressed by the words "lassitude," "inert- 
ness," or by the French, " def alliance." There is a gen- 
eral sense of prostration, as if it were impossible to 
make much exertion. Sometimes this is the case when 
the local symptoms are by no means urgent, often 
when there is little pain; and in some cases where no 
pain whatever had been experienced. 
A young lady, between twenty and twenty-three years 
old, on whose account I was consulted, was the sub- 
ject of a similar muscular -weakness, and refused abso- 
lutely to go out, stating that she could not walk, even 
for half a block, without feeling like " dropping down." 
From inquiry, I obtained the information that this 
girl's health had nothing of a disquieting character, 
and that she only complained at the time of her 160 
woman's complete guide to health. 
courses, which were characteristic of dysmenorrhoea. 
She complained, moreover, of an occasional headache, 
was slender, looked pale and anaemic, and was exceed- 
ingly nervous, and would cry and weep, if somewhat 
opposed in her conversation. Under the stimulus of 
a strong will, of great mental or moral excitement, or 
even of physical stimuli, such patients-and so it 
proved to be with the young lady just mentioned-can 
make temporary exertions, but will afterwards relapse, 
usually into a more decided state than ever, of appa- 
rent exhaustion. To these sufferers, the only com- 
fortable position is the recumbent, reclining on a tete- 
a-tete ; it is an effort to sit, stand, or walk. In some, 
the same lassitude affects the mind and feelings ; no 
interest is expressed in the usual social relations and 
business of life. To the patient all things are indif- 
ferent, and most objects of affection decidedly weari- 
some and perturbing. In most, however,' there is 
considerable local irritation, as evinced by pain in the 
back, a sense of pressure, and other symptoms con- 
sidered at length in other places. Much more might 
be said on this subject but for the limit of these con- 
tributions, and that I have yet to consider the moral 
feelings-hallucinations, anticipations of impending 
evil, etc., with which patients are affected in diseases 
of the womb. 
First. As to these, the moral feelings, they may, in 
many patients, be regarded as in a state of irritation : 
every thing worries and agitates them ; the merest 
trifle not only annoys, but excites strong expressions 
of displeasure, even of anger. Such persons may have 
sufficient self-restraint to command themselves among 161 
AFFECTION OF THE CEREBRAL SYSTEM. 
strangers; but at home, among children and domes- 
tics, and even towards the husband, self-command 
seems to be impossible, or at least requires a powerful 
exercise of the will. 
These states of mental and moral excitement, some- 
times even in strong-minded and religious women, be- 
come uncontrollable by the most determined efforts of 
the will and of the conscience. They mourn and are 
distressed and mortified at the ebullitions of passions 
which they cannot restrain. 
Second. Indescribable and inexplicable feelings 
of dread, anticipations of impending evil to them- 
selves or their friends, take possession of the minds of 
other patients. They fear to be alone, even for an 
instant-they cannot divert their thoughts from dis- 
agreeable or painful subjects. They often not only 
lose their interest in their relations, and are disposed 
to quarrel with them, but even to seriously injure 
them. 
Third. A variety of this state of the cerebral func- 
tions, but usually not so terrific, consists in hallucina- 
tions and spectral illusions of various kinds. Every 
one of my readers has heard of the fancies, the no- 
tions, the vagaries, the strange thoughts and imagin- 
ings of nervous women. They are sometimes pleas- 
ant, but often very disagreeable, and even fearful to 
themselves or companions. In other cases, mental 
hallucinations, deceptive perceptions, are so vivid that 
they appear to be realities. 
Finally, the wretched physical and mental sensa- 
tions from cerebral disturbance cannot be described. 
Patients have no language to express the nature of 162 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
their feelings, but portray in strong terms the misery 
of the horrors of their mental and spiritual state as 
far more distressing than physical pain. The line of 
demarcation between sanity and insanity cannot in- 
deed be drawn in the various states of cerebral dis- 
turbance. Decided mania occasionally ensues ; the 
patient sometimes sinks into the hopeless wretched- 
ness of melancholy, or into chaotic musings of idiocy. 
These extremes are, however, rare ; but nothing is 
more frequent than some mental or moral disturbance 
dependent on an affection of the womb. When this 
affection is cured, the cloud is removed from the men- 
tal vision ; the chaotic confusion of ideas vanishes ; 
the indifference to friends and to the business of life 
is superseded by warm affections and active devotion 
to duty. The morbid excitements of the mind subside ; 
cheerfulness and hilarity succeed; the patient feels 
rejuvenated, and can hardly believe the reality of 
past sufferings, or that she has retained her personal 
identity. 
(8.) SYMPATHETIC AFFECTION IN THE ORGAN OF VISION. 
The sight may be merely impaired and rendered 
weaker by the reaction of the affection of the womb ; 
but it may also be more deeply affected. Amaurosis 
may supervene. The connection between the two 
morbid conditions, as cause and effect, is rendered 
evident by the cure of the affection of the womb at 
once arresting the onward progress of the amaurotic 
affection when everything else had failed. Unfor- 
tunately, however the ground lost is not always en- SYMPATHETIC AFFECTION OF HEARING, ETC? 
163 
tirely regained, and vision sometimes remains perma- 
nently impaired in one or both eyes. See Appendix, 
Case XLIV. 
(9.) SYMPATHETIC AFFECTION IN THE ORGAN OF 
HEARING. * 
/ 
The hearing is less frequently affected than the 
sight. However, cases have been met with in which 
an affection of the womb had evidently occasioned 
partial deafness. This form of deafness is also gene- 
rally arrested by the treatment of the disease, but 
occasionally the hearing of the patient cannot entirely 
be restored. 
(10.) SYMPATHETIC AFFECTION OF THE SPINAL SYSTEM. 
The spinal system, like tire cerebral, has a large share 
in the array of sympathetic symptoms, when the womb 
or its neck is affected. Patients complain of pain or 
some distressing sensation in some part of the spinal, 
cord, generally in some part of the lower back. This 
pain or distress, commonly called a " weakness " or a 
" weak back," or perhaps a " broken back," is mostly 
constant, and is very readily aggravated by anything 
that excites the vascular system of the womb, such as 
standing, walking, stooping, lifting or jumping, or any 
sudden emotions, as fright, anger, anxiety. Some 
cannot assume the erect position without inducing 
pain and distress, and any attempt to walk is followed 
by great suffering. Others can walk moderate dis- 164 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
tances, but are punished for their temerity by suffer- 
ing for hours or even days. Nothing troubles such 
patients so much as ascending stairs or hills. The 
fact is, that any and all muscular exertion induces 
pain. Occasionally patients will be distressed by 
swelling of the legs and. feet, lasting for a time more 
or less long. All these pains and distresses are, as 
those experienced in other organs, aggravated at the 
time of menstruation. 
(11.) SYMPATHETIC PAINS, AND DISTRESSING SENSA- 
TIONS, ETC., IN THE PELVIC AND OTHER REGIONS. 
When the womb or its neck is affected, there are 
pretty generally experienced by the patient some ten- 
derness, pain, distress or soreness in one of the groins, 
increased on pressure, and radiating towards the 
hip. Usually the left side is so affected, occasionally 
it is the right. These pains may also be felt in the 
region of the seat of the womb. All these pains and 
distressing sensations are aggravated by all the cir- 
cumstances that aggravate the pain in the back. 
Besides the various pains just noticed, there are 
other distressing sensations experienced by patients, 
radiating in every direction from the source of mis- 
chief in the pelvis, along the course of particular 
nerves. The pain may be traced from the groin, fol- 
lowing the course of some nerves or branches of nerves 
on the inside of the thigh, and producing pain or sore- 
ness in some part of the inside of the thigh, or lower 
down, in the knees, and still lower, in the ankles, and 
often in very small spots, as at the top of the instep, SYMPATHETIC AFFECTION OF THE SKIN. 
165 
or at the heel, according to the particular nerve fol- 
lowed. Sensations of numbness, a dead feeling, a 
prickling often co-exist, increasing the indisposition 
or inability to move. When these pains or distress- 
ing sensations radiate from their source of mischief 
towards the upper extremities, there may be pains 
felt, according the nerve in sufferance ; for instance, in 
the fingers, wrists, elbows and shoulder, together with 
feelings of numbness or deadness. The characteris- 
tics of all these pains or distressing sensations are 
fixed, darting, transitory, constant or of a paroxysmal 
nature. The patient may thus enjoy immunity for 
hours, days, even weeks, or may be a constant sufferer 
from them. It is hardly necessary to add, it having 
been repeated constantly, that menstruation exercises 
its influence more or less over all the sensations just 
described. 
(12.) SYMPATHETIC AFFECTION OF THE SKIN OR 
HYPERESTHESIA 
The cutaneous sensibility and impressibility in affec- 
tions of the womb, is sometimes much exaggerated 
or excessive all over the body, in isolated regions, as 
the head, back, abdomen, or on the left side only. 
When this is the case, pain is experienced on the 
slightest contact. This exaggerated sensibility may 
be confined to the pelvic region only, and be attended 
by a very distressing sensation of internal soreness. 166 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
(13.) SYMPATHETIC AFFECTION OF THE NERVOUS 
SYSTEM. 
The various nervous manifestations to which the 
term hysterical is familiarly applied, are very frequently 
met with in patients suffering from chronic inflamma- 
tory disease of the neck of the womb, and vary con- 
siderably according to the constitutional idiosyncracy, 
or the gravity of the affection. Patients may be taken 
by mere fainting spells, or attacked by epilepsy, cata- 
lepsy, chorea, or perhaps mania. These different 
forms of convulsions and nervous manifestations may 
be met with from accidental causes, but occur mostly, 
as with other morbid sensations, before and during 
menstruation, and may then be so severe and so con- 
tinued as to be followed by paralysis and to threaten 
life. All these forms of convulsions, nervous attacks 
and manifestations are too familiar to my readers 
generally to require any details. An excellent insight 
into these nervous manifestations is given by Dr. By- 
ford, as follows : 
" Aches, pains and complaints of evident nervous 
ailments are the peculiar province of disease of the 
womb. There is hardly a disagreeable or even excru- 
ciating sensation that these patients do not experience ; 
and too often this real suffering is mistaken by the 
friends for imaginary, and the woman's complaints 
are treated with unreasonable impatience and rude- 
ness by persons from whom she ought to receive kind- 
ness and sympathy, because her appearance does not 
correspond with her morbid sensations, as we are apt 
to observe them in other examples of disease. It is SYMPATHETIC AFFECTIONS-SLEEP. 
167 
remarkable, too, and a fact that often impeaches them 
with insincerity in their complaints when the unin- 
itiated are the judges, that these patients will pass 
from a state of excruciating suffering and loud com- 
plaints, under a little excitement, to one of actual en- 
joyment and hilarity, or conversely. The transition 
from the excitement of private company, or a public 
party, gives way in a few minutes to a doleful condi- 
tion of suffering and unappeasable complaints. The 
inconsistency of the complaints and enjoyments, the 
incapacities and the performances of these patients 
are almost characteristic-at least in their sudden 
alternation-and are inexplicable in any other way 
than by supposing that the pains in the different 
organs to which they are referred, are more depend- 
ent upon the general nervous susceptibility than upon 
the organic disease of even trivial character. They 
are strictly neuralgic in their nature, and confined to 
the nerve matter, or tissue of the parts. A great 
number of the disagreeable sensations and pains ap- 
pear more frequently in particular parts, and hence 
may be distinctly referred to in this description." 
(14.) SYMPATHETIC AFFECTION IN SLEEP. 
But little refreshing sleep is obtained by women 
laboring under trouble of the womb in a severe form, 
especially when the digestion is much impaired. The 
state of suffering in which they live re-acts on the 
brain, renders sleep and interrupted, and 
occasions disagreeable dreams and nightmare. The 168 
woman's complete guide to health. 
sufferer often awakes in an agony of apprehension. 
This is principally the case when the sympathetic 
nerves of any of the viscera, ovaries, womb, stomach, 
heart, etc., are the seat of the constant, dull aching 
pain, several times noticed before. Existing, as it 
does, during sleep as well as during wakefulness, by 
its continued reaction on the cerebrum, it effectually 
" murders rest." When these pains are absent or 
slight, the sleep is often very good, sometimes, indeed, 
too prolonged and heavy. 
Here I end this long sketch of symptomatology, or 
symptoms of disease of the womb. My readers are 
now fully acquainted with most of the symptoms, both 
local and constitutional or sympathetic, which may 
be considered to indicate especially inflammatory 
ulceration of the neck of the womb. If, in this rapid 
review, any symptom or symptoms should have es- 
caped notice, they are either of very trifling import- 
ance, or belong to some affection independent of an 
affection of the womb. The totality of the symptoms 
complained of will always tell the sufferer where to 
look for the cause of her suffering, and act under- 
standingly. Finally, I wrould add 
V.-SUMMARY OF SYMPTOMS. 
An affection of the neck of the womb may safely 
be suspected from the isolated existence of any of 
the following local or subjective symptoms, viz. : 
a. Sterility, b. Increased juiin during menstrua- 
tion. c. A constant return of the menses at an ear- 169 
SUMMARY OF SYMPTOMS. 
lier or later period, and a great change in the duration 
or amount of the menstrual secretion, d. Slight or 
severe continued pain in the back or ovarian regions. 
e. Weight, shooting and bearing down pains, f. Per- 
manent vaginal secretions, g. Modified sensibility of 
the womb. CHAPTER IX. 
DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF INFLAMMA- 
TION AND ULCERATION OF THE NECK OF THE WOMB. 
I.-DIAGNOSIS OF INFLAMMATION AND ULCERATION OF 
THE NECK OF THE WOMB. 
I would not wish my readers to suppose that a cer- 
tain number of both local and constitutional symp- 
toms, enumerated in the preceding pages, must, of 
necessity, be present in, or characterize every case of 
affection of the womb. Nor that patients seeking for 
advice will complain of a certain number of symptoms 
belonging to the one or other of the two named cate- 
gories of symptoms. If this were the case, if patients 
did always complain of a certain number of symp- 
toms belonging to both categories, or exclusively to 
one of them, the cause of their suffering would readily 
enough be recognized. But very frequently indeed a 
few symptoms only are complained of, and in many 
instances merely one or two are met with. It is 
this circumstance which frequently renders it so dif- 
ficult to recognize positively the existence of an 
affection of the womb unless physical examination 
be resorted to, a mode of diagnosis that has until 
lately been too much neglected. This is, however, at 
present recognized by all intelligent practitioners to 171 
DIAGNOSIS OF INFLAMMATION AND ULCERATION. 
be indispensable in all affections appertaining to the 
womb and organs of generation. Thus, patients will 
complain of a discharge (the whites), of painful, irregu- 
lar or suppressed menstruation, of backache (they call 
it also weakness) ; others, again, of want of appetite 
or of general weakness. The true nature of the case 
has in almost every instance to be sifted out. What 
is only a symptom is considered and insisted upon by 
the sufferer to be the disease, and cause of her suffer- 
ings. Nor should my readers infer, that the intensity 
of woman's sufferings will be found to be in due pro- 
portion to the relative intensity of the affection of the 
womb. This part of gynecological science is consid- 
ered as yet most unsatisfactory. 
In a lecture, in 1851, on Uterine Diagnosis, Profes- 
sor Sympson remarked on this subject: " It is in con- 
sequence of this want of relation between diseases of 
the womb and their dynamic symptoms, that it be- 
comes so requisite in this class of affections to have 
recourse to physical diagnosis, in order to determine 
what ascertainable changes have taken place in the 
structure and organization of the womb, or its appen- 
dages. It is only by instituting in this way a physical 
diagnosis that you can hope, in most instances, to de- 
cide upon the specific nature of the disease that may 
be present. In many cases, we may make the general 
diagnosis of the existence of diseases of the womb by 
the consideration alone of the rational symptoms or 
functional derangements to which such diseases give 
rise. We can only make a differential diagnosis of 
what the existing specific disease is by physical diag- 
nosis, or, in other words, by the physical examination 172 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
of the anatomical conditions of the organ itself." 
"And," he further remarks, "in whatever way we may 
explain the fact, it is still an undoubted, important 
(pathological) and practical fact, that, in diseases of 
the womb, there is generally no very direct or fixed 
relation observable between the intensity and charac- 
ter of the local disease which is present, and the inten- 
sity and character of the dynamic symptoms to which 
that disease gives rise. The accompanying dynamic 
symptoms may be severe, where the local disease of 
the womb is slight and simple; and, on the other 
hand, it too frequently happens that the local disease 
is severe and serious in its nature, when the dynamic 
symptoms that accompany it are apparently trivial and 
transient in their character." 
From what precedes, my readers are to conclude, 
that the constitutional symptoms alone are no gilide 
in arriving at a correct knowledge of difficulties of the 
womb, whether of an organic or of a functional nature 
alone; and, also, that in consequence of this, of all 
means a physical examination, as above alluded to, is 
the only medium of communicating at once the actual 
condition of the parts diseased. The further con- 
sideration of this special subject, however, I have? 
thought best to postpone till I come to consider the 
treatment of inflammation and ulceration of the neck 
the womb. 
II.-DIFFERENTIAL DIAGNOSIS OF INFLAMMATION AND 
ULCERATION OF THE NECK OF THE WOMB. 
I have deemed it of paramount interest to my read- 
ers, to be informed of the errors that were formerly DIFFERENTIAL DIAGNOSIS. 
173 
committed, and are to a certain extent, at the pres- 
ent day, in relation to the affections already considered. 
These errors were of common occurrence, and occa- 
sionally of a very grave nature, and it must thus be 
obvious that they were capable of producing the 
greatest mischief, if not, perhaps, irreparable conse- 
quences. For these reasons, I thought it preferable 
to group them together in a special paragraph, rather 
than to take notice of them in other places of this 
wrork, where they might have escaped attention. 
These errors are the following, namely : 
1. Errors in relation to Leucorrhcea.-At the 
head of these errors is leucorrhcea, called also the 
"whites," or "vaginal discharges," with which women 
are troubled, when laboring under some affection of 
the womb. I have described them at length, page 116. 
These " whites," or " vaginal discharges," have been 
all but universally supposed to be the result of " con- 
stitutional weakness." This error has, perhaps, been 
the most inveterate and the most general of all, and, 
consequently, sanctioned during centuries by writings 
of innumerable men of eminence; yet it is founded on 
the grossest disregard of every day experience, clinical 
observations, and of the laws of pathology. Are we 
not aware that a large proportion of women have, for 
a short time before and after menstruation, a more or 
less abundant white vaginal discharge; some -women 
even having this discharge after certain excitements 
or fatigues, while their health remain perfectly good ? 
This circumstance alone satisfactorily proves that a 
mere mucous vaginal secretion does not, of itself, pro- 174 
woman's complete guide to health. 
duce the " constitutional debility " which is often ob- 
served when a leucorrhoeal discharge exists-which it 
is supposed to occasion. A copious mucous hyperse- 
cretion, apart from inflammation, may exist for years 
from the nares, lungs, or intestinal canal, without the 
supervention of general debility and emaciation. 
Both experience and pathological analogy thus prove, 
that if great constitutional debility exists, along with a 
vaginal discharge, and if there is no other local disease or 
cachexia to account for it, the uterine system must be the 
seat of some more serious lesion than a mere mucous hyper- 
secretion (preternatural secretion). This remark ap- 
plies still more forcibly when the discharge is not 
merely mucous, but purulent. The presence of pus is 
conclusive as to the existence of some internal inflam- 
mation. And yet there are many practitioners who 
still believe that even a discharge of this kind (puru- 
lent) is merely the result of " weakness." The absur- 
dity of such an opinion cannot be better demonstrated 
than by applying it to other organs. What medical 
man in his senses would think of attributing the daily 
expectoration of a considerable quantity of pus from 
the lungs, or its discharge from the intestinal canal, 
to mere " debility ! " 
2. Errors in Relation to Weight, Dragging, and 
Bearing-down Sensations. - These sensations of 
weight, dragging and bearing down, which character- 
ize falling of the womb, as well as inflammatory hyper- 
trophy of the neck of the womb, are generally supposed 
to be the result of the womb falling from weakness or 
laxity of its natural supports. This is a most disas- DIFFERENTIAL diagnosis. 
175 
irons error ; for not only does the practitioner neglect 
to adopt proper means to ascertain the real nature of 
the case, and omit to resort to correct means of treat- 
ment-impressed as he is with an erroneous notion of 
the state of his patient-but the pessaries and physi- 
cal means of support that he adopts nearly always 
aggravate the disease. Numerous cases in which 
great mischief has evidently been done by the use of 
physical means of sustentation, in cases in which in- 
flammation is the real cause of the morbid symptoms, 
are daily met with. See Appendix, Case LVI. 
3. Errors in relation to the Backache and other 
Pains.-The pains in the lower part of the back (in 
the region of the sacrum), and in the hips and thighs, 
formerly described, have also generally been mistaken 
for indications of " constitutional weakness." Indeed, 
as these pains nearly always accompany the vaginal 
discharges in cases in which extreme debility occurs 
as the result of inflammation of the womb and ulcera- 
tion, they have become popularly connected with leu- 
corrhoea. Thence it is that " backache " and " whites " 
are considered not only by the public, but even by 
professional men, as symptomatic of constitutional 
debility," existing as a (primary) affection of itself. 
4. Errors as to the Ovarian Pains.-The pain in 
the ovarian regions, and especially that on the left 
side, the most characteristic of all the local symptoms 
occasioned by ulceration of the neck of the womb, was 
and is often erroneously supposed, by the medical 
attendant, to be the result of inflammation, or other 176 
woman's complete guide to health. 
disease of said ovary itself. When the pain occurs 
on the right side, it has been frequently referred to 
the liver, and supposed to indicate disease of that 
organ, etc. 
5. Errors in relation to Symptoms emanating from 
the Rectum and Bladder.-If the neck or the body 
of the womb is enlarged and retroverted, so as to press 
on the rectum, and to offer an obstruction to a natural 
passage, the obstacle has been mistaken for stricture 
of the rectum, and women have been martyred for a 
lengthened period by attempts to dilate a supposed 
stricture of the rectum, when nothing of the kind in 
reality existed. 
When the irritation about the bladder is very great, 
the attention of the practitioner may be directed 
almost exclusively to it, and the disease of the womb 
may thus be overlooked in toto. This is a mistake 
that has frequently been committed. Patients thus 
suffering, have been examined for stone over and over 
again, or treated for years for (idiopathic cystitis) in- 
flammation of the bladder. Much more could be said 
on this important subject of errors in diagnosis, but 
I only would add, reiterating my previous observation 
on the subject, that an accurate analysis of the history 
of the patient, of the functional and other symptoms which 
she presents, and of their origin and progress, will nearly 
always enable the practitioner to form a tolerably correct 
surmise as to their idiopathic or sympathetic nature. CHAPTER X. 
PROGRESS OF INFLAMMATION AND ULCERATION OF THE 
NECK OF THE WOMB. 
The progress of inflammation, etc., of the neck of 
the womb, is very variable, both in its subjective or 
local and in its general or sympathetic manifestations. 
Sometimes inflammation rapidly leads to ulceration, 
the neck speedily becomes hypertrophied, and the 
bladder and rectum soon become involved in the in- 
flammatory action. The sympathetic reactions being 
also soon experienced, the patient, in the course of a 
few months, falls into a state of extreme debility. 
This latter condition may speedily supervene, even 
when the local disease is very limited in extent and 
intensity. In some instances, on the contrary, years 
elapse before the general health is seriously affected, 
even when there is extensive disease. See Case XXVI. 
Inflammation, ulceration, hypertrophy, and other ab- 
normal conditions of the womb, may, indeed, exist 
during a portion of the life of the patient, without de- 
stroying life, although producing a constant valetudi- 
narian life. CHAPTER XI. 
TERMINATION OF INFLAMMATION AND ULCERATION OF THE 
NECK OF THE WOMB. 
Inflammatory ulceration of the neck of the womb 
may be said not unfrequently to terminate in the death 
of the patient. When, however, this is the case, death 
all but invariably occurs indirectly. The debility oc- 
casioned by the reaction of the inflammatory condition 
of the womb in the functions of organic life, coupled 
with the pain and irritation caused by the local symp- 
toms, may, no doubt, be carried so far that the patient 
at last sinks under their influence. Such an unfortu- 
nate termination, nevertheless, is scarcely ever wit- 
nessed by the practitioner who is acquainted with the 
disease, and with the treatment it requires ; for he has 
it in his power to arrest its progress, and to rally his 
patient, however low she may be reduced, provided 
that no necessarily fatal complications have appeared. 
The principal danger of the disease consists in its re- 
ducing the powers of the economy to so low an ebb, 
that any cachexia, or tendency to cachexia, which lies 
dormant in the system, is liable to be called into ac- 
tion, and in the fact that these patients are both more 
exposed to accidental disease, and less able to resist 
its attacks. Thus, if there is any hereditary predisposi- END OF INFLAMMATION AND ULCEBATION. 
179 
tion to disease in the constitution, it is very likely to 
develop itself under these circumstances, and an ex- 
treme liability to epidemic influences frequently be- 
comes apparent. From what precedes, it may safely 
be concluded that inflammatory ulceration of the neck, 
although seldom directly fatal, is a disease which 
brings very many women to a premature grave; and 
that when the existence of the malady shall be gener- 
ally recognized by the medical profession, not only 
will a vast amount of suffering be spared to humanity, 
but a great number of valuable lives will be saved, 
which now fall an indirect sacrifice to its influence. CHAPTER XII. 
PROGNOSIS OF INFLAMMATION AND ULCERATION OF THE 
NECK OF THE WOMB. 
The progress and termination of inflammatory dis- 
ease of the neck, once it is recognized and under 
appropriate treatment, may generally be considered 
favorable, provided the patient be not laboring under 
any incurable complication. No matter how great 
the debility, exhaustion and emaciation-no' matter 
how severe the pelvic irritation, or how intense the 
sympathetic reactions, all may be subdued in time, 
and the patient restored to health. There are few 
diseases, indeed, in which medical treatment is capa- 
ble of effecting a greater change in the state of the 
patient. Women who have been for years racked 
with aches and pains and are in a state of the most 
extreme exhaustion, gradually rally, and again become 
fresh and blooming. Nor is this favorable reaction 
surprising, when it is considered that these patients 
are not reduced to this melancholy condition by any 
necessarily fatal disease or cachexia, but by a malady 
which in most instances is amenable to therapeutic 
means, and only produces debility and weakness by 
reacting, through the sympathetic system of nerves, 
on the functions of organic life. When the disease RESULT OF INFLAMMATION AND ULCERATION. 
181 
has been subdued, and the incubus taken off the sys- 
tem, these functions often recover all but sponta- 
neously. Digestion, assimilation and nutrition again 
become healthy, and the patient is generally, in the 
course of time, restored to the full integrity of life. 
This complete recovery, however, is often a very 
slow process. In severe and chronic cases, it may 
take years to accomplish it, and in a few instances, it 
may never occur. The powers of life may have been 
too much depressed by the long continued influence 
of the local affection, t6 rally even when all disease 
has been removed, and the patient, although better 
and free from much disease, discomfort and danger, 
may remain languid, weak and a prey to a host of 
functional disturbances. Happily, such very extreme 
cases are exceptions. In more than five hundred 
cases of inflammatory diseases of the womb and others 
successfully treated by me since 1857, I recollect only 
one instance where the patient remained nearly as 
languid and delicate after all traces of the local dis- 
ease, which had been the primary and effectual cause 
of an excessively debilitated state of health, and was 
the occasion of her coming under my special treat- 
ment, had been removed. This lady, I should add, 
was of stout build, and enjoyed a robust health when 
she married, and the bridegroom took her from the 
country to live in the city of New York. The follow- 
ing case, which occurred in my own practice, is a good 
illustration of the observations made in this chapter, 
and is interesting in more than one respect. 182 
woman's complete guide to health. 
Case XXVII.-Extensive disease of the womb in a mar- 
ried lady, not discovered by former medical advisers. 
Premature death, after long suffering from a curable 
but neglected disease. 
In June, 1862, Mrs. S , a lady of refinement and 
of good family, aged thirty-five or thereabouts, several 
years married, but childless, requested me to call at 
her residence in New York, on account of her greatly 
impaired state of health. I found Mrs. S out of 
bed, but half seated, half reclined in a large Voltair- 
chair, amid pillows, cushions and shawls. A small 
table was standing close at her right hand, covered 
with a great variety of bottles of all dimensions and 
colors. She complained of having for nearly a week 
suffered from almost constant nausea, occasionally 
followed by vomiting alternated with diarrhoea, of 
fainting spells, of great weakness and prostration and 
want of appetite, with a distressing burning sensation 
on the summit of her head and pain in the pit of the 
stomach after eating, were it ever so little-of sleep- 
lessness and a most choking state of nervousness. 
These attacks had mostly appeared at the time of her 
expected courses, but they also appeared at other 
times ; her courses were scanty, and of very variable 
duration ; usually they were of short duration. Her 
general appearance indicated great and long suffering, 
emaciation and anaemia. On this and subsequent 
calls, I was informed that Mrs. S enjoyed pretty 
good health previous to her marriage, but that almost 
immediately subsequent to it her sufferings began, 
and she had ever since that period, some ten years, A NEGLECTED FATAL CASE. 
183 
been more or less an invalid, though enjoying at some 
moments, for a few days perhaps, comparative quiet- 
ness, allowing her to go out and to call on her rela- 
tions and friends. 
I did not hesitate for a moment to refer her wretched 
state of health to disease of the womb, and suggested 
that unless appropriate treatment was at once directed 
to the removal of the affection, whatever its charac- 
ter, there was very little prospect of her health ever 
improving; that the cure of the local disease would 
be the restoration of her health, but that, on the con- 
trary, if the disease remained unchecked in its onward 
progress, her health, already considerably impaired, 
would sooner or later break down without a shadow 
of hope of ultimate restoration. Mrs. S gently 
but decidedly rebuked me for what she thought a very 
hasty diagnosis. She knew I was mistaken and would 
easily convince me of it. Three or four years ago, 
she said, she had been examined, and the verdict in 
relation to a disease of the womb had been negatived. 
And only very recently, to satisfy the importunities, 
as she called it, of her friends and relations, she had 
again submitted to an examination, by a physician 
of New York who stands high in the profession as a 
general practitioner, and whose success in the treat- 
ment of diseases peculiar to women places him in the 
foremost ranks of gynecologists, and that he also had 
assured her that there was nothing the matter with 
her womb-that all her sufferings were referred to 
constitutional debility. Any further arguments upon 
the subject, in the lady's then state of mind and 
nervous mood, I deemed quite useless. Still, I in- 184 
woman's complete guide to health. 
sisted upon my belief that her troubles were traceable 
to an affection of the womb, and that an effectual and 
thorough physical exploration would fully bear out 
my diagnosis, and I further protested against being 
bound to respect the verdict given by the physicians 
she had consulted previously. I then withdrew and 
left her medicine most suitable to relieve and mitigate 
both her great nervousness and the irritability of her 
stomach. 
On calling next day, I found Mrs. S considera- 
bly improved. She had slept better and longer, her 
nervousness had mostly subsided, and the irritability 
of her stomach, she cheerfully acknowledged, had left 
her with the taking of the second dose of the medicine. 
I renewed the medicine, to be taken every four hours, 
for twenty-four hours longer. 
I was again requested to call on Mrs. S , August 
27th and September 1st, for precisely the same train 
of symptoms as those for which I was requested to 
prescribe on the 11th of June. At her solicitation, I 
gave her the same medicine-a medicine, she said, 
from which she had derived more benefit, which had 
acted more promptly, and whose effects had lasted 
much longer than any she had ever taken before. 
Finally, October 6th, I received early in the morning 
a message from Mrs. S , appointing eleven o'clock 
that day at my office for consultation and examina- 
tion, if I thought best. The last words are taken 
literally from her note, which is still in my possession. 
Mrs. S kept her appointment, and was accom- 
panied, I believe, by her sister. 
On examination, I found the parts greatly relaxed, A NEGLECTED FATAL CASE. 
185 
moist, and of a higher temperature than was natural. 
The neck of the womb was low, considerably hyper- 
trophied, greatly congested, somewhat retroverted, 
and rather painful wherever pressed upon. The mouth 
of the womb was round, small, and nearly closed; its 
mucous membrane a tinge higher in color than the 
surrounding tissues. When well brought within the 
focus of the speculum, and opened by separating the 
lips, and removing therefrom a plug of an ugly-look- 
ing, offensive mixture of pus, mucus and blood, said 
mucous membrane was discovered to be highly in- 
flamed and extensively ulcerated, the ulceration cover- 
ing more than half of the lower lip, and extending as 
high up the cavity as could be seen. The body of the 
womb itself was increased in bulk, and sensitive to 
slight pressure. This sensitiveness extended even to 
the ovaries, in the region of the urethra, the neck of 
the bladder, and very slightly in the region of the rec- 
tum. Here was unmistakably a case of chronic inter- 
nal metritis, or chronic internal inflammation of the 
womb, and in greater active operation than is gener- 
ally the fact in such chronic cases of so long standing, 
manifesting itself by such undoubted and self-accusing 
local and constitutional symptoms, that it puzzled me 
not a little to understand how it was possible that this 
case could have been so totally mistaken or over- 
looked in its character. While I write (in 1866), I am 
free to say that I have met with several other cases 
similar to the above. Comments I deem here un- 
necessary. 
Having informed Mrs. S of the true state of the 
womb, and the treatment imperatively called for, she 186 
woman's complete guide to health. 
at once consented to it, and the treatment began the 
same day. She called October 10th, 14th, and 18th, 
also on the 21st, which was destined to be her last 
visit. October 25th, Mrs. S had another of her 
attacks-the last. When it was in its greatest activity, 
I was sent for; but was then for nearly twenty-four 
hours in close attendance on a lady in Bloomingdale. 
