plplliiiilp Gmmnui! iiilteife^fe:;.^;:,;:,:;^'.}/ (Ft! '•>!('.>•.'■ -I'' I ■ r; ' : : ■.■" 1,1 It, 1975 NLM001039959 > HOME TREATMENT -----FOR----- * Diseases of Women And Some Favorite Prescriptions. Embracing- Discussions of the Relation of Medical, Social and Meta- physical Questions. JOHN A. MILLER, M. D. Graduate Medical Department University of California, also holding Credentials from the Universities of Berlin and Heidelberg, Germany. Published for the Author. \89| Entered According to Act of Congress, in the Year 1891, BY JOHN A. MILLER, In the Office of the Librarian of Congress, at Washington, D. C ,^^f% m& TO THE LATE DR. CARL SCHROEDER, PROFESSOR OF THE DISEASES OF WOMEN IN THE FREDERICK WILLIAM UNIVERSITY, BERLIN: MY TEACHER AND FRIEND. do I PREFATORY NOTE. The publication of this volume was suggested by the astonishing ig- norance displayed and the antiquated ideas entertained upon questions of health and disease by most persons with whom I came in professional contact, even by those who were accomplished in other subjects of a scholastic and scientific nature. The practical importance of the subject naturally led me to the consideration of diseases that are essentially in- flammatory, for over seventy-five per cent of all diseases of women are of an inflammatory nature. In this respect the book differs from other works on similar subjects. In discussing this class of diseases I have aimed to present a treatise simple in style, and easily understood by the casual reader. While I have endeavored to impart strictly scientific information, I have tried to impart it in familiar language, avoiding the use of technical terms as far as possible, and carefully defining them when their use became indis- pensable. JOHN A. MILLER, M. D. No. 1137 Geary Street, .San Francisco, Cal. ?V..%.^ BY THE SAME AUTHOR. MEDICAL EDUCATION IN THE UNITED STATES AND AN OUT- LINE OF THE GERMAN SYSTEM. Essay read before the Alumni Association of the Medical Department of the University of California, March, 1886. EROSIONS OF THE VAGINAL PORTION OF THE CERVIX, OR ULCERATION OF THE SAME PART. Pacific Medical and Sur- gical Journal, January, 1887. RETROVERSIO-FLEXIO AND A NEW INSTRUMENT FOR THE REPOSITION OF THE UTERUS. American Journal of Obstetrics and Diseax/s of Women and Children, February, 1887. UTERINE HEMORRHAGE AND LIGATION OF THE UTERINE VESSELS AS A THERAPEUTIC EXPEDIENT. The New York Medical Record, September, 1889. PHLEGMASIA ALBA DOLEN, OR MILK LEG; ITS PATHOLOGY AND TREATMENT BY MEANS OF COLD WATER COMPRESSES AND ICE BAGS. Pacific Medical Journal, June, 1891. CONTENTS. CHAPTER I. INTRODUCTION........................................................................... ]5 CHAPTER II. DELUSIONS AS TO THE CURATIVE VALUE OF DRUGS......... 36 CHAPTER III. WHAT IS MIND CURE?............................................................ 46 CHAPTER IV. GENERAL CAUSES OF UTERINE AND PELVIC DISEASES OF WOMEN................................................................................ 61 CHAPTER X. UNCLEANLINESS AS A CAUSE OF DISEASES IN WOMEN...... 76 CHAPTER VI. MARITAL EXCESSES AND PREVENTION OF CONCEPTION... 87 CHAPTER VII. CRIMINAL ABORTION OR FETICIDE.......................................101 CONTEXTS. CHAPTER VIII. ANATOMY OF THE FEMALE ORGANS.....................................119 CHAPTER IX. MENSTRUATION AND MENSTRUAL DISORDERS.....................1 2(i CHAPTER X. HISTOLOGY OF INFLAMMATION..............................................145 CHAPTER XL URETHRITIS AND NEURALGIA OF THE URETHRA...............ir,0 CHAPTER XII. INFLAMMATION, CATARRH, AND OTHER DISORDERS OF THE BLADDER....................................................:..............157 CHAPTER XIII. ACUTE AND CHRONIC INFLAMMATION OF THE VAGINA....172 CHAPTER XIV. HYGIENIC* MEASURES FOR CATARRHAL DISEASES OF THE FEMALE ORGANS..................................................."...........182 CHAPTER XV. METRITIS OR INFLAMMATION OF THE WOMB.......................199 CHAPTER XVI. CHRONIC METRITIS OR CHRONIC INFLAMMATION OF THE WOMB...................................................................................o03 ('(>X TEXTS. CHAPTER XVII. ENDOMETRITIS OR CATARRHAL INFLAMMATION OF THE WOMB................................................................................209 CHAPTER XVIII. THE NATURAL POSITION OF THE UTERUS AND HOW IT IS SUPPORTED.....................................................................226 CHAPTER XIX. PROLAPSUS OR FALLING OF THE WOMB..............................231 CHAPTER XX. VERSIONS AND FLEXIONS OF THE WOMB............................240 CHAPTER XXI. DISEASES OF THE FALLOPIAN TERES....................................25S CHAPTER XXII. DISEASES OF THE OVARIES...............................,...................2H3 CHAPTER XXIII. PERIMETRITIS AND PELVIC PERITONITIS............................275 CHAPTER XXIV. PELVIC CELLULITIS OR PARAMETRITIS................................285 CHAPTER XXV. ELECTRICITY AS A REMEDY.................................................294 CHAPTER I. INTRODUCTION. I sec a large field of usefulness which has not been cov- ered by competent authorities. I propose, therefore, to offer a plain, simple statement of the most common causes of physical suffering in women, and a simple and reliable method of home or domestic treatment, to be carried out by the patients themselves, which, in the great majority of cases, is easily applied. The first nine years of my professional life was an untir- ing and incessant devotion to the arduous demands of a large family practice, after which I decided to go to Europe, and there prosecute such studies in two German universities as my experience as a practitioner had fully convinced me to be of the greatest practical and scientific importance; hence, I offer no excuse or apology for aught I may say on a subject with which I have taken especial pains to famil- iarize myself. Having in a measure established my iden- tity, I am more fully prepared to proceed in a more con- genial way. In the realm of thought there is no monopoly, and it is, after all, at the bar of public Opinion that a final judgment must decide the merits of my course. ■ The question is not what to teach, but whom to teach. This may seem, at first sight, an easy matter to determine, but a more careful inquiry will show the complexity. The platform of a medical college is considered by some the only legitimate place from which a medical man may impart his knowledge, but here the opportunity is lim- ited, notwithstanding the abnormally great number of these institutions. This, however, is not the only reason. Med- ical colleges are becoming so numerous, that they should (is ) 10 HOME TREATMENT KOI! WOMEN. be discouraged by all honest and high-minded medical men, because in this country they are private institutions, with very few exceptions, and subserve sinister purposes, in furthering the interests of their promoters either as adver- tising schemes or money-making institutions, or both. Of course they are incorporated under State laws, which make them <7uo.s/-public institutions, but the State exercises no authority over them, and their self-constituted professors conduct them to suit their own private ends. They are not limited by law, nor is a required course for their stu- dents imperative, so that the public have no guarantee of the fitness or competency of their graduates. There is, also, an unhealthy rivalry among our colleges for students, im- proper material is taken in, and correspondingly poor material is turned out; this in turn causes a rivalry among their graduates in making spoil of the sick. Every self-respecting and competent medical man has an utter contempt for these doctor mills. This will never be different in this country until we follow the plan of European governments, and make medical colleges State institutions, and their professors officers of the State, with liberal salaries. The medical press has a comparatively limited oppor- tunity for imparting information to the public, unless the editor of the secular press happens to make a quotation. The exclusiveness that has characterized the learned professions generally, and the medical profession particu- larly, is rapidly passing away. Only half a century ago, the medical lectures in Germany were mostly delivered in the Latin language, and, while we now often suffer, in listening to medical lectures in bad English, the latter may still be the lesser evil. In fact, so great is the deference to public opinion in favor of diffusing knowledge that medical fac- ulties court popular favor by delivering a course of lectures on medical subjects, and consider these the best-drawing card of the institution. INTRODUCTION. 17 Information that is not sensational nor untruthful can- not fail to do incalculable good to the class for whom it is intended, namely, our wives, mothers, daughters, and sisters, so that they ma f avoid errors, that entail suffering and dis- ease; information that will teach them how to cure them- selves of the commoner and simpler ailments, and thus avoid running to the doctor, who cannot always afford to tell them the truth. Some would not if they could. The Darwinian theory is of wider application than to mere animal or plant life; it extends itself to the over- crowded professions, and the increasing "struggle for ex- istence" in the ranks of the profession makes men dishonest and greedy for any opportunity to raise a fee, so that patients are being treated for diseases which are created for them by the cunning and dishonesty of their doctors. A little common sense and a knowledge of the elemen- tary principles of disease would be the best protection against these deceptions; but, as a rule, sick persons are inclined to throw aside all good sense, and give themselves up entirely to their feelings or to their doctor. This is a very wrong thing to do, and opens the door for all manner of imposi- tions. The general practitioner of thoughtful and studious habits finds that, in the course of years, a diversified read- ins on the different diseases which in the routine of his work he is called upon to treat makes him a generally well- informed man, but not a thoroughly exact man, either in theory or in the details of his treatment. Fifty to sixty years ago the entire field of medicine was comparatively so small that it was easier for a brilliant mind then, to comprehend all that was believed to be known, than it is for the same quality of mind to understand any of the subdivisions of medicine to-day. Those were the days of doctrines and rules. Little that was absolutely correct or true was then known about disease, otherwise such absurd theories as the " dynamization or spirit-like" influence, causing disease on the one hand, or 18 HOME TREATMENT FOR WOMEN. that the "great source" of chronic diseases was p.som, or itch, on the other, as Hahnemann would have them believe, could never have gotten a foothold. These are the days of scientific deductions from micro- scopical and physiological research, in laboratories con- nected with great universities, and the result is, that any of the specialties or subdivisions of medicine is as large and interesting a field as the entire area was some time ago. It thus happens, that some thoughtful persons, after years of general practice, drift almost involuntarily into some one department of medical art and science. To this they become gradually wedded, and in it they grow in knowl- edge and experience far beyond their previous anticipations. What they read on the subject is better understood, and new ideas are constantly formed, which enlarge the scope of their knowledge. In this manner the writer drifted into the domain of diseases peculiar to women, which was as un- happy on the one hand, as it is interesting on the other, for the phrase "diseases of women" has fallen into disrepute because every superficial practitioner professes to know all about them, and it often is but another name for criminal abortion. But for all that, there is a legitimate and scientific spe- cialty of women's diseases. The time-serving specialist must be exposed in every department of medical science. Whether the pretender is labeled, a professor in a college, or labels himself through glaring newspaper advertisements, one is just as much a catch-penny as the other. The object of educating the laity cannot be reasonably confined to a few medical truths, but the perversion of the truth must also be understood, so that the false can be de- tected. It is necessary to point out the dangers and frauds which are the unhealthy outgrowths or excrescences of established truths, and there must be no veneering of the wicked and sinful with ambiguous phrases to shield the guilty; the truthful and innocent require no apologist. The honest observer can pursue no middle wav in a INTRODUCTION. 19 work to which he has devoted the best years of a studious life, and hence he may seem radical in his opinions. While policy often dictates a conservative course, that which con- science and reason dictate to be true is prompted by loftier motives, namely, to subserve the highest purpose of moral integrity. It has often been said that this is a mechanical age. How true is this even, in the furtherance of science! How true is this of the science of astronomy, which was revolu- tionized by the construction of good telescopes! Mechanical genius has perfected a lens for Mount Hamilton thirty-six inches in diameter, and one is now in course of construction for Mount Wilson, in Southern California, which is to measure forty inches. Through these means scientists hope to decipher the complexion of remote planets. Microscopic lenses have been equally perfected, and, by means of achromatic condensers and immersion lenses, great magnifying power can be obtained with perfect dis- tinctness. That this mechanical spirit of the age should also have obtained a foothold in medical art and science, is but natural. Surgical and other mechanical methods have entered so boldly into the field of diseases of women that the writer feels constrained to sound a note of alarm. (Jreat strides have been made in a more perfected technique in abdominal operations, and, by favorable recoveries from grave and severe operations, the field of surgical usefulness became enlarged, but this has degenerated into a license for notoriety and personal aggrandizement of not over- scrupulous and selfish surgeons who are over-anxious to operate so as to be able to boast of the great number of their capital operations, or laparotomies. I was enthusiastic in abdominal and pelvic surgery, but not until I entered the field as a specialist in this depart- ment of medicine did I see and- hear of daily abuses and misuses of this branch of surger}r. In many instances it degenerated into criminal malpractice. It will be instruct- 20 HOME TREATMENT FOR WOMEN. ive information to cite a few cases which occurred under my observation, and present the actual facts to the reader. It was in the month of February, in the year 18S8, that a business trip to the southern part of the State forced an absence of several weeks upon me. Some two months before this time I had been called to see a young woman, who had then been sick for several months. She informed me that she had been married nine years, and, not having had any children, she concluded to see a noted specialist of female diseases. By this physician she was told that her sterility was owing to a closure or contraction of the mouth of the womb. This was obviously a wrong diagnosis, and for these reasons: she had always menstruated regularly and Avithout pain, which excludes a constriction; and, secondly, no physician can honestly call a woman sterile until he has examined her husband, who, in the majority of in- stances, is the cause of his wife's sterility, because it is he who is sterile. This woman and the doctor agreed, how- ever, on a course of treatment, which was to forcibly open or stretch the mouth and cervical canal of the womb. This by itself is neither a dangerous nor a severe operation, if carefully performed, but care in this case was evidently not exercised, because the young woman was taken with severe inflammation, which caused a pelvic abscess. I found her after two months of suffering. The dis- charge had become extremely offensive, her body emaciated, and her strength exhausted. I enlarged the opening of the abscess, placed a large drainage tube in the cavity, through which it was washed out, by means of an antiseptic solution of bichloride of mercurv, 1 part to 2,000 parts of water, and, by further giving her simple, nutritious food, she improved rapidly, so that the day before I left the city she was at my office, and told me that she felt as well as ever, although not thoroughly re- covered. I was absent two weeks, and a few days after my return I incidentally met her husV.and, who told me that INTKODUOTION. 