This latter lady had the previous evening been at- 
tacked with convulsions (Bright's disease of the kid- 
neys), and was seven months pregnant with her first 
child. This case was of unusual severity, the fits fol- 
lowing each other with great rapidity. I was, conse- 
quently, under great apprehensions for the safety of 
my patient. Mrs. S 's message meanwhile had 
reached me there, but I could not well trust the safety 
of my patient in other hands, and, therefore, sent word 
to Mrs. S , requesting the attendance of the first 
practitioner she could get, if she should not improve 
under the medicine I prescribed her. It was thirty 
hours before I was enabled to congratulate the friends 
of my patient in Bloomingdale upon her safety; and 
when I reached New York I heard of Mrs. S 's 
death. 
Remarks.-Mrs. S , strange to say, for a lady of 
her refinement, education and wealth, had resorted to 
any thing and every thing that the ever-ready offici- 
ousness of friends could suggest to her, and I do not 
exaggerate in saying, that very likely there did not 
exist a nostrum or patent-medicine vender but that 
she had patronized him sometime or other, and for a 
time more or less long, till discouraged, disappointed, 187 
A NEGLECTED FATAL CASE-REMARKS. 
and disgusted. Just before I had seen her, she had 
taken great quantities of opium and the like. Later 
still, her favorite remedy was port-wine, of which she 
drank, she acknowledged, a dozen glasses or more, 
whenever her sick spells would come on. One morn- 
ing, on calling, towards eleven o'clock, she had just 
quaffed her seventh glass of port-wine; it was the 
best the market afforded, she said, and graciously 
offered me some. I had to acknowledge its merit. 
It is almost useless to say, that, considering well all 
the circumstances of the case, Mrs. S was certainly 
carried to a premature grave, being but thirty-five 
years old, the victim, through its well-known debili- 
tating and destructive effects, of a disease not neces- 
sarily fatal at all, which might have been cured, had it 
been submitted in time to appropriate treatment. This 
case, too, I beg my readers to believe, is neither fiction 
or overdrawn truth, nor is it a solitary one. It pre- 
sents a true picture of real fife and sufferings to be met 
with daily in New York and elsewhere. I now know 
some five or six cases in New York, being all of them 
more or less similar to the case here so fully described. 
And I most respectfully invite the attention of my 
readers in general, and the suffering in particular, to 
the case of Mrs. S , that they may, if there yet be 
time, solicit the attendance and treatment best calcu- 
lated to restore them to a lasting health, and may be- 
come once more, as formerly, ornaments to society, 
loving waves, affectionate and attentive mothers to 
their children. 
To conclude, I would beg my readers' leave to draw 
their attention, for a moment longer, to the following 188 
woman's complete guide to health. 
clinical remarks upon this important subject of prog- 
nosis, from Dr. Henry R. Madden, of Brighton, the 
author of a very scientific Monograph on Uterine Dis- 
eases, to wit: 
" Three things, however, are quite certain, viz. : 
1st. That in the vast majority of females (women) 
who are suffering from inflammation of the neck of the 
womb and its consequences, the general health is far 
from good. 2d. That such derangement of health, for 
the most part, proves extremely difficult to be relieved 
except by the employment of remedies known to have 
a specific action on the womb ; and 3d. That although 
many females may be to a considerable degree restored 
to health without the local affection being cured, yet 
it but rarely happens that such persons become really 
or permanently well until the womb is restored to its 
normal state. Founded upon these data, we may 
form the following prognosis in the great majority of 
cases, viz.: that if the case is left to nature, the 
probability of a spontaneous cure is exceedingly small, 
whereas if submitted to treatment for the purpose of 
restoring the general derangement, such treatment 
will not prove entirely successful unless combined 
■with means which will, at the same time, cure the dis- 
ease of the womb." CHAPTER XIII. 
TREATMENT OE INFLAMMATION AND ULCERATION OF THE 
NECK OF THE WOMB. GENERAL REMARKS. 
The treatment of inflammation and ulceration of the 
neck of the womb, I have long since concluded should 
partake of a double character in gynecology, and 
accordingly should be essentially of a medico-surgical 
character. It is, therefore, a delusion to suppose that 
the affection under consideration can be removed by 
resorting to the old method of general treatment 
alone, which consisted chiefly in the employment of 
antiphlogistics, sedatives, derivatives, and by some 
attention paid to the general health, by rest of body 
and mind, or by hip-baths, medicated injections, etc. 
The proper treatment, as I said above, being of a 
medico-surgical character, it is consequently of the 
greatest importance that the state of the internal 
organs of generation in women presenting unmistaka- 
ble symptoms of disease of the womb, should be at 
once ascertained. We are able to ascertain this by 
physical examination. 
This examination, I would only add, rendered im- 
perative by the necessities of the patient's state of 
health is, in the hands of a gentleman and duly quali- 
fied physician, unattended by any uneasiness, irksome- 
ness or distress. Under all circumstances, such local 190 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
manipulation is conducted with an honorable and due 
regard to the patient's feelings. Health and life, 
moreover, are too valuable to allow any possible sacri- 
fice to be withheld when they are endangered by such 
denial. The object to be attained in this physical 
examination is so well stated by Dr. Tyler Smith, that 
I make no apology for giving his statement a place in 
this connection. He says : " By digital examination 
we ascertain the presence or absence of tumors in the 
pelvis, the various forms of descent or version of the 
uterus, relaxation or constriction of the vagina, ten- 
derness of any particular part of the vagina or of the 
os or cervix uteri, increase in volume in the uterus, or 
any variation from the natural shape, volume or den- 
sity of the os uteri, warts or small polypi upon the os 
uteri, or polypi descending from the fissure of the 
os uteri, fullness or emptiness of the rectum, any mal- 
position of the bladder, or abnormal state of the 
urethra. 
" By examination with the speculum, we confirm 
many of the points of information acquired by digital 
examination; we learn the precise condition of the 
mucous membrane of the os and cervix as regards vas- 
cularity and loss of surface, the nature and extent of 
the discharge issuing from the os and cervix, the con- 
dition of the vagina as regards vascularity, granular 
condition, and the state of the epithelial coat, the 
presence of eruptions upon the os uteri and the vagina, 
the existence of ovula nabothi, the presence of small 
bleeding vascular polypi, which may be upon or just 
within the os uteri, which the finger may fail to detect, 
and the presence of vascular tumors of the miatus." TREATMENT OF INFLAMMATION AND ULCERATION. 
191 
Both constitutional and local treatment should be 
combined, if the case requires such combination. 
Such has always been the principle of my practice. 
Local treatment alone, in the great majority of cases, 
is all powerful and effectual to remove the disease of 
the womb, and with it the effects it has produced. 
Innumerable clinical observations attest this daily ; it 
is a fact, moreover, recognized by the most eminent 
of our gynecologists. This local treatment consists in 
the applications to the neck of the womb, when brought 
within the field of the speculum, of certain caustics and 
various other remedies, according to the nature and 
extent of the disease, its chronicity and the effects 
obtained. If, then, the constitutional or general treat- 
ment is of any importance in the affection under con- 
sideration, it is so only when wre look upon it as acces- 
sory to the local treatment employed, and to aid in 
effecting the cure and the removal of the effects left 
after a cure of the local disease has taken place. 
Finally, it is a fact recognized by all modern gyne- 
cologists, that general medication alone is totally 
powerless to subdue the disease, whereas, by the local 
means, as I remarked above, with appropriate dietetic 
and hygienic rules alone, the affection may, generally 
speaking, be entirely subdued and its sympathetic 
reactions removed. 
" The progress," observes Dr. Von Scanzoni, " which 
our age has made in the diseases of women has com- 
pelled us to recognize the small utility of the almost 
exclusive employment of the internal medicines pre- 
scribed by the old school for the treatment of uterine 
diseases. Physicians are themselves convinced that 192 
woman's complete guide to health. 
it is necessary to have recourse to a mode of treat- 
ment which permits them to act directly on the 
affected organ." Dr. Wm. H. Byford, of Chicago, 
in his excellent work lately issued, makes use of the 
following very emphatic language on this subject: 
" Seventy-five per cent, of the cases I have treated 
have had no general treatment-the local being quite 
sufficient. It will not do, therefore, to say that my 
cases were cured by the general treatment advised. 
I think that general treatment is essential in a few 
instances only, in conjunction with the local. It is at 
best but auxiliary. That inflammation and its conse- 
quences are the cause of these multitudinous ailments 
is most satisfactorily proven, I repeat, by their entire 
removal by this local treatment." These remarks, I 
am happy to say, evidently come from a man of great 
experience in the treatment of the diseases peculiar 
to women. 
Professor Simpson's views and principles of treat- 
ment in uterine diseases, we find embodied in the fol- 
lowing remarks : " The diseases of tire uterus," he 
observes, " do not essentially differ in their principles 
of pathology and treatment from the diseases of other 
individual organs of the body. The uterus is liable, for 
example, to be the seat of congestion, inflammation, 
carcenoma, etc., like any other organ of the body which 
you can name. It may be, and certainly is, more 
liable than other organs to some morbid states and 
actions; but what I wish to impress upon you is, that 
the diseases are generally the same as the diseases of 
other organs, and the general principles of their treat- 
ment are also the same, the special modifications of 193 
TREATMENT OF INFLAMMATION AND ULCERATION. 
management which they require not being greater 
than the special modifications that must be attended 
to in applying any general principles of cure to any 
other individual organ, or set of organs. ' You treat 
and cure, for example, an attack of acute inflammation 
of the uterus, or a chronic inflammatory ulcer of the 
cervix of the organ, as you would treat an acute in- 
flammatory or a chronic inflammatory ulcer of the 
cornea, or of the pharynx, or larynx, or of any other 
part of the body, with this difference, that you can ap- 
ply local antiphlogistic and other curative measures 
much more readily and easily to the uterus than to 
many other more internal organs. In fact, you may, 
if you deem it necessary, apply lotions and dressings 
to an ulcer, for example, of the cervix uteri, with as 
much certainty and precision as if you apply them to 
an ulcer of the external surface of the body; you can 
thus almost reduce the organ, in relation to treatment, 
to the facilities presented in treatment by an external 
as compared with an internal organ." 
The duration of the treatment necessarily varies 
greatly according to the nature, the extent, and the 
intensity of the disease, to the structural changes 
which it may have produced, and to the influence ex- 
ercised by menstruation over its phenomena. When 
menstruation is unfavorable, the treatment is always 
prolonged. This is also generally the case when 
ulceration and hypertrophy are both present, and a 
fortiori when induration is a complication of the ulcera- 
tion, the treatment in all these cases lasts much longer 
than under more favorable circumstances. 
I might here consider that I had said enough in 194 
woman's complete guide to health. 
relation to the treatment of inflammation and ulcera- 
tion of the neck of the womb. So much of it has been 
considered, in its general bearing, as might be thought 
both consistent with the obligations incumbent on a 
popular work like the present, and the fear that fur- 
ther developments would not offer sufficient interest to 
most of my readers. Yet I am aware that not a few 
of my readers will think the contrary, and that further 
details on this important subject of the treatment of 
the diseases of the womb, will not come amiss. I shall 
then further' consider the subject of the treatment, 
under the following heads, to wit: 1. The speculum; 
2. Topical treatment; 3. Constitutional or general 
treatment; 4. Vaginal injections. 
1. THE SPECULUM. 
It has been observed in the general remarks on the 
treatment of inflammation and ulceration of the neck 
of the womb, that physical examination was the proper 
and the necessary course to be adopted to ascertain 
the state of the womb, and of its neck, in women pre- 
senting unmistakably the symptoms indicating local 
disease, and that this physical examination, in addition 
to other means, is conducted by means of the speculum. 
This is an instrument which has nothing dreadful 
about it but the name, and, in whatever form made 
use of, is always adapted to the capacity of the parts, 
and its introduction effected under cover, and, in the 
generality of cases, in the presence of a third person. 
In the general remarks of this chapter (p. 190), to which 
I would refer my readers, will be found a fuller con- TREATMENT OF INFLAMMATION AND ULCERATION. 
195 
sideration of the uses of the speculum. I conse- 
quntly do not wish to go over the ground again. 
2. TOPICAL APPLICATIONS. 
These topical or local applications are made to the 
neck of the womb, and to its cavity, when brought within 
the field of the speculum, and consist of certain caustics, 
and other remedies, in dilution with glycerine, in form 
of pencils or ointments, according to the nature and 
extent of the disease, its chrouicity, and the effects 
obtained. At the head of this class of medical agents, 
or caustics, should be placed the chromic acid, prop- 
erly diluted, which possesses the merit of attacking dis- 
eased tissue, and not interfering with healthy tissue, 
its caustic properties being destroyed or suspended 
almost simultaneously with its application. Next 
comes the nitrate of silver, the acid nitrate of mercury, 
of varied strength, and the acidum nitricum, in dilu- 
tion. These caustics, of which I have made consider- 
able use, I consider in all respects safe in their 
application, and efficient. They accomplish by their 
action two well-defined objects, namely, the formation 
of an eschar on the ulceration, which protects it effi- 
ciently both from friction with the surrounding organs, 
and from the contact of the menses, or unhealthy 
and irritating secretions, and by stimulating the parts 
to healthy and restorative action. 
Dr. Bennet very justly remarks : " The object in 
view is to modify the vitality of the diseased tissues, 
and to substitute healthy, reparative, manageable 
inflammation for morbid inflammation, which is un- 196 
woman's complete guide to health. 
healthy, destructive, and unmanageble." " The 
caustic," observes M. Lisfranc, "is never to be applied 
otherwise than very lightly, nor with a view to destroy 
the ulcerated or altered surfaces, but to modify their 
vital state-to produce a new action on the parts." 
Such, then, is cauterization, which has been, and is 
still, more or less looked upon with alarm by some, and 
dread and apprehension by others. From it, however, 
I never yet saw any mischief, or unpleasant results 
ensue. 
3.-CONSTITUTIONAL OR GENERAL TREATMENT. 
In diseases of the womb, it is customary with some 
physicians to recommend for some weeks, or even 
months, a recumbent position. I do not consider such 
recommendation advisable, in consequence of the de- 
rangement in digestion, the constipation and the 
impoverishment of the blood which result from the 
observance of such a course, all of them consequences 
to be avoided in these as much, if not more, than in 
other affections. *These observations, of course, apply 
mostly to the disease under consideration, and to 
those cases which allow of the following hygienic 
rules to be observed. 
Instead of confining my patients to the recumbent 
position, I recommend daily exercise on foot in the 
open, pure air. Let the walks be daily lengthened, 
but let this exercise fall short of fatigue. The exer- 
cise will improve and invigorate the appetite, and food 
taken should in all respects be sufficient, nutritious, 
substantial and easy of digestion. It is also of the 197 
GENERAL TREATMENT-VAGINAL INJECTIONS. 
greatest importance to avoid and remove all causes 
which might favor local plethora, or in other words, 
congestion of the womb. In the course of these con- 
tributions I have indicated most of the circumstances 
capable of causing the local congestion just alluded 
to, and consequently, will not fatigue my readers by 
going over the same ground again. 
For obvious reasons, I do not recommend exercise 
in carriages, unless the Nicholson pavement should 
become a general establishment of this country. 
Horseback exercise should be shunned by patients 
suffering from any and all affections of the womb. It 
can only be indulged in when all traces of such disease 
have been removed. Patients should several times a 
week take hip, sitz or general baths, and use daily 
local ablutions and injections of lukewarm, cool, or cold 
water, according to the impression or benefit derived 
from their individual use. I very seldom recommend 
medicated injections, unless they answer a particular 
purpose, such as correcting corrosive and fetid vaginal 
discharges. But this subject I shall consider in the 
next article. 
4.-VAGINAL INJECTIONS. 
Although, for all practical purposes, I said enough 
at the close of the preceding article concerning vagi- 
nal injections, yet, I think most of my readers will not 
consider it altogether uninteresting to know what in 
reality is the value of the injections they have been in 
the habit of employing, and which were thought to be 
one of the ne plus ultra means of treatment in uterine 
affections generally. 198 
woman's complete guide to health. 
Injections, differently medicated, have at all times 
been recommended and resorted to with a will in the 
treatment of diseases of the womb. But as Robert 
Ellis, obstetric surgeon to the Chelsea and Belgrave 
Dispensary, very judiciously remarks, " The uses of 
injections may be learned by their failures. They are 
insufficient for the cure of ulceration, if it has existed 
for some time, and there is no satisfactory evidence 
that they can cure this condition effectually under any 
circumstances. In the great majority of cases they 
are even insufficient to cure leucorrhoea. They are 
useless for the cure of inflammatory induration and 
hypertrophy of the neck of the womb, and they are 
equally ineffectual in the sole treatment of the spongy, 
indolent, patulous and ulcerated neck occasionally 
met with in obstetric practice." This is what is 
thought of the " time-honored " practice of vaginal 
injections, and the remarks come from a high authority 
in gynecological science. 
If, then, these vaginal injections are worthless to 
cure the diseases under consideration, what, it may be 
asked, are they good for ? I reply, they are of good 
service and of great use as adjuvants to a higher class 
of remedies. For the relief of pain, for the removal 
of acrid discharges, for the deodorization or destruc- 
tion of offensive, and for the suppression of exhausting 
fluxes, for instance, the injections are of value. Fur- 
thermore, these injections are of use in giving tone to 
a relaxed and weakened organ, and as astringents for 
the support of the womb when it has a tendency to 
prolapse. Conjoined with judicious and appropriate 
cauterization, where the latter is required, they are of VAGINAL INJECTIONS. 
199 
the greatest use in hastening the cure of the inflamed 
and ulcerated neck. Unmedicated injections, I beg 
leave to add, should always be had recourse to, in 
health as well as in sickness, and this for reasons my 
readers will readily understand. I need not insist 
upon this point further. 
The substances that have been made use of for 
injections are various, and have not always been very 
wisely selected. Some of these substances cause too 
much irritation, others are capable of doing great mis- 
chief and injury. The selection of these substances 
for injections, I suggest, should always be left to the 
medical adviser. Women cannot possibly be good 
judges of the kind of injection that will benefit them. 
That which may benefit one will be ineffectual, if not 
injurious, to the other, etc. In other places in this 
work, I have alluded to the difficulties that exist in 
the way of laying down rules or a plan of treatment 
which will answer every individual case ; I need but 
re-affirm here what I have before said of this nature. 
As to the instruments for injections, I would say, 
that any instrument, except of glass, will answer, pro- 
vided these injections are properly made. It is cus- 
tomary, I believe, to make these injections in a stand- 
ing or nearly perpendicular position, and in one long, 
hurried-up stream. But no method could be more 
ineffectual or more useless. It will be otherwise, if 
the proceeding takes place in the following way. The 
injections are to be made in a reclining posture, the 
feet higher than the rest of the body, in order that 
some of the injected fluid may remain longer in the 
parts injected than the rest. The syringe should con- 200 
woman's complete guide to health. 
tain from six to eight ounces of the fluid to be injected, 
and its nozzle be brought in contact with the neck of the 
womb; in other words, the nozzle of the syringe is to 
be pushed up till it meets with resistance, when it is to 
be emptied slowly and gradually in several interrupted 
streams propelled with some force. The performer 
may resume the erect posture a moment after the 
withdrawal of the instrument. By such method the 
injections may be made effectual and beneficial. It 
will require a little exercise and practice to do this, 
but it will soon be performed very readily. Injections 
made differently, as said before, are seldom effectual. 
I have had many opportunities of making physical 
examination immediately after injection had been 
made, and it was easily ascertained that the injected 
fluid had never reached home, but had stopped short, 
as it were, on the road, midway. 
If I have dwelt at length upon the subject of vagi- 
nal injections, it is because, restricted as they are in 
their usefulness, they are not without importance, in a 
practical point of view, and, consequently, should be 
better understood than they have been hitherto, by 
those who should ever make them their daily practice, 
rvhether in health or in sickness. 
Before closing this long and yet incomplete sketch 
of the treatment of inflammation and ulceration of the 
neck of the womb, I seize the opportunity which has 
not presented itself so appropriately hitherto, of im- 
parting to my readers a few of the most important 
conclusions which Dr. Madden has been led to form, 
in connection with the affection we have been con- 
sidering. They are as follows : CONCLUSIONS OF DR. MADDEN. 
201 
First. That inflammation and ulceration of the neck 
of the womb is a very common cause of female deli- 
cacy. 
Second. That, almost without exception, cases of 
permanent leucorrlioea owe their origin to this disease, 
save when dependent upon much graver causes. 
Third. That many cases of functional deranged 
menstruation are connected with this disease. 
Fourth. That the constitutional disturbance which 
accompanies this disease varies so much in different 
cases, that no unvarying connection can be traced be- 
tween the exact state of the womb and the subjective 
sensations experienced by the patient. 
Fifth. That the constitutional disturbance may be 
greatly benefited, if not altogether removed, by gen- 
eral treatment, while the state of the womb remains 
unchanged, but that such cases seldom retain their 
health for any length of time. 
Sixth. That the local disease may be cured by 
purely local treatment, without any immediate relief 
to the constitutional disturbance. But once the local 
mischief is remedied, the constitutional treatment be- 
comes more facile, and affords a much better prospect 
of complete success. 
Seventh. That the treatment by general remedies 
alone proves sufficiently successful, in slight cases, to. 
warrant a trial of these means in almost all cases in 
the first instance, and warrants the hope that the time 
may come when local treatment may be dispensed 
with. 
Eighth. That wre have no positive evidence of a 
sufficient number of cures of severe casess especially 202 
woman's complete guide to health. 
of ulceration, by general treatment alone, to warrant 
our persevering in the use of general remedies, to 
the exclusion of all local treatment, in such cases as 
present well-marked signs of ulceration, which are 
not benefited locally after a fair trial of internal 
remedies. 
Ninth. That, owing to the want of correspondence 
between the local and general symptoms of this dis- 
ease, it is not safe to pronounce positively on the local 
condition of any given case, until it has been sub- 
jected to a careful physical examination, etc. CHAPTER XIV. 
HYPERTROPHIC ELONGATION OF THE NECK OF THE WOMB. 
GENERAL REMARKS. 
A few preliminary remarks, in relation to the proper 
size, form, and density of the neck of the womb, are 
necessary, in order to understand its variations in 
size from its normal standard. In Another part of this 
work, page 79, I gave a general description of the 
womb, and there stated that this organ was a pear- 
shaped, or a hollow, truncated, rounded and elastic 
organ, and that its length was from two and a half to 
three inches, etc. The neck of the womb is normally 
about half this length, and projects into the vagina 
from a fourth to the third of an inch. This vaginal 
portion is the rounded, truncated part of the womb 
just alluded to, and is elastic to the touch. Such is 
the normal neck of the womb, though it may vary 
from this in many particulars. 
I.-NATURE OF ELONGATION OF THE NECK OF THE 
WOMB. 
We have already seen, elsewhere, that, as a sequela 
of inflammation, the neck of the womb may increase 
in bulk, in a word may become hypertrophied. This 
hypertrophied state of the neck of the womb, we have 204 
woman's complete guide to health. 
also seen, is of a comparatively regular and uniform 
character, and further, that the neck, although it may 
become somewhat distorted, retains, for the most part, 
its ordinary shape. This state of the organ, how- 
ever, may project downward in its progress, not un- 
like the finger of a glove, and constitute then what is 
called an elongation of the neck of the womb, while 
the body of the womb remains unchanged, and in its 
normal condition. 
The hypertrophied elongation, generally, is only 
partial: it may take place in the anterior or in the 
posterior section of the neck; in other words, in its an- 
terior or posterior labia. Von Scanzoni found that it 
was the anterior labia that was mostly so affected. It 
very seldom affects both anterior and posterior parts 
at the same time. The degree of elongation of the 
neck of the womb, from its normal length, varies 
greatly, say from half an inch to one, two, three and 
more inches, and occasionally it may project entirely 
beyond the external parts, exposing thus the protruded 
portion to the air and friction of the clothing, and, as 
a consequence, considerably increasing both its mor- 
bid condition and the discomfort of the patient. This 
latter condition, however, must be of very rare occur- 
rence, since Dr. Becquerel, of France, never met with 
a case presenting such protrusion of the neck, although 
he had seen a great number of cases of this affection. 
Drs. Roux, Huguier, and Goupil of France, and other 
gynecologists, speak of the morbid elongation of the 
neck of the womb, as of frequent occurrence. I have 
met with nearly a dozen of such cases. See cases in 
Appendix. Olliviej-, Lisfranc, Simpson, Dupuytren, CAUSES OF ELONGATION. 
205 
Sims, Von Scanzoni, Virchow, Goupil, Gardner, and 
others, have recognized the frequent connection of this 
elongated state of the neck with sterility. M. Goupil 
informs us that he has observed an elongation of the 
neck of the womb to exist in five sisters, all of whom 
were sterile. All the parties I have met with similarly 
affected were married; most of them had no children. 
One or two others had become mothers, but ceased 
to give birth to any children during their married life, 
for no reasons they could assign. Of two hundred 
and eighteen married women who had never borne 
children, Dr. Sims examined particularly the condition 
of the neck of the womb, and be noticed that out of 
these two hundred and eighteen women, one hundred 
and sixteen, or more than half, were the subject of 
hypertrophic elongation of the neck of the womb. 
Finally, Professor Virchow, who has occupied himself 
with this anomalous condition of the neck of the "womb, 
says that these elongations are always rich in arterial 
vessels, and that in these cases there must exist a cer- 
tain predisposition to this affection - statements in 
which Von Scanzoni fully concurs. 
II.-CAUSES OF ELONGATION OF THE NECK OF THE 
WOMB. 
The causes for the development of this affection are 
not well ascertained. The observations of Von Scan- 
zoni, in this relation, seem to prove that compression 
of long duration, severe contusions which the parts 
undergo during the act of parturition, as well as the 
congestion (hypersemia) hence resulting, are not with- 
out influence in the development of this malady. 206 
woman's COMPLETE GUIDE TO HEALTH. 
III.-DIAGNOSIS OF ELONGATION OF THE NECK OF THE 
WOMB. 
I observed in the preceding article, that the neck of 
the womb may attain great length, and that it may 
even protrude externally. This state of things, and 
particularly the last condition, might, by a careless 
examiner, be taken for a prolapsed womb, or even a 
procedentia. In the main, however, the diagnosis of 
this morbid state of the neck presents no serious dif- 
ficulties. A minute exploration will prevent this 
affection being mistaken for another. That such mis- 
takes as above to have been committed, must 
be evident, since M. Huguier, of France, the author 
of a treatise on Elongations of the Neck of the Womb, 
in conclusion says, that he can certify that the affec- 
tion, which so generally is considered as a falling of 
the womb,is nothing else but a hypertrophied elonga- 
tion of the neck, and that, perhaps, out of thirty cases, 
there is not one exception. 
IV.-SYMPTOMS OF ELONGATION OF THE NECK OF 
THE WOMB. 
Patients who are the subjects of elongation of the 
neck of the womb, generally experience a sense of 
bearing down or weight, pain in the back, occasional 
flooding, and some of the various sympathetic symp- 
toms already sufficiently dwelt upon elsewhere. This 
state, moreover, may interfere with sexual congress, 
rendering it painful, or even impracticable. It is 
almost always the source of a very considerable mu- TREATMENT AND CASE OF ELONGATION. 
207 
cous secretion, which is extremely disagreeable for 
the patients. Every movement of the body provokes 
painful sensations, which often radiate towards various 
regions. 
V.-TREATMENT OF ELONGATION OF THE NECK OF 
THE WOMB. 
Therapeutic measures, in this affection, whether 
general or local, are of no efficacy whatever, and the 
amputation of the hypertrophied portion of the neck 
of the womb is the only rational treatment. For illus- 
tration, I call attention to the following case : 
Case XXVIII.-Hypertrophic elongation of the neck of 
the ivomb in a married lady, twenty-three years old, 
the probable cause of sterility and of her ill-health. 
Cured after three months of treatment. 
In July, 1861, I was consulted by Mrs. C , of 
New Jersey, on account of her impaired state of health. 
She was twenty-three years old, and had enjoyed 
excellent health until within three years, when she 
married. She began to menstruate at the age of 
eighteen, at first somewhat irregularly, but before the 
expiration of the first year, more regularly, and sub- 
sequently remained so. Later, however, and within 
six months of her contemplated marriage, her menses 
became somewhat distressing for a day or two pre- 
ceding their occurrence, without her being aware of 
the cause of this change. With this exception, she 
enjoyed, as said before, excellent health, when she 208 
woman's complete guide to health. 
assumed new relations in life. When she consulted 
me, she had been married three years, but had no 
children, neither had she been pregnant as she 
knew of. For nearly two years, her health had not 
been good. Her menses had become more painful 
and more profuse. Subsequently, she was troubled 
with a vaginal discharge, rather variable in its charac- 
ter, but always debilitating. Sexual intercourse had 
for the last year been attended with distress, and 
occasionally with perfect agony. She had at times 
slight bloody vaginal discharges ; she could not walk 
for any distance without feeling distressing sensations 
in the pelvis and back, and other symptoms of rather 
a nervous character. She had been treated for over 
a year without benefit. She had not been examined, 
and had only heard her troubles referred to her deli- 
cate constitution-that she would outgrow it, and 
that possibly she would get better as soon as she 
should be with child. 
On examination, I found the cause of her troubles. 
She was the subject of a hypertrophic elongation of 
the anterior labia of the neck of the womb, the ex- 
tremity of this elongated part reaching nearly to the 
external organs. Three months later, Mrs. C was 
entirely cured of her affection and restored once more 
to her former good health. The record of other cases 
will be found in the Appendix. CHAPTER XV. 
DISPLACEMENTS OF THE WOMB. GENERAL REMARKS. 
I had not, at first, designed to consider the dis- 
placements of the womb, on account of their compli- 
cated nature. I even now doubt my ability to render 
the subject intelligible to my readers without entering 
into uninteresting details and fatiguing repetitions. 
And yet, aware of the great frequency of these dis- 
placements, and how little their charac.ter is under- 
stood, perhaps a short space may well be spared for 
their consideration, and be the means of awakening 
greater solicitude on their part on the appearance of 
such displacements, and enabling them, in conse- 
quence, to seek at the earliest opportunity, and before 
their presence has occasioned greater mischiefs, the 
means of removal. 
Before proceeding, it will be necessary to give a 
short synopsis of what has been said in other places 
in regard to the womb and its neck. We have already 
seen that the womb occupies normally very nearly a 
central position in the pelvic cavity, and is situate 
about midway from both the rectum behind and the 
bladder in front. It is indeed, as it were, between 
these two organs, the body or upper part of the womb 
being slightly inclined anteriorly, and its neck in the 210 
woman's complete guide to HEAT,th. 
opposite direction, giving thus to the axis of the organ 
(womb) a slight anterior oblique direction in the pel- 
vis, instead of a straight one. The unimpregnated 
womb weighs about one and a half ounces, and is 
supported by means of the (vaginal) walls of the canal 
leading to the womb, ligaments and some of the sur- 
rounding tissues, and lastly, possesses a degree of 
mobility to a greater extent than any other organ in 
the system. Being, as just stated, poised in the mid- 
dle of the pelvic cavity, and delicately supported, and, 
moreover, possessing the property of great mobility, 
it cannot but be manifest that from such peculiar 
arrangement, there should result various and frequent 
displacements of the womb, that are about to be con- 
sidered. This outline, brief as it is, of what the womb 
really is, will, for a fair understanding of what follows, 
and for all practical purposes, be sufficient. 
Displacements of the womb are divided into : 
1. Anteversion of the womb. 2. Retroversion of 
the womb. 3. Prolapsus and procedentia of the 
womb. These various displacements some authorities 
subdivide again into anteflexion and retroflexion, but 
these, as a general rule, are but different stages or 
degrees of the same thing. In other words, ante- 
flexion, for instance, is merely an anteversion to a 
greater extent or degree. I do not, therefore, intend 
to consider these last affections, not thinking them of 
any practical importance, or as modifying in the least 
the general principles of treatment. NATURE OF DISPLACEMENTS OF THE WOMB. 
211 
L-NATURE AND FREQUENCY OF DISPLACEMENTS OF 
THE WOMB. 
That displacements of the womb are of very fre- 
quent occurrence daily clinical observations sufficiently 
show. M. Goupil, in one hundred and fifteen exami- 
nations of women who had never borne children, met 
with anteversion fourteen times ; and in one hundred 
and fourteen examinations of women who had borne 
children, he found it in thirty-six instances. Of five 
hundred and five women examined by Dr. Sims, in 
relation to sterility, he observed that three hundred 
and forty-three, or more than two thirds, were affected 
with displacements of the womb ; or, in other words, 
out of these five hundred and five women, one hun- 
dred and sixty-four were affected with anteversion, 
and one hundred and seventy-nine with retroversion 
of the womb. My own memory is correct, when I 
state that the majority of women who have come 
under my special observation, who were either child- 
less, or had become sterile after the birth of one or 
two children, were affected with some form or other 
of displacement of the womb. I remember that, in 
half a dozen instances at least, the subjects of a pre- 
vious sterility lost their sterility very shortly after the 
restoration of the displaced organ to its normal posi- 
tion, q.nd became happy mothers. While I write, two 
patients, among others, are under my special care, 
one for retroversion of three years' standing, which 
had taken place almost immediately after her marriage, 
three years ago; the other for incomplete or partial 
falling of the womb of five years' standing; both are 212 
woman's complete guide to health. 
childless. Displacements of the womb as independent 
diseases are, by general acknowledgment, considered 
as of extreme rarity, while, as complications and 
" effects " of inflammation of the womb, its neck, or 
other affections of the organ, they are of very frequent 
occurrence. I proceed now to consider their indi- 
vidual character. 