21 a week after I had left, his wife felt unwell and called in one of her former doctors, who, by the way, rides a hobby- horse on surgery. This man found a few pimples on her body, which can be found on almost any healthy person, these, he said, were signs of blood poisoning from her ab- scess, and that an operation to extirpate the abscess, with one or both of her ovaries, was of urgent necessity to save her life from blood poisoning. The deceived woman was of course frightened into giving her consent to the opera- tion, which was undertaken immediately, and, as luck would have it, she recovered; but she might have easily died, which she undoubtedly would have done had this knife- man got her sooner, or before I had restored to her a splendid physical condition, which withstood the unnecessary butch- ery to which she was induced to submit. Some doctors seem to have a perfect mania for cutting operations, just as though the entire science and art of medicine were exhausted in surgery alone. To assume this for an instant is manifestly ridiculous. More lives are an- nually saved by a scientific application of other methods of cure than the most elaborate and brilliant statistics of surgery can approach. There is science and skill in select- ing proper medicines, in the employment of hygiene or the rules of health, in the practice of obstetrics, and in a variety of other ways to demonstrate the triumphs of the art of healing. The rash and unnecessary resort to the knife has brought surgery into general distrust, so that some patients would rather die, or wait until they are almost dead, before they allow an operation to be performed on them, in cases where surgery is, indeed, the only possible method of cure. A lady recently called at my office for a consultation. I found her uterus and other pelvic organs in a perfectly healthy condition, although she suffered pain there. This was due to neuralgia from a generally exhausted and de- bilitated condition. I was not a little surprised to learn, 22 HOME TREATMENT FOR WOMEN. from her own lips, that she had been treated for womb disease, and was about to undergo an operation for a tear in the mouth of her womb. This was manifestly absurd, be- cause no laceration existed at all, and if there had it might not have been necessary, because it is quite natural for women who have borne children to have the scars of old lacerations on the mouths of their wombs, and they are not any the worse for them. It is important for mothers to know something about themselves and of the common diseases to which they are liable, for then they will not be so easily persuaded to per- mit the use of caustics, or the cutting, stitching, or scraping of their wombs, which is quite likely to excite complicated inflammations, more serious in their results than the diseases for which these operations were performed. I know of what I write, and there is no one who can successfully deny it. Dr. William Goodell, who stands as high in the depart- ment of diseases of women as any American, had an article in one of the medical journals on "The Abuses of Uterine Treatment," He says: " From a large experience I humbly offer to the reader the following watchwords as broad helps to diagnosis: 1. Always bear in mind what another has pithily said, that 'woman has some organs outside of the pelvis.' 2. Each neurotic case will usually have a tale of fret or grief, of cark and care, of wear and tear. 3. Scant or delayed or suppressed menstruation is far more frequently the result of nerve exhaustion than of uterine disease. 4. Anteflexion of the womb, per se, is not a pathological con- dition. It is so when associated with sterility or painful menstruation, and only then does it need treatment, o. An irritable bladder is more a nerve symptom than a uterine one. 6. In a large number of cases of supposed or actual uterine disease, which display marked gastric disturbance, if the tongue be clean the essential disease will be found to be neurotic, and it must be treated so. 7. Almost every sup- posed uterine case, characterized by excess of sensibility INTRODUCTION. 23 and by lack of will-power, is essentially a neurosis. 8. In the vast majority of cases in which the wornan takes to her bed, and stays there indefinitely, from some supposed uterine lesion, she is bedridden from her brain and not from her womb. I will go further, and assert that this will be the rule even when the womb is displaced, or it is disordered by a lesion or disease, that is not in itself exacting or dangerous to life. Finally, uterine or womb symptoms are not always present in cases of uterine disease, nor, when present and even urgent, do they necessarily come from uterine disease, for they may be merely nerve counterfeits of uterine disease.'' There is not a physician of any extended experience in the land who, if he be true to his better judgment, will not indorse every word of Professor Goodell's propositions. But the chances are they will never accomplish the good for which they were intended if the mothers, wives, and daughters are not permitted " a little peep " behind the curtain, and learn for themselves. For those who are wealthy and have plenty of money, doctoring may be a luxury or an amusement, but there the line must be drawn for the benefit of the deserving poor, with whom any treat- ment is a hardship. Stupidity of the masses is one of the causes of the abuse of surgical treatments, for they always look upon a surgical or bloody operation as one of the greatest achievements of modern medical art. Then there is the cupidity of the professional classes, who trade upon this popular error and delusion, and charge correspond- ingly large fees, which, as a rule, are exorbitant, particularly when the working classes are the sufferers. A little cutting or stitching is much more quickly done, and the patient may be dismissed as cured, or left under the impression " that everything was done that could have been done," than a conservative medical or hygienic treat- ment, which involves more thought, labor, and patience, qualities which' are not as eagerly cultivated as the art 24 HOME TREATMENT FOR WOMEX. to wring out a good fee by a little surgery, with less labor and skill. There is not only too much mischievous doctoring, but there is too much of every kind, whether good, bad, or in- different. The trouble is there are too many in the ranks of the medical profession j and this is not only true of this country, but is raising a cry of warning in Europe. The struggle for existence is a natural law, and nature is immu- table. I do not mean to say, that it is a humane law, or that competition is a virtue; in fact, I believe quite the reverse. But much that is natural from a physical stand- point might not be so from a moral or spiritual plane; thus the two natures are distinct, It is reasonable to suppose that, if the natural crop of diseases falls short of supplying the demands of those who hunger for an opportunity to treat disease, and it lies within their power to create disease, they will certainly do so. The deficiency must be supplied, or one of two things must be done by the doctor: he must either starve, or go to work at something else. This may be cruel logic, but I know that these are the actual facts. Now let me ask how many persons who have some sort of a diploma will be self-sacrificing enough or sufficiently unselfish to prefer to starve or honestly work for a living, if they can avoid either,by defrauding someone out of a fee, for pretending to cure some manufactured disease? It seems almost a waste of time to argue such a self-evident proposi- tion. I have known physicians of high standing who treated women for womb diseases which never had a real existence, and surgeons of large incomes to remove the female breast for a "supposed cancer;" and, that being the case, what would you expect from a less fortunate brother practitioner who is eking out a miserable existence? Plow many a case of simple sore throat or tonsilitis is being paraded as a case of diphtheria. Why, I know of doctors who built up their reputations in that way. It is INTRODUCTION. 25 quite an easy matter, to call an ordinary, simple case of bronchitis, pneumonia. Harmless swellings, no matter of what sort, are treated and palmed off every day as cancers. The quack cancer doctor is almost ubiquitous. Souk.' would much rather part with the village parson, or their regular old town doctor, than to part with the cancer doctor. Diseases that,are conjured up in the minds of sus- ceptible or hypochondriac persons have for them a real existence, because if a person believes he has a certain dis- ease, it becomes a reality, as far as his own state of mind is concerned, and as far as the treatment is concerned to him who created the delusion, it is much more desirable than if the disease were real, because you can cure an im- aginary disease, which may be impossible when a real one comes under treatment. This is another method of making a reputation for extraordinary cures that really never occurred. When I contemplated writing a book, which I hoped to.make a vade mecuvi for those who felt interested in the subject, I felt that it would be a duty which I should reluc- tantly perform, for it would be a criticism on the status of the medical profession of this country. I was convinced that whatever I said that would lower the tone of the pro- fession in the estimation of my countrymen would naturally reflect on me as unfavorably as upon any other member, for I never claimed to be anything else -but an American physician, and, as such, I have an ambition to elevate the rank and file to honor and respectability. There is also a motive that underlies a work of this nature which should appear justifiable to the author. It is absolutely necessary that side-lights should be thrown into dark corners and recesses that are usually screened from public notice. If there is a growing deterioration in meth- ods of proficiency and morals, the public should know it, for who is the greater villain, he who trifles with human life through officious ignorance and venturous operations, or the mi'-night assassin, who, under cover of darkness, waylays 26 HOME TREATMENT FOR WOMEN. his unwary victim? The title "doctor," from the Latin doiro, "I teach," has a halo of learning that it derives from the original significance that was attached to it when it was first sanctioned at Bologna University, about the middle of the twelfth century, where it first passed into the faculty of divinity. It was afterwards introduced into the universities of Northern Europe, and remained ever since a degree of distinction in theology, law, philosophy, and medicine. In the German universities doctor implies also a license to teach within the university, as a privat-doceid. When we now consider that no person can matriculate in a German university who has not graduated from the gymnasium or high school, it is clear that, under the above conditions, the title "doctor" guarantees that the possessor is an educated person, not only of the high school, but added thereto is the accomplishment in the specialty of which he holds the doctor degree. What may a "doctor degree" mean in this country? The title of an illiterate and utterly incompetent person, who was by natural environment and occupation a teamster, saloon keeper, barber, tailor, or patent-medicine vender, etc. If a woman, she may be retraced to an ignorant nurse, midwife, or quacksalver, the conceited wife of a man who indulges her in the freak of " learning .to be a doctor," for she had demonstrated her genius for the profession by suc- cessfully treating a case of measles, which started the doc- tor's bee a-buzzing in her bonnet, until she passed through a medical college; Tast, but not least, are the winsome daughters of the millionaire or successful business man, who imagine themselves too smart to make useful house- wives and good mothers. There is not a medical college in this State, and there are few, if any, in the United States, that would not eagerly take in all of this material, and guarantee to them before- hand, that they can graduate as mediciiuc doctor in twelve INTRODUCTION. months to three years, a five months' course being consid- ered a year. The above comparison is a disgraceful commentary on the degree of doctor in this country, and the public should learn to know the difference. " The United States and Its Doctors " is the title of an editorial in the July number of the New York Medical Record, and it says: "There is certainly no more curious social phenomenon than that of the extraordinary popu- larity of the medical profession in this country as a means of securing a livelihood. "This subject is one that is often dwelt upon, but we doubt if many even yet realize the grotesque misproportion which medicine in the United States holds to other bread- winning occupations. Here are some of the naked facts in, the matter:— "France has 3 Examining Boards. Experience has demonstrated that these boards are but the excrescences of the various medical colleges, who are themselves the root of the very evils that are sought to be remedied. The duties of these boards are simply to make themselves officious, and to in- quire into the source of the credentials or diplomas of the applicants for a license to practice medicine, and not into the qualifications or competency of the applicants. All that is necessary under such laws is simply to present a diploma of some sort; whether it was stolen, or the diploma of a dead 30 HOME TREATMENT FOR WOMEN. man, or gotten from any of the numerous worthless colleges, is not made the subject of inquiry ; and as by far the greatest number of quack-salvers in this country have diplomas, the law falls short of remedying quackery. There are, usually, enough boards of examiners, represent- ing the different schools, so that the different interests of the diploma manufacturers are well represented. A medical examining authority whose functions and powers do not go higher or beyond the mere granting of licenses, or which does not examine into the qualifications of the persons who possess diplomas, is utterly absurd, because it is no protec- tion against ignorance and imposition. A law that pre- sumes that all persons holding diplomas are qualified and competent to practice medicine, is essentially wrong, or inadequate to fulfill the purpose for which it was designed. I have known graduates from what were considered good colleges who could neither write a safe prescription nor diag- nose a case. There is only one way towards an approach to an efficient and intelligent board of medical examiners, and that is, one single State board in which the different schools may be represented as to their pet theories of prescribing medicines, but in all other departments of medical science and art there must be a uniformity of talent and qualification. There must be a standard of excellence established by the State, which is higher than and above the recognized stand- ard 6f any medical college, for no medical college is trust- worthy in this respect. The State in its sovereignty must prescribe what shall constitute a medical education, and the requirements should be embodied in the statutes. A license or degree from that source, after a final examination, should be the onlv legiti- mate license to practice medicine.. Such a method would establish a system that would clearly define the status of every medical practitioner. The board must have the power, and it must be their duty, to examine each and every applicant for a license, as all INTRODUCTION. 