1. ANTEVERSION OF THE WOMB. 
Anteversion of the womb is that form of displace- 
ment in which the body of the womb is thrown for- 
ward, inclining towards or pressing more or less 
against the bladder, and its neck is thrown in the op- 
posite direction, resting on the rectum. This may 
take place to an extent more or less great, that is to 
say, the displacement may be either complete, incom- 
plete, or constitute what some authorities call an ante- 
flection, to which I alluded in the general remarks on 
the displacement of the womb. The greater the dis- 
placement, the greater the evils it may occasion ; in 
other words, the greater this form of displacement, the 
greater the troubles it may occasion in both the blad- 
der and rectum. This form of displacement is an 
affection which is developed slowly and insidiously, 
and is mostly encountered in unmarried women. We 
have seen that the normal position of the womb is that 
of a slight anterior inclination. Consequently, it will 
not be difficult to understand that this natural anterior 
inclination may be increased to a greater or less ex- 
tent by very slight causes, and may constitute then 
the morbid state we call anteversion. It will also be 213 
RETROVERSION OF THE WOMB. 
seen, that it must be impossible to lay down any ex- 
act rule as to the line which separates what is normal 
from what is abnormal, or, in other words, what is the 
"normal anteversion of the womb" from what is the 
" abnormal anteversion," the affection under considera- 
tion. Anteversion, as might be presumed from the 
natural anterior obliquity of the womb, may occasion- 
ally occur as an independent or idiopathic affection, 
and may then have for its cause pressure of the small 
intestines, for instance, forced down upon the body 
of the womb by tight clothing, that baneful and ridi- 
culous contrivance of fashion, or else some muscular 
effort. As I observed in my concluding remarks upon 
the frequency of displacements of the womb, however, 
it is mostly the result or effect of some abnormal con- 
dition of the womb, increasing its weight, etc. Lastly, 
Dr. Becquerel, who concurs in the views of Dr. Bennet, 
emphatically declares that there exists no well-authen- 
ticated observation demonstrating the existence of a 
confirmed anteversion, independent of any chronic in- 
flammation or other affection of the womb, or of its 
neck* 
2.-RETROVERSION OF THE WOMB. 
Retroversion of the womb is another displacement, 
in wdiich the body of the womb is thrown backward, 
and rests on the rectum, while the neck is either 
thrown forward, or may maintain its usual position. 
The observations made in the preceding paragraph, in 
relation to the extent to which anteversion may be 
carried, apply equally to retroversion. This affection, 
as an independent or idiopathic disease, is of extreme 214 
woman's complete guide to health. 
rarity, even much more so than anteversion. But as 
sympathetic of some inflammatory disease, or other 
states which increase the weight of the womb, it is of 
very frequent and almost daily occurrence. This form 
of displacement is mostly met with in women who 
have borne children. 
3. PROLAPSUS AND PROCIDENTIA. 
Prolapsus, or "Falling of the Womb," defines its 
own character with sufficient clearness, and is well 
known to women, for whom it constitutes an object of 
dread and apprehension. Falling of the womb is par- 
tial or complete. I consider the displacement partial 
or incomplete, when the womb has departed from its 
normal position, and descended to a greater or less 
degree lower down in the pelvic cavity; it is this de- 
gree of the displacement which has received the name 
of Prolapsus, or Falling of the womb. When it has 
gone still further, when the womb depasses the vulva, 
or external organs, and projects outside the parts, 
whether in toto or partially, the displacement is com- 
plete, and is called Procidentia. Falling of the womb 
is, of all the varieties of deviations, the most impor- 
tant, the most complicated in its nature, and, in all 
respects, attended with greater inconveniences to the 
patient than any other of the displacements we have 
considered successively. It may take place gradually, 
or it may occur very suddenly and quite unexpectedly. 215 
CAUSES OF DISPLACEMENTS OF THE WOMB. 
IL-CAUSES OF DISPLACEMENTS OF THE WOMB. 
The causes which may produce the displacements 
of the womb are numerous, various and complicated. 
Consequently, I shall not dwell at any length upon 
their consideration. But they may be classified as 
follows : 
1. Any influence which increases the weight of the 
womb. Thus, congestion, inflammation and hyper- 
trophy of the womb, or its neck, retained fluid in the 
cavity of the womb, tumors in the walls or cavity of 
said organ, pregnancy, tuberculous or cancerous de- 
posits-all these conditions may, by increasing the 
weight of the womb, or of its neck, produce one or 
other of the various deviations. Dr. Bennet thinks 
that when inflammation attacks the posterior walls of 
the womb, retroversion is the result, and that antever- 
sion is caused by inflammation of the anterior wall, 
and leads it to be inferred that these displacements 
are almost always connected with inflammation as an 
effect. Dr. Byford thinks tliat he has seen every 
variety of displacement connected with inflammation 
of the neck. One of the most common causes of 
anteversion, remarks Dr. Sims, is a small fibroid in 
the anterior wall of the womb; and if a fibroid not 
larger than an English walnut is attached in any way 
to the posterior wall of the womb, it almost invariably 
pulls the womb over backwards, producing retro- 
version. 
2. Any influence which diminishes the supports of 
the womb. Through long continued congestion or 
inflammation, the natural supports of the womb may 216 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
become weakened, may relax or even be ruptured, and 
from this may follow want of tone and other abnormal 
conditions in the womb and other tissues. These 
morbid conditions may particularly be called into ex- 
istence in the state existing after confinement. The 
womb is heavier than is normal, the recently distended 
vagina relaxed and feeble, and the ligaments very 
much stretched. 
3. Any influence which pushes the womb out of 
place. Tight clothing, or heavy clothing unsupported 
by shoulder straps, exercises a considerable and bane- 
ful influence in producing displacement, and falling of 
the womb in particular. Muscular efforts, tumors 
and repletion of the bladder are so many abnormal 
conditions which may push the womb out of its nor- 
mal position. 
4. Any influence which displaces the womb by trac- 
tion. Violent efforts of some kind, abdominal tumors 
and effusions, and false membranes, tight lacing by 
which direct pressure is exercised, forcing down the 
small intestines upon the body of the womb. Ante- 
version, in some cases, has been observed to be caused 
by cicatricial adhesion between the neck of the womb 
and the floor of the vagina ; in some by peritoneal- 
utero-vesical adhesions ; and in many cases the cause 
is undemonstrable. 
III.-SYMPTOMATOLOGY OF DISPLACEMENTS OF THE 
WOMB. 
" According to my experience," observes Dr. Ben- 
net, " displacements of the womb and of its neck, in 217 
SYMPTOMS OF DISPLACEMENTS OF WOMB. 
whatever direction they occur, when slight, and when 
they have taken place gradually, do not occasion any 
symptoms whatever,.if there is no inflammation pre- 
sent." These views of the great gynecologist are con- 
curred in by Drs. Depaul, Aran, Goupil, Becquerel, 
Huguier, and others equally eminent. On the other 
hand, these views are at variance with those taken on 
the subject by gynecologists of known ability and no 
less eminence, as Drs. Velpeau, Simpson, Valleix, and 
others. I have often turned my own attention exclu- 
sively to this subject, but as yet have come to no defi- 
nite conclusion. It is of exceedingly rare occurrence 
to meet with patients suffering exclusively from one 
or other of the various deviations of the womb, when 
the displacement or deviation is as yet slight and 
recent. I have treated a great number of patients 
laboring under some form or other of displacement of 
the womb, but in the majority of cases, they were 
complicated with inflammation or some other abnor- 
mal condition of the womb or its neck. On the other 
hand, I have also met with a large number of cases 
where inflammation, etc., of the womb or of its neck 
existed, but were unattended by any deviation of the 
womb whatever. The symptoms in both these cate- 
gories of patients were nearly alike ; their symptoms 
were those said to characterize particularly some form 
or other of the displacements under consideration, 
such as bearing down, weight in pelvis, functional de- 
rangement, vesical irritation, pains in the back and 
leucorrhoea. These circumstances would so far sub- 
tan tiate the views taken on the subject by Dr. Bennet 
and others. 218 
woman's complete guide to health. 
Dr. Goupil, taking advantage of his position at the 
Loucine (a " Lock " hospital), examined by " the 
touch," every patient that was admitted (two hundred 
and twenty-nine), and was led to conclude " that de- 
viations of the womb, when simple, with the exception 
of prolapsus and procidentia, do not cause any func- 
tional disturbance." Retroversion, he says, when 
uncomplicated, gives rise to neither pain nor any 
other symptom. It usually occurs after a confine- 
ment, and there is almost always some falling of the 
womb. When it is found accompanied by distress in 
the womb, this is due to some affection of the tissues; 
and if this be cured, the position of the womb is of no 
consequence. As to anteversion, he shows, by illus- 
trative cases, that though the anteversion is not infre- 
quent, as he found it in thirty-four per cent, of nulli- 
para examined, yet in every case in which distress in 
the womb was complained of, catarrh of the womb or 
congestion was also present; and when these were 
cured the uterine symptoms disappeared, although the 
anteversion remained. Be this as it may, Dr. T. Gail- 
lard Thomas, of New York, I am plea'sed to say, very 
forcibly states, what he believes to be, at present, the 
prevailing views on the subject. " The following 
propositions may, I think," he remarks, " be presented 
as embodying the present opinions of the majority of 
the enlightened gynecologists of our day. 1st. Ver- 
sions and flexions of the womb may exist without 
causing any symptoms, for in themselves they do not 
constitute disease. Thus it is that we see the uterus 
forced completely out of its place by tight clothing 
without the production of morbid signs. 2d. By RESULT OF DISPLACEMENTS OF THE WOMB. 
219 
interfering with the escape of menstrual blood, by dis- 
ordering uterine circulation, by causing pressure and 
friction from contact with surrounding parts, and by 
creating a barrier to the entrance of seminal fluid, 
they become of great importance and require special 
attention. 3d. Generally being the results and not 
the causes of uterine and peri-uterine inflammations, 
they are best treated by alleviation of these states. 
4th. Treatment by pessaries is rarely effectual, for we 
generally reach only a symptom and not the disease 
in this way. Sometimes, however, it becomes neces- 
sary after removal of the causative lesions to prevent 
their return, and to combat resulting relaxation of 
uterine supports." 
IV.-COURSE, DURATION AND TERMINATION OF DIS- 
PLACEMENTS OF THE WOMB. 
The displacements of the womb are unlimited in 
their duration, and unless their causes are relieved by 
art, will continue indefinitely. They impair the pa- 
tient's comfort and capacity for exertion, but rarely 
have a fatal termination, unless by exciting inflamma- 
tion in the serous membrane covering and enclosing 
the abdominal viscera or small intestines, etc. 
V.-PROGNOSIS OF DISPLACEMENTS OF THE WOMB. 
No decided or serious injury from displacements of 
the womb, if slight and recent, need be apprehended. 
But we may not be without some apprehension, if the 220 
woman's complete guide to health. 
affection is of old standing, has become chronic, and 
morbid conditions have taken place, in which case, 
we need not be too sanguine of effecting an ultimate 
cure. We may meet with difficulties in removing the 
cause of this displacement. Or even should this be 
accomplished, the womb is so prone to retain the 
abnormal position in which it has long been kept, that 
great difficulties not only attend its restoration, but 
its retention. If early attention be paid to these 
various forms of displacements of the womb, as well 
as to diseases of the womb generally, the hope of their 
ultimate cure may be indulged. 
VI.-TREATMENT OF DISPLACEMENTS OF THE WOMB. 
To restore the displaced organ to its normal condi- 
tion, is self-suggestive, and, consequently, should be 
the first indication as to treatment. In recent cases, 
and before any complications have been allowed to 
set in, this reduction will not be attended with any 
difficulties. But, in the contrary state of things, that 
is to say, in old standing cases, where complications 
of some kind or other exist, difficulties, often of a very 
serious nature, will be met with in almost any kind of 
effort at reduction. The special course of treatment 
for maintaining the womb in its position, after reduc- 
tion has been accomplished, will depend greatly on 
the cause of the displacement. Thus, if the displace- 
ment be due to congestion, inflammation, hypertrophy 
of the womb or of its neck, by which the weight of the 
organ has been unduly increased, or to any morbid 
condition of the organ, which has exercised similar 221 
TREATMENT OF DISPLACEMENTS OF THE WOMB. 
effects, or to pressure exerted upon the womb from 
above, as in tight lacing, or to the presence of tumors ; 
any and all such causes must be removed before we 
may expect with any certainty to cure the displace- 
ment, or the effect of the various causes just men- 
tioned. Such is, in short, the treatment to be pur- 
sued in cases of displacements of the womb. So much 
has already been said in other places in this work, in 
relation to the appropriate treatment of the diseases 
peculiar to women, that I do not deem it necessary, 
or even of any practical importance, to dwell further 
on the subject in this place. I shall, however, in the 
next article, say a few words in relation to the use of 
pessaries in displacements of the womb. 
VII.-PESSARIES, THEIR USE AND ABUSE. 
In displacements of the womb, pessaries have been 
used for two distinct purposes, to wit: to Eft up and 
give support to the womb after reduction has been 
accomplished, and to diminish pressure against the 
bladder. Consequently, it is readily seen that pes- 
saries are not curative, but simply palliative, and are 
thus open to one great objection, for while they sus- 
tain the reduced organ by their own force-by their 
bulk, they both distend and prevent the vagina (canal 
leading to the womb) from contracting, and in time 
regaining its former tone and power, and also its be- 
coming capable of resuming its natural duty, that of 
supporting the womb. But pessaries, notwithstand- 
ing this objection, are useful instruments, as adjuvants, 
in the management of displacements of the womb. 222 
woman's complete guide to health. 
Their employment, however, is much less called for 
than it has been. It is all but certain that the proper 
estimate of the nature of this mechanical support for 
the womb has not been sufficiently considered nor un- 
derstood, for their usefulness has been greatly over- 
rated. 
But if harm has been produced by pessaries, it is, 
nevertheless, not sufficient reason for repudiating 
them altogether. Indeed, much unnecessary suffer- 
ing has been given by their employment, because 
they were called into requisition in many instances, 
where they were not needed, in cases where no dis- 
placement really existed, save in imagination. In 
other instances, they were applied -when the womb, 
neck, or surrounding tissues were too tender, irritable 
and painful, on account of existing congestion and in- 
flammation. In such cases, pessaries are inapplicable. 
But, as before remarked, pessaries are useful both 
as adjuvants to another and higher class of remedies 
(to those remedies as curative of those causes of which 
the displacements of the womb are but the effects), 
and because, if we did not use them, we might turn 
away cases without being able to do any thing at 
all for their relief. These instruments, then, I allow, 
are an evil, but a necessary evil. They are not to be 
resorted to, except in cases where they cannot be dis- 
pensed with, and as a " dernier ressort." It becomes, 
then, the part of wisdom to resort to such appliances 
as will best answer the indications of the individual 
case. 
In conclusion, I would state that I do not often find 
opportunity for the use of pessaries. In a very great USE OF PESSARIES. 
223 
number of cases of displacements of the womb, which 
have come under my attention and treatment, I have 
observed that inflammations of the womb, or of its 
neck, with its usual sequelae, ulceration and hyper- 
trophy, were the conditions which almost invariably 
caused the displacement, since by subduing these 
inflammatory conditions, the displacements mostly 
righted themselves, not having been the subjects of 
special attention. In other instances, suitable pes- 
saries have been very effectually applied, after the 
inflammation had been subdued, or nearly so, and the 
displacement still remained unchanged. It is thus in all 
cases of displacements of the womb, where no inflam- 
mation of any kind, or morbid condition capable of 
keeping the womb deviated exists, that pessaries are 
applicable, and will do good. See Case LXI. in Ap- 
pendix. As to the material of such instruments, I 
would say, with Dr. Sims, " Away with cheap things! 
whether drugs or instruments, for our sick, especially 
for our sick women, and more especially still, when 
they are affected with such fearful calamities as we 
have now been considering." CHAPTER XVI. 
TUMORS OF THE WOMB. GENERAL REMARKS. 
To the tumors of the womb may be applied, and 
with still greater reason, the preliminary observations 
made in relation to the displacements of the womb. 
I would refer my readers to Chapter XV., where I 
considered said displacements of the womb. Any 
organized growth within the womb, whether in its 
walls, whether depending, or connected with any of its 
surfaces, may be called a tumor, but such tumors are 
distinguished by their structure, position and relation- 
ship with different parts of the womb. Thus, tumors 
of whatever structure or size, which remain imbedded, 
as it were, in the substance of the womb, or attached 
to the external surface (peritoneal) of the body of the 
womb or of its neck, are in ordinary professional lan- 
guage simply spoken of as tumors ; those which are 
attached to the womb by means of a pedicle, are called 
polypi, and all these tumors form one distinct class or 
type, to wit : the fibrous tumors and fibrous polypi of 
the womb. A second class or type of tumors are those 
intimately connected with the lining or mucous mem- 
brane of the womb, and are known as mucous polypi 
of the womb. There is a great variety of these two 
classes or types of tumors. 225 
TUMORS OF THE WOMB-GENERAL REMARKS 
The womb scarcely ever retains all its healthy pro- 
perties and proportions if these tumors be connected 
with it. It is almost always increased in size and 
hypertrophied. Sometimes, however, there is no per- 
ceptible increase noted. Prof. Francis, many years 
ago, reported a (post-mortem) case of a fibrous tumor 
weighing one hundred pounds, that had developed 
from a small pedicle connected with the external sur- 
face (peritoneal) of the body of the womb healthy in 
every other respect. 
The functions of the womb, as might be surmised, 
are pretty generally disturbed by these affections. 
These may be arrested; much more frequently they 
are rendered more than naturally profuse, protracted 
and frequent. Pregnancy may be prevented or va- 
riously influenced as the location and the size of the 
tumor vary. These observations are specially refer- 
able to those instances where tumors grow in the 
cavity of the womb. Conception and gestation, how- 
ever, may be accomplished in the presence of very 
large intro-mural fibrous tumors. On February 27th, 
1859, I attended a lady in her fourth confinement, in 
whom I observed, after the birth of the child, nearly 
the same shape and size of the abdomen as before, 
and I expected it to be a case of twins. Having at- 
tended to the child, I turned attention again to the 
lyitig-in. After a suitable lapse of time had been 
allowed to pass without bringing away the afterbirth, 
I introduced my hand in the womb for the purpose of 
delivering it. On reaching the body or fundus of the 
womb, I discovered the afterbirth on the left-hand 
side, pretty firmly adhering as yet to the wall of the 226 
woman's complete guide to health. 
womb, and at the same time discovered that the right- 
hand side of the fundus w'as the seat of an intra-mural 
fibrous tumor of about the size of the child's head 
just born. The confinement had been a very painful 
and unfortunate one. The breech presented, the cord 
was coiled three times round the child's neck, and the 
child was still-born. The tumor I found had been 
observed by the lady on a previous confinement, which 
had also ended unfortunately, the child being born at 
the end of the eighth month of pregnancy. During 
her pregnant state, the lady's health was less favora- 
ble than at other periods, but the tumor had not 
during its existence, then quite three years, given any 
trouble whatever. 
I.-NATURE OF FIBROUS TUMORS AND FIBROUS POLYPI. 
The fibrous variety of tumors are those originating 
in the substance or texture proper of the womb, and 
are by far the most common, the most difficult of man- 
agement and dangerous of all the benign tumors of 
the womb. They are hard, resisting, and generally of 
a globular or oval form. As they grow, they either 
remain imbedded in the wall of the womb, or extend 
in any direction. If they extend outside the womb, 
they protrude in the abdominal cavity ; if inside the 
cavity of the womb, they may fill up this cavity, and 
still increasing in size, project through the mouth of 
the womb into the vagina. Their growth is slow. 
Sometimes years will elapse before they attain a size 
capable of mischief, and probably before they are MUCOUS POLYPI OF THE WOMB. 
227 
detected. Numerous fibrous tumors have been found 
to exist after death, which had caused no suspicion of 
their presence. They are seldom solitary, but their 
number is almost unlimited. Their size is exceedingly 
variable. Some of these tumors are no larger than a 
pea, or hazelnut, or chestnut, some are as large as a 
fist. Dr. Courty speaks of a tumor weighing fifty 
pounds, Dr. Dupuytren of another weighing twenty- 
five. Dr. Thomas exhibited to the New York Patho- 
logical Society, the womb of a negress which contained 
thirty-five tumors of every size between that of a foetal 
head and that of a marble. 
These fibrous polypi are usually of an oval form. 
The size of the pedicle or attachment becomes larger 
in proportion as they are found distant from the neck 
of the womb. But, generally, the attachment of these 
tumors on the lower end of the neck of the womb is quite 
slender. In different specimens we find considerable 
difference in this respect. The firmness of these polypi 
is governed also by their locality. They are less 
firm below, and more firm above the cavity of the neck. 
Dr. McClintock remarks, in relation to the frequency 
of tumors, that " without question the most frequent 
organic disease of the womb, if we except inflamma- 
tion and its effects, is the fibrous tumor." 
II.-MUCOUS POLYPI OF THE WOMB. THEIR NATURE. 
These tumors, the second of their class or type, are 
those which have for their base of attachment the 
mucous or lining membrane of the womb, and hence 228 
woman's complete guide to health. 
are called mucous polypi. Having this membrane for 
a base of origin and support, they are softer than 
those before considered, and may, in consequence, 
become detached by slight handling. Sometimes they 
are firm enough to require considerable force to 
destroy or separate them from their attachment. 
Their shape and size vary very considerably. Occa- 
sionally they are cylindrical and very long; some- 
times pear-shaped, and as large as an egg, with a 
small pedicle ; they may occur singly or in a great 
number in the same womb, and may be found on any 
part of the lining or mucous membrane, but are often- 
est seated in the neck of the womb or on its extremity. 
More frequently than the fibrous variety, these are 
cured by the efforts of nature. They are also removed 
by much slighter means than the fibrous. And on 
account of the facility with which these tumors are 
removed or destroyed, much less importance is at- 
tached to them than to the class of fibroids. In the 
Appendix, some cases complicated with small polypi 
attached to the neck of the womb will be noticed, 
where these tumors disappeared after a few applica- 
tions had been made, for the cure of the existing ulcer- 
ation from which these polypi had originated. 
The tumors which have now been successively con- 
sidered are not all those met with in the womb; but 
I think that the consideration of those most com- 
monly existing will answer practical purposes. To 
conclude this subject, I give my readers the views of 
Professor Virchow, the greatest living authority on 
these special affections of the womb. According to 
him, the true myoma (fibrous tumors) infests, by pre- NATURE AND CAUSE OF TUMORS. 
229 
ference, the body (the fundus) of the womb, where 
muscular fibres are naturally most abundant, and is 
there met with in three forms, according to the rela- 
tions which it holds to the uterine walls : first, the 
polypus, which projects into the cavity of the womb ; 
secondly, the submucous myoma, which projects into 
the cavity of the peritoneum ; thirdly, the intra-parie- 
tal, or interstitial myoma. The description of the first 
and second varieties, according to Professor Virchow, 
contains nothing particularly worthy of notice. The 
third, or intra-parietal, is not only completely sur- 
rounded by muscular substance, but appears as a very 
part of the wall of the womb. From the presence of 
this form of tumor, the cavity of the womb may un- 
dergo various elongations, contractions and twistings, 
as well as the different flexions (displacements or 
deviations) of the womb itself. A remarkable phe- 
nomenon is seen in the occasional birth or spontaneous 
expulsion of the intra-parietal myoma and the poly- 
pus. In the case of the former, separation from the 
(uterine) wall of the womb takes place by a process of 
suppuration or sloughing round the tumor, or by the 
action of the tumor itself in wearing away the muscular 
and mucous layers which cover it, and is followed by 
expulsion, with regular labor-pains. 
III.-ETIOLOGY, OR CAUSES OF TUMORS OF THE WOMB. 
In 1814, Sir Charles Clarke remarked, that " noth- 
ing is known respecting the cause of this disease." 
And while I write, in 1868, fifty-four years later, no 
light has yet been thrown upon the -causes of these 230 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
tumors. The causes which are generally regarded 
as predisposing to the formation of these tumors are: 
inflammation of a chronic character, and any influence 
tending to keep up (uterine) congestion of the womb ; 
menstrual disorders of long standing, or sterility. 
The African race seem peculiarly predisposed to these 
tumors. 
IV.-SYMPTOMATOLOGY, OR SYMPTOMS OF TUMORS OF 
THE WOMB. 
The symptoms that may give occasion to suspect 
the presence of some form or other of tumor in the 
womb, are numerous. Among the most prominent 
are the following : 
1. Leucorrhoea, more or less profuse; 2. Pains in 
the back and loins ; 3. Hemorrhages or floodings, of 
more or less severity, occurring at the periods of men- 
struation and in the intervals ; 4. Irritability of blad- 
der and rectum, from pressure of the tumor ; 5. Uterine 
tenesm, or spasms of the womb; 6. Dysmenorrhoea, 
or painful menstruation, and other irregularities of 
this function; 7. Watery discharges, hydrorrhcea, 
etc., etc. 
These symptoms are not equally common to the 
three varieties of the affection. Some tumors are ac- 
companied by none, or at least by very few of them, 
while others give token of their presence by quite a 
number of symptoms. It will be remarked, that many 
of the symptoms above enumerated are similar to 
those described when I considered inflammation and 
ulceration of the neck of the womb. This circum- 
stance proves what difficulties and perplexities might COURSE, DURATION AND END OF TUMORS. 
231 
present themselves, in affections such as those now 
under consideration, and, in fine, in affections of the 
womb generally, if physical examinations were neg- 
lected, or otherwise carelessly availed of. 
V.-GENERAL COURSE, DURATION AND TERMINATION OF 
TUMORS OF THE WOMB. 
As already stated, tumors of the womb may attain 
an enormous weight. Fortunately, however, they do 
not often reach such dimensions ; but even when they 
do not, they frequently exhaust patients by flooding, 
leucorrhoea, watery discharges, and a low grade of 
constitutional irritation, often attended by hectic 
fever. Having attained a moderate size, they gener- 
ally remain stationary or increase slowly, until the 
change of life, creating considerable inconvenience, 
and depreciating the patient's strength by hemorrhage 
or flooding. Then undergoing a certain degree of 
atrophy, with the cessation of (uterine and ovarian) 
the various functions of the womb, they cease to be, to 
any great degree, a source of annoyance, or at least of 
danger. Even during the age of the activity of the 
womb, nature may, unaided, effect a cure by absorp- 
tion or atrophy, by direct expulsion, by rupture of 
attachment, sloughing from deprivation of nutrition or 
inflammation, and, lastly, by calcareous degeneration. 
The above results may, and may not, be looked for 
with any confidence. In the majority of instances, 
without surgical interferences, steadily advancing anaa- 
mia will ultimately destroy life. 232 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
VI-PROGNOSIS OF TUMORS OF THE WOMB. 
Too much caution and reticence cannot be dis- 
played in pronouncing upon the future progress and 
termination of fibrous tumors of the womb; but, un- 
less of great size, they rarely end fatally, however 
gloomy the prospect may appear when they are first 
discovered. The prognosis, in relation to mucous 
polypi, is favorable, depending, however, upon the 
possibility of removal. 
VII.-TREATMENT QF (UTERINE) TUMORS OF THE 
WOMB GENERALLY 
The treatment of tumors of the womb is, in the ma- 
jority of cases, limited to palliation of the evils result- 
ing from their growth. The mechanical interference of 
the tumor is prevented by artificial supports, such as 
abdominal supports and pessaries ; the floodings and 
vaginal discharges, by the administration of suitable 
medicines and appropriate vaginal injections. Sur- 
gical means are to be resorted to only under the fol- 
lowing conditions : 
a. When the growth is so located as to render 
removal easy and safe. 6. W7hen the disease is threat- 
ening the patient's life. This course of treatment is 
especially applicable to fibrous tumors of the womb. 
As to mucous polypi, the first indication is to cause 
the expulsion of the growth from the cavity of the 
womb into the vagina, and second, to accomplish its 
removal when thus expelled by the same surgical 
means adopted for tumors of the -womb generally. CHAPTER XVII. 
INFLAMMATION OF THE MUCOUS MEMBRANE OF THE VAGINA, 
OR CANAL LEADING TO THE WOMB. VAGINITIS. GENE- 
RAL REMARKS. 
The " mucous membrane " that lines the vaginal 
canal may, from some cause or other, become the sub- 
ject of inflammation, whence its name, vaginitis. It 
is, in many instances, a very distressing affection. 
It assumes various forms-it may be general or it may 
be limited. The acute form of the disease is not a 
very common affection. The chronic form, on the 
contrary, is of greater frequency. In this form it is 
mostly considered as of a secondary character, a symp- 
tom of some other affection. 
The only form of this affection which I shall con- 
sider is the simple vaginitis in its acute and chronic 
character. It is typical of the various forms of inflam- 
mation with which the mucous membrane of the vag- 
inal canal may be attacked. This inflammation of 
the mucous membrane of the vaginal canal, whether 
acute or chronic, is an affection that is met with at all 
periods of woman's life, and at all ages. 
I.-NATURE OF VAGINITIS, OR INFLAMMATION OF THE 
MUCOUS MEMBRANE OF THE VAGINAL CANAL. 
As just observed, the disease under consideration 
consists in an inflammatory condition of the mem- 234 
woman's complete guide to health. 
branous lining of the canal leading to the womb, from 
some cause or other presently to be mentioned. The 
disease, as just stated, is met with in both acute and 
chronic forms. Each type may appear originally to 
be the result one of the other. The acute form may 
be excited by some special cause and rapidly pass 
into the chronic. The affection may also have origi- 
nated in an incipient and low grade of inflammation, 
or it may at any time take on an acute and occasion- 
ally a very virulent character. The tendency of the 
inflammation is to extend and invade the surrounding 
organs, tissues, etc., such as the womb, its neck, or 
the bladder, and to constitute so many complications 
superadded to the original character of the affection. 
IL-ETIOLOGY, OR CAUSES OF INFLAMMATION OF THE 
MUCOUS MEMBRANE OF THE VAGINAL CANAL. 
► 
Among other causes recognized as capable of ex- 
citing inflammatory action in the mucous membrane 
of the vaginal canal, are the following : 
1. Various vaginal secretions. 2. Exposure to cold, 
dampness, etc. 3. Various abnormal states of the 
womb, its neck, and of its surrounding organs, tissues, 
etc., such a's inflammation, ulceration, etc. 4. Pecu- 
liar habit of the constitution, such as the scrofulous, 
the lymphatic, etc. 5. Various injuries of a mechan- 
ical origin, such as may be produced by pessaries, 
excessive intercourse, or contusions, lacerations, etc. 
6. Chemical agencies, such as applications to the 
womb, or its neck, made in a careless manner. 
7. Specific poison. It is unnecessary to enter into a SYMPTOMS OF VAGINAL INFLAMMATION. 
235 
full consideration of these various causes ; they suffi- 
ciently explain themselves. 
III.-SYMPTOMATOLOGY, OR SYMPTOMS OF INFLAMMA- 
TION OF THE VAGINAL MUCOUS MEMBRANE. 
Inflammation of the mucous membrane that lines 
the vagina or canal leading to the womb, if acute, may 
be recognized by the following symptoms : 
A sense or sensation of heat, it may be burning- 
and fullness, swelling, tension, redness of some of the 
organs and more or less itching, great tenderness, 
amounting sometimes to actual pain, rendering the 
necessary instrumental manipulation painful and fre- 
quently unsatisfactory. An arrest of secretion, which 
produces dryness, then a profuse purulent vaginal dis- 
charge of a yellowish or greenish color takes place, of 
an acrid and offensive character, lasting more or less 
long. More or less frequent desire for micturition 
exists. Erotions or excoriations occur within and 
around the external organs. All these symptoms are 
Hable to be periodically aggravated by the menstrual 
congestion ; thence arises a tendency to its perpetua- 
tion, if it does not at once subside or give way to the 
proper means of treatment. 
It is thus easily seen, that if the slightest amount 
of inflammation is left previous to menstruation, the 
congestion which precedes this function may fan it 
into a flame, developing anew the inflammatory action. 
In the chronic form of this affection, the symptoms 
are much less decided, but a long train of sympathetic 
appearances, not unlike those observed in inflamma- 236 
woman's COMPLETE GUIDE TO HEALTH. 
tion and ulceration of the neck of the womb, to which 
I would refer my readers, usually accompanies it. 
The chronic form, whether general or partial, may 
last indefinitely, like chronic inflammations of all other 
mucous membranes, giving rise to a constant vaginal 
secretion, varying in intensity according to the pa- 
tient's state of health, social and hygienic position, 
and the particular period of the month. In the course 
of time, this secretion passes into a mere flux, and its 
existence in this aspect is a source of great annoyance, 
discomfort, weakness and general debility. 
IV.-DIAGNOSIS, OR DISCRIMINATION OF INFLAMMATION 
OF THE MUCOUS MEMBRANE OF THE VAGINA. 
The symptoms enumerated in the preceding article 
may be the result of various morbid conditions, in- 
flammatory or other, of the womb, its appendages, of 
the mucous membrane of the vagina, or the surround- 
ing tissues, and hence, there is occasionally great dif- 
ficulty, almost impossibility, in recognizing the real 
character of the affection under observation. It is, 
consequently, necessary to obtain a truthful and accu- 
rate history of the case, and all the antecedents of the 
patient, and above all, to make a thorough local 
examination. Nothing short of this will enable the 
practitioner to discriminate between the disease under 
consideration and any other disease of a similar char- 
acter ; or, in other -words, between an inflammation of 
a specific or non-specific origin. TREATMENT OF VAGINAL INFLAMMATION. 
237 
V.-PROGNOSIS OF INFLAMMATION OF THE MUCOUS 
MEMBRANE OF THE VAGINA. 
The prognosis of this affection is not unfavorable. 
It is the nature of this disease, generally, to run a 
certain course, more or less long. Its chronic form, I 
observed when considering the symptoms of the affec- 
tion, may continue indefinitely, and become the source 
of great annoyance and discomfort; and the general de- 
bility it occasions may render women whom it attacks 
invalids for the remainder of their life, or for that 
period of years in which the affection remains un- 
checked or uncured. 
VI.--TREATMENT OF INFLAMMATION OF THE MUCOUS 
MEMBRANE OF THE VAGINA. 
The character of this affection having been suffi- 
ciently explained in the preceding articles, my readers 
will see the necessity of trusting its management, 
without loss of time, to the physician, who alone is 
competent to bring it to an early and safe termina- 
tion. In the meantime, patients attacked with this 
disease, should at once make such preparations as 
will enable them to enjoy perfect rest, and a horizontal 
posture ; they should avoid locomotion and excite- 
ment, and abstain from intercourse. Their diet should 
be light, of moderate quantity and unstimulating. 
Fomentations, by means of flannels wrung out of hot 
water or some soothing decoction, may be advan- 
tageously applied over the lower part of the stomach 
and around the hips. They should also, several times 238 
woman's complete guide to health. 
a day, take a hip or sitz bath, or better still, sit over 
a tub partly filled with warm water, in which, for 
soothing purposes, a sufficient quantity of boiling 
starch, poppies or linseed, have been thrown. In this 
position they should make use of copious injections of 
the same water, administered in the way I have recom- 
mended, page 197, to which I refer my readers. 
This outline of treatment applies more to the acute 
than to the chronic form of the disease. In the latter 
form, the patient should take frequent out-door exer- 
cise ; her diet may be more liberal, yet unstimulating : 
cold bathing, sea-bathing if possible, and daily injec- 
tions, as recommended above, are appropriate meas- 
ures to be employed. " In the treatment of all cases 
of vaginitis," remarks Dr. Graily Hewitt, " whatever 
be the cause, very great importance is to be attached 
to the observance of cleanliness; frequent ablutions 
should be employed." Finally, perseverance and time 
are important items in the treatment of the disease in 
its chronic form. " If," observes Dr. Byford, " we can 
remove this chronic inflammation in three or even six 
months, we ought to be satisfied. And we ought not 
to be surprised to have it return one or more times 
after it is apparently cured. It is well, also, to teach 
our patient patience in this respect." CHAPTER XVIII. 
LEUCORRHCEA, OR WHITES. GENERAL REMARKS. 
In most instances, leucorrlioea (or the whites) is to 
be viewed rather as a symptom than as a disease, 
properly speaking. Accordingly, I had intended 
merely to notice it as a symptom, and as such gave it 
some consideration in another part of this work at 
page 116. Still, as this affection may be met with 
occasionally, independent of any other affection, and 
depending on some constitutional cause, and as it is 
very imperfectly understood by the greater number of 
those who become troubled with it, a special reference 
to the whole subject may not be altogether unprofit- 
able. 
Leucorrlioea, then, whether it is considered as a dis- 
ease, or as a symptom the effect of some remote dis- 
ease in the system, is certainly in the whole list of the 
diseases peculiar to women, the one most commonly 
met with, and I shall not commit an error in stating 
that probably few women ever go through fife without 
at some period or other, and for a variable time, suf- 
fering from it. It is only when it becomes annoying 
by its constancy, abundance, irritating properties, its 
weakening tendency, and, at the eleventh hour, that it 
attracts woman's attention, and causes her to seek 
assistance. 240 
woman's COMPLETE GUIDE TO HEALTH. 
I.-NATURE OF LEUCORRHCEA. 
The mucous membrane lining the vagina, or canal 
leading to the womb, and a number of glands (sebace- 
ous and muciparous) situated in its whole tract, pour 
out a secretion sufficient to moisten or lubricate the 
surfaces of the membrane. This natural secretion 
may, however, be increased in quantity during sexual 
congress, for instance, or under other circumstances ; 
but it does not thus increase enough to constitute 
a genuine vaginal discharge. This is the physio- 
logical or natural condition of the mucous mem- 
brane and glands under consideration, nothing more 
nothing less. This physiological or natural secretion 
of the organs under notice, differs somewhat in char- 
acter, according as the secretion takes place from the 
mucous membrane lining the vaginal canal, or from 
the glands alluded to, or from the mucous membrane 
lining the canal of the neck of the womb, and is, there- 
fore, of a white-milky, or white-of-egg, and very viscid 
and tenacious character. 
The various secretions, as already stated, may be 
increased in quantity during the excitement of inter- 
course, or before and at the period of menstruation, 
and, under such circumstances, may constitute a 
slight vaginal discharge, appearing then at the exter- 
nal organs, and the mixture of the various secretions 
alluded to, results in a white soapy or creamy dis- 
charge. But this discharge, although increased in 
quantity, so as to appear externally, must yet be 
viewed as of a physiological or natural character, and 
generally may be said to be without sensible odor. NATURE AND CAUSES OF THE WHITES. 
241 
If, however, the vaginal discharge is of a pathological 
or abnormal character, and consequently a symptom, 
and the result of inflammation of the mucous mem- 
brane of the vagina, or of that of the womb, or of its 
neck, or of any other morbid state of these organs and 
their appendages, the secretion is no longer of the 
character just mentioned, but is then of a muco-pus 
character, that is to say, the increased natural mixture 
above mentioned, has become mixed with pus, and its 
color is yellowish or greenish ; it is a foul mixture of 
these secretions, according to the nature and severity 
of the local disease; and, finally, this secretion may 
be very offensive. 
For further particulars in relation to this morbid 
vaginal discharge, my readers are referred to page 116. 
IL-ETIOLOGY, OR CAUSES OF LEUCORRHCEA. 
It is evident, from what precedes, that the causes of 
leucorrhoea must be considered and divided into two 
distinct classes, to wit: Constitutional or general 
causes, and local causes. These two, it is obvious, 
are not always easily separable, because both kinds 
are often present in the same case. 
(1.)-CONSTITUTIONAL OR GENERAL CAUSES OF LEUCOR- 
RHCEA. 
Warm countries, moist and damp situations, appear 
to give rise to leucorrhoea. Again, a state of plethora 
may induce it, the discharge being in such cases a kind 
of relief to the overburdened system. Want of exercise 
and too good living give rise to it. The opposite of 242 
woman's complete guide to health. 
the foregoing, anaemia, or defective nutrition, or a sys- 
tem reduced by loss of blood, produces it, as does an 
abnormal state of menstruation, and also childbearing. 
The influence of childbearing is very considerable, 
and its effects are twofold. Women of a weakly or 
anaemic constitution, whose blood is thin and watery, 
frequently suffer to a very troublesome extent from 
leucorrhoea during the period of gestation. After preg- 
nancy has ended, the increased action of the various 
glands connected with the generative organs continues, 
the effect of which is persistent vaginal discharge; a 
congested state of the womb, and the other organs 
connected with childbearing. The effect of parturition 
at full time, or abortions, etc., is also a cause of leucor- 
rhoea. Again, in women who have borne children in 
quick succession, or who have had abortions, and who 
have for some time been the subjects of leucorrhoea, 
the womb becomes seriously altered in texture, in size 
and in shape; and this may be associated with an 
amemic condition generally. Here, as in most cases, 
we perceive the difficulty of drawing fine distinctions ; 
the constitutional merges into the local cause, and the 
local into the constitutional cause. Still further, in 
women of phthisical tendency, leucorrhoea is more apt 
to arise in connection with childbearing, and in such 
persons, indeed, very frequently independently of it. 
Prolonged lactation also produces leucorrhoea. This 
is one of the most frequent causes in childbearing 
-women, by inducing a state of extreme debility. In a 
number of cases of leucorrhoea during lactation, which 
have come under my special care, the leucorrhoea wTas 
exceedingly profuse. Chronic diseases of the lungs 243 
CAUSES OF THE WHITES. 
and of the heart are often observed in association with 
chronic leucorrhoea, which is, under such circum- 
stances, obviously difficult to cure. Finally, exces- 
sive sexual intercourse, the various tumors of the 
womb, as well as irritation in the bladder and rectum, 
variously produced, may be set down as giving rise to 
this affection. 
(2.)-LOCAL CAUSES OF LEUCORRHCEA. 
The local causes of leucorrhoea are very numerous. 
Any irritation, and almost any disease of the womb 
and its appendages, may be associated with a leucor- 
rhoeal discharge. The following are the chief of these : 
inflammation, acute or chronic, of the womb or of its 
mucous membrane, and its sequelae, ulceration, etc.; 
irritation produced by excessive sexual intercourse; 
inflammation of the vaginal canal, whatever its cause ; 
irritation exercised by abnormal growths, such as 
fibrous tumors, polypus, etc., wherever located; the 
various displacements, versions, etc., of the womb; 
displacements of the bladder and vagina ; irritation in 
the bladder; cancer of the womb, or of its neck. 
HL-DIAGNOSIS OF LEUCORRHCEA. 
It is obvious, that from the various constitutional 
and local causes enumerated above, the diagnosis of 
leucorrhoea must offer some serious difficulties. It 
would be impossible to arrive at a correct discrimina- 
tion of the case from a mere distinction between the 244 
woman's complete guide to health. 
various local conditions causing leucorrhceal discharge, 
without resorting to a thorough physical examination. 
IV. PROGNOSIS OF LEUCORRHCEA. 
What the ultimate progress and termination of leu- 
corrhoea may be, will depend in a great measure upon 
the particular cause producing it. If this cause can 
be removed, the case will, of course, terminate favor- 
ably. If, on the contrary, leucorrhoea be connected 
W'ith some serious organic lesion (cancer, tumors, etc.), 
a happy termination of the case cannot be hoped for. 
V. TREATMENT OF LEUCORRHOEA. 
The treatment of leucorrhoea requires caution, re- 
flection, and some solid knowledge of the causes that 
may originate the trouble. Without these, the treat- 
ment of the disease will very likely be all but empirical, 
and consequently ineffectual and of no avail. It has 
been shown that leucorrhoea may arise from an im- 
mense variety of causes. The treatment must then 
differ correspondingly, according to the nature of the 
case. We may hope to arrive at satisfactory results 
from a mode of treatment based on a complete knowl- 
edge of the case actually before us, and on a just 
appreciation of the relations which, as cause and 
effect, subsist between the condition of the patient and 
the symptoms present. 
We must endeavor at once to seize upon the true 
indication for treatment. This should always be our TREATMENT OF LEUCORRHCEA. 
245 
object, and to be able to do this the diagnosis must 
be a complete one. From these remarks, my readers 
will conclude rightly, that cases of this affection, like 
many others noted in this volume, should, in my judg- 
ment, be intrusted to the care and the management 
of the medical adviser. 
The treatment of leucorrhoea, in reality, is of two 
kinds, general and local. So far as I write of it, I will 
endeavor to consider these two with all the brevity 
consistent with clearness. To remove the cause of 
the leucorrhoea is the first indication. The treatment 
must have regard primarily to that. In a case of con- 
sumption, for instance, in which leucorrhoea is present, 
the treatment must have regard to the consumption 
in the first place, although it may be necessary also 
to employ local or other measures calculated to arrest 
or diminish the leucorrhoeal discharge. Where the 
leucorrhoea is due to, or associated with, an anaemic 
condition, the removal of that condition should be the 
chief object of endeavor. If there be any reason to 
suppose that the patient's residence is unfavorable hy- 
gienically, this must be remedied. If the leucorrhoea 
be associated with exalted activity of the sexual 
organs, as is frequently the case when intercourse is 
indulged in inordinately, the indication is obvious. 
There are few cases of leucorrhoea in which the 
womb is altogether sound. It is usually congested, 
increased in bulk, its tissues relaxed, and the activity 
of the glandular apparatus lining the neck of the 
womb unnaturally increased. Under such circum- 
stances, the primary object is to remove the condition 
of the womb on which the leucorrhoea depends. The 246 
woman's complete guide to health. 
quantity, quality and mode of taking food must be 
carefully adjusted to the requirements of the case. 
The skin must be kept warm, and its due action 
insured by the employment of friction, baths and 
exercise. In patients who have been long the subjects t 
of leucorrhoeal discharge, the importance of carefully 
regulating the " mode of life " cannot be over-esti- 
mated ; and it is the more necessary to insist on this, 
as not unfrequently the practitioner on the one hand, 
and the patient on the other, pay far too little atten- 
tion to these essentials ; the result of this neglect 
being a temporary, and not a radical, cure of the 
affection. Here a caution may be given. There are 
some cases of long standing profuse leucorrhoea in 
which bad results may ensue from a too sudden stop- 
page of the discharge ; due caution should be exer- 
cised, therefore, in the application of remedies in 
these cases. 
Certain watering-places have obtained repute from 
the efficacy of the mineral waters there to be obtained 
in removing leucorrhoea, especially that of a chronic 
form. It is unquestionable that very good effects 
may be obtained under the use of the waters in ques- 
tion. The effect produced results, however, in many 
cases, from the change of air, the perfect rest and 
relief from ordinary cares and anxieties, the regular 
exercise, simple diet, and change in the mode of life 
generally, all of which play, unquestionably, a most 
important part in bringing about the cure as much as 
the specific curative power of the water itself. Im- 
provement in the general health is usually rapidly 
followed by a cessation or diminution of the leucor- TREATMENT OF THE WHITES. 
247 
rhoea. In many instances, great difficulties are met 
with in persuading patients systematically to follow 
up the course of treatment enjoined while they are 
living in their own houses, surrounded by homo asso- 
ciations, and, in a manner, tied down to home habits. 
For this reason it is sometimes necessary to send 
patients to watering-places, in order that they may 
be induced to give themselves a fair chance of re- 
covery. 
There are very powerful therapeutical agents in the 
treatment of leucorrhoea dependent on constitutional 
causes in the use of baths. These effect the determi- 
nation of the blood to the skin, and thus relieve the 
the congestion of the internal organs usually present 
in these cases. The most simple and convenient form 
of bath is the " sponge bath." Next comes the hip 
bath. These various baths may be used in all cases, 
however debilitated the patient. But it is necessary 
that a " reaction," as it is termed, take place after the 
bath, or it does harm, and the patient suffers from 
headache or other inconvenience for some hours after. 
For those patients who are able to bear it, the " shower- 
bath," or the cold plunge-bath are to be recommended. 
There are also cases which may be most benefited 
by the warm-bath. Injections, moreover, judiciously 
used, are of the greatest value in the treatment of 
leucorrhoea. In many cases they have a curative 
effect, in all cases they are of some service, and in 
certain cases they are almost indispensable. So much 
has, however, already been said elsewhere in relation 
to their use, that it is needless to dwell on the subject. 
To conclude, I would remark, that if I have not 248 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
clone entire justice to so frequent, annoying and im- 
portant a subject as leucorrhoea, I yet hope that 
enough has been said to give my readers a fair idea 
of its nature, its numerous causes, its consequences if 
unrelieved, and most of all, the persevering attention 
and treatment it requires from both themselves and 
the medical practitioner. 
CONCLUSION.-ON THE INDIFFERENCE OF WOMEN IN 
RESPECT TO THEIR HEALTH, AND THE PRESENT 
SYSTEM OF THEIR EDUCATION. 
The following Sketch is drawn by one of the most 
eminent gynecologists of the day, Professor Gunning 
S. Bedford, of New York. As this sketch is in every 
respect graphic, vivid, truthful, logical and conclusive 
on the subject it treats, as it is so sincere, earnest, 
irresistible in its appeal, and, moreover, as it corre- 
sponds so exactly in every regard with my own feel- 
ings on this subject, I cannot resist the temptation to 
give it a place in extenso. 
" In this city," he says, " there is much and intense 
suffering among females from disease. Wealth and 
its associate influences cannot stay the progress of this 
unrelenting enemy. The lady who revels in luxury, 
and has around her, even to satiety, all the comforts 
and pleasures which opulence can secure, would 
gladly, whilst writhing under the agonizing pain inci- 
dent to some formidable affection of the womb, sur- 
render all these comforts to regain the health which, 
it too often happens, she has sacrificed by her own 
folly and imprudence ! She once possessed a good woman's indifference to her health. 
249 
constitution-she relied too strongly on that consti- 
tution-she became careless, entered into all the dis- 
sipations of society, infatuated and bewildered by the 
constant excitement of fashionable life-a devotee to 
pleasure. She is heedless of the first manifestations 
of disease; but that disease, like the silent night, pro- 
gresses-it brings with it physical infirmity and moral 
anguish-her strength is declining-her mind weak- 
ened, and, compelled by absolute suffering to withdraw 
from society, she finally invokes the aid of a physician. 
He investigates with great care her case, and finds 
that her disease is without remedy. She may, perad- 
venture, be laboring under some organic affection of 
the womb, which, if seen to in time, would have been 
perfectly manageable. Her days are numbered ; and, 
instead of being the attraction and idol of the gay 
crowd, she now becomes the victim of the most dis- 
tressing bodily suffering-suffering so agonizing that 
she is impatient to die ; and, when her last hour has 
come, she breathes a prayer of thankfulness to heaven 
that her agony is at an end ! There is no fiction here; 
I am not presenting you an exaggerated picture ; it is 
true in fact and detail. I have been compelled on 
more than one occasion to say, when my opinion was 
requested, ' Madam, I can do nothing for you-your 
disease has made fearful progress-it is beyond the 
reach of science! ' These words fall on the ear 
of the afflicted patient with chilling and disastrous 
effect; they bring to her mind with vivid truth the 
painful reminiscences of her own indiscretion-indis- 
cretion which is about to consign her to an early 250 
woman's complete guide to health. 
grave, and make desolate the hearts of those to whom 
she was united by the ties of the closest affection. 
" When will the females of the present day become 
rational, and emancipate themselves from the delusion 
which is constantly resulting in disaster and .death ? 
When will they hearken to the admonitions of common 
sense, and turn from the path of folly, which leads 
with the certainty of truth to unhappiness and misery ? 
Let them but take a brief retrospect of what has be- 
fallen their own immediate friends. Where is the 
lady who has not been called to mourn the premature 
death of some fond and devoted sister-of some gay 
and cherished companion ? In the death of that sis- 
ter, she may, perhaps, have learned the importance of 
attending to the early developments of disease, and 
appreciated the cruel wrong of allowing them to pass 
unnoticed and unchecked. Yet with these admoni- 
tions fresh in the memory of almost every female in 
the land-with the daily and lamentable experience 
before her of the consequences resulting from indiffer- 
ence to the first indications of deranged health, we see 
her-wayward and thoughtless as she is-passing to 
her own destruction! 
" I could enumerate many examples of melancholy 
suffering which commenced, in the first instance, in 
simple aberration of the menstrual function. This 
aberration, however, was unheeded ; it was permitted 
to continue month after month, until finally it termi- 
nated in the development of a malady, which, after 
years of torture, occasioned the death of the unhappy 
victim. * * * * * * . * * 
" Here is a practical case, the very type of what you 251 
MELANCHOLY SUFFERING FROM INDIFFERENCE. 
will constantly see in practice. This girl's system is 
thrown into disturbance because of the arrest of the 
menstrual function-a function which, I have repeat- 
edly said, cannot be unduly interrupted without in- 
volving the general economy in more or less difficulty. 
Among the causes of this sudden suppression, there is 
none more frequent in its action than cold. This fact 
is well understood by those beyond the pale of the 
profession, and it will fall to you, as it has frequently 
done to me, to witness in the more elevated sphere of 
society the effects of the wanton manner in which young 
ladies, not availing themselves of this knowledge, trifle 
with their health. I have now before my mind a mel- 
ancholy example of this thoughtless temerity in the 
the person of a pure and loving creature, whose life 
was forfeited, and whose death caused a blank in the 
parental heart, and threw a gloom over the domestic 
hearth, which no time can dissipate. Without guile, 
and full of purity, this young girl, unconscious that 
the rash act would prove her destruction, plunged her 
feet into a bucket of ice-water a few hours after the 
menstrual flow commenced. The function became 
immediately arrested, and such was' the reaction on 
the brain, that in less than six hours she was a corpse 
from apoplexy. It is not for me, gentlemen, to depict 
the anguish of that hour, or to tell you of the bleed- 
ing hearts that hung in the bewilderment of grief over 
the lifeless body of that beloved daughter, and fondly 
cherished sister. Let it suffice to tell you that I was 
a witness to the scene, and that night, in harrowing 
but graphic truth, revealed to me how death can sport 
with human affection. It is a great misfortune that 252 
woman's complete guide to health. 
young girls budding into life should be kept in such 
profound ignorance of their own peculiar mechanism, 
and of the laws by which its harmony is maintained* 
Interrogate the grave, and ask that last and dismal 
abiding place to reveal its triumphs, obtained through 
this ignorance, and it will tell you their name is 
legion. On us, as medical men, devolves the sacred 
duty of admonishing mothers to instruct their daugh- 
ters as to their physical well-being. 
'tWhat parent who is not a maniac would give to her 
infant an open razor with which to amuse it ? Would 
not her common sense at once disclose the absurdity 
of such an act ? She would see that this was placing 
in the hand of her child an instrument of destruction, 
and if forfeiture of life were not the result, it would 
be only because of the interposition of a merciful 
providence to protect the child against the insanity of 
the parent. The open razor to the young child is not 
more fatal in its effects than are the multitudes of 
vicious practices countenanced by society to the young 
girl. 
" The whole system of female education among us 
is, in my judgment, radically wrong, and the wrong 
strikes at the very foundation of all happiness-health. 
The three leading objects which should interest a 
mother in behalf of her daughter are-healthy physi- 
cal development, high mental cultivation, and a moral 
training, which will not only cause her to appreciate, 
but will also enable her to perform with inflexible 
fidelity her duties to society. 
"Does the present system of education-do the 
prurient books with which the boudoir and chamber MELANCHOLY SUFFERING FROM INDIFFERENCE. 
253 
are crowded-does the no less prurient dance, which 
so few have the moral courage to resist, though in 
their hearts they condemn it-tend to the accomplish- 
ment of these objects ? No, gentlemen, they are like 
the fatal upas, whose touch is withering, and whose 
impress is death." APPENDIX. 
I append to the illustrative cases contained in the 
body of my present work, a few abstracts of cases I 
have treated, all derived from private practice. 
Case XXIX. 
Engorgement and inflammatory ulceration of the neck of 
the womb, fainting fits etc., in a married lady. Com- 
plete cure after a course of medico-surgical treatment. 
In September, 1857, Mrs. R , aged thirty-five, 
twice married, but without children from either mar- 
riage, consulted me for the following state'of her 
health, which had gone on declining for four or five 
years. She complained of pains in the head and back, 
generally constant; occasional dizziness; obstinate 
constipation, with disposition to piles, bleeding at 
intervals, and tenesm, when the bowels moved; want 
of appetite ; menstruation irregular as to quantity, 
bearing down pains, scalding pain when urinating, and 
profuse leucorrhoea. But the chief symptom she spoke 
of was fainting spells, coming on without any apparent, 
immediate or direct cause ; she dreaded going out, lest 
an attack might overtake her in the street, and, con- 
sequently, kept much to her room. 255 
PARTIAL PROLAPSUS. 
On examination, I found the womb greatly hyper- 
trophied, extending to the neck, which was soft, and 
in a state of great congestion, with extensive ulcera- 
tion around the margin of the mouth of the womb, and 
extending upwards within its cavity. This lady was 
declared entirely cured of her affection after a few 
months of medico-surgical treatment, with an inter- 
ruption of some five weeks spent in another State on 
the occasion of death in the family. Meeting her a 
few months subsequently to her withdrawal from treat- 
ment, she informed me that her health was excellent, 
and that no fainting fits had intervened to mar her 
new enjoyment of life. 
Case XXX. 
Partial prolapsus, the result of engorgement and ulcera- 
tion of the neck of the womb, the inflammation extending 
downwards and to the external parts, in an unmarried 
girl. Cured after a few months of steady treatment. 
In 1857, Mary C , aged twenty-three, single, and 
seamstress, of New York, consulted me for pains in 
the head and back, both being nearly constant, and 
occasionally more or less severe, burning sensation in 
urinating; sometimes dizziness ; whites ; great nerv- 
ousness and a general inaptitude for work. Digestion 
was impaired ; tendency to constipation existed ; men- 
struation was accompanied with pain for a day or 
two; the complexion was sallow and very sickly. 
Having been for over a year under treatment, without 
benefit, I made an examination of the womb, and 
found it in the following state: the neck swollen, 256 
woman's complete guide to health. 
rounded almost in the shape of a ball, lowered in the 
vagina, which was lax and moist, the hypertrophied 
lips of the mouth of the womb open, and its margin 
ulcerated, the ulceration ascending and involving the 
cavity of the neck; the vagina slightly inflamed and 
extending downwards towards the external organs, 
rendering these parts very sensitive to manipulation. 
After a few months of steady and uninterrupted at- 
tendance, the local disease was entirely removed, the 
patient's health improving daily, while under treat- 
ment. She regained with it her previous aptitude for 
work, and was finally, as she expressed it, " herself 
again." 
Case XXXI. 
Inflammation, ulceration, engorgement and induration of 
the neck of the womb ; profuse leucorrhoea. The look 
and complexion the index of great sufferings, in a widow 
lady. Complete cure. 
In October, 1857, Mrs. K , a widow, between 
thirty-five and thirty-eight, consulted me. Five years 
before, her husband died. She took this event much 
to heart; her youngest child being then seven years 
old. Her previous health was indifferent, neither good 
nor bad; but after her husband's decease, it began 
sensibly to flag, sinking almost daily. Symptoms, 
'which had previously been slight, and hardly con- 
sidered important in her daily avocations, such as a 
vaginal discharge, pains in the head, back and left 
side, became now more prominent, and at times quite 
severe. To these, other symptoms were soon added, 
such as dizziness, weight in the pelvis, with shoot- CASE OF INFLAMMATION AND PROLAPSUS. 
257 
ing pains, radiating down the thigh; costiveness; a 
very poor appetite, with great distress in the region 
of the stomach; occasional disagreeable feelings of 
sinking; exhaustion. Menstruation became very 
irregular as to time, periodicity and quantity. The 
look and complexion of this lady were those of one 
" whose sands of life were nearly run out." She had a 
pinched nose, sunken eyes, hollow temples, skin dry, 
wrinkled and cold; complexion yellowish, sallow and 
livid. For the last two years, she had at times been 
under medical treatment, but no improvement had re- 
sulted from it. 
On examination, I found the womb in a wretched 
condition. There was considerable inflammation and 
swelling of the neck, involving the whole organ; the 
neck very much thrown backwards, presenting exter- 
nally a large ulcerated surface, partly indurated, the 
ulceration extending within the cavity of the neck, 
from which issued a thick, viscid, tenacious, yellow- 
brownish secretion, removed with difficulty. This pa- 
tient, after a few months of uninterrupted medico- 
surgical treatment, entirely recovered her health, and 
looked ten years younger. A few months later, she 
visited the continent. As I write (October, 1864), I 
have heard from her, and she enjoys the best of 
health. 
• Case XXXII. 
Prolapsus of the womb, the result of extensive ulceration 
of the neck of the womb, in a married lady. Complete 
cure. 
In April, 1858, Mrs. B , aged twenty-seven, mar- 258 
woman's complete guide to health. 
tied, and the mother of three children, consulted me 
foi' a- dull aching pain in the summit of her head and 
back, for weight and for bearing-down pains in the 
pelvis; a slight but permanent vaginal discharge, at 
times more profuse and debilitating ; costiveness, with 
disposition to piles, defecation occasionally very pain- 
ful. Menstruation was regular, but of longer duration 
than formerly (from eight to ten and twelve days). 
Sexual congress had been painful for the last two 
years, and lately almost impossible. She had mis- 
carried twice. On examination, I found the womb 
decidedly low down, with swelling extending to the 
neck of the womb, which reached within an inch from 
the external organs ; the mouth of the womb open, so 
as to admit the extremity of the finger, and extensively 
ulcerated; the external parts hot and very sensitive. 
After a course of irregular and interrupted treatment, 
the lady was entirely cured from all her troubles, and 
restored to perfect good health. 
Case XXXIII. 
Inflammation and ulceration of the neck of the womb; 
itching of the external organs; profuse leucorrhcea ; 
obstinate cough, in an unmarried girl. Complete re- 
covery. 
In June, 1858, Charlotte D , aged twenty, arfd 
single, consulted me for the following symptoms: 
She complained for the last two or three years of pains 
in the head and back ; of dizziness ; irregular courses; 
constipation, with occasional painful evacuations; INFLAMMATION AND PROLAPSUS. 
259 
weight in the pelvis and pains shooting down the right 
leg; at times swelling of the feet; yellowish-sanious 
vaginal discharge ; dry, hacking, harrassing cough for 
nearly five years; has to make water often, particu- 
larly in the night. This was for some time painful 
and burning. Sleepless nights were passed, ugly 
dreams experienced. Internal and external itching of 
the genital organs was present She acknowledged 
that she had indulged in sexual pleasures. Had been 
under treatment of several physicians without improve- 
ment. On examination, I found the genital organs 
hot, and filled with a thick yellow-brown secretion. 
The neck of the womb was inflamed, very painful to 
the touch, and considerably displaced backwards, with 
a bleeding livid ulcer on its anterior lip. External 
parts and vagina were very sensitive on manipulation. 
After a due course of appropriate treatment, this pa- 
tient was cured of all her uterine derangements, and 
only complained of her cough, which was by no means 
so harrassing as formerly, with some weakness of the 
digestive organs. For these latter symptoms, I treat- 
ed her on general principles, and had the satisfaction 
to be informed shortly afterwards, that the cough had 
disappeared, her appetite improved, and, finally, that 
her health was now most satisfactory. 260 
woman's complete guide to health. 
Case XXXIV. 
Pruritus Pudendi, or itching of the external organs, de- 
pendent on follicular and granular inflammation of the 
neck of the ivomb, with an excoriated surface on its in- 
ferior lip; profuse vaginal discharge, etc., in a mar- 
ried lady. Complete cure. 
In June, 1858, Mrs. G , aged thirty-four, mar- 
ried, but without children, applied to me on account 
of a distressing and almost unbearable itching of the 
external sexual organs, which had already lasted for 
some three months. This was the only trouble she 
complained of, and for it she anxiously sought relief. 
On further inquiry, however, she acknowledged the 
presence of a profuse vaginal discharge, and of pains 
in the head and back, with lightness in the head, and 
an extreme nervousness. Her courses were more pro- 
fuse than formerly, and increased all her troubles. 
Intercourse had lately become painful, almost impos- 
sible. On examination, I found the external organs 
very much inflamed and swollen, and of extreme sen- 
sitiveness ; no doubt the effect and extension of in- 
flammation of the womb, and of its appendages. 
After a few weeks of general treatment, the inflamma- 
tion and sensitiveness of the parts just described hav- 
ing somewhat abated in intensity, I made a further 
examination, and found the neck highly inflamed, and 
excessively sensitive to the touch ; the inferior lip of 
the mouth of the womb excoriated (slightest form of 
ulceration) ; the vaginal walls still swollen, red, and 
covered in its whole length, extending to the upper 261 
CASE OF INFLAMMATION. 
part of the neck, with red, rounded, elevated spots, 
secreting copiously a thick transparent mucus, which 
also issued abundantly from the mouth of the womb. 
No doubt could exist but that the severe inflamma- 
tion of the neck, and of its cavity, was the primary 
cause of the inflammation and its accompanying itch- 
ing of the external sexual organs-a circumstance 
which had been overlooked by the practitioner whom 
the lady had consulted on the breaking out of the 
itching. He had satisfied himself by merely prescrib- 
ing medicated washes, etc., for nearly three months- 
a* treatment which she might have pursued during her 
natural lifetime, and have neither been cured nor re- 
lieved of it. After a short ultimate treatment, the 
patient was cured of all her troubles, and health re- 
gained. 
Case XXXV. 
Inflammation, ulceration, engorgement, and induration of 
the neck of the tvomb ; profuse leucorrhoea, etc., in a 
married lady. Premature termination of the case ; the 
cure nearly completed. 
June, 1858, Mrs. C , aged thirty, mother of four 
children, consulted me for the following state of her 
health: she had suffered for the last three or four 
years from severe pains in the back and head ; the 
lower extremities easily fatigued; from a profuse vagi- 
nal discharge; was inclined to constipation; sharp 
and stitching pains darted across the pelvis. Men- 
struation was, she said, normal; digestion greatly im- 
paired ; her nervousness extreme ; complexion sickly. 262 
woman's complete guide to health. 
On examination, I found the genital organs hot and 
well lubricated; the neck of the womb so considerably 
enlarged, as to render its insertion within the field of 
a speculum of the largest size difficult; the anterior 
lip partly indurated ; the mouth of the womb ulcerated, 
and from it issued abundantly a thick yellow bloody 
secretion. After a treatment of nearly a year, the 
hypertrophied indurated and ulcerated neck had con- 
siderably changed for the better, and was so much 
improved as to enable me to predict, at no very dis- 
tant day, its entire restoration to its normal state. 
But the case came to a premature end, through the 
vicissitudes of fortune. The lady's health had, in the 
mean time, greatly improved, and most of the local 
symptoms had left her. Her husband failing in busi- 
ness, he removed with his family into the country. 
Case XXXVI. 
Inflammation and ulceration of the neck of the womb, com- 
plicated with a polypus ; menorrhagia, or profuse men- 
struation, and metrorrhagia, or hemorrhage from the 
womb in the intervals of menstruation, etc., in a mar- 
ried, lady. Complete recovery. 
In November, 1859, Mrs. C , aged twenty-eight, a 
rather robust looking lady, and mother of a son seven 
years old, consulted me, and the account she gave is 
as follows : " Though I may look stout and apparently 
healthy, I nevertheless enjoy less good health than 
for some years back. I am much troubled with my 
courses, which have for the last two years become ex- CASE OF INFLAMMATION, ETC. 
263 
cessively profuse, lasting from ten to twelve clays. I 
have known them on me for fourteen days; now they 
seem to come on for some time past every two weeks, 
and they leave me quite weak and prostrated. I am 
much troubled with bearing-clown pains. These pains 
become exceedingly distressing when I am unwell: 
they make me nervous and apprehensive that some- 
thing will fall from me. I am a good deal troubled, 
too, with the whites. I have in several instances 
taken physic, but nothing seems to stop my flood- 
ings." 