31 candidates for the army medical service are examined. All this noise and talk about a preliminary examination and an extended course of medical study are simply the vaporings of superficial minds. It is neither the preliminary course, nor the length of time that a person consumes in trying to become a doctor, in which the public is interested, but what kind of doctor a person is when he hangs out his shingle and begins to practice, whether he is competent to do that which is expected from him in the hour of sickness or great peril, irrespective of any diploma or any medical college. Foreign graduates should be amenable to the same exam- ination, for behind these, too, belongs the interrogation point. The gushing mediocrity of some of these diploma holders gives rise to the suspicion that their credentials are not genuine. As an American to the manor born, I would not for a moment deny the humblest citizen an opportunity to ele- vate himself to the highest professional honors; but why can he not be required to thorougnly equip nimself and prove, bv oral and written examinations on subjects of preliminary education, that his mind has become disciplined for broader or special studies, irrespective of any course in a college? After the State has satisfied itself of the profi- ciency of the applicant in scholastic acquirements, it should go further, and examine into the qualifications for a degree of medicine, just as they do in the U. S. Army, only with this exception, that no diploma of any medical college should be required from the candidate, and if he has one it should not be recognized. This would simply incorporate in the State laws the distinctive feature of the University of London, which ex- amines and confers graduation on persons who have received instruction in such institutions at home and in the colonies as have satisfied a Secretary of State with regard to their studies. This university also has and exercises a power of exam- ining for degrees persons who have not been at any institu- 32 HOME TREATMENT FOR WOMEN. tion. Nothing could be more democratic than for the State to make such a provision for State medical examinations. The German Government does precisely the same thing, with the exception that it makes graduation from the med- ical department an essential prerequisite. It has a State board of examiners to examine all graduates in medicine of their own universities, to further prove if they are really qualified. A diploma in Germany is of no value; it is the so-called nrzliche Approbationspruefung, State's examination, that gives the license to practice legally. When-this is found necessary, notwithstanding the high standard of German medical schools, how much more is this safeguard against incompetency needed with us? I have endeavored to prove from the methods of Germany and the course of the United States medical department that di- plomas cannot be accepted as bona-f.de evidence of a medical education. AVith us a half dozen doctors can get together any time, incorporate a medical college, call themselves pro- fessors, and start out advertising themselves and their col- lege for the purpose of manufacturing diplomas and doctors. Why, a diploma under these conditions should not be worth the parchment it is written on, as evidence of a medical education, unless attested by a higher and perfectly inde- pendent authority! If the public once understood that too many doctors are dangerous to the morals and health of society, they would be quite as anxious as the most enthusiastic medical edu- cator to remedy the evil. The question of too many doctors is one of economical and social science, not of medical science, and, therefore, it can only be intelligently considered from these philosophical standpoints. It is a well-understood and accepted law of po- litical economy that in the industrial pursuits, whether in the manufacturing departments or in agricultural production, the surplus or glut in the market of any of the products of in- dustry, reduces the price and stimulates consumption, which, INTRODUCTION. 33 in the course of time, is regulated by a suspended or reduced production, thus restoring a healthy equilibrium. It would be an absurdity to apply the same rule to a surplus of doc- tors, because human ills or diseases do not increase in pro- portion to the surplus of doctors, nor will fees be any less. But the surplus, in order to live, must live on the earnings of the community, and here the disastrous consequences appear. The credulous, and those who often may imagine that they require medical advice, become the unconscious victims < >f the unhealthy disproportion, for the doctor seizes the op- portunity to make a case, while the normal proportion of cases do not reach around. Thus, it is calculated that at least fifty per cent, of all the diseases for which patients are treated are fictitious as far as actual disease is concerned, and the remaining fifty per cent, are, in the majority of instances, overdosed and overdoctored. For this reason medical legis- lation would not make a privileged class of physicians, nor throw unusual safeguards around medical practitioners, but medical legislation is to protect the people themselves from imposition and quackery. The reason for the overcrowded state of the profession is not alone the laxity of medical laws, or the low standard of medical education in most of our colleges, but the general tendency of the country population to drift into the cities. Honest labor has not the dignity which its importance de- mands, and a radically faulty method of common-school edu- cation is another reason. Utilitarian manual methods, in which the hands are educated for useful employment and the minds to habits of industry, are to be wished for. Young men who have acquired a technical education in mechanics and arts will learn to respect labor in every department, and their ambition in life will be greater than to swing a cane or wear a silk tile. In proportion as the productive employments are made respectable, this questionable ambition to become M. D.'s will fall off. ... 34 HOME TREATMENT FOR WOMEN. i History tells us that the opulence of Rome was speedily accompanied by a decline of its agriculture, after which came the fall of the Roman Empire, because the country population became too indolent and restless and flocked to the cities for an easier and luxurious living. History in this respect seems to be repeating itself. We are always talking of encouraging the beauty and growth of our cities, but not one word of encouraging agriculture; no one talks of encouraging farm life and making it profitable and attract- ive, so that men and women would prefer the more inde- pendent subsistence in the country to a shabby gentility in the city. Some reader may ask, What has all this to do with doctoring ? I say that the answer must already have been apparent; it becomes the duty of everyone to interest him- self, that the division of labor shall be apportioned so as to do the greatest good to society. We have a national characteristic which shows itself in an abnormal conceit for everything American in a degree that is not essential for true patriotism and love of country. But when by comparisons we learn that there are abuses and errors which are destructive to a healthy intellectual and material growth, we must have the honesty and inde- pendence to acknowledge them, and busy ourselves to find a remedy for existing evils. The physician who can assist in the amelioration of society by administering to human ills which are the result of unwise laws, is accomplishing as much good as if he writes prescriptions or bleeds patients. The sooner every- body recognizes the fact that the time has come to deflect the current of ambition from the practice of medicine as a means of making a living, the sooner will untold suffering be lessened, and there is no honest-minded physician who does not heartily agree with me. Mercenary persons, and ignorant or unscrupulous doctors who run diploma mills, may criticise severely the honest sentiments here expressed,, but the truth is so apparent, that he who runs mav see INTRODUCTION. 35 the inevitable consequence of this unhealthy competition. Professors of colleges have a direct interest in the ignorance and incompetency of their graduates, because they are the hleans of calling them into consultation on every possible occasion in trifling ailments, and if the disease belongs to some specialty, they have the cases entirely turned over to them, because, in the mind of the incompetent and newly- made doctor, the professor who was the means of getting him a diploma, poses as the beau ideal of medical wisdom. In this way it becomes exceedingly profitable to be a pro- fessor. If there are not enough medical colleges in a com- munity to afford places for the ambitious, it is considered to be one of the best-paying financial investments for a com- pany of physicians to start one, and in most of these con- cerns it is easier to get a diploma as a doctor than to learn to be a good dressmaker or shoemaker. Hence there is only one remedy to control the educa- tional aspect of this evil, and that is to take medical colleges entirely out of the hands of private individuals and make the State the only source of the necessary credentials to practice medicine. An American system of medical education fostered by the State would be productive of grand results, because, under the shadow of our free institutions, the mind tran- scends the circumscribed sphere of despotism. This has already been proven in numerous instances, notwithstand- ing unfavorable surroundings. Forming the galaxy of great names that illumine the milky way of science, there are none brighter than a Gross, a Flint, a Sims, and some others. These were great Ameri- can authors and physicians, who never pretended anything else; they never dreamt of the Don Quixotic escapade of pretending to be American professors while they appended to their names initials or abbreviations of questionable credit from foreign institutions. The brilliancy of true genius was their only passport to fame. CHAPTER II- DELUSIONS AS TO THE CURATIVE VALUE OF DRUGS. Medicines that are sure cures for all the diseases to which humanity is heir, are not the spurious discoveries of the quacksalver and patent-medicine vender alone, but some very intelligent persons believe that if there is not a panacea, there is at least a remedy, for every disease. In cases where the patient does not recover, they believe that either the disease was not thoroughly understood or the medicines which were given were not properly selected. This is a great error, because there is no such thing as a specific or infallible remedy for any disease, and, on the other hand, it is quite possible that most patients, with proper nursing and diet, would naturally recover without any drugs or medicines whatever. Outside of those drugs, like ether, chloroform, opium, or morphine, that are em- ployed for the purpose of deadening the sensibility of the nerves, so as to render them insensible to pain, there is not another drug that is absolutely sure and true in its medical effects. Some few are very useful at times, but the great bulk of medicines do much more harm than good. Medicine in its broad sense means a knowledge of the cause, course, treatment and ultimate results of disease. The study of medicine cannot be circumscribed by dogma or theory, nor can it be mastered in a few short years of study at the very best medical schools. It requires a mind adapted by nature for a plodding investigation of her laws, and incessant application, long after the college curriculum is ended. In fact, the student must unlearn much of the (36) DEUSIONS AS TO THE CURATIVE VALUE OF DRUOS. 37 stereotyped lessons of the text-books, and this is particularly true of the supposed medicinal effects of drugs, which are always exaggerated. When physicians really have a threat- ening case, under their observation and care, the attributed therapeutic action of drugs is nearly always disappointing, and very often injurious, and they are forced to let the drug- ging entirely alone, and bring their skill to bear on meas- ures which support the strength and vitality of the system, so that nature can effect a cure in her own way. This may seem to some simple doctoring, but I can assure the reader that it requires the highest degree of medical skill, notwithstanding the droll sarcasm of Voltaire, that "medi- cal science is the art of amusing the patient while nature performs the cure." There is neither skill nor much learn- ing required to give an ordinary prescription; that the aver- age apothecary could do with the greatest exactness. But science and medical skill can be exhausted in managing and husbanding the resources of nature, in order to effect a cure. Medicine no longer stands alone as a simple art, based on theoretical deductions, as it was less than a hundred years ago, but it has become a department of natural science, a part of the natural history of the human race. Disease is as much a vital process as health, only in one case the vital function is perverted, or destructive, while in health it is constructive. The germ theory of disease and cellular pathology are clearly within the domain of bio- logical research, while chemistry has solved many phys- iological processes. Mental philosophy has been no less serviceable in the department of medicine, by teaching the wonderful influence of thought and emotions on the phys- iological functions of the organs. A one-sided education is inadequate to appreciate the subject of healing or teaching. A comprehensive knowl- edge of all that bears on the subject of health and disease has several important objects in view, namely, it thoroughly 38 HOME TREATMENT FOR WOMEN. acquaints the doctor with all of nature's resources for the amelioration or cure of disease; and it gives him judgment in all cases to avoid irreparably wrong treatment, which places obstacles in the road of nature's efforts to heal spontaneously. The quack or professional imbecile will, in the ordinary course of diseases, be accredited with remark- able cures; in fact, the cures wrought by a quack or an ignorant person are just as welcome and valuable to the patient interested as if they were accomplished under the advice of the most erudite and skillful physician, but the invalid ran the chances of malpractice or bad treatment at the hands of the quack, which might have cost him his life, because the incompetent healer does not know wiien his method of treatment does mischief. Every method of cure may possess merits of its own, which are beneficial when the disease or conditions for its employment are present, whether this is mind cure, water cure, or anything else that you may name. All that any system of treatment can do is simply to stimulate the curative force of nature, which is the only first cause of any cure. The reparative energy of nature has never been duly recognized, because the selfishness and pride of the doctors will not concede this as often as they ought. The doctor should be the most useful as a monitor to the sick, in guid- ing and controlling thought and conduct, in harmony with the curative energy of nature. From this point of view the pretensions of anyone effecting this or that cure are only a delusion, because the doctor effects nothing, he only assists, guides, and directs towards effecting a cure. What this cur- ative force is has by no means been understood. Some believe it identical with life or vital action, which manifests itself only in organized substances, but even if we admit this identity, we are balked again, because we do not really know what life is, any more than we know what electricity is. Descartes resolved life into matter and motion; this, however, is rather the phenomena of life and gives us DELUSIONS AS TO THE CURATIVE VALUE OF DRUGS. 39 no idea of the real essence of the force that we call life. There is another theory, that all life whenever or wherever found is a spiritual force, ethereal and universal. For our purpose, the discussion of this question has no particular value, were it not for the fact that life, or vital activity, wherever we find it in organized substances, whether in the lowest living thing or in the highest type of physical devel- opment, is accompanied by or is endowed with the natural tendency to repair defects or injuries in that in which it is active. Regeneration, or the curative process of nature, is always the handmaid of vital activity. It is present at the earliest formation and division of a cell, which constitutes the unit of all organisms. Just as one brick is laid on the other with mortar or cement between them, so as to make a whole wall of a building, so are our bodies built up of minute cells, one added to the other, with cement between them, until the entire structure is completed. There is no tissue of the liv- ing body which was not at one time during its existence a cell. This curative force is beautifully illustrated in the lower animals, where parts of organs are replaced to a far greater extent than among warm-blooded animals. Professor L. Landois, in his work on " Human Physiology," says that "when a hydra is divided into two parts, each part forms a new individual—nay, if the body of the animal be divided into several parts in a particular way, each part gives rise to a new individual. The planarians also show a great capacity for producing lost parts. Spiders and crabs can reproduce lost feelers, limbs, and claws; snails, part of the head, feelers, and eyes, provided the central nerv- ous svstem is not injured. Many fishes reproduce fins, even the tail fin. Salamanders and lizards can produce an entire tail, including bones, muscles, and even the posterior part of the spinal cord, while the triton reproduces an amputated limb, the lower jaw, and an eye. This reproduction re- quires that a small stump be left, while total extirpation of 40 HOME TREATMENT FOR WOMEN. the parts prevents reproduction. In amphibians and rep- tiles the regeneration of organs and tissues, as a whole, takes place after the type of embryonic development, which is by cell division, and the same is true as regards the his- tological processes which occur in the regenerated tail and other parts of the body of the earth worm." Comparative pathological anatomy clearly demonstrates the inherent curative power of nature, and this is also apparent in the vegetable kingdom, and together they deliver a lecture on the "art of healing" from the stage of creation, in silent and modest language, but eloquently instructive to the thought- ful observer. The question now naturally arises How far this curative energy of nature operates in warm-blooded animals, and especially in man? The answer must be that, while it falls short of reproducing parts of organs or even tissues in the same degree of perfection as in the lower orders, the innate tendency towards regeneration and recovery from injury and disease is, on certain lines, practically the same. There is not the slightest doubt that ninety per cent, of all cures, whether the invalid took this, that, or the other medicine, or whether the method of treatment was homeopathic, allo- pathic, or mind cure, are entirely due to this inherent cura- tive energy; and the other ten per cent, may have required some active remedy, but this, too, alone, without nature's healing force, would have been ineffectual. What is ordinarily termed mind cure is not mind cure in the sense that the term implies, but it is simply the mind toying or playing with the idea of a cure, for while the mind is thus engaged, nature's energy is accomplishing the result or cure. This is the only rational explanation, and corre- sponds with the cures that nature is continually making in the lower orders of animals. If the recovery of the sick depended entirely upon the caprice and wisdom of the doctor, and not on the reparative forces of nature, the race would soon die out. I fully recognize the fact that the cur- DELUSIONS AS TO THE CURATIVE VALUE OF DRUGS. 41 ative force can be stimulated; this may be done through the influence of nourishing food, alcoholic stimulants, a drug or medicine, or through purely mental influences. No physi- cian can estimate how much merit he can accredit to the methods or substances he employs in any particular case that recovers, and how much to the lady physician, Dame Nature. This old lady doctor is ever active, and the most inert drugs, employed or administered with her assistance, have achieved wonderful cures; this the history of medicine confirms. The tar water cure of Bishop Berkeley is an illustration how an inert substance is capable of making for itself an enviable reputation for curing ailments, like pleu- risy, pneumonia, erysipelas, asthma, indigestion, hypochon- dria, and other diseases. This remedy had the vehement indorsement of.one of the greatest metaphysicians of the English-speaking world, and that the cures reported by him were genuine no one will doubt for a moment; but the bishop, like many of our day, was determined to have a remedy to cure disease, where none was required, but the mind had to be humored, while nature was actively repair- ing the disorder. To-day almost everyone is satisfied, that the virtues ascribed to tar water by Berkeley were a delu- sion, which was shared by all those who believed as he did. The Weapon Ointment affords another instance where the credulity of the public was supported by abundant facts to prove the efficacy of the remedy, yet it was based on the wildest superstition. This ointment was employed for the healing of wounds, but instead of being applied to them, the weapon with which the wound was inflicted was carefully anointed and hung up in a corner, and the wound was washed and bandaged without the salve being allowed to touch it. This ointment created such a furor that eminent medical men indorsed its virtues as a healing agent, An- other example of superstition and charlatanry was the equally famous Sympathetic Powder, which, when applied to the blood-stained garments of wounded persons, cured 42 HOME TREATMENT FOR WOMEN. their injuries even when miles away. That dukes and knights vied with each other to obtain the secret of its preparation and ingredients is a matter of history. In- stances of delusions on medical subjects could be multiplied a thousand fold, but they prove nothing but ignorance and superstition on the one side, and the inherent all-powerful curative force of nature on the other. While I wish to avoid wounding the fastidious and sensitive in the matter of their faith in their cherished system of cure, I cannot refrain from classing homeopathy as a similar delusion. I am glad to admit at the outset that I have read Hahnemann's " Organon of the Art of Healing" with a great deal of interest and some profit. I am convinced that his theory of infinitesimal dilutions is as absurd and ridiculous as either the Weapon Ointment or the Sympathetic Powder treatment already referred to. If we consider the harsh, or, preferably-termed, heroic treatments, then in vogue, we need not be surprised that the pendulum of medication should have swung in the opposite extreme. Blood was drawn from the already enfeebled body, emaciated by disease; emetics were administered to sensitive and inflamed stomachs, and only aggravated into greater disorder; blisters, or the burning moxa, scorched into greater agony the suffering mortal, while large doses of drastic cathartics depleted the waning forces of nature. There was a tendency of the medical profession about that time to entirely ignore the curative forces of nature, and to attack disease as you would a midnight marauder, with the most powerful and dangerous weapons at command; and there is no doubt that with these powerful expedients, disease was destroyed, but life also. Under these conditions Hahne- mann appeared on the scene, and I am frank to admit that he rendered suffering humanity invaluable service by es- pousing a system of cure which had the merit of being harmless. If we take into account that physiological studies were then in their infancy, and that the word "Biologie," DEUSIONS AS TO THE CURATIVE VALUE OF DRUGS. 43 from the Greek words which signify'a discourse upon life and living things, was made use of for the first time by Lamarck, in a work published in 1801, it will not seem altogether strange that even learned men were mystified into beliefs which, in the light of our present knowledge of the subject, appear preposterous. This was a most oppor- tune time to fasten on the healing art any doctrine or dogma, however absurd, and on this tide of ignorance and superstition, the doctrine of infinitesimal dilutions floated into popularity. Homeopathy affords us one of the most striking illustrations of the uselessness of drugs in ordinary ailments, and conclusively proves that nature possesses in- herent curative powers. Cases treated under this system make splendid recoveries, and often much better than when the powers of nature are opposed or weakened with nauseat- ing drugs and poisonous doses, prescribed by incompetent persons. Hahnemann truthfully observed that existing diseases are liable to become aggravated, complicated or replaced by drug diseases. There is no doubt of the truth of this statement where drugs are heedlessly administered. When I was a student I was told that calomel was par excellence a babies' medi- cine without any qualification. I was credulous enough to believe it and prescribed it for my own children for its purgative eti'ect whenever it was deemed necessary. • In later childhood, when the second dentition set in, the germs of the permanent teeth were so injured, evidently from the calomel that had been absorbed into the system, that the teeth were ragged and defective. The glands of the neck were also inclined to swell and suppurate, and there is no doubt in my mind that a great deal of what is generally supposed to be scrofula in young children, is nothing more nor less than a "drug disease." I believe that Hahnemann was cognizant of the potency of nature under ordinary cir- cumstances to cure disease. I believe that he absorbed this 44 HOME TREATMENT FOR WOMEN. view of the philosophy of healing from the writings of Para- celsus, which he had studied, and from which he drew his inspiration, but he also appreciated the practical necessity that success depended on satisfying the superstitious belief of the times, and that consisted in offering some tangible remedy. Hahnemann proved himself equal to the emergency by formulating his doctrine of potentizing drugs or medic- inal substances by reducing them to a wonderful degree of minuteness. The preparation of these dilutions was directed to *be carried out in a ceremonial sort of way. Chalk from an oyster shell, sulphur, charcoal, or any other substance, was potentized by taking one grain of the drug and mixing it with one hundred grains of sugar of milk. Of this mix- ture one grain was taken and mixed in the same manner with another hundred grains sugar of milk. This gave the* ten-thousandth of a grain of the drug. Take one grain of this with another hundred grains of sugar of milk and the powder will contain the millionth of a grain of the sub- stance, or the first potency, which forms the bases of other dilutions. This is reducing the doses of any drug to an ab- surdity, and Hahnemann was too brilliant a mind not to know this. It might be mentioned in connection with these dilutions, that if one grain of the most powerful drug, strych- nine, aconitin, arsenic, or any other chemical that is known, is mixed with six hundred grains of sugar of milk, one grain of this powder, or the one six-hundredth of a grain of this substance, cannot be detected by any test or chemical re- agent; or, in other words, the quantity of the drug or chemical contained is so small that the most delicate chemical test fails to show it; yet, in homeopathy, the dilutions are carried to the decillionth of a grain, from which important medical effects are expected. Drugs are physical agents, and if they are diluted so as to destroy their chemical or physical properties, it is sheer nonsense to expect any physical result from them on the DELUSIONS AS TO THE CURATIVE VALUE OF DRUOS. 45 system. Chemical and physical facts conclusively prove the utter inertness of certain drugs either in themselves or in the manner in which they are employed, and the indisputa- ble evidence of biological science demonstrates the natural curative tendency of nature observable in the lowest living thing to the highest, so that we should stultify our reason were we to arrive at any other conclusion than that the doctrine of this therapeutic creed is one of the most irrational delusions that ever befogged the mental horizon of a think- ing being. The supposed cures effected through the employment of the Weapon Ointment, the Sympathetic Powders, the end- less dilutions of the Hahnemann system, and, indeed, most other remedial agents from any school or source, whether offensive powders, mixtures, or patent medicines, or the more agreeable and tasteless pellets, have but one role to play, that is, to assuage the apprehensions of the mind while nature is performing the cure; that is, to engage the mind with the thought or idea that something tangible is being done to bring about a certain result. If the patient has pinned his faith to the curative value of mind alone, the mind is for the time being engaged with idea that mind is performing the cure. This is a de- lusion quite similar to the previous one, in which medicines are taken, with only this difference, that while you pin your faith on drugs in the one case, you pin it to mind cure in the other. -t CHAPTER III WHAT IS MIND CURE? This subject has given rise to an endless variety of con- tradictory discussions, and while it has won for itself fanatical devotees on one side, it has been ridiculed on the other. This is not at all surprising, when an inquiry is made into the competency of the parties to the controversy. To be in- formed in metaphysical philosophy, or fully equipped in scriptural lore, but without a practical study in the art and theory of medical science, precludes the possibility of pre- senting the theme in a logical manner, or establishing a rele- vancy between medical science and mind cure. A medical education that is based on strictly physical characteristics of disease, as they are studied at the bedside, or in a microscop- ical laboratory, is equally inadequate; for the question of mind cure goes beyond the physical into the metaphysical, and not until the operations of the mind have been closely followed to the bodily or organic functions, can the intimacy of their relations be thoroughly appreciated. Medical men betray their incapacity for observation if they contemptu- ously dismiss the subject of mind cure by some superficial, disparaging illustration, for there is much more in the sub- ject than is dreamt of, even in the mind of the average college professor. "The mind," says Dr. W. F. Evans, "can be made the plastic or formative principle of the body, and that thought can retard, pervert, or stimulate and correct the 'different functions of the human organism." The relation of spirit and matter is very intimate, and some very clever thinkers resolve all matter into spirit, in its ultimate analvsis. (46) WHAT IS MIND CURE? 47 Bishop Berkeley affirms this in his " Principles of Hu- man Knowledge." In section seven he says "there is not any other substance than spirit." If we view nature from a materialistic standpoint, we see only one-half of what we think we do, and even that must be very imperfectly judged by our senses. Friedrich Wilhelm Joseph Schelling states the relation of matter and spirit, in very simple and plain words, so that a child can understand what he says: "Nature is spirit visible, and spirit, is invisible nature." This may be illustrated in phys- ical science from what chemistry teaches of the physical properties of the diamond, whose atoms or molecules are so perfectly continuous and closely aggregated that it forms one of the hardest substances known to physicists. These atoms of pure carbon may be made to repel each other, so that the diamond assumes a gaseous state, which is imperceptible to our senses. I am aware that the definition of a gas is not that which metaphysicians would accept as applicable to spirit, and yet it illustrates the idea from a physical standpoint. It is much better to illustrate a question with something with which people are generally familiar. The body and every organ and tissue forming a constituent part of it, is simply the plain ordinary matter in motion, vitalized by what we call life, and this life principle is a mystery, and what is true of the diamond is true of the human body in its entirety. If placed in a crematory, it is reduced to a few ounces of bone ash, and, with the addition of a little acid, this too would soon disappear into invisible gases, so that the doc- trine of philosophers, that matter is spirit, is, after all, not so for removed from physical evidence. Physiological science gives abundant proof that the mind has a powerful influence over the body. By mind is meant all that class of mental phenomena called reason, and the emotions and passions. Doctor Evans says " the body is in- cluded in the being of the mind," or, in other words, that matter is included in the being of spirit, 4S HOME TREATMENT FOR WOMEN. The thinking quality of the mind is undoubtedly the mainspring of its action, of which the formation of ideas is the highest kind of mental activity. These originate either within the mind or are brought within its sphere In- transformed impressions from without, but through the power of the Will these are more or less modified, and may, indeed, be entirely suspended, so that the mind may become entirely passive and not think of anything. It is the exer- cise of this Will power which may make the operations of thought conducive to health or disease. Cogito ergo sum, "I think, therefore I am," is a maxim of Descartes. What we think and give shape to in thought has for us a real existence, and we have it in our power to create thoughts that will have either a painful or pleasur- able sensation. Painful sensations have occurred to persons by the conviction of the existence of a cause which would, when present, have produced certain results. Of this sev- eral examples are given in W. B. Carpenter's physiology: "A clergyman told me that some time ago suspicions were entertained in his parish of a woman who was supposed to have poisoned her newly-born infant. The coffin was ex- humed, and the coroner, who attended with the medical men to examine the body, declared that he already perceived the oder of decomposition, which made him feel faint, and in consequence he withdrew. But on opening the coffin it was found to be empty, and it was afterwards ascertained that no child had been born, and consequently no murder committed." The second case is yet more remarkable: 'A butcher was brought into the drug store of Mr. Macfarlan, from the market-place opposite, laboring under a terrible accident. The man, on trying to hook up a heavy piece of meat above his head, slipped, and the sharp hook penetrated his arm, so that he himself was suspended. On being ex- amined he was pale, almost pulseless, and expressed himself as suffering acute agony. The arm could not be moved without causing excessive pain, and in cutting off the sleeve WHAT IS MIND CERE? 49 he frequently cried out. Yet when the arm was exposed, it was found to be quite uninjured, the hook having only trav- ersed the sleeve of his coat." In this, and similar cases, the sensation was perfectly real to the individual who experienced it, but it originated in the mind by an impression through the nerves of internal sensation which created the idea or image in the brain, and the external senses to which it was referred had nothing to do in causing the feeling. Diseases are thus created every day, either by ourselves or by those to whom we go for advice. I call to mind a lady who had gone to a distinguished practitioner for a supposed womb disease for some six months. She experienced no change for the better, but kept on growing continually worse, so