On examination, a polypus, half the size of a hen's 
egg, was found lying in the vagina, and its pedicle 
traced within the cavity of the neck; the neck inflamed, 
and very tender to the touch. A bivalve speculum 
enabled me to ascertain that considerable ulceration 
existed without and within the neck, and that from 
this ulcerated field originated the polypus. I at once 
removed the polypus, and with its removal no more 
flooding between the courses occurred, nor were the 
courses attended with such loss of blood as before. 
They assumed soon the character of healthy menstrua- 
tion. After further treatment for some time, the 
womb was restored to its normal state, and Mrs. 
C recovered the best of health. Two years after 
this, I heard from her, and her health was still ex- 
cellent. 264 
woman's complete guide to health. 
Case XXXVII. 
Slight retroversion, with inflammatory ulceration of the 
neck of the womb ; prof use vaginal discharge, in a widow 
lady. Ultimate cure. 
In May, 1859, Mrs. H , a widow lady of good 
family, aged thirty-five, consulted me for the following 
symptoms, which had appeared gradually for the last 
three years: headache, which, as she said, was of a 
confused, dull, burning sensation situate on the sum- 
mit of her head; pains in the back, at times very 
severe; flushes to the head and face; inclination to 
costiveness; pains under the left breast; thick yellow 
leucorrhoea; weight in pelvis ; menstruation appear- 
ing every two or three weeks, and very great nervous- 
ness. She had been treated without benefit. On 
examination, I found the vagina slightly congested 
and sensitive, hot and well saturated; a thick muco- 
pus, dark-looking secretion, issued freely from the 
open mouth, which was also painful on pressure. Ex- 
tensive ulceration existed without the mouth, and 
within the cavity of the neck. After a due course of 
medico-surgical treatment, the womb was restored to 
its natural condition, and Mrs. H to perfect good 
health. PARTIAL PROLAPSUS CURED. 
265 
Case XXXVIII. 
Partial prolapsus, the result of engorgement and extensive 
inflammatory ulceration of the neck of the womb, ex- 
tending to the upper part of the vaginal mucous mem- 
brane, occasioning a most uncomfortable friction-pain, 
not described hitherto in works on the diseases-of women, 
in a married lady. Complete cure. 
In September, 1859,1 was consulted by Mrs. W , 
a German lady, twenty-eight years old-married three 
years, but childless-in relation to her health, which 
began declining shortly after her marriage. Before 
her marriage, she enjoyed good health in every re- 
spect. She complained of great headache and pain 
in the back ; of a considerable vaginal discharge ; of 
sharp pains across the pelvis ; sexual congress was 
decidedly painful, and attended occasionally with a 
slight bloody discharge. She miscarried in the first 
year of her marriage, when three months pregnant, 
with no ascertained cause. But she complained par- 
ticularly of a deep-seated, circumscribed pain in the 
region of the womb, apart from the other pains above 
mentioned ; this pain was generally present, and more 
severe when she was seated for ever so short a time. 
She compared this pain, very properly, as if two sores 
came in contact with, or were rubbing against each 
other. 
On examination, I found the neck of the womb very 
low down, that is to say, resting on the floor of the 
pelvis, greatly enlarged, and very painful on pressure. 
Owing to extreme retroversion, the neck could but 266 
woman's complete guide to health. 
partially be brought into the field of a large-sized 
speculum. Enough was ascertained, however, to indi- 
cate a section of a considerable ulcerated surface. 
Any attempt to explore the parts more thoroughly 
was out of the question, being attended with too much 
distress. I had to renounce at the time, very reluc- 
tantly indeed, the discovery of the cause of that par- 
ticular pain so graphically described by my patient. 
After some six weeks of treatment, the neck became 
more favorably situated, owing to the womb being 
raised higher up, and placed now nearly in its natural 
position in the pelvic cavity. With this change, the 
neck of the womb was brought in full view, and 
the extension of the ulceration ascertained. I now 
discovered another ulcerated surface (perhaps it would 
be more correct to say an excoriated surface) circum- 
scribed, on the upper extremity of the vaginal mucous 
membrane, just on that part whereon the neck would, 
as in this case, very naturally repose, and thus the two 
surfaces being in so close contact, the ulceration of 
the neck could not but extend to the vaginal mucous 
membrane, and produce that peculiar friction-pain 
described by Mrs. W . That this pain showed its 
cause and effect is to be gathered from its total disap- 
pearance as soon as the womb had changed its posi- 
tion for one higher up. 
This friction-pain was said to be more uncomfort- 
able, and even intolerable, when the patient was 
seated, or turned or moved in her chair, were the mo- 
tion ever so slight. One day being sent for to pre- 
scribe for her husband, I noticed her bearing and 
her distress, when I had scarcely been five minutes in PARTIAL PROLAPSUS CURED. 
267 
the house. And this was the explanation of the cause 
and effect of the trouble. When Mrs. W was in 
a sitting posture, the whole upper part of the body 
weighed upon the pelvic organs. These latter, the 
womb, and particularly its neck, increased in bulk as 
they were, through inflammation, in turn crowded 
down, as it were, and weighed heavily upon that part of 
the pelvic floor upon which it (the neck) rested, usually 
lightly, and the close contact of the ulcerated sur- 
face of the neck, together with its irritating secretion, 
and the vaginal mucous membrane, occasioned the 
latter to inflame, and finally to ulcerate. Hence, that 
uncomfortable friction-pain complained of, and its in- 
creased severity, when the lady turned or moved in 
her chair. After nearly ten months of appropriate 
treatment, Mrs. W was perfectly cured of all her 
troubles; her health had improved steadily, and was 
finally restored to her entire satisfaction. 
If I have dwelt somewhat upon this case, it is be- 
cause I think it to be the first, if I can trust to the re- 
sults of my researches in works on the diseases of 
women, wherein has been described and substantiated 
with a case, the possibility of severe ulceration of the 
uterine neck, extending, under particular circum- 
stances, as in falling of the womb, to the vaginal 
mucous membrane, with which it may come in so close 
a proximity and contact. Scanzoni, I notice, alludes 
casually to an ulceration of the mucous membrane 
lining the vagina, but he does not enter into any ex- 
planation in reference to it. 268 
woman's complete guide to health. 
Case XXXIX. 
Engorgement and inflammation of the neck of the rvomb ; 
hysterical convulsions, in a, married, lady. Ultimate 
cure. 
In January, 1860, Mrs. B , nineteen years old, 
married two years, but with no children, consulted me 
for the following symptoms: severe pain in front of 
her head and temples ; dizziness ; menstruation regu- 
lar, as to time, but very painful, increasing her head- 
ache, and accompanied with soreness in the small of 
the back ; abundant vaginal discharge and bearing 
down pains ; sexual congress attended with great suf- 
ferring. She had miscarried twice ; the first at about 
four months, the last still earlier. The chief symp- 
tom, however, for which she sought advice, was fits. 
These fits came on on the least excitement. Sexual 
congress had sometimes brought them on ; when so 
affected, she experienced a feeling as if the chest was 
tied up in a knot. This feeling would occasionally 
ascend to her throat, and produce a feeling of chok- 
ing. She had no fits before her marriage, and then 
enjoyed excellent health. These attacks of fits came 
on after marriage gradually, and occurred particularly 
at the time of her courses, with great severity. On 
examination, I found the womb greatly increased in 
bulk, the neck of the womb greatly inflamed and very 
tender to the touch; the mouth of the womb exces- 
sively small, and its opening by separating the lips, 
giving issue to a stream of a dark, dirty mixture of 
mucus and blood. CASE OF PARTIAL PROLAPSUS. 
269 
Mrs. B , after persevering in treatment, with 
only two or three short interruptions, got rid- of all her 
troubles, nervousness was greatly diminished, and she 
experienced in the last three or four weeks of the 
treatment, only one slight attack of convulsions. I 
met this lady some seven or eight months after her 
last call at my office, and she enjoyed as good health 
as could be wished, particularly under the circum- 
stances, she being with child. No fits had occurred 
since the cessation of treatment. 
Case XL. 
Partial prolapsus and inflammatory ulceration of the 
neck of the womb; hysterical sore throat, in a young 
girl twenty years old. Ultimate recovery. 
In August, 1860, Margaret S , aged twenty, sin- 
gle, a very stout, tall and good-looking girl, chamber- 
maid, recommended to me by her mistress, who had 
herself received my professional services, consulted 
me for the following conditions : Her health had been 
gradually failing for the last three years. It com- 
menced with a cough and some soreness in the throat, 
this throat trouble coming on every few days, and 
lasting from two, three, to four days. Then and grad- 
ually came severe headaches, irradiating all around, 
with dizziness and pain in the back; leucorrhoea; 
shooting pains down the legs, disenabling her occa- 
sionally from walking. A tendency to constipation, 
with distress when the bowels moved, existed, as also 
a burning pain in making water for two or three days 270 
woman's complete guide to health. 
before her courses ; the latter lasted from five to ten 
days, weakening her greatly, and were attended wTith 
pain in and sickness of the stomach. Hesitation as to 
the proper treatment to be pursued would have been 
unjustifiable. Having explained to the girl what her 
case seemed to demand from her and from me, she 
consented to an examination, and I found the neck 
rather low down and very sensitive to the touch; the 
mouth of the womb highly inflamed and ulcerated all 
around its margin, and open enough to admit the tip 
of the finger. The hymen was intact, and the aper- 
ture small, but extraordinarily dilatable, allowing the 
introduction of a small-sized speculum at her second 
call, without having to resort to a division of it. After 
a course of uninterrupted medico-surgical treatment, 
this girl was dismissed, cured of all her ailings, and 
restored to as good health as she could wish. 
Case XLI. 
Inflammatory ulceration of the neck of the womb in a 
married lady, three months pregnant, threatened with 
a second, miscarriage, but averted by the timely course 
of the treatment recommended. Happy termination of 
pregnancy, and ultimate recovery and restoration to 
health. 
In October, 1860, I was requested to call on Mrs. 
S , a lady of a highly respectable and well-to-do 
family, aged twenty-five, on account of her peculiarly 
delicate health. The history of the case was as fol- 
lows : Mrs. S had been married two years. Be- 271 
CASE OF INFLAMMATION IN PREGNANCY. 
fore that event she would have enjoyed pretty good 
health, but for the irregularity of her courses. For 
two or three years following their first appearance, 
they were regular in every respect; but in some way 
or other, and quite unaccountably to herself, they be- 
came deranged, and would come on every three weeks, 
were more abundant, and accompanied with a good 
deal of pain, generally preceded and followed for a few 
days by a vaginal discharge. Such was her condition 
for two years, when she married. Shortly after she 
had entered into new relations, her health gave way 
under the combined influence of uterine irritation and 
pregnancy; the hitherto white vaginal discharge, 
present only at the time of her courses (the secretion 
of congestion), now became permanent, and of a thick 
yellowish character, and she complained also of pains 
in the back, and a general tendency to weakness. In 
the latter part of the third month of her marriage, and 
also of her pregnancy, her health grew rapidly worse, 
and, notwithstanding the best of care and medical 
advice, she miscarried. She rallied slowly, and in 
time recovered a tolerably good state of health. How- 
ever, the whites from this period became more abundant 
and debilitating, while the pains in the back became 
permanent. Pains in the head would also occasion- 
ally trouble her. Intercourse had become highly dis- 
tressing. All the symptoms just described, more- 
over, were always aggravated preceding and during 
menstruation. 
Mrs. S was then in the third month of her sec- 
ond pregnancy, and, as in her first gravid state, her 
health was again growing w'orse and giving way. 272 
woman's complete guide to health. 
After due consideration of the case-she being very 
anxious to avert the calamity that had befallen her 
first offspring-I advised a short course of uterine 
treatment, until all symptoms of threatened miscar- 
riage should have disappeared, to which she readily 
consented ; thus putting full confidence in my prom- 
ises. On examination, I found the vagina very hot, 
and well covered with a thick muco-pus secretion, 
slightly tinged with blood. The neck was very volumi- 
nous and highly inflamed; the mouth of the womb 
exhibited all around its margin severe ulceration, ex- 
tending upwards within the cavity of the neck, and 
bleeding on contact with the speculum. The whole 
of the generative organs presented a much more florid 
red hue than is the case in severe inflammatory ulcera- 
tion of those organs in the non-gravid state. After 
three weeks treatment, all the more prominent symp- 
toms were subdued, and miscarriage averted, and 
from that time Mrs. S continued to improve daily. 
The treatment was discontinued at the end of the fifth 
month of her pregnancy. Her pregnancy progressed 
most favorably, and I had the satisfaction to deliver 
her at full term of a healthy and lovely little daughter. 
Mrs. S spontaneously solicited, three months 
after her accouchement, the continuation of the treat- 
ment so auspiciously commenced and discontinued, 
and perfect success was its result. Her uterine affec- 
tion was entirely cured, and with it all the symptoms 
which had marked its existence, while her health had 
rapidly improved, and was better then than she had 
ever known it. As I write, 1863, she still enjoys excel- 
lent health, and has added a boy to her family. YOUNG GIRL CURED OF PROLAPSUS. 
273 
Case XLII. 
Partial prolapsus and inflammatory ulceration of the neck 
of the womb, the cause of severe dysmenorrhoea, in a 
young girl twenty-one years old. Complete cure. 
In October, I860, Margaret K , twenty-one, sin- 
gle, came under my treatment for the following state 
of her health : she complained that for nearly two 
years she had pain in the back and head ; was inclined 
to constipation, with distress occasionally (tenesm) 
when the bowels acted ; menstruation was painful, the 
pains being present throughout the flow, lasting in 
most instances for eight, ten and twelve days-was 
always accompanied with nausea, and at intervals severe 
vomiting, her distress at this time being so great as 
to oblige her to stay in bed till the severity of the 
symptoms had abated. She dwelt also upon distress 
and scalding when urinating, and said she often re- 
mained twenty-four hours before relieving the bladder. 
Her appetite was very poor; her nervousness great, 
and in all respects she was a very sickly girl. 
On examination, I found the hymen so softened and 
lax, as almost to doubt of its still existing; the neck 
lower than was normal, and resting against the 
urethra and bladder. It was swollen, tender, and 
highly inflamed. The mouth of the womb was slightly 
ulcerated ; the genital organs were hot and moist with 
a thick yellowish muco-pus secretion, of which latter 
the patient had also complained. This girl was de- 
clared cured of her affection, and the symptoms which 
characterized it, after a due course of treatment, with 274 
woman's COMPLETE GUIDE' to health. 
an occasional short interruption, depending on the 
durability and severity of her courses. These latter 
had become quite regular, and she enjoyed, when 
withdrawing from further attendance, as excellent 
health as she well could ask for. 
Case XLIII. 
Engorgement and inflammatory ulceration of the neck of 
the womb, cough and weakening leucorrhcea, in a mar- 
ried lady. Premature termination of the case, with 
the cure nearly complete. 
In April, 1861, Mrs. M , twenty-three, a delicate, 
refined and prepossessing lady, consulted me. She 
married in March, 1860. Before this event, she com- 
plained of a slight white vaginal discharge, of cough, 
and of some sickness preceding menstruation, this 
function being in other respects quite normal. This 
state of things, however, was thought of little import- 
ance, as her health did not suffer specially from it. 
But, since her marriage, the vaginal discharge, from 
white, had become yellow and more profuse than 
formerly, and of rather a weakening tendency. Her 
courses were about the same as in the past, except 
that they lasted longer ; the cough was still trouble- 
some, and as before her marriage, was unattended 
with expectoration. Digestion was slightly impaired. 
Mrs. M had been constantly under the care of her 
family physician for " constitutional weakness," with- 
out deriving any benefit from it. No signs of pregnancy 
existed thus far. In the presence of well-marked CURE OF ENGORGEMENT. 
275 
uterine symptoms, and considering the total failure of 
her family physician to restore her health, I proposed, 
and it was instantly agreed to, exploring the organs 
of generation to ascertain their true condition. I 
found the neck of the womb greatly congested and 
engorged, with a highly inflamed and corroded border 
all around the mouth, from which issued a mixed 
viscid muco-pus secretion, indicating the extension of 
the inflammation and ulceration within the cavity of 
the neck. Great sensitiveness existed in manipulating 
the parts. So much for " constitutional weakness." 
This lady was a short time under medico-surgical 
treatment; the inflammation «and ulceration of the 
neck being mostly cured, and her health considerably 
improved, when she went for a short time on a visit, 
previously postponed, to her family in the Western 
States : she thought and hoped that this trip to the 
country would achieve and accelerate the entire 
restoration of her long lost health before coming back 
to the city. My advice to put off this visit for a few 
weeks did not prevail. As I have not seen her since 
she started for the West, it is surmised that the state 
of her health was such as to be in no need of any fur- 
ther medical attendance. While preparing this paper 
(1865), I have been informed that Mrs. M is 
mother of a son a little over a year old, and enjoys 
excellent health. 276 
woman's complete guide to health. 
Case XLIV. 
Inflammatory ulceration of the neck of the womb, the 
cause of dysmenorrhcea, enuresis and impairment of 
sight in a young girl, aged twenty-two. The case pre- 
maturely ended, but so greatly benefited f rom the treat- 
ment as not to have required its further continuation. 
In 1861, Mary C , twenty-two, single, consulted 
me in reference to her impaired state of health. For 
a year she had complained of a profuse vaginal dis- 
charge, which increased at the time of her courses. 
These latter, recurring every three weeks, were scanty, 
lasted about three days, were accompanied by severe 
pains, nausea and vomiting, with pains in the back. 
Her appetite was good, but she experienced some dis- 
tress in the region of the stomach, though at no par- 
ticular time. Had frequently to pass water a little at 
a time. This was attended with scalding and invol- 
untary discharge of urine in the night. She com- 
plained also of lightness in the head and weakness in 
the eyes, meaning that her sight was slightly impaired, 
constituting what is called near-sightedness; lastly, 
she was exceedingly nervous ; complexion pale and 
sickly. 
On examination, I found the hymen intact, but very 
dilatable, the genital organs hot and moist with a 
thick yellow mucus discharge. The neck of the womb 
was inflamed and sensitive to pressure ; the mouth of 
the womb very small, slightly ulcerated, giving vent 
to a goodly discharge of blood on separating its lips, 
so much so as to fill the speculum with it, and obscure 
the sight of the cavity of the neck. CASE OF FOLLICULAB INFLAMMATION. 
277 
This girl, after a short course of medico-surgical 
treatment, took leave to go into the country with the 
family with whom she resided, a little prematurely, as 
I thought. However, while under treatment, the 
local affection had considerably improved and was 
well nigh cured, at the same time that her health had 
likewise improved in every respect. I have not heard 
from her since I last saw her, and it is surmised that 
the cure was complete, as I think that my profes- 
sional services, being well known to the family, would 
have been anew called for at her return from the 
country,'or subsequently to it, if it were not so. 
Case XLV. 
Follicular Inflammation of the neck of the womb, the pri- 
mary cause of a chronic cough and leucorrhoea, in a 
young girl seventeen years old. Constitutional treat- 
ment unsuccessful. Cured by local treatment alone. 
In 1861, Miss A , seventeen, single, a slender 
and rather prepossessing girl, accompanied with her 
mother, consulted me for cough and a leucorrhoeal 
discharge, with which she had been troubled for the 
last two years, always increased at the period of 
being unwell. This periodical function, moreover, 
was performed irregularly as to time, being occa- 
sionally two or three weeks behind time. For this 
state of her health she had been attended by the 
family physician for over a year, without the least 
change for the better. I carefully examined Miss 
A 's chest, but neither auscultation or percus- 278 
woman's complete guide to health. 
sion could detect anything amiss there, and I sub- 
mitted her for some three or four months to general 
or constitutional treatment alone, without a shadow 
of improvement. I then informed Mrs. A that I 
saw little prospect for her daughter's health under the 
treatment hitherto pursued, that I thought that con- 
stitutional treatment alone had been fairly tried 
(nearly fifteen months), and that I had reason to be- 
lieve that the cause of Miss A 's impaired health 
would be found to be connected with some abnormal 
state of the womb, that this should be investigated at 
once and a treatment adopted accordingly, and I 
assured Mrs. A that the cure of the affection of 
the womb, if such affection existed, would restore her 
daughter to perfect health. A few days subsequent 
to the last call, an examination was granted, and I 
found the hymen perfectly intact, but dilatable enough 
to admit without difficulty and without division a small 
sized speculum. The neck of the womb and the vagi- 
nal mucous membrane were the subjects of follicular 
inflammation, the neck somewhat increased in bulk, 
and on its anterior lip existed a small, circumscribed, 
ulcerated, or I should say, corroded patch, just issu- 
ing from the mouth of the womb, which was highly 
inflamed. 
Miss A improved fast under treatment, and tho 
last vestige of the local affection soon gave way. In 
the mean time, she had entirely recovered her former 
good health, and was joyfully preparing herself to 
assume new relations in society. I would add that 
she belonged to a first-class family, who had always 
enjoyed all the comforts which wealth bestows, but that, INTERESTING CASE OF "CHRONIC EIARRHCEA." 
279 
through reverses of fortune, their means had become 
limited and compelled them to assume a part of the 
numerous household duties which in former times they 
had left to the hands of others. It is useless to say 
that Miss A had her share in the household 
drudgeries, and that to these circumstances her ill 
health was undoubtedly due. 
Case XLVI. 
Prolapsus and chronic engorgement and ulceration of the 
neck of the womb, the cause of chronic weakening diar- 
rhoea in a married lady. Premature termination of 
the case, but great improvement under the treatment. 
In December, 1861, Mrs. T , thirty-two years 
old, a very refined and intelligent lady, consulted me 
for a supposed chronic diarrhoea with which she had 
been troubled for over a year, and for which she had 
consulted more than one practitioner, and been treated 
without benefit. This diarrhoea consisted in three or 
four successive liquid evacuations very early in the 
morning (between 1 and 3 o'clock, a. m.), sometimes 
preceded by rumblings in the intestines, but most 
generally without any forewarning at all, occasioning 
hurry and scarcely allowing suitable dressing. The 
evacuations, at times, commenced with what was pre- 
sumed to be a natural one, and were immediately fol- 
lowed by several very watery yellowish discharges. 
At other times, quite the reverse of this would take 
place. They were unaccompanied by any pain or any 
of the sensations usually present in cases of chronic 280 
WOMAN'S COMPLETE GUIDE TO HEALTH. 
diarrhoea, but they left behind them a weakened state 
of the system at large. This weakening was gaining 
ground daily, and seemed occasionally to cast its 
influence upon Mrs. T 's mind, as shown by some 
dread or forebodings of impending evil, in which she 
could not help occasionally indulging. These evacua- 
tions, moreover, were always more numerous at the 
period of her courses. Such was this lady's history 
of the state of her health when she consulted me. She 
complained of no symptoms characteristic of an affec- 
tion of the womb, though I carefully made inquiries 
in that direction. The functions of the womb were 
performed regularly and naturally ; the digestion was, 
however, somewhat impaired. 
This case, as might be expected, was the occasion 
of a good deal of reflection. To resort to general or 
constitutional treatment alone, and to consider this 
diarrhoea as an idiopathic disease, would probably 
have exposed me to failure, as others had failed be- 
fore, and there could be no doubt that every thera- 
peutical resource that might benefit her had been 
tried by her former medical advisers. To recommend 
and to resort at once to a treatment for disease of the 
womb, in the absence of well-defined symptoms indi- 
cating its existence, could not well be thought of, and 
seemed uncalled for. Yet, for all this, I made up my 
mind and I believed that the origin of the diarrhoea 
could be traced to some morbid state of the uterine 
organs. I was aware that, in some instances, the 
almost permanent state of congestion of the womb, or 
its chronic inflammatory state might, and does occa- 
sionally extend to the liver, as was stated when I CASE OF " CHRONIC DIARRHCEA." 
281 
enumerated the biliary sympathetic symptoms, page 
149, and that the congestion of the liver is necessarily 
the occasion of a greater activity in its functions, and 
as a consequence, it must relieve itself by throwing 
off the superabundant bile, by vomiting, if it reaches 
the stomach, or by purging, when it reaches the intes- 
tines. The case of Mrs. T seemed, in my opinion, 
to illustrate unequivocally one of the two conditions 
just stated. In this dilemma, I adopted general treat- 
ment, with the understanding, however, on both sides, 
that, should no benefit be derived from it within six 
weeks or two months, then I would urge an examina- 
tion of the womb, and a treatment more adapted to 
the state in which it might be found. In the latter 
part of January, or more than six weeks after the 
commencement of the treatment on general or consti- 
tutional principles, there was no amendment whatever 
in the lady's condition, and she urged spontaneously 
an examination. I found the womb in the following 
abnormal condition : the womb and the neck decidedly 
increased in bulk and low in the pelvic cavity; the neck 
was the seat of considerable ulceration, without and 
within its cavity, and from it issued a long stream of 
a thick, tenacious, brownish muco-pus secretion. Of 
the existence of the latter, the lady had made no men- 
tion whatever. There was, moreover, a total absence 
of any active inflammation (generally characterized 
by pain, sensitiveness and increase of the temperature 
of the organs of generation), but the womb presented 
unmistakably a low congested or chronic state of ex- 
istence or vitality. After seven months of medico-- 
surgical treatment, and when there was a great change 282 
woman's complete guide to health. 
for the better in the local affection, and while Mrs. 
T was improving in health and gaining strength 
daily, the diarrhoea modified in so much that it was 
no longer of daily occurrence, less debilitating, and 
the attacks, instead of occurring early in the morning, 
setting in later in the day-this case came to a pre- 
mature end, both through death in the family and the 
lady's husband's business prospects. If the modifica- 
tion of the diarrhoea, the change for the better in the 
local affection, and the improvement in Mrs. T 's 
health, as above stated, be taken into consideration, 
there is scarcely room left to doubt respecting the 
cause and effects in the case. To state it more clearly, 
the disease of the womb, and through it, the congested 
state of the liver and its appendages were the primary 
cause, the diarrhoea its effects, and as soon as the two 
organs, the womb and the liver, should have returned 
to their normal, physiological state, so soon would 
the diarrhoea have ceased to recur. 
Case XLVII. 
Falling of the womb from inflammation a,nd engorgement 
of the neck of the womb, severe pains in the back and 
dragging down pains, painful menstruation, etc., in a 
married lady. Complete recovery. 
In February, 1862, I was consulted by Mrs. B , 
about twenty-eight years old, a lady of good standing 
and the mother of four children, the last three years 
old. Her health had been tolerably good till the birth 
of her last child. Her confinement, on this occasion, 283 
CURE OF FALLING OF THE WOMB. 
contrary to her former ones, was greatly protracted, 
tedious and laborious, and had been entrusted to a 
lady acquaintance, in the absence of her family physi- 
cian. She made a very slow recovery, and from this 
time dated her sufferings. By degrees, her health 
flagged, and began to give considerable concern to 
her family and friends. This state of health had now 
lasted for over three years, and the medical attentions 
she had received during this period, had never relieved 
her for a moment. The family physician attributed 
all her troubles to nervous prostration in consequence 
of her last hard accouchment, and prescribed accord- 
ingly. 
A friend of Mrs. R , who had formerly been a 
patient of mine, recommended her to me, and both 
called on me. She complained of an almost perma- 
nent pain in the back, of. a, dragging sensation in her 
groins, and a bearing down feeling " that makes me 
apprehend that something will fall away from me," 
(her own words). She experienced frequent desire to 
pass water, spoke of nausea and of a greater or less ten- 
dency to constipation; her appetite was very poor, and 
her nervousness great. Her courses, which aggra- 
vated all her painful sensations for the time being, 
were defective in quantity and lasted only about forty- 
eight hours. Finally, Mrs. R looked in every 
respect the picture of suffering. 
I at once requested a physical examination, and 
found cause enough for the lady's wretched condition 
of health. The womb and its neck were the subjects 
of considerable hypertrophy, and the latter (the neck) 
situate an inch from the external organs, inflamed 284 
woman's complete guide to health. 
and very sensitive to the touch. No ulceration could 
be detected in the cavity of the neck. On separating 
the lips, quite a quantity of blood escaped from it 
as fast as I wiped it away. The prolapsus, in this 
case, was caused evidently by engorgement or hyper- 
trophy consequent on chronic inflammation of the 
womb in considerable activity, dating probably from 
the birth of Mrs. R 's last child. After seven 
months of a persevering treatment, Mrs. R had 
recovered her health ; the womb had gradually as- 
cended the pelvic cavity, while its hypertrophied or 
engorged state diminished, and finally assumed its 
normal condition. No pessaries or other mechanical 
supports had been made use of. 
Case XLVIII. 
Prolapsus or falling of the womb of several years standing ; 
severe sufferings from sympathetic irritation of the 
right ovary, and of the bach, the result of chronic in- 
flammation of the cavity of the neck, with occlusion of 
the mouth of the womb, in an elderly lady, erroneously 
treated for neuralgia of the back. Complete recovery. 
In January, 1862,1 was requested to see Mrs. G 
at her residence. I found Mrs. G , who was a lady 
apparently fifty or fifty-five years old, in bed, laboring 
under a certain amount of febrile action, as indicated 
by a flushed face, an increase of the temperature of 
the body generally, and a rather active pulse, etc. 
She complained of severe pains in the right ovarian 285 
CASE OF FALLING OF THE WOMB. 
region, which she described as of a continuous, deep- 
seated, dull, aching character (quite characteristic of 
sympathetic symptoms), irradiating towards the loins 
on that side, and descending down the thigh to the knee. 
When these pains were at .their height, she experi- 
enced an uncomfortable sensation of heat and burning 
in the seat of the right ovary, extending to the organs 
of generation. 
She complained also of severe pains in the lumbar 
vertebrae (generally called the " back"), which seldom 
left her. Standing, walking, or any bodily exertion, 
going up stairs particularly, were all alike, and were 
all so many causes of their increase in severity. These 
attacks of pain came on almost daily, at variable 
hours, but oftener towards four or five o'clock in the 
afternoon, lasted throughout the night till early in 
the morning, and were always attended with more or 
less fever, at whatever time they did set in. They 
continued several hours, and subsided very slowly. 
These attacks left Mrs. G exceedingly prostrated, 
and in direct proportion to the severity they assumed. 
In consequence of these repeated attacks, this lady 
had for the last six or seven months past scarcely left 
her bed. Her nervousness was very considerable, 
and her appetite greatly impaired. Since the attacks 
commenced, she had till very recently been under 
treatment by two highly reputed physicians of New 
York in succession, for neuralgia of the back, but 
with not a shadow of amendment in her sufferings. 
Mrs. G , some ten years before had been seized 
with attacks similar to those just described, when it 
was the left ovary that was the seat of the most intense 286 
woman's complete guide to health. 
agony. Such was the history of her sufferings, as given 
me by herself. I do not believe that any practitioner 
at all cognizant of the various diseases peculiar to 
woman, could have doubted for a moment as to the 
true cause and effect of her distress. He would at 
once have discerned that the pains in the right ovary, 
together with the pains in the back, etc., were mere 
sympathetic manifestations, the effects of some affec- 
tion of the womb, very likely the lingering remains of 
inflammatory disease operating at the time her men- 
struation ceased, and would not, consequently, have 
considered said ovarian and lumbar pains as the 
cause of the disease, as the physicians alluded to had 
done, and thus signally failed to benefit or cure their 
patient. 
On examination, I ascertained that the right ovary 
was very tender to the touch, and slightly swollen; 
the genital organs were dry and hot; the neck of the 
womb poised at the very threshold of the external 
organs, enlarged, round, soft and fluctuating, as if 
containing some fluid matter, and rather sensitive. 
The mouth of the womb had disappeared; there was 
complete occlusion, and its original situation was only 
discernible through a very small depression. 
The first indication called for was obviously to 
puncture this depression, and re-open the communi- 
cation of the cavity of the womb with the cavity 
of the vagina. This operation was immediately fol- 
lowed by a goodly discharge of a thick dark, mix- 
ture of blood and pus, indicating unmistakably the 
existence of ulceration in the cavity of the neck of 
a chronic character, which extended probably high CASE OF FALLING OF THE WOMB. 
287 
up, and involved perhaps the cavity of the womb 
itself, as the womb seemed too bulky for an organ 
which could never have been very considerably dis- 
tended, the lady having had no children during her 
married life. On my second visit, I carried a stick of 
solid nitrate of silver very carefully up the cavity of 
the neck, and as high as it would reach. This was 
followed for several days in succession by a similar 
discharge to that which had followed the opening of 
the mouth of the womb on my first call. This dis- 
charge was quite profuse for two or three days. The 
lady subsequently continued the treatment for some 
eight months, after which all her ovarian and lumbar 
pains had gradually disappeared, while her condition 
had daily improved, and she declared on her leave- 
taking, that she had not enjoyed such excellent health 
for many years past, but felt herself several years 
younger. A circumstance in this case which I cannot 
well omit to state, was, that Mrs. G was aware of, 
and felt the greater beneficial influence of one cauteri- 
zation over the other; she would almost invariably 
ask me on entering my office, " Doctor, will you 
make use of the strong cauterization to-day ? " The 
caustic alluded to was the acid nitrate of mercury. I 
would add, that this circumstance is not a solitary 
one, and that in several instances patients requested 
this strong cauterization, in preference to the milder 
one (the nitrate of silver) ; the influence of the former 
over the latter, on the system generally, and on the 
local disease in particular, being so much greater in 
strengthening and healing. 288 
woman's complete guide to health. 
Case XLIX. 
Partial prolapsus, the result of extensive ulceration of the 
neck of the womb, complicated with a small vascular 
polypus; profuse vaginal discharge, in a widoiv lady. 
Complete recovery. 