that she no longer had a refreshing sleep, and her appetite for food was entirely gone. On examination I found her womb entirely healthy, in fact, exceptionally so, thanks to her attending physician, because, after a certain amount of useless doctoring, the rule is quite the other way. I told tli is lady of her error or delusion respecting her womb, and prescribed a quieting mixture for the night and a tonic for the day. She began at once to improve, and when I saw her again, six weeks afterwards, she had so fleshed up that I failed to recognize in her traces of her former delu- sion. The disease of which this woman was suffering was im- aginary, and had no real existence for anyone outside of her- self. She was the victim of the harrowing symptoms which her mind conjured into shape, and an attempt to brush aside the disease, with the flippant remark that "there was noth- ing the matter with her," would have been cruel, unscientific, and absurd. The ailment which she thought she had, had as much an existence as though the most malignant disease was destroying her life ; for her imaginary disease was doing the same thing, only in a different way. Imagination is the most powerful function of the human brain. Associated with thought, it constitutes the empire of the soul, which recognizes neither time nor space. With 4 50 HOME TREATMENT FOR WOMEN. it we are brought into communion with everything that is grand and beautiful in nature. Imagination is the archi- tect of our souls; it continually creates and projects into the beyond; it enlarges the sphere of our thought in building up artificial structures for our pleasure and entertainment. When it becomes perverted and abnormal from false im- pressions, either through the nerves of internal sensation or through the nerves of external sense, or, what quite often occurs, from morbid thoughts or ideas received from others, it becomes equally potent in causing misery and disease. Expectation or attention influences, in a remarkable de- gree, the bodily functions. There are a great many persons who keep themselves in misery and disease by always think- ing of their imaginary or real sickness. I had a profitable experience some years ago in my own case, which conclu- sively proved to my mind the aggravating tendency which constant attention has on disease. I had contracted an ordi- nary catarrh of the pharynx, or what is generally called a sore throat. At first I did not mind it, but in the course of time, from continued exposure in all kinds of inclement weather, at all hours of the day or night, it fastened itself upon me so that it was at times very annoying b}r its dry- ness and pain. I do not know of anything that I did not use, but, after a trial of several years, I was convinced that the more Plooked at it and the more I treated it with sprays, gargles, etc., the worse it became, so that one day I resolved to let it alone, and not think about it. I took a teasponful of glycerine once in a while when it became too dry. For years I have not looked at it, and for all I know, it is per- fectly well. I stopped bundling up my neck, used light bedcovering, so as not to sweat, and by this simple method accomplished what the very best selected drugs utterly failed to do. The great English authority, Daniel Hack Tuke, in his work, " The Influence of the Mind on the Body in Health and Disease," quotes from Unzer's work, published in Germany in WHAT IS MINI) CURE? 51 the year 1771: "Expectation of the action of a remedy often causes us to experience its operation beforehand." And John Hunter said as early as 17S0: "I am confident that I can fix my attention to any part until I have a sen- sation in that part." A great number of cases are recorded where complete insensibility to bodily pain has been induced without the use of drugs. The intention of administering a certain drug was made known in this manner. Bread pills have acted as decided cathartics, and an empty chloroform or ether bottle put the sensitive into a profound stupor or insensibility. Dr. Woodhouse Braine, of the Charing Cross Hospital, writes: "During the year 18G2 I was called upon to give chloroform to a very nervous and highly hysterical girl, who was about to have two fatty tumors of the scalp re- moved. On going into the operating room, it was found that the bottle containing the chloroform had been removed to the dispensary, and on testing the Snow's inhaler, which' at that time I was in the habit of using, I found it to be quite devoid of even any smell of chloroform. Then, hav- ing sent for the bottle, in order to accustom the girl to the face-piece, I applied it to her face, and she at once began to breathe rapidly through it. AVnen she had done this for about half a minute, she said, 'Oh, I feel it, I feel I am go- ing off,' and as the chloroform bottle had not arrived, she was told to go on breathing quietly. At this time her hand, which had been resting across her chest, slipped down by her side, and as she did not replace it, I thought I would pinch her arm gently to see the amount of discomfort her hysteri- cal state would induce her to bear. She did not notice a gentle pinch, and so I pinched her harder, and then as hard as I could, and to my surprise I found that she did not feel at all. Finding this was the case, I asked the operator to be- gin, and he incised one of the tumors, and then, as the cyst was only slightly adherent, peeled it away. At this time I had removed the face-piece, and, wishing to see the effect of 52 HOME TREATMENT EOR WOMEN. her imagination, I said to the operator, who was going to remove the second tumor, ' Wait a minute ; she seems to be coining round.' Instantly her respiration, which had been quite quiet, altered in character, becoming rapid as when I first applied the inhaler, and she commenced moving her arms about. I then replaced the face-piece, and her breath- ing again became quiet, and she submitted to the second operation without moving a muscle. When the water dress- ing and bandages were applied, in answer to the question as to whether she had felt anything, she said, ' No; I was quite unconscious of all that was done.'" The mental phenomenon that we observe in this case clearly shows how completely the sensation of the patient was suspended by the imaginary chloroform, which existed only in her mind, yet the real drug could not have been more potent in its effects. Phenomena of the same mental process, like the different colors of the solar spectrum coming from one source, consti- tute the different stages or degrees of what is generally called mesmerism or somnambulism, until the sensitive ar- rives at that condition of complete double consciousness now commonly called hypnotism, in which state the will power of the person becomes entirely suspended, so that he acts only from suggestions of another person, regardless of propriety or consequences. When a subject who has been completely hypnotized is restored to his normal condition, he remembers nothing of what has transpired during the somnambulistic state. WTe all have acquaintances of whom we speak as being easily led; by that we mean that they have no will or mind of their own. These persons are truly unfortunate, because they are at the complete mercy of every designing person or cunning rogue. They consti- tute the large army of dupes who support the great number of idle women and lazy men, who claim to be clairvoyants, life readers and fortune tellers. In sickness they are equally as credulous, and when they are a little out of sorts, they would a great deal rather be told that some dangerous or se- WHAT IS MIND CURE? 53 vere illness has hold of them than to hear the truth that, outside of not eating properly, or clothing themselves im- properly, or being out late at nights when they should be in their beds, there is nothing the matter with them. These are the dupes who fill up the chairs in the doctor's waiting rooms, on regular days, for local or special treatment for diseases which could be much better treated by themselves at home, if they only were fortunate enough to fall into a physician's hands who had the honesty to tell them so. This can be further illustrated by an experience of which every one of us has been a victim at least once in'our lives. When we were trying on a pair of new shoes, we felt that they pinched, or were too short and generally uncomfortable; but the salesman insisted that they were a " perfect fit" and that after a little wearing they would surely suit. The shoes were bought, and we were convinced, after a few days, that our impression of the smallness of the shoes was cor- rect, because they continued to pinch us; but we were for the time mesmerized or psychologized by the clerk into buy- ing what we were satisfied in our own minds to be not what we wanted. This should be constantly guarded against, and our conscious will power should always be exercised on all occasions. Parents should take particular pains to cultivate the will power of their children, in the right direction, of course. To stifle the will of children, when the exercise of it entails no bad consequences, is wrong, because it weakens their character, and makes them the prey of the wicked and selfish when they are grown to adult age. This influence which one person may exercise over another is not due to any particular force or magnetism, as was supposed by Mos- mer, and which is yet claimed by ignorant frauds and pre- tenders, but it is simply a suspension of your own will, or a sacrifice of force of character. Dr. J. M. Charcot, of France, has lately taken up this subject, and has given it a great deal of attention. His researches have confirmed the experiments 54 HOME TREATMENT FOR WOMEN. and conclusions of Braid, an English surgeon of Manches- ter, who, in 1841, showed that, in order to produce artificial somnambulism, there was no need of any extraneous influ- ence, and that any person of moderate sensibility can easily produce in himself the " magnetic sleep" without any aid or act of another. Braid discovered that to simply fix the eyes for a few minutes on some shining object, placed a little higher than the ordinary plane of vision, and five or six inches from the eyes, caused that total abstraction which Doctor Braid called " hypnotism," and which now, in honor of the experimenter, is often called "Braidism." This Doctor Charcot calls "im- personal " sleep, artificially produced by mechanical means. He remarks: "The psychic characteristic of the state of somnambulism is an absolute trust, a boundless credulity on the part of the subject toward the one who has hypnot- ized him. Take one example from among a thousand: I present to a woman patient in the hypnotic state a blank leaf of paper, and say to her: ' Here is my portrait; what do you think of it? Is it a good likeness?^, After a moment's hesitation she answers, 'Yes, indeed; your photograph! Will you give it to me?' The image being now fixed in her mind, I take the leaf of paper, with a private mark, and mix it with a score of other leaves precisely like it. I then hand the whole pack to the patient, bidding her to go over them. and let me know whether she finds among them anything she has seen before. She begins to look at the leaves one after another, and as soon as her eyes fall upon the one first shown, she exclaims, ' Look! your portrait!'" This is the latest phenomenon, and proves how the mind may print an image on a substance, as the sun prints on a negative. For persons of casual thought or reading, hypnotism may at first appear complicated and mysterious, but if you will only bear in mind that the different mental processes operating between two persons always resolve themselves into a weaker will power yielding and a stronger will power WHAT IS MIND CURE? 55 controlling, you have a key which unlocks the different man- ifestations of minds in their relations one with the other. This does not relate to action alone, but to the creation and meaning of our thoughts. The cures effected by the royal touch, which prevailed in England from the time of Edward, the confessor, to Queen Anne, were but a disguised hypnotism, or a sort of mind cure. Soothsayers, or magnetic healers, who claim a healing mag- netism, are either knaves or fools, and often both. They undoubtedly can report cures, but these are due to the nat- ural tendency of some diseases to get well, and to the hopeful thoughts which these persons inspire by their prom- ises of a cure; sometimes these hopes are heightened by the different movements or passes which the healer makes. The greatest healer of whom we have any reliable record never claimed any abnormal power or force. Christ healed by the Word, that means by the thought or mind. Faith in anything creates a curative or healing thought in the mind of the patient, which stimulates the reparative or heal- ing force of nature, and in this manner wonderful cures are effected. The faith, or confidence, which you have in a physician stimulates you at once into a better or stronger feeling. This has been the experience of every sick person, but this is not due to any power or force that this person possesses, which departs from him and goes over to you, but is entirely due to the confidence, which stimulates your own nerve centers, and especially the brain. The soothing and quieting influence which the "Weapon Ointment" had on the injured person was not due to any virtue of this ointment, because it was never applied to the wound, but to the weapon or implement which caused the wound. Its operations were entirelv mental or psychical. It pacified the excited and anxious mind into the faith or belief that the best possible thing to do was being done, and nature went on trium- phantly and effected the cure, for which, of course, she never 56 HOME TREATMENT FOR WOMEN. got any credit. When a doctor or healer enters the cham- ber of the sick, putting on a wise air, or indulges in affecta- tion, and when he succeeds in making a good impression, that alone assuages the pain. But if, on the other hand, he im- presses his patients unfavorably, the sooner he gets out of their sight, the better they feel, because his presence has inspired neither confidence nor hope. Hysteria constitutes a peculiar group of diseases which belong to that class of nervous ailments that are included among functional affections; they are oftener amenable to faith or mind cures than to drugs. A great number of dis- eases of women belong to this class and these poor de- luded creatures never had anything real or serious the matter with them, until they went to some doctor who began to apply irritating drugs to their delicate organs, which made them ever afterwards habitues of doctors' offices. Functional diseases have a wide range. As their name implies, they are characterized by a disturbance of the func- tion of an organ or system, without any visible alteration of its tissue or texture; there are no pathological or histological changes, which the most careful microscopic examination can detect. They constitute a scapegoat for our ignorance; it appears to be in the majority of instances a disturbance between the psychic or spiritual forces as they operate on the tissues. The normal and harmonious relations between the mind and the body or any particular organ are disarranged. Such are the hysterical convulsions or spasms which we see in women who have suffered great mental strain, es- pecially grief, and often it is due to pure "cussedness," or un- bridled passion. In men there is also a hysteria; it was for- merly believed that this peculiar nervous derangement was confined to women only, hence the name, but this was an error. I was once called to attend a physician of more than average ability, who located in this city for the purpose of enlarging his field of labor and usefulness; from where he came he had been very successful. His reputation as a sur- WHAT IS MINI) CURE? goon was enviable and deservedly so, but here, in this city, among strangers and strange customs, he was a failure. This preyed on his mind so that he became despondent aiid gloomy. He failed in flesh and strength. I found him in his room convulsively sobbing, which shortly turned into a paroxysm of laughter. I prevailed upon him to return to his former residence among his friends and admirers, which he did, and he told me afterwards that from the moment he struck his "old stamping-ground" he felt stronger and bet- ter, and shortly recovered his former mirth and healthful- ness. Girls show this abnormal nervous function in different ways. I have known a case where a sensitive girl accidentally saw another girl in an epileptic fit; the contortions became so real and fixed in her mind, or imagination, that they were transmuted into motions or epileptic fits. I tried remedies but without any beneficial results. The parents afterwards went the rounds of the "fits doctors," but with the same negative results. A Christian scientist or faith healer cured her, by cultivating or strengthening her will power. There is a class of these faith healers, composed of silly, loquacious women and men, who know nothing at all of the principle governing their cures, and they glibly tell their patients, "You must say or think there is no disease, or I have no pain, or there is no body; all is well; all is good," and a great deal of similar nonsense. xVll is not good, and all is not well by any means. I would say, Indeed there is pain, disease, and a body, but by striving to live a healthful moral life, and thinking healthful thoughts, of the good, the pure, and the beautiful, the curative energy of nature will become stimulated to repair the defects, to harmonize the functions and dissipate disease. A person who is troubled with dyspepsia canimt get well if he thinks of nothing but an acid or sour stomach, or feels the food disagreeing with him before he has it in his mouth. He must have thoughts quite remote from these. 