In March, 1862, I was consulted by Mrs. P , 
twenty-nine years old, for the following state of her 
health, which she said, had become deranged within 
the last four years. She complained of great pains in 
the head, over the eyebrows, and severe pains in the 
back; of a very profuse vaginal discharge, so profuse, 
as to compel her constantly to wear napkins; of a 
great enlargement of the breasts with tenderness of 
the same, occasional swelling (bloating) of the abdo- 
men and region of the stomach ; of straining and burn- 
ing when urinating, which was performed often, was 
scanty, red-colored, and left a thick deposit on cool- 
ing ; of dragging and heavy weight in the pelvis, in- 
commoding her considerably when standing, with 
shooting pains down the thigh and leg. Menstruation 
was regular but very profuse ; bowels rather consti- 
pated ; appetite good, etc. A superficial looker-on 
would have thought this lady enjoyed excellent health ; 
but on examination, I found the neck of the womb 
very low down, and considerably retroverted, so much 
so, as to be brought in view with difficulty; highly 
inflamed, swollen, and very tender on pressure. The 
mouth of the womb was open, and the seat of an ex- 
tensive, luxurious ulceration, and from this ulcerated CASE OF PARTIAL PROLAPSUS. 
289 
surface originated and protruded a soft, flattened, 
fleshy surface (fungous or semi-organized granulation), 
bleeding profusely, and along this fleshy substance 
protruded a small vascular polypus, the size of a large 
pea ; the endeavor to bring this vascular organized 
neck well in view produced considerable distress and 
bleeding. 
After eight months of almost uninterrupted treat- 
ment, the nock of the womb was entirely restored to 
its normal state and position in the pelvic cavity, 
while the lady's health had constantly improved in 
every respect, and was -finally as good as she could 
wish it. 
Case L. 
Partial prolapsus, the result of congestive engorgement of 
the neck of the womb, and the cause of aphonia or loss 
of voice, etc., in a married lady. Complete recovery. 
In May, 1862, Mrs. C -, a very refined and rather 
handsome lady, aged twenty-four, consulted me for 
weakness of the voice, which at times was quite audi- 
ble, but at others was nearly reduced to a whisper. 
Change of weather generally exercised its influence 
upon her voice. Her general health, previous to her 
marriage, which' took place three years before, and 
for a year or so subsequently to it, was excellent, and 
she complained of nothing else but a deviation in 
her menstruation from what it had been years back. 
This only lasted two days, or at most three ; the flow 
was scanty, and would come on a few days earlier or 
later than the previous one. She had not been preg- 290 
woman's complete guide to health. 
nant. For this state of her health, she had been un- 
der the care of the family physician, without any 
change for the better, all his attentions and solicitude 
as well, having been merely directed to her chest, and 
her throat in particular. To satisfy Mrs. C , and 
the lady friend who accompanied her, I examined her 
throat, but we could not notice any thing amiss there ; 
it looked perfectly natural. 
I then examined the state of the womb, and found 
it in such an abnormal condition as accounted both 
for the lady's troubles in her throat, and the abnormal 
state of her menstruation. The womb itself was in- 
creased in bulk, the hypertrophy extending to the neck, 
the latter retroverted, and lower than was natural. 
No ulceration was visible externally, nor did any seem 
to have existed within the cavity of the neck; but the 
inflammation and congestion of the organ were very 
apparent; there w'as also pain on pressure ; this pres- 
sure on the neck produced such an effect or sensation, 
that Mrs. C started, and said instantly that it 
had affected her throat-a circumstance that illus- 
trated the " cause " and " effects " in her case. A 
little over four months of medico-surgical treatment 
removed Mrs. C 's vocal affection, and with it the 
abnormal state of her menstruation, while her voice 
had become perfectly natural for the last month or so, 
and her health, moreover, was all that she could de- 
sire. This case illustrates fully the sympathetic 
effects of an affection of the womb upon the organs 
of the voice. CASE OF PARTIAL FALLING. 
291 
Case LI. 
Partial prolapsus, and inflammatory ulceration of the 
neck of the womb, the cause of globus hystericus, in an 
unmarried lady, treated for chronic spasmodic laryn- 
gitis. Premature termination of the case, but consider- 
able benefit from the treatment. 
In October, 1862, Miss H , twenty-eight years 
old, consulted me on account of being troubled with 
occasional lightness and pain in the head, the latter 
mostly felt above the eyebrows, irradiating to its sum- 
mit ; complained of weakness in the back; tendency 
to constipation ; of great nervousness ; her menstrua- 
tion was regular, but was attended with some pain 
before its appearance. However, the main complaint, 
for which she felt a considerable solicitude being a 
teacher, was a spasmodic sore throat, coming on at 
intervals more or less apart from each other; it con- 
sisted in a dry cough, unattended with any expectora- 
tion ; uneasiness and scraping .in the throat; dryness 
or hoarseness after speaking or reading for a while; a 
ringing cry and a hard object wandering in her throat, 
etc. She was treated for a long while by the family 
physician and others, for chronic spasmodic laryngitis, 
without any improvement. 
In presence of well-marked symptoms denoting dis- 
ease of the womb, and considering the globus hysteri- 
cus with which Miss H-- was affected, a mere sym- 
pathetic manifestation, the "effects" having for cause 
some abnormal state of the womb, I made an exami- 
nation, and found the neck of the womb lower than is 292 
woman's complete guide to health. 
usually the case iu unmarried women, inflamed and 
very tender, even painful on pressure ; the mouth very 
small, its internal margin ulcerated, and extending 
high up in the cavity of the neck: the vagina lax, 
and filled with a thick muco-pus secretion, the pres- 
ence of which had not been mentioned. Miss H 
was some five months under treatment, and the bulk 
of her symptoms had disappeared, while she had only 
once or twice experienced, under treatment, any attacks 
of sore throat, and those were of a much milder char- 
acter than her former attacks. She then withdrew 
from further attendance, on account of the death of a 
sister. 
No doubt could exist but that the attacks of the 
throat difficulties referred to would have entirely left 
her, had the local affection been entirely cured. 
Case LII. 
Inflammatory ulceration of the neck of the womb the 
probable cause of two previous miscarriages, in a mar- 
ried lady, three months pregnant. Her third threat- 
ened miscarriage averted by the timely treatment pur- 
sued. 
In April, 1863, Mrs. McC , a rather stout and at 
first sight, a healthy looking lady, aged twenty-nino 
or thirty, asked my advice on account of the state of 
her health, which she described pretty nearly in the 
following language, to wit: " I have been married 
five years, but have no children. I miscarried twice, 
both happening between the third and fourth month, A THIRD MISCARRIAGE PREVENTED. 
293 
and I cannot account for either. My health was very 
good before I married, the only trouble having been 
that I had a good deal of pain when my courses came 
on, with nausea and sometimes vomiting ; I could 
then scarcely keep anything on my stomach. After 
my first miscarriage, my health became poor, and my 
appetite impaired ; my courses came on as before, 
but they lasted much longer and were more profuse. 
After my second miscarriage, I grew worse and grad- 
ually have been losing flesh. I have the whites very 
badly, and I have almost constant pain in the back 
and head, with dragging pain in my hips and a heavy 
load across me ; my face flushes up occasionally, and 
I then feel cold all over. I believe it to be now three 
months since I have become again in the family way, 
and I fear to lose my child again. I wish, doctor, 
you could do something to save it." 
My advice was readily listened to, and an examina- 
tion at once obtained. I found the genital organs in 
a high state of congestion, lax, moist and very sensi- 
tive. The neck was voluminous and highly inflamed, 
the mouth of the womb plugged up with a thick, 
whitish, viscid secretion, considerably ulcerated all 
around its margin, and of a very florid and inflamma- 
tory character. This lady was under treatment till 
past her sixth month of pregnancy, and was safely 
delivered, at full term, of a very stout and healthy 
boy. It is almost useless to add, that the threatened 
miscarriage was only averted through the timely treat- 
ment the lady had undergone, as she recognised in 
her last condition exactly the same train of symptoms 
which had preceded her two former miscarriages. 294 
woman's complete guide to health. 
Case LIII. 
Severe inflammatory ulceration of the neck of the womb, 
complicated with a small vascular polypus, in a mar- 
ried lady. Complete cure. 
In June, 1862, Mrs. L , aged thirty-two, mother 
of three children, the last five years old, came under 
my treatment. She had enjoyed very good health in 
every respect until within the last three or four years. 
Some day about the latter part of December, year not 
remembered by Mrs. L , she crossed the river 
to New York from Brooklyn, in rather rough and 
stormy weather, while she was and had been men- 
struating for twenty-four hours. Returning towards 
evening, the drifting rain and snow and the cold had 
increased since morning ; she retired at night fatigued, 
nervous and rather feverish, and noticed that her 
courses had discontinued to flow. After a wakeful 
and restless night, she arose apparently as well as 
usual. At the next monthly period, however, her 
courses did not make their appearance, nor did they 
appear at the two subsequent periods. In the mean- 
time, she had experienced a good deal of sickness at 
each of the last mentioned periods. She menstruated 
the fourth month, after having taken, as she said, a 
good deal of physic to bring back her courses. From 
this time, with Mrs. L , menstruation became de- 
ranged and irregular; that is, her courses would either 
make their appearance one week earlier or one week 
or about that later, and instead of lasting from five to 
six days, lasted from ten to twelve days. She lost 295 
CASE OF INFLAMMATION AND POLYPUS. 
much more blood, and, moreover, her courses were 
accompanied with a good deal of sickness and pains 
in the back, hip, head, etc. This state of things had 
continued for more than three years, and seemed to 
go from bad to worse. She complained of almost 
constant pains in the back, head, loins, and dragging 
pains in the chest and legs; a slight, bloody vaginal 
discharge occasionally attended sexual congress. This 
discharge would take place, indeed, when she was 
greatly excited or had over-exerted herself in domestic 
duties. It was a thick, yellowish, viscid discharge. 
A burning sensation accompanied her making water ; 
she spoke of alternate costiveness and looseness of the 
bowels, of sensations of lightness in the head as of 
impending dizziness. Most of these troubles and sen- 
sations increased at the periods of menstruation. Her 
appetite was exceedingly capricious, but was usually 
poor, and she experienced feelings of weight and an 
indescribable uneasiness after eating. Her general 
appearance indicated poor health. She had been 
treated unremittingly for the last two years, her trou- 
bles being regarded as the forerunners of her " change 
of life." 
On examination, I found the genital organs hot and 
well lubricated, the neck of the womb considerably 
congested, enlarged and sensitive on pressure and 
inclined somewhat backwards. The mouth of the 
womb was open, and its margin nearly all around ex- 
tensively ulcerated, extending over the neck externally 
and up the cavity as high as could be perceived ; the 
ulceration bleeding profusely and especially on manipu- 
lation : just within the lips of the mouth, and imbed- 296 
woman's complete guide to health. 
ded, lay a small red soft vascular polypus, of about 
twice the size of an ordinary pea. After nearly a 
year of persevering treatment, the lady was declared 
entirely cured of her local disease, and her health 
effectually restored. Meeting her in December, 1864, 
she declared her belief that she was pregnant, and 
spoke of her excellent health. 
Case LIV. 
Engorgement, inflammatory ulceration and elongation of 
the anterior lip of the neck of the womb in a married 
lady. Ultimate recovery. 
In March, 1864, Mrs. M , a very refined and 
accomplished lady, aged twenty-five, called for advice 
in reference to the following state of health. She 
married five years previous, her health having been 
till then most excellent in every regard. She became 
a mother at the expiration of a year, but had not since 
given birth to any children, nor had she been preg- 
nant. Her accouchment, she said, had been a natural 
one, but very tedious, having lasted over three days, 
and left her prostrated and an invalid for five months, 
after which she recovered tolerably good health. 
However, from the time of her first and last confine- 
ment, she dated the state of her ill health. Gradually 
her courses had become irregular as to time and 
quantity. Subsequently, she was troubled with a 
slight whitish discharge, which later became, and had 
been for the last three years, yellowish and quite 
weakening. At the same time, her appetite was im- INFLAMED LIP OF THE NECK OF THE WOMB. 
297 
paired and pains in the back and head made their 
appearance, first occasionally, but afterwards more 
habitually. Her bowels were alternately constipated 
and loose. Her nervousness was great, her humor 
changeable, her sleep unrefreshing, restless and inter- 
rupted by dreams of a frightful character. She gave 
up nursing a short time after her confinement; her 
health, it was evident, not being equal to the effort, 
and the child suffering from the delicacy of its nurse. 
On examination, I found the vagina in a rather 
high temperature and quite moist. The neck of the 
womb was poised in about its natural place, but some- 
what hypertrophied, and very sensitive to pressure ; 
the anterior lip of the mouth of the womb elongated, 
I should think, three-quarters of an inch beyond the 
posterior lip. On raising the elongated, hypertro- 
phied lip upwards, the mouth of the womb was noticed 
to be well open, of a transverse, enlarged shape, 
indicating considerable inflammation and ulceration 
around its margin, extending within the cavity of the 
neck, from which issued abundantly a mixture of a 
viscid muco-pus secretion. After a few months of 
medico-surgical treatment, this patient recovered per- 
fect good health. The elongated lip had returned 
to its normal state and left no trace of its former 
existence. 298 
woman's complete guide to health. 
Case LV. 
Partial prolapsus dependent on inflammatory ulceration 
and engorgement of the neck of the womb, in a married 
lady. Complete cure. 
In June, 1864, Mrs. McM , aged twenty-six, a 
well educated and refined lady, and a sister of Mrs. 
K , whose case is noticed in this Appendix (Case 
XXIX), consulted me respecting her health, which 
had, for the last five years, become considerably im- 
paired. Her experience, as she conveyed it to me, 
runs thus: She married seven years before, in her 
nineteenth year, while enjoying perfect good health in 
every respect, her courses being regular, and attended 
with no difficulties. She had given birth to five chil- 
dren, the youngest then seven months old. She mis- 
carried about a year before, between her fifth and 
sixth months of pregnancy. After the birth of her 
second child, she recovered less rapidly than after her 
first, and her health from thence seemed to flag; nor 
could she well account for this, unless it were from a 
slight white, glairy mucous vaginal discharge she had 
lately observed to appear from time to time, and par- 
ticularly before the coming on of her courses, and 
also an occasional weakness in her back. These 
symptoms were, however, of rather a fugitive charac- 
ter, and it did not seem to her that they accounted for 
what she felt. After the birth of her third child, these 
symptoms assumed a more serious character. The 
white discharge that had been previously noticed at PARTIAL PROLAPSUS CURED. 
299 
intervals only, became yellowish, of a thicker consist- 
ency, and almost permanent, and of a rather weaken- 
ing character. The backache, too, had become more 
acute, and was felt almost constantly. Her bowels 
were disposed to constipation, and could only be acted 
upon through medicine ; this state of the bowels origi- 
nated piles. Her courses so far were very regular, 
and appeared almost to the very day, but they pro- 
duced a greater loss of blood than before, and also 
lasted longer. Moreover, she lost blood from her piles. 
Still further, her courses had begun to be attended 
with considerable sickness, and obliged her to remain 
in bed for several days, and all the symptoms above 
enumerated became greatly intensified. To this 
state of suffering were joined stupefied headache, un- 
easiness in the stomach, severe dragging sensations : 
in one word, she " ached all over." Lastly, she was 
laboring under a highly excited state of the whole 
nervous system. From this period, she began to be 
attended by the family physician, who declared her 
troubles to originate from " constitutional weakness." 
After some time, and with scarcely any improvement 
in the state of her health, as fully described just now, 
she passed through two other accouchments and a 
miscarriage, and all within the space of about three 
years. This rapid increase of her family, it must be 
imagined, could not but be greatly injurious to her 
already deranged health. In June, 1864, or more 
than five years from the period her health began to 
fail, she became one of my patients. It wo aid be tire- 
some and useless to recapitulate all of her symptoms. 
None I have mentioned had left her; all were still in 300 
woman's complete guide to health. 
active operation, and her countenance bore the unmis- 
takeable stamp of the most wretched state of health 
that can well be imagined. 
Examination revealed the womb to be in the follow- 
ing condition: the organs hot, moist, and consider- 
ably relaxed; the neck of the womb resting on the 
floor of the pelvis, greatly enlarged, sensitive, and 
retroverted. The latter circumstance, undoubtedly 
prevented the womb from descending lower down, so 
as to constitute a procidentia uteri, or complete falling 
of the womb. The mouth of the womb was open, giv- 
ing vent to a thick viscid, muco-pus secretion, with 
difficulty wiped away. The body of the womb was 
increased in bulk, lower, and its posterior wall very 
sensitive. 
After three months of medico-surgical treatment, 
the neck had assumed nearly its natural situation, and 
five months later, the lady was entirely cured of the 
local affection, while her health had rapidly improved 
during the treatment. I recommended her a short 
stay in the country, and, if possible, to avoid an in- 
crease of family for some time to come. Two years 
have now gone by, and Mrs. McM enjoys perfect 
good health. Her family has not increased. Never 
before did I receive warmer, and, I believe, more sin- 
cere thanks, than the day Mrs. McM took her 
leave from further attendance. PARTIAL PROLAPSUS CURED. 
301 
Case LVI. 
Partial prolapsus, or falling of the womb, the result of in- 
flammatory ulceration and hypertrophy of the neck of 
the womb, in an unmarried lady. Aggravation by the 
use of a, pessary. Complete recovery. 
In January, 1866, I was consulted by Miss H , 
aged twenty-three, a very accomplished and prepos- 
sessing young lady, for her health. The history of 
the case is as follows: It appears that some ten 
months previously, in March or the beginning of April, 
1865, Miss H came to New York to see relations 
and friends. While leaving her carriage in one of her 
visits, she missed its steps, and fell rather than step- 
ped heavily upon the sidewalk, without any other 
apparent mischief at the moment than a sudden fright, 
vanishing almost, instantly. She reached home safely, 
as lively as -when she started on her trip, forgetful of 
the incident just related. However, her courses ap- 
peared unexpectedly a few days earlier than usual, and 
were accompanied with pain and sickness of the 
stomach, with a feverish state of the system-symp- 
toms which had never before attended their occurrence. 
Her courses, from having been regular, now appeared 
earlier or later, while the quantity of the flow varied 
also, and became, in other respects, more and more 
sickening and troublesome. At the same time a vagi- 
nal discharge had made its appearance, at first slight 
and white, but subsequently yellow, and more profuse. 
This was accompanied with pains in the back, weight, 
and a dragging sensation in the pelvic region, which 302 
woman's complete guide to health. 
disabling her from walking or standing any time, made 
her fearful that something was going to escape from 
her person. She began also to complain of distressing 
headache; her appetite was capricious; her humor 
changeable ; her sleep restless, and her nervousness so 
great that she did not know what to do with herself, 
and she was discontented with almost every thing that 
was done for her comfort. This state of things seri- 
ously alarmed her parents, who, after a good deal of 
persuasion, induced her to consult a physician. Her 
case was stated to be falling of the womb, owing to 
relaxation of its supports, and she was told that she 
would soon improve and recover her health, as soon 
as the womb should be properly supported. To effect 
this, a pessary was introduced into the vagina-an 
operation from which she suffered considerably. This 
pessary, notwithstanding its presence was declared to 
be painful, even insupportable, and its withdrawal 
bitterly begged for, was readjusted about once a week, 
with such words of encouragement, patience and 
promises of a speedy relief, as were best calculated to 
soothe the suffering lady. Thus was this unhappy 
girl martyrized for some three months, when all pa- 
tience, and forbearance, and fortitude had forsaken 
her. The state of her health, instead of having im- 
proved under this treatment, had, on the contrary, 
grown worse from day to day. She was then recom- 
mended to trust her case to me. After hearing her 
sad story, I proceeded to investigate the condition of 
the organs of generation, and found, indeed, a most 
shocking state of things. The external organs looked 
red, were slightly congested, and somewhat swollen, and 303 
PARTIAL PROLAPSUS CURED. 
very sensitive, amounting to soreness : when penetrat- 
ing farther and higher up the canal leading to the 
womb, within about an inch and a half from the external 
organs, the pessary ring lay wedged in the soft parts 
Its extraction was more difficult than I expected, and 
accompanied with considerable soreness. Great relief 
seemed then to be experienced by my patient. The 
withdrawal of this mechanical support, however, was 
followed immediately by the descent of the neck of 
the womb to a point just within the threshold of the 
external organs. The neck was considerably inflamed, 
red, engorged, and painful, covered thickly with muco- 
pus, mixed with blood. In separating the lips of the 
mouth of the womb, the inflammation was perceived 
to exist all along the canal of the neck; there was 
ulceration around the margin of the mouth, extending 
upwards, and giving issue to a copious viscid, muco- 
pus secretion. 
Such was then her general and particular state of 
health. I recommended the wearing of a bandage by 
day, to be left off on going to bed, till further order. 
The materials of the bandage were left to the choice 
of the patient, only it was to be similar to the one 
generally worn when menstruating. This was dis- 
pensed with after six weeks of treatment, when the 
neck of the womb had ascended nearly two inches, 
had assumed a healthier and firmer condition, and no 
descent of the organ wTas any longer to be appre- 
hended. After a further treatment of five months 
every vestige of the late inflammatory condition of the 
womb and its sequelae had disappeared ; the neck was 
ascertained to be poised some three inches higher up 304 
woman's complete guide to health. 
than it had been before : it had, in a word, assumed its 
natural position. The health of Miss H had grad- 
ually improved under the treatment pursued, and the 
day I declared her to be free from all disease, it 
was as excellent as it had ever been before. 
Case LVII. 
Slight prolapsus, the result of extensive inflammatory 
ulceration of the neck of the womb: profuse leucorrhoea, 
in a married lady. Cure complete. 
In March, 1865, Mrs. R , twenty-six years old, 
a very prepossessing lady, consulted me in reference 
to the state of her ill health. She married in October, 
1863, and enjoyed excellent health ; a slight white 
vaginal discharge only existed at the time, but she 
took no notice of it, neither did it seem to affect her 
health in the least. She miscarried in the second 
month of her marriage and pregnancy, through fright, 
she thought, in witnessing an attack of epilepsy in a 
young girl. She had not noticed any signs of preg- 
nancy since, and her health from that period has 
become impaired. 
When she consulted me, a year and five months from 
the time of her miscarriage, she complained of a pro- 
fuse thick yellow discharge, which seemed to increase 
when she walked; of lightness and dizziness in the 
head, of impaired appetite, having no appetite in the 
morning, but later in the day; her bowels were inclined 
to costiveness; her courses appeared eight days too 
soon, were accompanied with a good deal of sickness, SLIGHT PROLAPSUS AND LEUCORRHCEA. 
305 
and were rather profuse ; she experienced sharp shoot- 
ing pains in the region of the womb, and often faint- 
ing feelings ; also weight in the pelvis as if everything 
would escape from her person. Intercourse was at- 
tended with a sensation of fainting, and occasionally 
followed with a slight bloody discharge. Her water 
was high colored and voided with some trouble, etc. 
On examination, I found the organs in a higher 
temperature than was natural, well lubricated with 
the secretion complained of, and rather lax ; the neck 
of the womb resting on the floor of the pelvis, in the 
close vicinity of the rectum, greatly congested and 
hypertrophied, and sensitive to pressure. On bring- 
ing the mouth of the womb into the field of the specu- 
lum, it was found open and excoriated all around its 
margin, extending externally a little over the anterior 
lip, and internally the mucous membrane was, as far 
as could be seen, in the same inflammatory and ulcer- 
ative condition. Moreover, the neck, externally, was 
seen to be dotted with a few florid papulae, and the 
organ, in toto, was colored with the secretion men- 
tioned above. Six months of irregular attendance 
cured Mrs. R of all her local affection. Her 
health, she said, when taking final leave, could hardly 
ever have been better. 306 
woman's complete guide to health. 
Case LVIIL 
Slight prolapsus, the effect of chronic inflammation of the 
womb, and of considerable inflammatory ulceration of 
the neck < f the womb, irritation in the ovaries and blad- 
der, in a married lady aged forty. Cure complete. 
In July, 1865, I was requested to see Mrs. D 
at her residence. She complained that for the last 
five years, her courses suddenly remained behind, 
spoke of constant backache, soreness under the left 
breast, of a slight yellow, thick discharge, of distress 
when making her water, etc., of shooting pains in both 
ovaries, but principally the left, descending towards 
the thigh and knee, of lower limbs generally weary, 
devoid of strength and support. She could neither 
stand or walk, for ever so little time, without an 
immediate increase in all her pains, and she expe- 
rienced then considerable heat, even burning in the 
vagina or canal leading to the womb; had a change- 
able appetite, bowels were generally constipated. On 
examination, I discovered the womb increased in 
bulk, sensitive and low down; pressure over both 
ovaries produced pain ; the neck of the womb was very 
large, diminished in length; the mouth of the womb was 
exceedingly small, with a small abraded surface just 
visible. On separating the lips, considerable inflam- 
mation and ulceration was noticed to exist within the 
cavity, from which issued a bad looking viscid muco- 
pus discharge. 
A few months of close attendance restored this lady 
to a pretty good state of health ; the womb was, as 
far as I could ascertain, free from disease. I recom- 307 
MISCARRIAGE PREVENTED. 
mended a stay in the country for some time, in order 
to enjoy its wholesome and strengthening influence. 
Case LIX. 
Inflammatory ulceration of the neck of the ivomb, the cause 
of previous miscarriages, in a married lady a little 
over two months pregnant. Third threatened miscar- 
riage averted by the timely treatment pursued; preg- 
nancy progressing satisfactorily towards its termination. 
In October, 1865, Mrs. McL , a rather delicate 
looking lady, twenty-six years old, called in reference 
to the state of her health, which, she said, had become 
greatly impaired. She married when twenty-three 
years old, but was childless so far. Her general 
health was very good before she married ; she only 
experienced some difficulties at the time of her courses, 
and as she described these difficulties, it was not diffi- 
cult to conjecture that they were characteristic of 
severe dysinenorrhoea. After a first miscarriage, her 
health changed considerably, and grew worse when a 
second happened. She thought herself in 1865 to be 
nearly three months with child, and experiencing 
sensations and difficulties which had preceded and 
accompanied her former miscarriages, she sought the 
means of preventing, if possible, a similar catastrophe. 
She had thus lately been troubled with the follow- 
ing symptoms : impaired digestion, increased painful 
courses (when not pregnant), profuse vaginal yellow 
discharge, pains in the back with dragging down 
pains and weight in the pelvic region, pains on the 308 
woman's complete guide to health. 
summit of her head, loss of flesh, great nervousness, 
depressed spirits, pains in the breasts, flashes of heat 
and sensations of cold. Some of these symptoms were 
almost constant with increasing gravity ; some had 
just appeared ; all characteristic of both disease of 
the womb and pathognomic of impending miscarriage. 
Having explained to Mrs. McL the probable 
cause of her trouble and the means to be adopted in 
her present emergency, she willingly assented to my 
proposed treatment. On examination, I found the 
organs throughout in a high state of congestion, hot, 
lax, moist and very sensitive. The neck of the womb 
was considerably inflamed, voluminous and tender to 
the touch ; the mouth of the womb plugged up with a 
thick, whitish, viscid mucous secretion, wrhich, when 
wiped away, left the os gaping, and showing its mar- 
gin to be all but ulcerated, and of a very florid inflam- 
matory character. Apart from the exaggerated state 
of the womb attendant on pregnancy, and from the 
increased activity of the disease at a time that preg- 
nancy was threatened with a premature termination, 
there existed cause enough to account for Mrs. 
McL 's wretched state of health in the intervals 
of her gravid state. 
After a treatment of five w7eeks at most, all the 
symptoms premonitory of threatened miscarriage had 
long disappeared, and the treatment was continued 
until the sixth month of pregnancy. She was safely 
delivered at full time of a boy weighing nearly ten 
pounds. Six weeks later, she solicited the continua- 
tion of a treatment that had inspired her with confi- 
dence, and every vestige of the local disease was soon ANGINA PECTORIS REMOVED. 
309 
removed, while her health gradually and steadily 
improved. 
Case LX. 
Inflammatory ulceration of the neck, of the womb, the cause 
of severe Angina Pectoris, in a married woman. Com- 
plete cure after six months of medico-sicrgical treatment. 
In October, 1865, Mrs. McF , a colored woman, 
married, but childless, aged twenty-eight, consulted 
me respecting her health, which, she said, became im- 
paired ever since she miscarried, nearly three years 
ago. It had been perfectly good before she married ; 
she had not known a day of sickness. She miscarried 
between the fourth and fifth month of her pregnancy, 
but she did not know to what cause to attribute it. 
She complained of a distressing fluttering and palpi- 
tation of the heart, always increased by the least 
excitement. This sensation of distress would radiate 
from the region of the heart towards the left shoulder 
and down the left arm in the direction of the wrist 
and fingers, and she experienced then sensations of 
prickling and numbness in these parts. Her distress 
and anxieties were greatest at night, when these symp- 
toms became aggravated ; she was often compelled to 
sit upright, pillowed, on account of a sensation of suffo- 
cation or shortness of breath. These symptoms were 
of a paroxysmal character, and lasted foi' a time more 
or less long. She had consulted some physicians, who 
attributed her troubles to disease of the heart, and 
hence her great alarm in relation to the symptoms 
just noticed,-the only ones she complained of. She 310 
woman's complete guide to health. 
had not been benefited from the treatment so far 
pursued. On questioning her, she acknowledged that 
she had been troubled very badly with the whites, as 
also by backache, weight and dragging in the pelvis, 
severe only at the time of her courses, by heat and 
scalding in urinating, and by impaired appetite, etc. 
Here, then, were some symptoms of such a nature 
that it was impossible not to refer to some affection 
of the womb. Consequently, I paid no regard for the 
time being to the Angina Pectoris, or to the symptoms 
simulating this disease, and requested an examination 
of the womb. After some hesitation she complied, 
and I found cause enough for her condition. The 
genital organs were hot and very much saturated with 
a yellow', viscid, bad-smelling muco-pus secretion, and 
exceedingly relaxed ; the neck of the womb placed at 
about its natural position, wras somewhat retroverted, 
enlarged to more than twice its natural size, and sensi- 
tive to pressure. The uterine opening or mouth of 
the womb was large enough to admit the first pha- 
lanx of the finger, and plugged up with the secretion 
alluded to, which, w'hen removed, showed the internal 
mucous membrane to be very much inflamed, bleed- 
ing and ulcerated; the ulceration extended upwards. 
The womb itself was enlarged, and slightly sensitive 
on pressure externally. This patient was some six 
months under treatment, when all the local affection 
was ascertained to be cured. Her health had im- 
proved considerably while under treatment, and was 
finally considered as good as ever. The Angina Pec- 
toris, above alluded to, had only visited her three 
times during the first four months of the commence- 311 
COMPLETE "FALLING" CURED. 
ment of the treatment, and had entirely ceased to 
trouble her afterwards. 
Case LXI. 
Procidentia, or complete falling of the womb, in a married 
lady, thirty-five years old, the mother of six children, 
the youngest one year old; consequence of too early 
rising after confinement. Complete cure. 
In October, 1864, I was consulted by Mrs. P , a 
lady thirty-five years old, for falling of the womb. 
Mrs. P had enjoyed tolerable good health until 
after the birth of her last child, a year before. Three 
days after her last confinement, she was one after- 
noon suddenly aroused from sleep, in which she had 
been indulging for a few moments, after having fed 
the baby and consigned it to the nurse, who retired to 
an adjoining room. She was suddenly aroused by a 
loud scream and crying from one of her younger chil- 
dren, also confined in the adjoining room ; she jumped 
out of bed, and hurriedly ran to ascertain what had 
happened, but soon returned to her own room and 
laid down. A week later, she had a regular " getting 
up," and a family sociable in the evening. However, 
Mrs. P did not enjoy the congratulations of her 
family and friends, not feeling so well as she usually 
did after the same lapse of time from her other con- 
finements. Consequently she withdrew early. From 
that time she began to complain of pain in the back ; 
of a dragging sensation in the groins; inconvenience 312 
woman's complete guide to health. 
and distress in walking or even standing a few mo- 
ments ; difficulties in making water; nausea, and 
occasional vomiting ; and most of all, of the presence 
of her womb between her thighs. She consulted her 
family physician, who, on ascertaining her condition, 
had at once reintroduced the prolapsed organ, and 
tried to maintain it in position with instruments, 
which, she said, he had changed several times, within 
two or three months, because she could not tolerate 
them on account of the pain and irritation their pres- 
sure produced. She had withdrawn the last, for the 
same reason, and had not had another applied for 
some six weeks, when she consulted me. 
On close inquiry, Mrs. P said, she thought, that 
at the time she left her bed precipitately to ascertain 
the cause of the screams, she-felt a sensation internally 
as if something had given way ; but in the excitement 
of the moment had forgotten the incident, and only 
reverted to it later, when her health began to fail, 
and the womb began to appear outside the external 
organs. 
On examination, I soon ascertained that the case 
was one of complete falling of the womb. The organ 
was slightly increased in bulk, congested. I read- 
justed the fallen organ, and maintained it in position, 
by means of a ring pessary, which proved to be the 
right thing in the right place. The rest of the treat- 
ment was directed to invigorate the general system, 
and to strengthen the natural supports of the womb, 
by medicated and other injections, etc. Within five 
months, Mrs. P was entirely restored to her former 
good health, and the womb remained in its natural 313 
CURE OF ITCHING. 
position afterwards. I saw this lady in 1867, and she 
continued to enjoy perfect health in every respect. 
Case LXII. 
Pruritus pudendi, or itching of the external organs, the 
effect of the final cessation of the menses, in a married 
lady, forty-eight years old. Complete cure by constitu- 
tional or general treatment alone. 
In 1865, I was consulted by Mrs. A , of New 
York, a lady forty-eight years old, for the following 
state of her health: Mrs. A had been married 
eighteen years ; had borne seven children ; had never 
miscarried, and had all that time enjoyed good health. 