58 HOME TREATMENT FOR WOMEN. and the chances are nine out of ten he will not feel what he eats. There is the same state of mind about " catching cold." Some persons are forever on the alert to catch a cold, and why should they not, when they are always watching out for it? If you dress so that }^ou do not sweat, and do not use too thick bedcovering, and are not constantly on the catch or lookout, I assure you you will, not catch cold, nor will it catch you. Terror or fright causes or cures diseases. Dr. Toad re- ports the case of a boy, in Tuke's work, nine years of age, who was frightened into chorea, or St, Vitus' dance, by his sister, who had covered herself with a white sheet and ap- peared before him unexpectedly, while he was in bed. I know, also, a case of functional bladder weakness of a child who wet his bed at night during sleep. There appeared no signs of any local disease, nor was any remedy which I em- ployed of the slightest advantage. The father of the child, becoming exasperated, gave the child a severe thrashing one morning. The mother remonstrated at what she considered cruel and useless chastisement. But, strange yet true, that child never wet the bed after that; it was entirely cured by fright. Sympathy will often make persons sick; of this I had in my own experience an opportunity for a very interesting observation. It was the husband of a woman who had been retching and vomiting incident to the early months of her pregnancy. So great was the sympathy of her husband that he retched and vomited exactly like his wife, not only when in her presence, but when separated from her, the impres- sions or thought exciting the excito-motor nerves of the stom- ach. This sympathetic sickness lasted as long as that of his wife. Dr. I-I. C. Sawyer, author of " Nerve Waste," has kindly shown the writer another form of functional or hysterical disorder, which was, or is even yet, considered by many gen- eral practitioners a scrofulous enlargement of the joints; but WHAT IS MIND CURE? 59 the doctor discovered the peculiarity of metastasis, which means a sudden or complete removal of a disease from one part to another. This gave the disease what he termed a hysterical or functional character. It would be the swelling of the elbow of one arm and the knee of the opposite side at one time; and in the course of a few weeks or months these would feel and appear entirely well, while the disease had located itself in other joints. This case the doctor consid- ered could be only reached through the mind, or some faith cure. He further believed that many of these enlarged and swollen joints among the wealthier classes were due to a nervous trouble. Indeed, it would be an easy matter to cite case after case, from my own experience, or quote cases from the highest medical authorities, illustrating in every con- ceivable manner how the mind, the imagination, the emo- tions, or the different passions, are continually causing dis- ease and suffering. It must naturally follow that what is potent to induce diseases will, under different conditions, be a means of curing them. A serious question now arises with reference to the selec- tion of cases suitable to mind-cure treatment. Bigoted fanaticism is quite incompetent, so are the great majority of spiritual healers, owing to their absolute ignorance of the scientific aspects of disease. The first prerequisite for intel- ligent and proper treatment is to establish the precise nature of the disease under consideration. It must be distinctly grouped or classed, whether it be a functional or hysterical disease, or a zymotic or contagious affection. In diphtheria or typhoid fever mind cure subserves no purpose; the treatment must be avowedly antiseptic and stimulating. If it be a physical injury, say a fractured bone, it must be treated on mechanical principles. A woman suffering in the pangs of labor, which is being delayed from some abnormal position or some other physi- 60 HOME TREATMENT FOR WOMEN. cal obstruction, can only be delivered through mechanical methods; and here the enthusiastic mind healer may com- mit serious errors, sacrificing limb and life by unnecessary delay. So I would lay down this broad maxim, that the mind healer must either be a competent, educated physician, or a physician should be a competent metaphysician. Note.—In the year 1887 Mrs. A. C. Hurrell was a healthy, middle- aged woman and th* mother of two children. "When the youngest was ten months old she contracted a severe cold. The coughing spells " took her breath," and from these exaggerated expiratory paroxysms she drifted into spasmodic asthma, at least that was the diagnosis of promi- nent medical men of Sacramento and of this city. Change of climate was advised and tried, so were also the different drugs which experience had taught to be useful, even operations were performed on her nasal passages by enterprising specialists, but all to no purpose. Morphine was prescribed by the first medical attendant, and when her suffering became unbearable she had to fall back on this drug for relief. In May, 1890, I was consulted, but a most careful examination revealed nothing which I could assign as a cause and upon which to base a hopeful treat- ment. In October, 1891, she was persuaded to take treatment from a lady who claimed to cure through Christian Science (a mind healer). The treatment commenced on a Thursday afternoon. The lady impressed on her that the morphine, of which she now consumed, hypodermically, the enormous quantity of ninety grains a week, was injurious, and that if she made up her mind that there was no disease the asthma would leave her. Friday night the patient was in great agony, both from the withdrawal of the drug and the asthmatic attack, and this double pres- sure weakened the faith of both patient and healer, but the husband stood firm and insisted that she have no morphine. The struggle for breath and the narcotic continued until four o'clock Sunday morning when she began to get easier; the improvement continued, and in ten days she had " outgrown " both. I saw her two months later, entirely recovered, and the most brilliant specimen of the efficiency of mind cure that one could wish to see. * CHAPTER IV- GENERAL CAUSES OF UTERINE AND PELVIC DIS- EASES OF WOMEN. Why are womb diseases so prevalent? is a question which we are not infrequently called upon to answer. At first sight this would strike one as a casual or commonplace remark, but a moment's reflection makes it one of vital inter- est, for a truthful and intelligent reply lays bare the causes which undermine the health, strength and character of the mothers of our citizens, and when a disease of this sort be- comes common, it thi'eatens the morality, health and life of our nation. The causes winch operate in producing these diseases of the female differ widely in their origin ; some are due to ordi- nary imprudence, while others are deeply rooted in moral depravity and marital abuses and for this reason I consider it convenient to arrange them into three distinct classes or groups. ( The first class is characterized by comprising those causes which are for the most part accidental. They are peculiar to confinement and motherhood, and may be in a great degree controlled or averted by the skillful and compe- tent accoucheur. They have principally a scientific interest, and do not fall within the scope of the non-professional reader. The second class is entirely beyond anyone's control. The causes belonging to this category are innate to the hu- man organism; they induce those numerous afflictions which here and there sprout up in.previously healthy per- sons, and are, in all probability, due to some specific hered- (61) 02 HOME TREATMENT FOR WOMEX. itary taint. They are to be attributed to the natural imper- * fections of humanity, and are a constant reminder that the body is simply the transient abode of the soul, or spiritual man, and as such only perfect in its imperfections. Like the causes of the first class, these, too, have principally a scientific interest. The third class of causes of uterine diseases constitutes a very large group, and has a popular or general interest. For this reason it should be freely discussed, because the causes of this class are avoidable. They are entirely within the control of the average sen- sible person, and for that reason should be known and under- stood by everyone. These causes superinduce inflammatory diseases, which are not confined to the womb alone but take in the entire pelvic appendages, the Fallopian tubes and ova- ries. They are the greatest source of revenue to the doctors, and vary in symptoms in different persons, from a slight casual reminder of something wrong to harassing pains and physical suffering; and that these all are brought about through ignorance, wanton carelessness, or sinful disrespect of nature's or God's law, is the characteristic feature of the causes under investigation. Exercise in the open air is so essential in strengthening the nervous and muscular systems that where this is neg- lected it predisposes to womb disease. I consider the differ- ently-devised indoor or room calisthenics or exercises as totally inadequate and no substitute whatever for healthful outdoor movement, and for the following reason: that while it irritates the muscular and nerve fibers, it lacks the stimu- lating and tonic influence of pure oxygen-laden air, so that the blood becomes still more deteriorated and overloaded by excessive waste material, which is not thrown off. If a per- son exercise at all with a view of deriving physical benefits, let it always be in the open air. Like walking, riding, rowing, to which bicycling should be added as one of the very best of outdoor exercises, the mmd can then be engaged at the same GENERAL CAUSES. 03 tine, though it must not be overstrained. The great obstacle nowadays arises from a fashionable and morbid desire to culti- vate an appearance of delicacy; if, instead, recreations which required muscular exertions were more fashionable, the re- sults in developing strong and hardy women would be aston- ishing. No exercise can be profitable which is not interesting to the person who practices it. It is not the bodily exertion alone which can profit a per- son, but the happy associations, the abandonment of self thought, the mental relaxation, and the pleasure which ac- companies it. With one or two companions Ave canjhave a jolly time, while taking a swimming bath or floundering in the surf, but alone it soon becomes tiresome. If we take a stroll with an agreeable companion, we can walk a distance which, when undertaken alone, would fatigue and tire us completely out, while, when with an associate or friend, we cover the same distance refreshed and invigorated, be- cause the mind is entertained while the body is exer- cised. This must have been the experience of everyone, and if it teaches anything worth remembering, it teaches that monotonous exercises should be avoided and entertaining ones sought and practiced. Walks over hills in small, friendly groups is one of the best modes of exercise I know of. And then there remain the many outdoor games. The perni- cious systems of training which are observed in some female seminaries often plant the seeds for future disease. All the school hours are employed in reading, drawing, music, and other brain work, while the evenings are devoted to prepar- ing lessons for the following day. This is very injurious, and should never be permitted. After school hours the mind should have complete respite from study, so that the forces can recuperate themselves for ihe next day. Nervousness or neurasthenia is often a result of this ex- cessive mental application. Where the mind is constantly 04 HOME TREATMENT FOR WOMEN. engaged in intellectual pursuits, the result often is a too rapid dvelopment of the brain and nervous system. When the thoughts and memory of girls of tender age are too long and too laboriously engaged, there will be an abnormal development of the nervous centers; they will grow or develop beyond the muscular or physical strength, and a morbid impressibility, great feebleness of the muscular system, and a marked tendency to disease of the pelvic or- gans, is established. Parents may refer with pride to the precocious talents, the refined and cultivated tastes, of their daughters, as qualities to be admired and appreciated, but without a physical substratum it is a dreamy delusion. It would be much better for the children if their parents took more pride in rotund figures and robust constitutions, for these would ever be a source of joy, while the cultivated talents, especially at the expense of their health, will not only be of little practical value to them in after years, but often inca- pacitate them for wives .and mothers, by making them rest- less, discontented, and physically unfit for maternal func- tions. There is entirely too much scholastic education imparted to our girls, and not enough domestic education. I be- lieve that the most favored should not have too much of one and not enough of the other, because if parents do not prepare girls for household duties in early life, they run des- perate chances of laying the foundation for a failure in the remote future. Children must be constantly reminded that they are in this world to serve a useful purpose, and that co-equal with every accomplishment is a utilitarian training. We take a pride if our boys trade pocketknives, espe- cially when our own gets the better one of the two, because we appreciate the natural business trait. He will be no less a good candidate for some of the learned professions, and, in- deed, it has come to this, that material success in the profes- sions depends as much on shrewd business tact as it does upon proficiency in professional attainments. GENERAL CAUSES. 05 The knowledge or even wisdomof a person is of no earthly use to himself or the world if he or she do not possess the faculty of'letting the people know of this superior wisdom; and that is why some persons often become more celebrated and even renowned than others, who are intellectually their superiors, because the former possess the faculty and cunning to make people believe in their superiority. By this I sim- ply desire to impress upon parents not to be overanxious about their daughters standing/rs^ in their class room, but, rather, to be very anxious that they attain a healthy and vigorous growth, and that sufficient practical knowledge of domestic affairs be imparted to them so that they can cred- itably fill their mother's places some day. This I consider the best legacy. The time to commence to train mothers is from the mo- ment they are born. The minds of parents should be dis- abused of the false delicacy about this aspect of a girl, and while no one expects daily lectures to be given to children or young girls upon the responsibilities which await them, such information should not be studiously avoided. I insist that this important fact should not be lost sight of, mother- hood is the ultimatum of feminine existence. Mistaken conceptions of woman's education, in pinning girls to a life of close mental application, is often produc- tive of uterine disease, by lowering the tone of the nervous system; while others who are ambitious to acquire a profes- sional education in later life, fall by the wayside as hope- less invalids. I do not disparage her capacity to study with equal proficiency the arts and sciences, often with more ardor and closer application, than her male colleagues, but she is sim- ply striving to accomplish that which the men can and do willingly accomplish for her, while at the same time she is neglecting the education of those qualities which are the sole inheritance of her sex, and which man could not usurp if he would. o 66 HOME TREATMENT FOR WOMEN. This class of uterine diseases develops in a few years into melancholy, which closes the windows of the soul to the sun- light of hope, and gradually drags the sufferer into a decline, that nothing but an entire change in the habits and thoughts of the patient will ameliorate or cure. I would have our girls as independent of our boys as the latter are of our girls. I would have it understood that each, in their specialty for which God and nature has ordained them, is as honorable and important in the social and industrial conditions of mankind as the other. I would give woman the right, and deem it her privilege, to frankly and unrestrainedly profess her