Her courses ceased to appear about a year previous. 
"With the cessation of her menstruation, her health 
became impaired, and was decidedly aggravated for 
the last six months. She complained, on consultation, 
of a constant itching of the external genital organs, 
which became exceedingly severe, and almost unen- 
durable once a month, at the period she used to men- 
struate. She could not help, at some time or other 
of the attack, seeking relief by scratching, and to such 
an extent as to occasion ulceration. When this period 
passed off, the itching subsided considerably, but did 
not disappear entirely. Its presence became merely 
endurable. Besides this itching, she complained of im- 
paired appetite ; of growing emaciated ; of flushes to 
the head, with lightness of the same, amounting occa- 
sionally almost to vertigo. 314 
woman's complete guide to health. 
Considering the itching, together with the other 
symptoms with which Mrs. A was affected, as 
probably caused by the final cessation of the menses, 
producing a plethoric state of the system, and in the 
absence of any well-marked symptom characteristic of 
disease of the womb, no physical examination was re- 
quired, and the patient was subjected to constitutional 
treatment alone, or the internal administration of suit- 
able remedies. She was, besides, recommended to 
abstain from rich and too substantial food, and to 
adopt for some time a diet almost exclusively vege- 
table,-the parts to be washed two or three times a 
day with Castile soap and water; she was also to use 
freely a solution I prescribed. Mrs. A was en- 
tirely cured within six weeks from the commencement 
of this treatment. FINAL REMARKS. 
315 
FINAL REMARKS. 
To conclude, the author would state, that if the ab- 
stract of cases given in this work and Appendix are 
few, it is not because a greater number could not have 
been added; on the contrary, numerous additional 
cases might have been taken from liis note-book, 
had it appeared that the interest of his readers re- 
quired it. 
The abstract of cases which are given may be con- 
sidered as typical of the diseases treated in these con- 
tributions. The perusal of a long series of cases, all 
reproducing more or less the same phenomena, would 
have been tedious, if not altogether uninteresting to 
his readers. Is not the history of a few, moreover, 
the history of a hundred? 
The author would also again repeat, that by his 
plan for this work no' particulars have been given, in 
relation to the treatment pursued. This was done 
advisedly. It must be obvious to his readers that, if 
minute indications of the treatment pursued in each 
individual case had been given, it would very unneces- 
sarily have swelled this work to an inordinate size; 
and the reading of such details would have been a 
tedious labor, without much practical interest or 
utility. INDEX. 
Abortion, frequently the result of inflammation and ulceration of 
the neck of the womb, 86. 
Acid, Chromic, its caustic properties and use for applications in 
inflammation and ulceration of the neck of the womb, 195. 
Acid, Nitrate of Mercery, as a topical remedy in inflammatory 
affection of the neck of the womb, 195. 
Acid, Nitric, as a topical application in inflammatory affection of 
the neck of the womb, 195. 
Amenorrhcea-Its character, 66. 
" nature of retention of the menses, 66. 
etiology, or causes of retention of the menses, 67- 
symptomatology, or symptoms of retention of the 
menses, 67. 
" nature of suppression of the menses, 68. 
" etiology, or causes of suppression of the menses, 69. 
" symptomatology, or symptoms of suppression of 
the menses, 70. 
diagnosis of amenorrhcea in general, 71. 
" prognosis of amenorrhcea in general, 71. 
" treatment of amenorrhcea, 72. 
Anatomical Changes in the neck of the womb, as effects of inflam- 
mation, etc., in that organ, 116. 
Anaemia-Its characteristic, of inflammatory affection of the neck of 
the womb in its advanced stages, 156. 
Anteversion of the Womb-Its nature and frequency, 212. 
Anticipations of Impending Evil as a sympathetic symptom in 
inflammatory affection of the neck of the womb, 161. 
Aphonia-How inflammation and ulceration, etc., of the womb and 
its neck may affect the voice or the vocal apparatus, 152. 
Aran, Dr., France, on the symptoms of displacements of the 
womb, 217. 318 
INDEX. 
Backache. See Lumbo-Sacral Pains. 
Barker, Dr. B. Fordyce, the erudite Professor of Obstetrics in 
the New York Medical College, and his clinic in uterine affec- 
tions, acknowledges the existence, frequency and importance of 
uterine affections, 98. 
Beatty, Dr., on recognition of the existence, frequency and impor- 
tance of inflammation, etc., of the neck of the womb, 97. 
Becquerel, Dr., France, on the existence, frequency and impor- 
tance of inflammatory affection of the neck 
of the womb, 98. 
" on elongation of the neck of the womb, 204. 
" on anteversion of the womb, 213. 
" on the symptoms of displacements of the 
■womb, 217. 
" his views on chlorosis, 25, 29. 
Bedford, Dr. Gunning S., the author of the Clinic for the Diseases 
of Women and Children in the N. Y. Fourteenth 
St. Medical University, on uterine affections, 
their frequency, importance, etc., 99. 
" on the predisposing anatomical causes of inflamma- 
tion, etc., of the neck of the womb, 103. 
" on the sympathies of the womb, etc., 83. 
" his remarks on the indifference of women respect- 
ing their health, and the present system of edu- 
cation, 248. 
" his theory of chlorosis, 28. 
Bennet, Dr. James Henry, of London ; Indebtedness of the Pro. 
fession to Dr. Bennet for having first called their 
attention to inflammation, etc., of the neck of the 
womb, 97. 
" statistics on the frequency of ulcerations of the neck 
of the womb, 100. 
" on the deleterious influence of uterine affections on 
the functions of digestion and nutrition, 115. 
" on inflammation of the womb, etc., .as cause of dis 
placements, etc., 215. 
" on the symptoms in displacements of the womb, 216. 
Biliary Derangements in cases of inflammation, etc., of the neck 
of the womb, 149. INDEX. 
319 
Bladder-Its anatomical connection with the uterine organ, ren- 
dering it liable to suffer, secondarily, when the 
neck of the womb is inflamed, and its irritability in 
consequence, 125. 
errors of diagnosis in relation to the affections of the, 
176. 
Boys de Loury, Dr., France, on the existence, frequency and im- 
portance of an inflammatory affection of the neck of the 
womb, 98. 
Breasts-Swelling and sympathetic pains and sensations of the 
breasts in inflammatory affections of the uterine organ, 145. 
Brown-Sequard, Dr. C. E., on the effects on the nervous system 
in anaemia, 156. 
Byford, Dr. Wm. H., of Chicago, on the constitutional causes of 
inflammatory affection of the neck of the womb, 
112. 
" on the sympathetic affections of uterine diseases, 84. 
his sketch of nervous manifestations in inflammations 
of the neck of the womb, 166. 
" on inflammation of the neck of the womb as cause of 
displacements, 215. 
" on the local treatment of uterine diseases, 192. 
" on the treatment of vaginitis, 238. 
Case I.-Chlorosis in a girl 18 years old, the result of the suppres- 
sion of the menstrual function. Cured in four months treat- 
ment, 34. 
Case II.-Chlorosis in a young lady of 19 years old, the result of 
displacement or falling of the womb. Cure complete within a 
year of appropriate treatment, 39. 
Case III.-Hysteria, dependent on an affection of the womb, in a 
married lady aged 28. The cure of the local affection effected 
the cure of hysteria, 62. 
Case IV.-Hysteria, consequent upon an affection of the womb in 
a lady aged 35. Successful termination, 64. 
Case V.-Retention of amenorrhcea, in a girl aged 17, from in- 
sufficiency of physical development. Nature abides its own 
time, 73. 320 
INDEX. 
Cases VI-X.-Retention of the menses in girls of various ages, from 
insufficiency of physical development. Time their benefactor, 
74. 
Case XI-XIX.-Suppression of the menses in persons of various 
ages single and married, from various constitutional and acci- 
dental causes. Successful termination of the cases, with the 
exception of one, 75. 
Cases XX.-Retention of the menses, in a young girl of seventeen 
years old, from imperforate hymen. Successful termination of 
the case, 77. 
Case XXL-Partial prolapsus, dependent on inflammatory ulcera- 
tion of the neck of the womb, the cause of previous miscar- 
riage, in a married lady. The disease of the womb not dis- 
covered by a preceding practitioner. Complete cure, 89. 
Case XXII.-Menorrhage, the result of extensive inflammation 
and ulceration of the neck of the womb; repeated miscarriages, 
in a married lady. Complete recovery, 119. 
Case XXIII.-Severe itching of the external organs, the effect of 
granular inflammation of the neck of the womb, in a lady of 
thirty. Ultimate cure, 123. 
Case XXIV.-Repeated miscarriages, dependent on extensive in- 
flammation and ulceration of the neck of the womb, etc., in a 
married lady. The treatment recommended declined, 135. 
Case XXV.-Seven consecutive miscarriages, the result of inflam- 
mation, and ulceration, and elongation of the neck of the womb, 
etc., in a married lady. Complete cure, 136. 
Case XXVI.-Extensive ulceration of the neck of the womb, in a 
married lady; no hindrance to impregnation, or to the preser- 
vation of a tolerably good health. Exceptional case, 143. 
Case XXVII.-Extensive disease of the womb, in a married lady, 
not discovered by former medical advisers. Premature death, 
after a long life of suffering, from a curable but neglected 
disease, 182. 
Case XXVIII.-Hypertrophied elongation of the neck of the womb, 
in a married lady twenty-three years old, the probable cause 
of sterility, and of her ill health. Cured after three months 
of treatment, 207. INDEX. 
321 
Case XXIX.-Hypertrophy and inflammatory ulceration of the neck 
of the womb; fainting fits, etc., in a married lady. Complete 
cure after a due course of medico-surgical treatment, 254. 
Case XXX.-Partial prolapsus, the result of engorgement and 
ulceration of the neck of the womb; the inflammation extend- 
ing to the external parts, etc., in an unmarried girl. Cured after 
a few months of steady treatment, 255. 
Case XXXI.-Inflammatory ulceration, engorgement, and indura- 
tion of the neck of the womb ; profuse leucorrhcea. The look 
and complexion the index of great sufferings, in a widow lady. 
Complete cure, 256. 
Case XXXII.-Prolapsus and engorgement of the womb; extensive 
ulceration of the neck of the womb, etc., in a married lady. 
Complete cure, 257. 
Case XXXIII.-Inflammation and ulceration of the neck of the 
womb; pruritus pul vie, or itching of the external organs ; pro- 
fuse leucorrhcea, and obstinate cough, etc., in an unmarried girl. 
Complete recovery, 258. 
Case XXXIV.-Itching of the external organs, dependent on folli- 
cular and granular inflammation of the neck of the womb, with 
an excoriated surface on its inferior lip ; profuse leucorrhcea, etc., 
in a married lady. Cure complete, 260. 
Case XXXV.-Inflammatory ulceration, engorgement, and indura- 
tion of the neck of the womb; profuse leucorrhcea, etc., in a 
married lady. Premature termination of the case, but the cure 
nearly completed, 261. 
Case XXXVI.-Inflammatory ulceration of the neck of the womb, 
complicated with a polypus, menorrhagia and metrorrhagia, 
etc., in a married lady. Complete cure, 262. 
Case XXXVII.-Slight retroversion, with inflammatory ulceration 
of the neck of the womb; profuse leucorrhcea, in a widow. 
Ultimate recovery, 264. 
Case XXXVIII.-Partial prolapsus, the result of engorgement and 
extensive inflammatory ulceration of the neck of the womb, ex- 
tending to the upper part of the vaginal mucus membrane, 
occasioning a most uncomfortable friction-pain, not described 
hitherto in works on the diseases of women, in a married lady. 
Complete cure, 265. 322 
INDEX. 
Case XXXIX.-Engorgement and inflammation of the neck of the 
womb; hysterical convulsions, etc., in a married lady. Ulti- 
mate recovery, 268. 
Case XL.-Partial prolapsus and inflammatory ulceration of the 
neck of the womb; hysterical sore throat, etc., in a girl twenty 
years old. Cure complete, 269. 
Case XLI.-Inflammatory ulceration of the neck of the womb in a 
married lady, three months pregnant, threatened with a second 
miscarriage, but averted by a timely course of treatment. 
Happy termination of her pregnancy and ultimate recovery and 
restoration to health, 270. 
Case XLII.-Partial prolapsus and inflammatory ulceration of the 
neck of the womb, the cause of severe dysmenorrhcea, in a young 
girl twenty-one years old. Complete cure, 273. 
Case XLIII.-Engorgement and inflammatory ulceration of the 
neck of the womb; cough; weakening leucorrhoea, etc., in a 
married lady. Premature termination of the case, but the cure 
nearly complete, 274. 
Case XLIV.-Inflammatory ulceration of the neck of the womb, the 
cause of dysmenorrhcea ; enuresis and impairment of sight, etc., 
in a girl twenty-two years old. The case prematurely ended, but 
so greatly benefited from the treatment as not to have required 
its further continuation, 276. 
Case XLV.-Follicular inflammation of the neck of the womb, the 
primary cause of a chronic cough, and of leucorrhoea, in a gir] 
seventeen years old. Constitutional treatment alone unsuccss- 
ful, but completely cured by local treatment, 277. 
Case XLVI.-Prolapsus and chronic engorgement and ulceration of 
the neck of the womb, the cause of a chronic, weakening diar- 
rhoea, in a married lady. Premature termination of the case, 
but great improvement under the treatment, and the ultimate 
cure near at hand, 279. 
Case XLVII.-Prolapsus from engorgement and chronic inflamma- 
tion of the womb; severe pains in the back, and dragging-down 
pains, painful menstruation, etc., in a married lady with four 
children. Complete recovery, 282. INDEX. 
323 
Case XLVIII.-Prolapsus of the womb of several years standing; 
severe sufferings from sympathetic irritation of the right ovary 
and of the back, the result of chronic inflammatory ulceration 
of the cavity of the - neck, with occlusion of the mouth of the 
womb, in an elderly lady, erroneously treated for neuralgia 
of the back, etc. Complete recovery and restoration to health, 
284. 
Case XLIX.-Partial prolapsus, the result of extensive ulcera- 
tion of the neck of the womb, complicated with a small vascular 
polypus; profuse leucorrhoea, etc., in a widow lady. Complete 
recovery, 288. 
Case L.-Partial prolapsus, the result of congestive engorgement of 
the neck of the womb, and the cause of aphonia, or loss of 
voice, etc., in a married lady. Complete recovery, 289. 
Case LI.-Partial prolapsus and inflammatory ulceration of the 
neck of the womb, the cause of globus hystericus, etc., in an 
unmarried' lady, treated for chronic spasmodic laryngitis. Pre- 
mature termination of the case, but considerably benefited from 
the treatment, 291. 
Case LIL-Inflammatory ulceration of the neck of the womb, the 
probable cause of two previous miscarriages, in a married lady, 
three months pregnant. Her third threatened miscarriage 
averted by the timely treatment pursued, 292. 
Case LIII.-Severe inflammatory ulceration of the neck of the 
womb, complicated with a small vascular polypus, etc., in a mar- 
ried lady. Complete recovery, 294. 
Case LIV.-Engorgement, inflammatory ulceration, and elongation 
of the anterior lip of the neck of the womb, etc., in a married 
lady. Ultimate recovery, 297. 
Case LV.-Partial prolapsus dependent on inflammatory ulceration 
and engorgement of the neck of the womb, etc., in a married 
lady. Cure complete, 298. 
Case LVI.-Partial prolapsus, the result of inflammatory ulceration 
and hypertrophy of the neck of the womb, in an unmarried 
lady; aggravation by the use of a pessary. Complete re- 
covery, 301. 324 
INDEX. 
Case LVII.-Slight prolapsus, the result of extensive inflammatory 
ulceration of the neck of the womb ; profuse leucorrhcea, etc., in 
a married lady. Complete recovery, 304. 
Case LVIII.-Partial prolapsus, the effect of chronic internal metri- 
tis, and of considerable inflammatory ulceration of the neck of 
the womb ; irritation in the ovaries and bladder, etc., in a mar- 
ried lady, aged forty. Cure complete, 306. 
Case LIX.-Inflammatory ulceration of the neck of the womb, the 
cause of previous miscarriages, in a married lady, a little over 
two months pregnant. Third threatened miscarriage averted 
by the timely treatment pursued; pregnancy progressing satis- 
factorily towards its termination, 307. 
Case LX.-Inflammation and ulceration of the neck of the womb, 
the cause of supposed Angina Pectoris, etc., in a married woman. 
Complete mire, after six months of medico-surgical treatment, 
309. 
Case LXI.-Procidentia, or complete falling of the womb, in a mar- 
ried lady thirty-five years old, the mother of six children, the 
youngest one year old, the consequence of too early rising after 
confinement. Complete cure, 311. 
Case LXII.-Pruritus pudendi, or itching of the external organs, 
the effect of the final cessation of the menses, in a married lady 
forty-eight years old. Complete cure by constitutional or gen- 
eral treatment alone, 313. 
Caustics, or cauterization of the neck of the womb; remarks on the 
subject, 195. 
Cazeaux, Dr., of France, on the frequency of ulceration of the neck 
of the womb in pregnancy, 141. 
Cerebral System. See Headache. 
Chlorosis, also called " Green Sickness," its character, 25. 
" its nature, 25. 
" etiology, or causes of, 26. 
" symptomatology or symptoms of, 27. 
" diagnosis of, 28. 
" prognosis of, 32. 
" treatment of, 32. 
Circulation, sympathetic affection of the state of circulation, in 
inflammatory affections of the womb, etc., 153. INDEX. 
325 
Clarke, Sir Charles, on the causes of tumors of the womb, 229. 
Conception, as a predisposing physiological cause of inflammation 
and ulceration of the neck of the womb, 107. 
Constipation, as a symptom of inflammatory affection of the womb, 
and its alternation with diarrhoea, 149. 
Consumption, or Phthisis; falling into consumption, is one of the 
dangers to which inflammation of the womb exposes those 
whom it attacks, 86. 
Cough, its character as a sympathetic symptom of inflammation of 
the womb, 151. 
Courty, Dr., France, on tumors of the womb, 227. 
Cutaneous Sensibility ; state of the skin in inflammation of the 
neck of the womb, 165. 
Deafness ; how the hearing may be affected in inflammation of the 
neck of the womb, 163. 
Debility, consequent upon affections of the womb, 156. 
Depaul, Dr., France, on the symptoms attending displacements of 
the womb, 217. 
Diarrhcea. See Biliary Derangements. 
Digestion. The organ of digestion one of the first sympathetically 
affected in affections of the womb, 147. 
Displacements of the Womb : General Remarks, 209. 
" its Nature and frequency, 211. 
" etiology or causes of, 215. 
" symptomatology or symptoms of, 216. 
" course, duration and termination of, 219. 
" prognosis of, 219. 
" treatment of, 220. 
Dupuytren, Dr., France, on the frequent connection of elongations 
of the neck of the womb with sterility, 204. 
" on tumors of the womb, 227. 
Dysmenorrhcea, a frequent sympathetic affection in inflammation 
of the neck of the womb, and in affections of the womb gen- 
erally, 104-130. 
Dyspnea, a frequent sympathetic affection in inflammation, etc., of 
the neck of the womb, 152. 326 
INDEX. 
Eisenmann, Dr., ofWurtzburg, on the nature of Chlorosis, 26. 
Ellis, Dr. Robert, London, on vaginal injections, 198. 
Elongations : hypertrophied elongations of the neck of the 
womb, as a result of inflammation. General 
Remarks, 203. 
" nature of elongations of the neck of the womb, 203. 
" etiology or causes of elongations of the neck of the 
womb, 205. 
" diagnosis of elongations of the neck of the womb, 
206. 
" symptomatology or symptoms of elongations of the 
neck of the womb, 206. 
treatment of elongation of the neck of the womb, 
207. 
Engorgement of the neck of the womb. See Hypertrophy. 
Enuresis, a symptom of inflammation of the neck of the womb, 151. 
Falling of the Womb. See Prolapsus. 
Fibrous Tumors of the Womb. See Tumors. 
Francis, Professor, of New York, on tumors of the womb, 225. 
Gardner, Dr., of New York, on the frequent connection of elonga- 
tions of the neck of the womb with sterility, 205. 
Globus Hystericus. See Hysteria. 
Goupil, Dr., France, on elongations of the neck of the womb, 204. 
" on the symptoms of displacements of the womb, 217-218. 
" his statistics of anteversion of the womb, 211. 
Gynecology, or the doctrine of the nature, diseases, etc., of women, 
etc., etc., 21. 
Hallucinations, frequent sympathetic symptoms in affections of 
the womb and of its neck, 161. 
Hammond, Dr. W. A., of New York, on chlorosis, 29. 
Headache, a most frequent and constant symptom in inflammations 
of the womb and its neck; its character, seat, variations, etc., 
etc., 157. INDEX. 
327 
Health, indifference of women in relation to their health, etc. See 
Bedford. 
Hearing. See Deafness. 
Hemorrhoids, or Piles, occasionally a complication of inflammation 
of the uterine organ, 126. 
Hewitt, Dr. Graily, London, on hysteria, 45. 
" on the treatment of vaginitis, 238. 
Hodge, Dr., Hugh L., of on mental depressions in 
uterine affections, 158. 
Huguier, Dr., of France, on the existence, frequency and impor- 
tance of inflammation of the neck of the 
womb, 98. 
on elongations of the neck of the womb, 204. 
" on the errors of diagnosis in elongations of the neck 
of the womb, 206. 
" on the symptoms of displacements of the womb, 217. 
Hypertrophy, or engorgement of the neck of the womb, the effect 
of undue activity performed in the nutrition of parts inflamed, 
94. 
Hypogastric Pains experienced in inflammation of the uterine or- 
gans, their seat, importance, etc., and other pains in the vicinity 
of the hypogastrium, 127. 
Hyperesthesia. See Cutaneous Sensibility. 
Hysteria, its character, 44. 
" nature of, 44. 
" etiology or causes of, 46. 
" symptomatology or symptoms of, 48. 
" on the hysterical paroxysm, 49. 
" on globus hystericus, as a symptom, 51. 
" how it affects the digestive function, 52. 
" hysterical colic, 52. 
" how it affects the respiratory function, 52. 
" " circulatory function, 53. 
" " function of the liver and kidneys, 53. 
" " nervous system, 53. 
" " cutaneous surface, 54. 
" " spinal senses, 55. 328 
INDEX. 
Hysteria, how it affects the function of voluntary motion, 55. 
" " sensorial functions, 55. 
" " reproductive function, 5G. 
diagnosis of, 57. 
" analogies of, with epilepsy, 57. 
prognosis of, 59. 
" treatment of, 59. 
Impregnation, how this important function may be modified in 
inflammation of the uterine organ, 133. 
Induration of the neck of the womb, and in what it consists, 95. 
Inertia of the womb. See Uterine Inertia. 
Inflammation of the neck of the womb. See Neck of the Womb. 
Injections, vaginal, their use and how they should be made, 197. 
See also Ellis, on Injections. 
Intestinal Canal, how it is sympathetically affected in uterine dis- 
eases, 149. 
Insanity, an occasionally sympathetic symptom in uterine dis- 
eases, 158. 
Kennedy, Dr., on the existence, frequency, etc., of inflammation 
and ulceration of the neck of the womb, 97. 
Kidneys. See Liver and Kidneys. 
Lacerations of the neck of the womb from parturition ; its impor- 
tance and consequences, 108. 
Lamball, Dr. Jobert de, France, on the existence, frequency, etc., 
of uterine diseases, 98. 
Landouzy, Dr., France, on the frequent connection of hysteria with 
inflammatory affection of the neck of the womb, 45. 
Landy, Dr. 0., of Paris, on the effects of anaemia on the nervous 
system, 156. 
Leucorrhcea, its character and importance as a symptom in uterine 
affections, 116-239. 
" erroneously considered a symptom of constitutional 
weakness, 173. 
" its consideration as a constitutional or local dis- 
ease, 239. INDEX. 
329 
LlSFRANC, Dr., France, his lectures on affections of the womb, 98. 
" on cauterization of the neck of the womb, 196. 
" on the frequent connection of elongations of the neck 
of the womb with sterility, 204. 
Liver and Kidneys, how these organs are sympathetically affected, 
in uterine affections; changes in the secretion of these organs 
respectively, 149. 
Lumbo-S acral Pains, or "Backache," also called "Weakness," one 
of the most constant local or subjective symp- 
toms of inflammation, etc., of the neck of the 
womb, etc., 163. 
" errors in relation to these sensations, 175. 
Madden, Dr. Herny R„*of Brighton, on the prognosis of uterine 
diseases, 188. 
" his views and summing-up in relation to 
uterine treatment, 200. 
Mania, an occasional sympathetic symptom in affections of the 
womb, 162. 
Marcy and Hunt, Drs., on the frequency of inflammation and 
ulceration of the neck of the womb, 101. 
McClintock, Dr., On the frequency of tumors of the womb, 227. 
Meigs, Dr., of Philadelphia, his remarks on uterine affections, 98. 
Menstruation, physiology of this function; its modification in 
uterine inflammation considered as a predispos- 
ing physiological cause of inflammation, etc., 
of the neck of the womb, 104. 
" considered as a functional (dynamic) symptom in 
inflammation, etc., 130. 
" pain experienced in menstruation in inflammation 
of the neck of the womb, 130. 
" periodicity of menstruation, modification of it, 131. 
" duration of menstruation, modification of it, 132. 
" quantity of the menses, as modified, etc., 132. 
Mental Depressions, sympathetic symptoms in inflammations, 
etc., of the neck of the womb, 158. 
Menorrhagia, or profuse menstruation, the effect of uterine inflam- 
mation, 132. 330 
INDEX. 
Miscarriage. See Abortion. 
Mitchel, Dr., on the frequency, importance, etc., of inflammation 
of the uterine organ, 97. 
Montgomery, Dr., Ireland, on the existence, frequency and impor- 
tance of affections of the womb, 97. 
" on the sympathies of the uterine organ with the 
bladder, 127. 
Moral Feelings, sympathetic symptoms in inflammation, etc., of 
the uterine organ, 160. 
Neck of the Womb, on inflammation of, and its sequelae. General 
Remarks, 85. 
" existence, frequency and importance of inflam- 
mation and ulceration of, 87. 
" recognition by the profession of, 97. 
" etiology or causes of inflammation and ulcera- 
tion of, 103. 
" predisposing anatomical causes of, 103. 
" predisposing physiological causes of, 104. 
" constitutional causes of, 112. 
" liability of the sex to, 113. 
" local or subjective symptoms of, 120. 
" diagnosis of, 170. 
" differential diagnosis of, 172. 
" progress of, 177. 
" termination of, 178. 
" prognosis of, 180. 
" treatment of, 189. 
Nitrate of Silver in the topical treatment of uterine affections, 
195. 
Nutrition, defects of modification in the, in inflammation, etc., of 
the uterine womb, 156. 
Odontalgia, or Toothache, as a sympathetic symptom in inflam- 
mation and ulceration of the neck of the womb, 157. 
Ollivier, Dr., France, on the connection of hypertrophic elongations 
of the neck of the womb with sterility, 204. INDEX. 
331 
Ovarian Pains, a very constant local or subjective symptom in 
inflammation of the uterine organ, 164. 
" errors committed in regard to this particular 
pain, 175. 
Pains. Pains experienced in inflammation of the neck of the womb; 
their character, intensity, seat, different regions, etc., 164. 
Parturition, a predisposing physiological cause of inflammation 
and ulceration of the neck of the womb, owing to the neck being 
exposed to lacerations and contusions during parturition, 107. 
Pessaries, on their use and abuse in the treatment of displacements 
of the womb, 221. 
Physical Examinations, object to be attained in, 189. 
Pregnancy, modification of, in uterine inflammation, 133. 
" predisposing cause of inflammation of the neck of the 
womb, 107. 
Procidentia, or complete falling of the womb; its nature, etc., 
214. 
Prolapsus Ani, an occasional symptom in uterine affections, 126. 
Prolapsus of the Womb, or partial falling of the womb ; its na- 
ture, etc., 214. 
Pruritus Pudendi, or itching of the external organs, frequently a 
symptom of inflammation of the neck of the womb, etc., 121. 
Rectum. Frequent extension of uterine affection to the rectum, 125. 
" errors in relation to symptoms emanating from this 
organ, 176. 
Respiration, state of the, in inflammation of the womb, etc., 151. 
Retroversion of the Womb, its nature, frequency, etc., 213. 
Rigby, Dr., on the existence, frequency and importance of inflam- 
mation, etc., of the neck of the womb, 97. 
Roux, Dr., France, on the frequent occurrence of elongations of the 
' neck of the womb, 204. 
Scott, Dr., of Ootacamund, India, on the frequency of inflamma- 
tory ulceration of the neck of the womb among the native 
women of Madras, 99. 332 
INDEX. 
Sexual Congress, how uterine inflammation affects it, 143. 
Sight, how this special sense may be modified in uterine inflamma- 
tion, 162. 
Simpson, Sir James T., the eminent and celebrated professor of 
Edinburgh, recognizing the existence, 
frequency and importance of inflamma- 
tion, etc., of the neck of the womb, 97. 
" on the diagnosis of uterine diseases, 171. 
" on the treatment of uterine diseases, 192. 
" on the frequent connection of hypertrophic 
elongations of the neck of the womb 
with sterility, 204. 
" on the symptoms of displacements of the 
womb, 217. 
Sims, Dr. Marion, on the frequent connection of elongations of the 
neck of the womb with sterility, 205. 
" statistics on displacements of the womb, 211. 
" on fibroids of the womb, as cause of displace- 
ments of the womb, 215. 
" on pessaries, 223. 
Sleep, how it is affected in disease of the womb, 167. 
Smith, Dr. Tyler, London, on the existence and frequency of in- 
flammatory ulceration of the neck of the 
womb, 97. 
" on physical examinations in diseases of the 
womb, 190. 
Spectral Illusions, sympathetic symptoms in uterine affections, 
161. 
Speculum, on the use of the, 194. 
Spinal System, sympathetic affections of the, in uterine affections, 
163. 
Statistics in relation to the frequency of ulceration of the neck of 
the womb, 100. 
Sterility frequently the result of uterine affections, 86. 
Stewart, Dr. D. S., of Calcutta, on inflammatory ulceration of the 
neck of the womb, 99. 
" his statistics on the subject, 101. INDEX. 
333 
Sunlight, its stimulating effect on the function of the lungs, 34. 
Sympathies of the uterine organ with other organs of the body, 82. 
Thomas, Dr. Gaillard T., on the symptoms of displacements of the 
womb, 218. 
" on tumors of the womb, 227. 
Tic-douloureux as a sympathetic symptom of inflammation, etc., 
of the neck of the womb, 157. 
Tilt, Dr., on the existence, frequency and importance of inflamma- 
tion, etc., of the neck of the womb, 97. 
Topical Treatment, on the power of, for subduing and curing 
uterine inflammation, 195. 
Tumors of the womb: General remarks, 224. 
nature of fibrous tumors and fibrous polypi 
of the womb, 226. 
" nature of mucous polypi of the womb, 227. 
" causes of, 229. 
" symptomatology or symptoms of, 23. 
" course, duration, and termination of, 231. 
" prognosis of, 232. 
" treatment of, 232. 
Ulcerations of the neck of the womb, generally considered, 85. 
erosion or excoriation of the neck of the womb, the 
simplest form of the ulcerations, 91. 
ulceration proper of the neck of the womb, 91. 
" granular ulcerations, 92. 
" fungous or cock's-comb granulated ulceration of the 
neck of the womb, 92. 
Urine, state of the, in inflammation, etc., of the neck of the womb, 
150. 
Uterine Inertia. How the sexual feelings may be modified in 
affections of the womb, 142. 
Uterine Surgery. Surgical character of the treatment of uterine 
affections, 189-196. 334 
INDEX. 
Vagina, or canal leading to the womb. Frequent extension of in- 
flammation, etc., of the neck of the womb to this organ, 121. 
Vaginal Discharges. The occasional bloody character of these 
discharges, dependent on uterine inflammation. See, moreover, 
Le/ucorrhaa, 117, 118. 
Vaginitis, or inflammation of the mucous membrane of the vagina, 
233. 
" nature of this disease, 233. 
" causes of this inflammation, 234. 
" symptoms of, 235. 
" diagnosis of, 236. 
" prognosis of, 237. 
" treatment of, 237. 
Valleix, Dr., France, on the existence, frequency and importance 
of inflammation and ulceration of the neck of the 
womb, 98. 
" on the symptoms of displacements of the womb, 217. 
Velpeau, Dr., France, on the symptoms of displacements of the 
womb, 217. 
Virchow, Dr. R., on tumors of the womb, 228. 
" on the frequent connection of elongations of the neck 
of the womb with sterility, 205. 
Virgins not exempt from inflammatory affections of the neck of the 
womb, 106. 
Vision, sympathetic affection of the organ of, in inflammatory affec- 
tions of the womb, 162. 
Von Scanzoni, Dr. F. W., the celebrated professor of Wurzburg, 
on inflammation of the neck of the womb, etc., 97. 
" on the local treatment of uterine diseases, 191. 
" on the frequent connection of elongations of the 
neck of the womb with sterility, 205. 
" on the sympathies of the womb, 82. 
" on elongations of the neck of the womb, 204. 
" on ulcerations of the neck of the womb, 93 
Vulva, or external organ of generation. Extension of inflamma- 
tion of the neck of the womb to this organ, etc., 121. INDEX. 
335 
West, Db. Chables, of London, on the existence, frequency, etc., of 
inflammation and ulceration of the neck of 
the womb, 97. 
" his statistics on this subject, 100. 
Whitehead, Db. James, of Manchester, on the existence, frequency 
and importance of inflammation of the neck of 
the womb, 97. 
on the consequence of inflammation and ulcera- 
tion, and the women it affects most, 115. 
on morbid pregnancies, etc.; statistics on the sub- 
ject, 138. 
Whites. See LeucorrhaM. 
Winslow, Db. F., on light; its influence on life and health, as con- 
nected with chlorosis, 33. 
Womb. Description of this organ, 79. 
Wood, Db. Geobge B., on the connection of hysteria with the 
uterine system, 47. GLOSSARY 
OF 
MEDICAL TERMS USED IN THIS WORK. 
.Abdomen. That part of the body containing the stomach, liver, 
spleen, pancreas, kidneys, bladder and intestines. 
Aberration. A straying or wandering from, as " aberration of the 
mind." 
Abortion. Synonymous with miscarriage-applied to the expul 
sion of the ovum before the seventh month of utero-gestation. 
Abrasion. Superficial excoriation, with loss of substance; also 
used as ulceration of some part of the skin, etc. 
Acquired diseases. Diseases which occur after birth, and which are 
not dependent upon hereditary predisposition. 
Acrid. An epithet for substances or secretions which occasion a 
disagreeable sense of irritation or of constriction. The " whites " 
are occasionally acrid. 
Active. This word conveys the idea of superabundant energy, or 
strength; is the reverse of passive, which see. 
Acute. Having a certain degree of severity ; a rapid progress, and 
short duration. 
Adjuvant. A medicine to aid the operation of the principal remedy. 
Adynamia. Appertaining to debility of the vital powers. 
Agony. The last struggle of life. 
Amaurosis. Diminution, or complete loss of sight, without any 
perceptible alteration in the organization of the eye. 
Anaemia. State of the system characterized by every sign of de- 
bility. It is the opposite of plethora. 
Anasurea. For dropsy. Swelling of a part. 
Anomalous. Irregular, contrary to rule-unusual. GLOSSARY. 
337 
Anorexia. Absence of appetite, without loathing; a sympathetic 
symptom of most diseases. 
Anteversion. Displacement of the womb, forward. 
Aphonia. Privation of voice, or of the sounds. 
Apnoea. Absence of respiration. 
Ascites. Dropsy of the peritoneum. 
Asthenia. Debility of the whole economy, or diminution of the 
vital forces. 
Asthma. Difficulty of breathing, recurring at intervals. 
Atrophy. Progressive and morbid diminution in the bulk of the 
whole body, or of a part. 
Benign diseases. Diseases of a mild character. 
Bile. A yellow-greenish, viscid, nauseous fluid secreted by the 
liver. 
Bronchitis. Inflammation of the lining membrane of the bronchial 
tubes. 
Cachexia. A condition in which the body is evidently depraved. 
Cardidlgia. Pain in the stomach; also heartburn. 
Catalepsy. A seizure, surprise, etc. A disease in which there is a 
sudden suspension of the action of the senses, and of volition ; 
the limbs and trunk preserving the different positions given to 
them. 
Caustics. Bodies which have the property of corroding. 
Cephalalgia. Pain in the head ; headache. 
Cervix uteri. Neck of the womb. 
Chorea. Synonymous with " St. Vitus's Dance." A disease which 
usually occurs before puberty. 
Chronic. Diseases whose duration is long, or whose symptoms pro- 
ceed slowly. 
Circulation. Motion of the blood through the different vessels of the 
body. 
Climacteric. Has reference to the period of puberty in 'both sexes, 
and of cessation of menstruation in women. 
Complication. The presence of several diseases. 
Congestion. Accumulation of blood in the organ. 
Conjunctivitis. Inflammation of the globe of the eye. 338 
GLOSSARY. 
Constitution. The state of all the organs of the human body con- 
sidered in regard to their special and relative arrangement, 
order, or activity. 
Consumption. Progressive emaciation or wasting away. 
Convulsion. Any violent perversion of the animal movements, or 
alternate contractions, violent and involuntary, of muscles, 
which habitually contract only under the influence of the will. 
Corrosive. Substances which, when placed in contact with living 
parts, gradually disorganize them. 
Curable. That which is susceptible of cure. 
Cutaneous tissue. The skin. 
Debility. Synonymous with weakness. 
Dementia. Synonymous with insanity. 
Diathesis. Predisposition to certain diseases rather than to others. 
Dynamic. Relating to the vital forces. 
Dysmenorrhcea. Painful menstruation. 
Dyspepsia. Disturbed state of the function of the stomach. 
Dyspnoea. Short breath ; difficulty of breathing. 
Dysuria. Difficulty of passing the urine. 
Elongation. Lengthening, extension. 
Emaciation. That condition of the body, or of a part of the body, 
in which it grows lean. 
Emmenagogues. Medicines believed to have the power of favoring 
menstruation ; also " forcing medicines." 
Epilepsy. Disease of the brain, which occurs in paroxysms, with 
uncertain intervals between. 
Erosion. Synonymous with ulceration and excoriation. 
Flatulence. Accumulation of wind in the digestive tube. 
Fluctuation. The undulation of a fluid collected in any natural or 
artificial cavity. 
Gastritis. Inflammation of the stomach. 
Genital organs. Private parts. 
Globus hystericus. A sensation experienced by hysterical persons 
as if a round body were rising from the abdomen towards the 
larynx (throat), and producing a sense of suffocation. GLOSSARY. 
339 
Granulation. Reddish, conical, flesh-like spots, which form at the 
surface of suppurating wounds and ulcers. 
Gynecologists. Practitioners who treat the diseases peculiar to 
women. 
HzEMA/temesis. Vomiting of blood. 
Hamorrhagia. Synonymous with bleeding; loss of blood. 
Hamorrhoides. Synonymous with piles. 
Hallucination. A morbid error in one or more of the senses; a fre- 
quent symptom in uterine diseases. 
Hemicrania. Pain confined to one half of the head. 
Hemiphlegia. Paralysis of one side of the body. 
Hepatitis. Inflammation of the liver. 
Hereditary diseases. Diseases prevailing among several members 
of a family, or family diseases or complaints. 
Hygiene. The part of medicine whose object is the preservation of 
health. 
Hymen. A small membrane existing at the entrance of the female 
genital organs. This membrane is ordinarily ruptured by the 
venereal act. Many circumstances, however, of an innocent 
character may occasion a rupture or destruction of this mem- 
brane. It is often found absent in children soon after birth; 
while it may remain entire after a venereal act. Hence its pres- 
ence does not absolutely prove virginity, nor does its absence 
prove incontinence. 
Hypercemia. Local plethora; congestion. 
Hypogastrium. The lower part of the abdomen. 
Idiopathic. Primary disease, not depending on any other. 
Idiosyncrasy. A peculiarity of constitution, in which one person is 
affected by an agent, which, in numerous others, would produce 
no effect. 
Imperforate. Absence of a natural aperture. 
Injection. The art of introducing, by means of a syringe, a liquid 
into a cavity of the body. , 
Intestinal canal. That which belongs to the intestines. 
Kidneys. Secretory organs of the urine. 340 
GLOSSARY. 
Labia. Synonymous with lips. 
Laceration. The breach made by tearing or rending. 
Laryngitis. Inflammation of the larynx. See Larynx. 
Larynx. The apparatus of the voice. 
Laxity. Condition of a tissue when loose or relaxed, or of one 
which wants tone. 
Lesion. Synonymous with hurt, injured; also derangement, disorder. 
Leucorrhoea. The " whites." 
Liver. The organ secreting bile. 
Lymphatic. That particular system of organs which is subservient 
to the formation and circulation of lymph. 
Malignant. Term applied to any disease whose symptoms are so 
aggravated as to threaten the destruction of the patient. 
Mammas. Synonymous with breasts. 
Mania. Disorder of the intellect. In some cases it means insanity. 
Melancholy. A variety of mental alienation, characterized by exces- 
sive gloom, mistrust and depression. 
Menorrhagia. Profuse menstruation. 
Metritis. Inflammation of the womb. 
Metrorrhagia. Hemorrhagia or bleeding from the uterine organ, 
either at the time of menstruation or other periods. 
Modus operand!. Mode of operating. 
Molimen hamorrhagicum or menstruate. The struggle and symp- 
toms preceding menstruation. 
Morbid. Diseased, or relating to disease. 
Mucus. A substance analogous to vegetable mucilage. 
Nephritis. Inflammation of the kidneys. 
Nervous diathesis or nervousness. Unusual impressibility of the ner- 
vous system. 
Neuralgia. A name given to a certain number of diseases, the chief 
symptom of which is a very acute pain, exacerbating or intermit- 
ting, which follows the course of the nerves, and their branches. 
Nutrition. The substance and act of nourishment. 
Occlusion. Synonymous with a " shuting up." It signifies, also, 
simply the transient approximation of the edges of a natural 
opening. GLOSSARY. 
341 
Odontalgia. Toothache. 
Odema. Swelling of some part. 
(Esophagus. The gullet. 
Ophthalmia. Inflammation of the eyes. 
Organic diseases. Diseases which concern the organ itself, in con- 
tradistinction to functional, etc. 
Os uteri or os tinea,. Mouth of the womb. 
Ovaries. -Organs in which the ova are formed and matured. 
Palsy. Synonymous with paralysis. 
Paralysis. Abolition or great diminution of the voluntary mo- 
tions, and sometimes of sensation, in one or more parts of the 
body. 
Paraplegia. Palsy of the lower half of the body, including the 
bladder and rectum. 
Passive. The condition of a diminution of the strength, or that 
state where there is no apparent reaction. 
Pathognomanic. A characteristic symptom of a disease. 
Pelvis and pelvic organs. The part of the trunk which bounds the 
abdomen below, containing the womb, the ovaries, the bladder, 
etc. 
Phenomena. Changes in disease appreciable by our senses, which 
supervene in an organ or function. 
Phthisis. Synonymous with consumption. 
Plethora. Synonymous with abundance; repletion of blood in the 
system, or in some part of it. 
Pleurisy. Inflammation of the membrane covering the lungs. 
Pleurodynia. A spasmodic or rheumatic affection, generally seated 
in the muscles of the chest, etc.; frequently a mere sympathetic 
symptom of disease of the womb. 
Pneumonia. Inflammation of the substance of the lungs. 
Predisposition. That condition of the constitution which disposes it 
to the action of disease under the application of an exciting 
cause. 
Prolapsus. Synonymous with falling of the womb. 
Prostration. Almost total loss of power over the muscles of loco- 
motion. 
Pyraxia. The febrile condition. 
Pyrosis. Synonymous with waterbrash. 342 
GLOSSARY. 
Rectum. The third and last portion of the great intestine. 
Retroversion. A displacement of the womb backward. 
Sacrum. ' The bone which forms the posterior part of the pelvis, 
and is a continuation of the vertebral or spinal column. 
Scrofulous. A state of the system characterized by indolent, glandu- 
lar tumors, chiefly in the neck, etc. 
Spinal. Relating to the vertebral column. 
Spontaneous. That which occurs of itself, or without any manifest 
external cause. 
Sterility. Synonymous with barren, infecund. 
Sternum. Synonymous with breast-bone. 
Stricture. A diminution or contracted condition of some tube or 
duct, etc. 
Sympathetic. That which depends on sympathy. Sympathetic 
affections of an organ are those morbid phenomena which 
supervene without any morbid cause acting directly on it, and 
by the reaction of another organ primarilv afiected. 
Syncope. Synonymous with fainting. 
Temperament. A name given to the remarkable differences that 
exist between individuals, etc. 
Tenesmus. A frequent, vain and painful desire to go to stool. 
Tent. A small roll of lint, or of prepared sponge, gentian root, etc. 
Thorax. Synonymous with the chest. 
Ulceration. A superficial ulcer. 
Uterus and uterine organs. Synonymous with the womb. 
Uterine cervix. Synonymous with neck of the womb. 
Uterine os. Synonymous with mouth of the womb. 
Vagina. Canal leading to the womb.. 
Venereal. That which relates to sexual intercourse. 
Vertigo. A state in which all objects seem to be turning round. 
Vulva. Appertaining to the external organs of generation of 
women. 
Whites. Synonymous with leucorrhoea. 
Womb. Synonymous with uterus. The organ of generation in 
females. TO THE PUBLIC. 
The author of this work has, for many years past, devoted consid- 
erable labor and study to the very important and often complicated 
diseases peculiar to women. He has successfully treated a great 
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time, often for five, ten and more years, and no hope of even a 
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OF THE 
UNITED STATES AND BRITISH PROVINCES OF NORTH AMERICA. 
NEW EDITION, ENLARGED, CORRECTED, AND REVISED. 
WITH ENGRAVINGS OF EVERY SPECIES OF GAME, DRAWN FROM NATURE 
BY THE AUTHOR. 
By MENRY WILLIAM HERBERT. 
This edition has been thoroughly revised since the death of Mr. Herbert, 
containing corrections and additions, with a brief Memoir of the Author. 
With numerous Illustrations on wood of every species of Game, drawn from 
Nature by the Author. Printed on highly-finished toned paper, and elegantly 
bound. 
Opinions of Leading Journals. 
" The readers of the 'Spirit ' know him well-in the science of woodcraft, he is there." 
- Wm. T. Porter, in Spirit of the Times. 
"Every man, who either has or intends to shoulder a fowling-piece or rifle, should at 
once get hold of this instructor, that he may know how, where, and when to bag his 
game."-Albany Evening Journal. 
"Since the days of Old Walton, or even Joanna Berner's book upon the 'Mysteries of 
Fishing with an Angle,'no more delightful book has appeared than ' Frank Forester's 
Field Sports.' "-Philadelphia Daily News. 
" The work embodies the natural history of the principal game birds and animals of 
this region, with accounts of the season, manner, and places of taking each respectively. 
Prairie-hunting, forest-hunting, upland, bay, and lowland shooting are fully described, as 
well as the treatment of dogs in sickness and in health, their training, uses, &c. To those 
following the exercise, we deem this book indispensable."-N. Y. Tribune. 
" Here we have all the learning touching the game of the country happily compressed, 
with the fruits of the observation of an enthusiastic sportsman."-N. O. Picayune. 
"In material and execution the work is truly admirable. To the sportsman it is, of 
course, of peculiar value, but not to him alone : to the naturalist and general reader, it is 
full of interest."-Southern Literary Gazette. 
"He goes through the whole catalogue of game; describes the character, haunts, and 
peculiarities of each; assumes the tone of a companion and instructor; and, in a hun- 
dred ways, keeps the reader- upon the scent as keenly as the best-trained setter."- 
N. Y. Courier. 
"Mr. Herbert may have drawn from stuffed specimens, but he has given us living 
copies."-N. Y. Albion. 
" It is worthy, by its binding, typography, and illustrations, to occupy a place on a 
lady's center-table, as by its intrinsic worth it deserves a nook on the student's shelf."- 
Democratic Review. 
STYLES -A-TsTZD PRICES. 
Two vol?., crown 4to, tinted paper, cloth, gilt back and sides, pp. 7S3, . . . $7 50 
" " " half calf, antique, or extra gilt, . . . 11 00 
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Mailed by the Publishers free of Postage, and for sale by all Booksellers. Published by W. A. TO-WNSEND & f DAMS, 434, Broome St., N. Y. 
JUST PUBLISHED, 
<rach Sljot; 
OR, 
YOUNG RIFLEMAN'S COMPLETE GUIDE. 
BEING A TREATISE ON THE USE OF THE RIFLE, WITH RUDIMENTARY AND FINISHING 
LESSONS ; DIRECTIONS FOR HUNTING THE BUFFALO, ELK, DEER, AND ALL KINDRED 
GAME FOUND IN THE UNITED STATES AND BRITISH PROVINCES, WITH 
THEIR VARIETIES AND HABITS; THE BREEDING, BREAKING, AND 
MANAGEMENT OF THE DEERHOUND, ETC., ETC. 
✓ 
INCLUDING JkN E S S A. Y 
ON THE LATEST IMPROVED BREECH-LOADING WEAPONS, WITH RULES AND 
REGULATIONS FOR TARGET PRACTICE; 
BY 
EDWARD C. BARBER. 
" The Crack Shot " will supply a want long felt in the sporting world; 
the author is a practical sportsman and accomplished writer ; he possesses 
a thorough knowledge of the subject, and has produced a Treatise on the 
science of Rifle-Shootiug, that must become of permanent interest and value. 
This companion volume of The Dead Shot, will take its place with that 
favorite work, as a standard guide to both the young and matured sportsman. 
From the Author's Preface. 
"No work has been published since the recent great improvements in breech-loading 
arms, and moreover, the books of Cleveland, Chapman, Wilcox, and others, are standard 
works, containing a vast deal of useful and valuable information, yet it has been felt that 
they are too purely scientific to meet the desired end. At the suggestion of a sporting 
friend of credit and renown, the preparation of a work designed to aid and 
instruct the young idea how to shoot ? I have acquitted myself to the best of my humble 
ability, and trust it may prove useful and interesting to those for whose use it was 
specially prepared-the young riflemen of America. I do not claim any great originality, 
nor do I profess to have propounded any peculiar theories; my object being to compile, 
in brief and readable style, the views and opinions of those who, from time to time, have 
written upon this subject." 
One volume tinted paper beveled boards, illustrated with numerous 
engravings from original drawings, uniform with " The Dead 
Shot." Price,$2 50 LIST OF STANDARD BOOKS 
jV GREAT WORK FOR HORSEMEN. 
NOW READY FOR SUBSCRIBERS. 
Being a compilation of the Pedigrees of American and Imported Blood Horses, from the 
earliest records, with an Appendix of all named animals without Extended Pedigrees 
prior to the year 1840. And a 
SUPPLEMENT, 
Containing a history of all Horses and Mares that have trotted in public from the earliest 
trotting-races till the close of I860. 
BY J. H. WALLACE. 
Illustrated with twenty original Portraits, finely engraved on Steel, from 
paintings and drawings by distinguished artists, of the following celebrated 
Runners and Trotters:- 
Sir Archy, American Eclipse, Fashion, Lady Palmer & Flatbush Mare, 
Dexter, Hambletonian, Boston, Pocahontas, 
Glencoe, Black Maria, Young Morrill, Lady Suffolk, 
Ethan Allen, Flora Temple, Black Hawk, Bashaw, 
Lantern, Whalebone, Stella, Alice Gray. 
pgr To be sold exclusively by subscription. .JgJ 
The publishers offer this valuable historical work on the thorough-bred and trotting- 
horse of America as the most complete publication of the kind in the world. The author 
-a true lover of the horse-stands pre-eminent for his ability, experience, reliability, and 
research on the interesting subject on which it treats. The best half of his life has been 
bestowed in collecting material, and he has received the support and assistance in his task 
of many of the first and most famous turfmen and breeders in the country. No pains have 
been spared to render it correct and entirely reliable as an indispensable authentic Stud- 
Register. 
Wallace's American Stud-Book will be found COMPLETE IN ITSELF, as no 
book outside of it is necessary to trace the pedigree of any given animal through all its 
various ramifications, until you reach its utmost bounds or the British Stud-Book. From 
the admirable system upon which the book is constructed, this completeness becomes an 
inevitable fact. 
From Wilkes' Spirit of the Times. 
"We are very glad to be able to announce to the horsemen of this country that a 
good, reliable btud-Book has been compiled by J. II. Wallace, Esq., who has devoted ten 
years of his time to faithful labor at it. Mr. Wallace brings many eminent qualifications 
to the task, lie is a gentleman of high culture and rare tact in discriminating between 
the true and the false. His order and system are apparent in every thing he undertakes. 
In all questions of doubtful or disputed pedigrees he has long been the recognized 
authority. * * * A man ofi clear intellect and very resolute perseverance has been 
for ten 'years arduously at work, and we heartily congratulate the country on the fact 
that it will gather the fruits of his labor." 
One royal 8vo volume of over 1,000 pages, on fine tinted paper, elegantly 
bound in extra cloth, gilt, beveled boards. Subscription price . . $10. 10 
LIST OF STANDARD BOOKS 
JUST PUBLISHED. 
gfarst portraiture. 
BREEDING, REARING, AND TRAINING TROTTERS. 
PREPARATION FOR RACES; MANAGEMENT IN THE 
STABLE; ON THE TRACK; HORSE LIFE, &c., &c. 
Containing a fine life-like Portrait of Dexter, the King of the Turf, with an Appendix 
containing the history of his performances. 
By JOSEPH CAIRN SIMPSON. 
From the Author's Introduction. 
"This book has been written in the hours intervening between the 
morning's drive and the evening's walk; and, when the rigors of winter put 
an end to active training, the labor of composition, and care of the horses, 
about equally divided the time. 
The practice recommended to be followed in these pages, in order that a 
horse may acquire condition and learn to trot fast, I offer with confidence. 
The treatment advised is no pet theory, but the result of years of practice, 
when the effects of any change in the work was anxiously watched for and 
carefully noticed. The system, as here exemplified, I have found the best 
that has come under my observation, and I do not hesitate to rest my name 
as a horseman on the award of those who will give it a faithful trial." 
Opinion of James Oakes, Esq., ("Acorn." ) 
"The 1 Horse Portraitures' are spirited and life-like pictures, evidently 
sketched by the hand of an artist. They are written with marked discrimin- 
ation, taste, and judgment, and cannot fail to command the attention of breed- 
ers, amateurs, turfmen, and admirers of the horse generally. The sketches 
abound with valuable knowledge, practical hints, and useful suggestions; 
while the pictures are faithful to nature, the light and shade of their color- 
ing reveals the taste an i genius of the author. They possess much literary 
merit, and will be a valuable acquisition to every gentleman's library who 
takes an interest in breeding, or in matters any* way relating to the horse, 
his treatment or management." 
One crown 8vo volume, tinted paper, beveled boards, green and scarlet 
cloth, gilt back and sides. Uniform with "Complete Manual for 
Young Sportsmen." Price,$3 00 PUBLISHED BY W. A. TOWNSEND & ADAMS. 
11 
The IKonders of the JTuman Mind. 
Mian anir Jb |lc!ations; 
ILLUSTRATING THE INFLUENCE OF THE 
MIX'D ON THE BODY; 
The Relations of the Faculties to the Organs, and to the Elements, Objects, 
and Phenomena of the External World. 
By PROF. S. B. BRITTAN, M. D. 
THIRD EDITION REVISED. 
This original and valuable work has attracted much attention on the part 
of reflective and learned minds on both sides of the Atlantic. It has become 
a standard work upon the subjects on which it treats, and is constantly 
growing in popular favor. 
Opinions of the Leading Journals. 
" We regard Professor Brittan as a man of superior intellect, an original thinker and 
profound student. . . . Our author has placed before us a mass of foots which can 
not be contemplated without wonder, however much we may differ from him as to the 
nature of those facts."-National Quarterly Review. 
" It is seldom that the idea of the relation, as to cause and effect, of the inner world 
of spirit with the outer or phenomenal universe of matter, has been so plausibly ex- 
plained. . . . Dr. Brittan's work contains a sufficient account of well-authenticated 
statements and fairly-drawn inferences to make it very suggestive. . . . Several 
passages of great truth and beauty might have been quoted."-London Atheneeum. 
" For a repository of evidence as to that twilight-region of human experience which 
we know as 'fascination,' 'spectral illusions,' 'ghostly apparitions,' 'premonition,' 
'clairvoyance,' and the like, its value is unrivaled and peculiar."-Christian Examiner. 
" It is emphatically a work to be studied. In it are many vital truths which have 
never before been presented so fully or so well ; truths, indeed, which may be said never 
to have been propounded before in any work on the human mind and its relations."- 
Hartford Daily Times. 
" . . . A comprehensive philosophy and a work of art. ... As a whole, we deem it 
one of the noblest works in elucidation of Spiritual Philosophy, and the true nature of the 
constitution of man and its relations, with which we are acquainted." - Howitt's 
Magazine. 
" It is impossible to give in a small space any idea of this elaborate and carefully pre- 
pared work. Dr. Brittan has for many years been an attentive student of physiological 
phenomena, and, apart from the theory they illustrate, his work has great value and curi- 
osity as a collection of remarkable cases in which the influence of mind on matter, and the 
preponderance of the spiritual over bodily power and force, are wonderfully exem- 
plified."- New York Daily Times. 
One elegant volume, 8vo, on fino tinted paper, extra vellum cloth, heavy 
beveled boards, gilt back and side, with portrait of the author engraved 
on steel expressly for this work, pp. 584, fourth edition, . . . $4 00 PUBLISHED BY W. A. TOWNSEND & ADAMS. 
15 
REPERTORY OZE1 PRACTICAL SCIENCE 
fjn (penned JJetos 
AND 
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WITH AMERICAN DRUGGISTS' PRICE CURRENT. 
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Edited by Wm. Crooks, F. R. S., authorized American bdition. 
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The Chemical News numbers among its regular contributors every eminent Chemist 
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While its importance to Chemists, Druggists, Physicians, Colleges, Apothecaries, 
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world. 
TERMS: 
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News," and "Physician's Hand-Book," 86.50; including 
"Braithwaite," $8.25. Prepaid. 12 
LIST OF STANDARD BOOKS 
$C(ic Jjoc of Washington 
AND ITS ASSOCIATIONS, 
HISTORICAL, BIOGRAPHICAL, AND PICTORIAL. 
|Icto (Bbitioir, foitlj 
By BENSON J, LOSSING, 
Author of " Field Book of the Revolution? " History of the United States? 
etc., etc. 
Illustrated with nearly 150 Engravings, mainly from Original Drawings by the 
Author, embracing numerous Views of Mount Vernon, various Interesting 
Objects upon the Grounds, copies of Famous Pictures, Portraits 
of Washington and other Members of the Family, as well 
as Distinguished Personages of his time, etc. 
This new edition of this popular work has been carefully corrected, and 
very interesting additional matter, with new engravings, introduced. It 
contains much very valuable information, first published in this volume, re- 
lating to the Washington Family •, and is acknowledged to be one of the 
most important contributions to our historical literature, presenting a com- 
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It is printed on superfine paper, delicately tinted, and elegantly bound in 
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Opinions of the Leading Journals. 
"It is in every respect a unique volume, for there is no other one which covers the 
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Country. It is manufactured in an unexceptionable style."-Am. Literary Gazette. 
" To any enthusiastic lover of our early national history, thi delightful, valuable, 
and handsome volume will supply the inner view, the peep behind the scenes, the 
latent life of the time. What American could consent that Mr. Lossing's Field 
Book of the Revolution should have remained unwritten ? And we believe that 
the present volume will come to have as great and rare value."-Independent. 
"In this new edition is added a picture of the original plaster mask, molded by 
Houdon, the sculptor, on the living face of Washington. The engraving is from a 
photograph of the original, in possession of Mr. J. R. Snowdon, of this city. This volume 
is well adapted as a gift-book, being at once historical and artistic.-Philadelphia Press. 
'"The Home of Washington' deserves the appellation given to it, of a ' superb National 
Gift-book.' The neat revised edition just issued is a unique tribute to the Father of his 
Country. It is a book whose value must necessarily increase with the lapse of years."- 
New York Times. 
"We do not believe there ever was presented to the rending public a book so noble 
as ' Lossing's Home of Washington,' which has just been published. The publisher and 
author are entitled to universal thanks for the production of so superior a work."- 
Boston Traveller. 
" Lossing has crowned all his labors in preparing ' The Home of Washington,' in 
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form an elegant volume of permanent value to every American household, a beautiful 
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13 
A BOOK EVERY FAMILY NEEDS. 
jxro"w READY, 
gradual ganschttpr, 
A 
CYCLOPEDIA OF DOMESTIC ECONOMY, 
NEW REVISED EDITION, 
EMBRACING 
Domestic Education, 
The House and its Furniture, 
Duties of the Mistress, 
Duties of the Servant, 
The Store-Room and Marketing, 
Domestic Manipulation, 
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The Table and Attendance, 
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Comprising 5,000 Practical Receipts and Maxims Illustrated with 500 Wood 
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EDITED BY MRS. E. F. ELLET, 
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The original receipts and directions contained in this valuable work have 
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Unlike others of its class, its instructions are given from practical knowl- 
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house."- Worcester Palladium. 
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Y\vc Cvexvvw. <'AxaaxX. 
raiHjhniitfs 
A HALF-YEARLY JOURNAL OF 
PRACTICAL MEDICINE AND SURGERY; 
CONTAINING A 
Retrospective View of every Discovery and Practical Improvement in the 
Medical Sciences, digested from the Leading Medical 
Journals of Europe and America. 
This invaluable compendium, which was commenced in 1840, is issued 
simultaneously with the London edition, by virtue of an arrangement entered 
into with its distinguished editor, and appears regularly in January and July 
of each year. 
The peculiar excellence of the " Retrospect " consists in the fact that it 
embodies in a confined space, after careful perusal, all the cream of all the 
Medical periodicals,-preserving all the essentially practical articles of dis- 
covery and improvement. The great advantage offered to practitioners by 
this method, is the saving them time, labor, and money. It constitutes a 
condensed register of medical facts and observations for the past year, and 
presents a complete retrospect of all that is valuable and worth possessing, 
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This admirable digest enjoys, throughout the world, a higher fame in its 
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LIST OF STANDARD BOOKS. 
A Work'every Physician Wants. 
Of 
TWELFTH YEAR, REVISED AND IMPROVED FOR 1869. 
INCLUDING ALL THE NEW REMEDIAL AGENTS OF THE PAST YEAR. 
By WILLIAM ELMER, M.D. 
This work possesses advantages peculiarly its own, embracing the con- 
veniences of a Diary with those of a Manual, which serves the purposes of a 
Prompter or Remembrancer to the Physician. The plan for the Registry 
of Practice is new, and, for simplicity and completeness, the most thorough 
of anything of the kind. 
IT CONTAINS 
1. A Classification of Diseases, with their distinguishing symptoms, and a state- 
ment of the diseases to be diagnosed in each, the complications and sequels ; together 
with figures referring to some of the most important remedies indicated in each dis- 
ease. 
2. An Alphabetical List of all Known Remedial Agents, including many new 
ones not named in the various Dispensatories, together with their Preparations, .Medi- 
cal Properties, and Doses. 
8. A Full Classified List of Poisons, with their Symptoms, Antidotes, and 
T'reaiment 
4. Marshall Hall's Ready Method in Asphyxia. 
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6. A Register of Daily Practice designed for thirty patients, and a blank for 
each for every day in the year ; so that an account may be kept, with the greatest facil- 
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and obstetrical cases, and the amount charged for the same, in a separate blank for each 
patient, at the close of each week. 
7. A Memorandum of Cases and Treatment, for future reference; thus enabling 
the physician to preserve and accumulate the record of his past experience. Also, 
blanks for the names and address of patients, etc. 
The Book is handsomely bound in morocco, with a tuck ; and contains a pocket for 
loose memoranda, prescription papers, etc. 
A i.l this is arranged in one small, neat volume, perfectly convenient for the pocket, 
occupying no more space than a common memorandum-book or diary. 
Physicians will find this little work a means of saving both time and money, and a 
correct and ready counselor at the bedside of the sick. 
Opinions of Distinguished Professors in the Medical Colleges of New York. 
Opinion of Valentine Mott, M.D. 
" I regard it as a very valuable work for 
physicians, and the best thing of the kind 
1 have seen." 
Opinion of Horace Green, M.D. 
"I resard this as decidedly preferable 
to anything of the kind that I have ever 
seen.'' 
Annually revised. Bound in Morocco, red edges, Pocket-book form. Arranged for 
sixty patients. Price, $1.15, postage free. With printed matter, $2.00. 
Braithwaite, one year, and The Hand-Book, $4.25. Braithwaite, Chemical News, and 
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17 
MEDICAL AND SCIENTIFIC BOOKS, 
MAN AND HIS RELATIONS :-Hlus- 
trating the Influence <f the Mind on the Body ; the 
Relations of the Faculties to the Organs, and to the 
Elements, Objects, and Phenomena of the External 
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Although treating of the profoundest of subjects, 
it is written in an elegant and attractive style, clear 
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A TREATISE ON OZONE AS A DIS- 
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Practice. In Press. 
WOMAN'S COMPLETE GUIDE TO 
Health. Doctrine of the Nature, Diseases, &c., of 
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of the Womb, &c., &c. By M. E. Dirix, M. D., author 
of Uterine Pathology. Price $2 00 
GARDNER ON STERILITY : ITS 
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LESSONS IN PHYSICAL DIAGNOSIS. 
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Bellevue and Charity Hospitals, &c. One vol., octavo, 
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A MANUAL OF THE DISSECTION 
of the Human Body. By Luther Holden, F. R. C. 
S., Assistant Surgeon of, and Lecturer on Anatomy at 
St. Bartholomew''s Hospital L'lnaon. With Notes 
and Additions, by Erskine Mason, M. D., Demon- 
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A RATIONAL TREATISE ON THE 
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HYSTERIA. -Be mote Causes of Disease 
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*Local or Surgical Forms of Hysteria, etc. Six Lec- 
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Skey, F. R. S. 
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ON CHRONIC ALCOHOLIC INTOXI- 
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LIGHT : ITS INFLUENCE ON LIFE 
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PATHOLOGICAL ANATOMY OF THE 
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MAN: WHERE, WHENCE, AND 
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THE DARTHROUS DIATHESIS, OR 
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ASIATIC CHOLERA.-Its Origin and 
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MEMOIR OF PROF. VALENTINE 
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Slit American journal of (SbsMtits 
AND 
DISEASES OF WOMEN AND CHILDREN. 
EDITED BY 
30. NOEGGERATH, NT . 3D . , 
Late Prof, of Obstetrics and Diseases of Women and Children in the N. Y. Medical College i 
AND 
3B . W . DAWSON, M . 1) . , 
Lecturer on Uterine Pathology in the Medical Department of the University of New York. 
The above Journal is published quarterly (May. August, November, and 
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consists of 112 pages, elegantly printed, and is divided into "Original Com- 
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In the numbers already issued, the followin >• eminent physicians have con- 
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of Physicians and Surgeons, New York; A. Jacobi, M. D., Prof, cf Infantile 
Pathology and Therapeutics in the Medical Department of the University of 
New York; Prof. Horatio R. Storer, of Boston; George T. Elliot, M. D., 
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