fondness or desire to marry the man who she believes would make her a desirable hus- band, because woman's intuition transcends man's reason. A reform in this direction would, indeed, elevate the woman to man's estate, where she belongs. A little less senti- ment and more sense is a wholesome panacea for some of the abuses of the marital contract. I fully subscribe to the view that a woman shall at all times receive the same wages for her mental and physi- cal labor that men receive for the same work, but I am entirely opposed to that modern tendency and false social philosophy which is constantly striving to make a man out of a woman. There is something so grossly absurd and un- natural in this artificial readjustment of the natural duties of the sexes, in their industrial and social relations, that it has degenerated in many instances into fanaticism. Women are organizing everywhere for the purpose of in- creasing the facilities of their sisters in the studies of science and philosophy. Large sums are offered to the faculties of universities to gain admission to female students on an equal footing with the male students, for the purpose of studying some of the already overcrowded professions. In the main, all this abnormal rivalry does not contribute a single advantage to either sex. There was a time in the history of civilized nations, GENERAL CAUSES 07 and that time is not more than twenty or twenty-five years ago, when an academical education gave an immense ad- vantage to its possessor over his less-informed contemporary, but this is not true in our time, because there is now an over- production of college-bred men. The man who can decline a Greek noun or conjugate a Latin verb is no longer a rarity, because the sons of European tradesmen and American farm- ers have deserted the pursuits of their progenitors—which, in the case of the American farmers, is to be deplored—and ob- tained a collegiate education, that is no longer the inheritance of the privileged few, so that in our time and day an academi- cal education has run to seed among the men. And now the attempt is being made, under the guise of social progress, to burden our girls with the same wisdom that has incapacitated many of our boys from making an honest and independent living. It would be much better for the'State if two-thirds of our universities or high schools were changed into manual training schools or polytechnical colleges, where the founda- s, tions for the industrial rmrsuits may be laid, so that labor will be made not only respectable but intelligent. We would then hear of educated mechanics or artisans, and scientific farmers, which, to my mind, requires the same order of intelligence to excel, that it does in the professions generally qualified as "learned." Why crowd our girls, then, into the professions for which they are not only unsuited by nature, but which are already demoralized by the keen competition within their ranks? It is, certainly, an open secret, in the profession to which I have now devoted the best years of my life, that the methods in vogue to get business have descended to the level of the "confidence trickster," and that, no matter what ability or merit a person may possess, without the natural instincts and elements of the quack and charlatan he can gain neither a livelihood nor fame. This theatrical demeanor of the pro- fession, this aping the gaudy display of European aristocrats by riding in closed coaches, driven by liveried coachmen, is 68 HOME TREATMENT FOR WOMEN. but the outward symptom of the internal disease of conten- tion for notoriety and success. If, instead of all this false and demoralizing philosophy, termed "woman's rights"—which is more appropriately designated "woman's wrongs"—we turn the thoughts and ambitions of women towards domestic economy and domes- tic virtue, which alone should be and ever will be the ideal of noble wTomanhood, there will be, then, much less disease, more happiness, and less discontent. There is enough on God's earth for all of his children to eat, wear, and work, if the labor and the subsistence are fairly and wisely appor- tioned. The growing sentiment, which is as vicious as it is ab- surd, is that a girl, to be educated or accomplished, must be either a teacher, lawyer, or doctor, or anything else except an accomplished housekeeper, just as though it required less tal- ent or ability to raise a child, cook a wholesome or digestible meal, and cut or sew a garment. t Why, there is much more thought and judgment re- quired in making an angel mother than in administering or prescribing a dose of medicine and filing a legal brief, and there is not a lawyer or doctor who has given sufficient thought to the duties and requirements of maternity who disputes it for a moment. If our strong-minded women would preach this doctrine, which would tend to make house- hold duties respectable, they would be benefactors instead of mischief makers, and then our comely girls would prefer to cultivate habits of domesticity, which should and would be- come as honorable an occupation as that of a doctoress or lawyeress. Improprieties of dress are to be found in excessive or deficient clothing, in an improper adjustment,, and in an inherent defect of the undergarments. I will reserve some of my views on these questions, for the chapter that is devoted to hygienic measures. In the main, the custom or manner of dressing women in Christian countries does not GENERAL CAUSES. 69 deserve that sweeping denunciation that some radical dress reformers make. I would not, if I could, change the very becoming and graceful modern female dress, for it possesses the merit of displaying the beauties of the figure in a mod- estly delicate manner, and it hides its defects from the vul- gar gaze. As a rule, there is too much pressure on the abdomen, from the weight of heavy skirts that are suspended from the hips, and not sufficient room for the chest to expand, so as to accommodate the respirating movements of the lungs. In the absence of shoulder bands, to which the skirts should all be fastened, the much-decried corset has its redeeming qual- ities, for it serves the purpose of a yoke or support for the different undergarments, and when not tightly laced is rather a benefit than an injury, and if the corset had a shoul- der strap fastened to it over both shoulders so as to keep the garments from dragging on the hips, there could then be no objection to it whatever. The corset must always be so loosely worn as to permit the wearer's hands to be easily passed between it and the waist. It then becomes a useful brace to a weakly woman and entirely harmless to a strong or healthy one. We can imagine how a tightly-fitting corset will cause mischief by compressing the ribs and abdom- inal walls, and that this absurd fettering will prevent the lateral expansion of the chest, and also injuriously press upon the internal organs, but this is not due to an inherent prop- erty of the corset itself, but to an abuse of it. One might as well advocate a return to the Roman sandal, on the ground that some persons are foolish and vain enough to wear shoes altogether too small for their feet, thereby causing deformi- ties and corns. For my part, I admire a nice, well-shaped, healthy foot, incased in a low, broad-heeled, comfortable shoe, even if its size were one or two numbers larger than a pinched- up, deformed one. But no one would be enthusiastic enough on the question of healthy feet to have us all wear sandals again. 70 HOME TREATMENT FOR WOMEN. Warmth of the lower extremities is a very important point in a female's apparel, and of more importance than all the other questions raised on this subject. The exposures endured by women, from ignorance or indifference to this fact, is, in my experience, a fruitful source of disease. The chilling blast which sweeps under the skirts must be miti- gated and the moist vapor arising from a damp and cold earth neutralized. If the limbs are only protected by thin cotton fabrics, they are insufficiently clad to avoid the evils above mentioned. It is of the greatest importance that the limbs of women should be incased in flannel drawers, and these can be worn underneath the white muslin or linen ones, and the hose, especially in cold or damp weather, should be made of woolen material; the soles of the shoes should be sufficiently heavy so as not to be permeable by the moisture from the ground, and in wet or rainy weather rubber over- shoes are always a necessity. When the feet and lower limbs are kept warm, the whole body is more or less protected against cold. Superfluous or too warm garments are the cause of an endless variety of diseases. The rule is this, that any gar- ment which by its weight or thickness excites perspiration when the wearer sits quietly or exercises moderately, is either superfluous or too thick or heavy, and, as perspiration re- laxes and softens the skin, it makes one susceptible to take cold. It is reported on good authority that sealskin wraps cause more deaths among those who wear them than typhoid fever and for the reason above mentioned. Loosely-woven woolen goods make the best wraps and the best underwear. If we were called upon to state a single proposition which we considered of the greatest importance in preventing dis- ease, we would frankly say that, next to an irregular and unwholesome diet, excessive clothing is the most mischiev- ous factor in causing or predisposing to disease. The same rule applies to bed covering; if it be so heavy as to make the sleeper sweat during the night, he is al- GENERAL CAUSES. 71 most sure to take cold from the sudden change, from a warm, moist bed to the cool room or comparatively chilled clothing. Imprudence during menstruation. A heedless disregard, ignorance, or carelessness of the precautions above referred to is, during the catamenial days, quite sure to lay the founda- tion for disease. Every practitioner has met with a great number of cases where the disease originated during men- struation from some indiscretion, and it ran on for years, until a condition of affairs was developed which was well- nigh incurable. The female organism is particularly sensitive about this time and much easier affected than at any other. During this period the ovaries and uterus are intensely congested, and the Fallopian tubes which connect the former with the latter share this condition, and if a cold should sud- denly check or interfere with the natural functions of these organs, it might result in inflammation of the ovaries or in a catarrh of the tubes and womb. Any one of these conditions is painful and often troublesome to cure, but when all these organs are complicated in the diseased process, which we frequently find to be the case, it may entail serious conse- quences. Dysmenorrhea, or painful menstruation, will be a promi- nent symptom, if any of the above organs have suffered from imprudence, during this period, and I have known of cases which jnive me no end of trouble before thev were restored to health. Measurements of the healthy uterus. In a grown person the average length is three inches, two inches in breadth and an inch in thickness. It weighs from an ounce to an ounce and a half. The size of the uterus is an important guide to the i>hysician in establishing the presence or absence of cer- tain diseases. In the child-bearing period measurements and weight change, because the organ grows correspondingly large to accommodate the growth of the child. 72 HOME TREATMENT FOR WOMEN. Growth of the uterus from the moment of conception is one of the most interesting physiological studies. All its tissues, muscles, nerves, vessels, and lymphatics are increased in bulk and multiplied in number. The human ovum is an extremely minute microscopic cell, from one two-hundred- and-fortieth to one one-hundred-and-twentieth of an inch in diameter. This grows so rapidly that at the end of nine months we often have the average nine-pound baby. The growth of the muscular fibers of the womb is truly remark- able. They grow eleven times longer and twice to four times thicker, so that the growth of the womb keeps pace with that of the child. Changes immediately after confinement. Women as a rule, and their husbands also, are wofully ignorant of the con- dition of the womb just after confinement, and at this point it will be opportune to impart the necessary information illus- trating that it is one of the most critical periods of the entire process, because the pelvic organs are again very sensitive, somewhat akin to the menstrual condition, namely, one of engorgement, or congestion. After the child is in the world, the uterus usually con- tracts to about the size of a cocoanut; its measurements and weight as compared with what it was before pregnancy have materially increased. The diameter is now about four inches, and its weight a little over two pounds. If we now stop to reflect that its weight was formerly an ounce to an ounce and a half, to which size and weight it must again return, we can readily appreciate the important changes that must take place to ac- complish this object. The scientific world has only learned how this is effected within the last thirty years. It was a very important discovery. The superfluous or excessive tis- sues are converted into fat—the process is called fatty degener- ation—and as fat the tissues are absorbed into the blood and disposed of, and thus gradually is the superabundant sub- stance removed, until its measurements are as they were for- merly and its wTeight as it was before. GENERAL CAUSES. 73 Involution is the name given to this process by medical writers. It signifies a rolling back of the size and substance of the womb to where it was before pregnancy. It is the physiological activity in the tissues of the organ to restore it to its former size and healthfulness. The time usually re- quired for nature to accomplish this remodeling varies in different individuals from six weeks to three months. Sub-involution is a term employed to designate a partial or complete cessation of this restorative action. The prefix sub means always under; in this case the same thing is meant, under-involution or incomplete involution. When, in six weeks to three months after confinement, the womb has not returned to its previous healthy size, weight and state, or if the enlargement of the womb incident to pregnancy lasts longer than already specified, we have the disease termed sub-involution. It generally becomes com- plicated with inflammation of either the cavity of the womb or of its entire substance, and often the inflammation extends to all the other organs and tissues in the pelvis. Indiscretion in getting up too soon may cause this state of affairs. Taking cold and excessive exertion should be guarded against. A mother who has just been delivered must gradually feel her way as to how much and what she may or can do without jeopardizing her recovery. Pains in the pelvis, back, and thighs, or a heavy, dragging sensation after getting up, indicate a sub-involution. These symptoms should be at- tended to, because the longer they last the more obstinate the disease becomes. Lying on the back after confinement for ten or twelve days is not only injurious but an unnecessary hardship for every mother. It is one of the most fruitful causes of an ab- normal position or falling back of the womb, and very often this excites diseases which greatly complicate the improper location of the organ. 74 HOME TREATMENT FOR WOMEN. Retroversion and retroflexion of the womb will be con- sidered more minutely later on. It is generally caused by this common error of nurses and physicians, who allow the delivered woman to lie and often insist on her lying on the back. Thus the womb gradually sinks backwards, instead of falling forwards, where it belongs: see Plate IV. Women will not generally feel that anything is wrong until some time after they are up and around. The first few weeks or months after confinement, persons are inclined to attribute their weakness, pains in the back or thighs, and other disagreeable sensations, to the natural consequences of what they have gone through. But after weeks roll into months, and their former strength and health do not return, then they seek the advice of a doctor, who wull disclose to them the cause of their suffering. This can be avoided every time by changing the positions of lying, from one side to the other, and from the back to the stomach for a change; then naturally the womb will gradually resume its normal position, which is inclined forward and rests with its body over and on the bladder. All of these displacements should receive early and prompt attention. Antiseptic precautions. Only a few years ago this phrase was entirely unknown. It originated with the modern anti- septic treatment of wounds, and from the domain of surgery it has been transplanted into the department of obstetrics, in which the application of antiseptic principles has achieve* 1 the most brilliant triumphs. From this conception ha's sprung the germ theory of disease, which is now, beyond doubt, an established fact. I never can forget my first case of childbed fever. It is only fourteen years ago, and then there was as yet no one who could give a scientifically truthful interpretation of the disease. My patient was a young mother, who was being rapidly consumed by a fever, but beyond that science had not unlocked the causes lurking in the organism, which had doomed the young woman, on the threshold of motherhood, to a premature grave. GENERAL CAUSES. Thousands of lives were yearly destroyed by puerperal fever. Volumes of literature had been written on the subject, but as yet no one had deciphered its origin. Now the whole scene has shifted; we know that the fever is essentially a blood poison, a septic infection of the patient, precisely similar to a wound infection anywhere else on the body. The act of parturition causes wounds or abrasions; these, then, place the woman in imminent danger of infec- tion of every sort, and it is this infection which it is now possible to avoid. There is the greatest precaution necessary on her part and on the part of her attendants, that she be not contaminated by suspicious-looking finger nails, or dirty hands, or soiled linen, or unhealthy and unclean surround- ings. The German Government has a compulsory law for a system of antiseptic precautions, which is incumbent upon all who attend lying-in women. The importance of a rule to guide midwives and others in carrying out strictly anti- septic measures was recognized in that country some ten years ago, and the statistics show a remarkable diminution of diseases peculiar to the childbed period. The sources of these infectious micro-organisms are very different. They may be derived from the body of another person, sick or having died from an infectious disease, from suppurating wounds and even from the secretions of healthy lying-in patients. The patient or person herself may have improp- erlv bathed or neglected cleanliness and ablutions, but the greatest danger arises from the neglected and unclean hands and sleeves of the midwives and physicians, and from the instruments usually employed under these circumstances, like forceps, catheters, or the nozzle of a syringe. The law above referred to requires all these instruments to be thor- oughly scalded, washed, and brushed every time they have been used, and by such a complete system of disinfection, the chances of infection are reduced to the minimum. I hope some day our legislators will be wise enough to give us similar laws. CHAPTER V. UNCLEANLINESS AS A CAUSE OF DISEASES IN WOMEN. The custom of washing and bathing has existed from the earliest times. Among the Egyptians it was a part of their religious worship. Among the Jews it formed part of the ceremony of purification prescribed by Moses. The Greeks considered it a sanitary expedient, and among the Romans it was instituted for similar purposes. All virtues when carried to extremes degenerate into folly or vice, so bathing in the days of the Roman Empire, became immod- erate and degenerated into enervating luxury and un- bridled debauchery, in which indiscriminate bathing of both sexes was one of the demoralizing features. The bath was usually taken after exercise and before the principal meal, which rule holds good to-day, as the very best and proper time. The gorgeous splendor of the Ihermfc, which was a palatial edifice constructed by Agrippa, was adorned with beautiful statues and fine paintings, while luxuriant green foliage of great variety formed en- chanting bowers of fairy splendor. This was thronged by the Roman citizens for the pleasures of gymnastic exercises and bathing. In those countries which have adopted the religion of the Arabian prophet, Mohammed, people bathe as a part of their'devotions, and a religion which has for a part of its ritual the washing of the body, goes a great way towards cleansing the spirit. Among the Northern nations the introduction of the bath dates back to the period of the Crusaders, although (76) UNCLEANLINESS A CAUSE OF DISEASE. , 7 Tacitus speaks of the river bathing of the Germans, which was one of the strengthening methods employed by the early Saxons. That filth and dirt generate crime and moral depravity seems to be apparent, where squalid misery has dulled the sensitiveness to unwholesome surroundings. Sanitary science has also demonstrated that filth is the most fruitful source of diseases that are called infectious, because their origin is due to germs of the lowest forms of vegetable life. The brightest page in the medical history of the nineteenth century is that which records the dis- covery of these micro-organisms as the cause of such dis- eases as septicaemia or blood poisoning, pyaemia, diphtheria, tuberculosis or consumption and others. All forms of fer- mentation and putrefaction are due to the presence of some germs, and upon this fact antiseptic surgery bases its scien- tific premises. The germ theory of disease, like every newT discovery, which supplants the accustomed and deeply-rooted theo- ries of the speculative philosophers, met with opposition, criticism, ridicule and misconstruction, but the brilliant achievements of Lister and Koch have established its found- ers upon a pinnacle of fame, which promises to be an im- mortal monument to their genius, and not only in surgery has its beneficial influence been exerted, but the entire field of medicine has been enriched by the germ theory, which plays so formidable a part in the causation of many diseases. The great boon that medical science will confer upon humanity, in the future, will not be so much in improved methods of treatment, as in the means and methods which medical science will "devise for preventing disease. One ounce of prevention will always be worth a pound of cure. When we look back fifteen or twenty years, we must even now acknowledge that preventive medicine has accom- plished greater results than curative measures, because the former can be made in the very nature of things* absolute, while curative agents are only relative. Puerperal, or child- 7,S HOME TREATMENT FOR WOMEN. bed fever, which is an infectious disease, was at times a pesti- lence, which destroyed women by the score, in maternity hospitals, or in certain neighborhoods, by the infection be- ing carried by midwives or accoucheurs from house to house, yet no one had the least suspicion that it was pos- sible to carry the germs of this disease under the finger- nails of the attendant, or on the clothing or a syringe, or on some other little instrument, from one patient to another, and, indeed, there are a great many to-day who are practicing mid- wifery who are still ignorant of the importance of refined cleanliness. But for this ignorance, there is no longer an excuse, be- cause the infectiousness of this and other diseases is so pos- itively established, and even the physical characteristics of the micro-organisms have become familiar to the micros- copists. This knowledge of the causation of puerperal fever has been applied to the employment of preventive measures, so that this dreadful malady is becoming a rarity, particularly in countries wrhere scrupulous care and cleanli- ness are enforced by governmental rules and regulations. I refer to this particular fever, because it is, to my mind, one of the most brilliant illustrations of the efficacy of preventive or antiseptic medicine. There is a gynecological hygiene with which women should become familiar; it is based on the principle of anti- septic precautions applied to the daily lives of their sex. The object of this is to keep the body and reproductive or- gans that are exposed to contamination or infection from the outer world in the most refined and scrupulous cleanli- ness. The vaginal douche or syrhrge is as important an auxiliary to a refined woman's toilet case as her tooth brush, because the cleanliness of the genitals is as essential to the preservation of health and comfort, as the possession of a sweet breath and the preservation of the teeth. I am therefore convinced of the hygienic value of familiariz- ing little children with washing or sponging their external UNCLEANLINESS A CAUSE OF DISEASE. ■ 79 genitals; in a few years this will have become second nature, and they are thus protected for all future time from con- tracting diseases which have their origin in personal un- cleanness. It behooves mothers to avoid all delicacy on this subject, so that their little ones may grow up with the sentiment that to the pure in heart all things are pure. It is false modesty and ignorance which degenerate into vice and excesses; the scientific truth is always pure and holy, because it is based on reason, while abnormal delicacy is only emotional, and is quite likely to shoot into the other extreme, namely, licentiousness. As the world grows wiser, the physiology of the reproduc- tive organs should form a part of its wisdom, and in pro- portion to this knowledge, will their functions become ques- tions of sense, instead of sentiment and nonsense. The vagina is a membranous canal. It is situated in the cavity of the pelvis, below and behind the bladder, and in front and above the rectum. Its direction is curved from before backwards and a little upwards; its walls are flattened and ordinarily in contact with each other. Its length is about four inches along its anterior wall, and an inch or two longer along its posterior wall. In introducing a nozzle of a syringe it must always be remembered, that the tube is to be introduced directly backward on a horizontal plane with the body in the erect posture; by attempting to introduce it directly upwards, you meet with resistance from the anterior wall of the vagina. In this cavity the secretion is susceptible of decomposi- tion, owing to the accessibility of air laden with germs, which excite fermentation. A day or two after the cessation of the menstrual flow, there still lingers a little blood in the cavity of the vagina ; this becoming infected with the germs in the vagina, a decomposition is the result, which is recog- nized by an offensive smell. The naturally soothing and harmless secretion is now changed into an acrid, irritating fluid, which not only may cause an inflammation of the 80' HOME TREATMENT FOR WOMEN. membrane of the vagina, but also excoriate the skin at the orifice of the canal. Leucorrhcea, or what is commonly called whites, js the most distressing symptom of this condition. In the course of months or in some instances a few years, the inflamma- tion spreads from the vagina to the mouth and lining mem- brane of the uterus. Inflammation of the endometrium or lining of the womb will excite another complication, the so- called ulceration, but more correctly termed erosion. AYho will deny the usefulness of any advice that will teach girls or women to avoid all these diseases? It is all contained in the simple phrase, Keep clean. Young girls must be taught by their mothers or guardians, not only the necessity of keeping the external genitals clean by daily ablutions, but a few days after menstruation, upon the slightest indication of offensiveness, she must resort to the employment of the vag- inal douche or syringe, so as to wash out the seeds of dis- ease, that are rapidly multiplying themselves, and if al- lowed to remain will entail the consequences to which I have already referred. As an antiseptic wash', there is nothing so simple, effica- cious and healing, as a solution of borax in previously boiled water, that has been allowed to cool to the proper temperature, which is between 103 and 106 degrees Fahr., one teaspoonful of the powdered article to the half gallon of water, to be used as a rinsing for each time. Directions for administering vaginal douches will be given elsewhere. The proper time of the day for the em- ployment of the wash is ahvays at bedtime; and once or twice a week is quite often enough in the majority of in- stances. Married women are more exposed to infectious contam- ination than single ones, because they are constantly liable to have infectious microbes introduced into the vagina dur- ing the ordinary course of marital relations. Men, as a rule, are neither cleanly nor careful in their habits, and UNCLEANLINESS A CAUSE OF DISEASE. 81 approach their wives without any thought of serious con- sequences in their sexual relations. I had a married woman under treatment for an offensive discharge from her vagina which I traced to her husband, thence to a sup- purating wound on his horse, which the husband had under his treatment. This can happen, of course, only through carelessness. By getting some of the matter or pus on the fingers, which incidentally contaminates his person, or not washing and brushing the finger nails, the husband may directly convey the infection to his wife, and thus inaugurate, unconsciously, an inflammation of the vagina, which becomes complicated, as the primary disease is neglected, leading to inflammation of the womb and ovaries, and often to ab- scesses, that compromise not only the health but the life of the sufferer. To preclude the possibility of innocent infection, between husband and wife, there is only one means of prevention, and that is a careful toilet, which thoroughly cleanses the bodies in general and the genitals in particular. Another fruitful source of disease of women, in this coun- try and to an alarming extent in Europe, to which the elder Martin of Berlin called the attention of the profession over thirty years ago, is the specific or gonorrhoeal infection of wives by their unfaithful husbands. The number of poor women whose health has been irretrievably ruined, by their husbands having had illicit relations with lewd, diseased women, is only known to those who have made this class of diseases a special object of inquiry. I have nothing to do with the moral aspect of this question, but only with the physical suffering that such men inflict upon their innocent wives and the mothers of their children, for the brief indulgence of libidinous pleasure. To think that any man would take the chances of making his wife a suffering and perhaps in- curable invalid, just for the purpose of gratifying temporary animal passions, is to place him beneath the brute creation, which has not the intelligence to reason on the fearful con- 6 82 HOME TREATMENT FOR WOMEN. sequences. No man who has been guilty of illicit relations should return to his wife until seven days have elapsed, and oven not then until he has repeatedly washed himself by means of a syringe with some cleansing or disinfecting fluid, like borax water, or, what is preferable, a weak solution of the bichloride of mercury. The wife and mother who entertains the slightest sus- picion, must insist upon these precautions, and then not neglect to thoroughly wash and cleanse herself in the man- ner previously referred to. It is the height of hypocrisy to be mealy mouthed on this subject; the wives and moth- ers who are fortunate to have husbands beyond suspicion, should learn that some of their sisters have dangers to en- counter and heartaches to suffer, with which their own lives are not marred, but perhaps the lives of their (laughters may be; for the unhappy woman who becomes the wufe of the blear-eyed sensualist, there is only one relief, and that is edu- cation in these subjects. I know of no disease in which a correct and early diag- nosis or recognition is of greater importance to avoid the frightful consequence and serious complications, than this one. It begins with a mild vaginal catarrh, which, when it is as yet locally confined to the vagina, can be easily cured. In course of time it spreads itself along the vaginal tract to the cavity of the womb. When it gets there, the treat- ment becomes more complicated, and for this reason; in or- der to reach the disease now, the cavity of the womb must be dilated, and this is an operation which the average physician can only accomplish in a bungling and imperfect manner. But even in this stage of the disease, in the hands of a skillful physician, the course of the disease can be checked and the patient readily cured. When the disease gets beyond the womb, when it invades the Fallopian tubes and the ovaries, the picture has entirely changed. The organs affected are then inaccessible to local treat- ment, so that the disease invariably continues until the or- UNCLEANLINESS A CAUSE OF DISEASE. 8:1 gans are more or less destroyed by inflammation, which results in the tissues breaking down into an abscess. In this stage of the disease it has become quite the fashion to operate in this class of cases, offering as an excuse a sure and speedy cure. Here I would interpose a word of warn- ing to sufferers belonging to this class, not to be too willing to comply with surgical methods, because I know from care- ful observations, that promises of this nature end often in disappointment and death, while an intelligent conserv- ative treatment can only disappoint but never kill, and with patience and perseverance in the application of electricity and hygienic rules of health, a cure is almost certain. The sick in body and mind are often beguiled into operations of a very serious nature, which are entirely unnecessary, be- cause better results can be accomplished by other methods of cure, in which the possibility of a fatal termination is excluded. Some women feel tired and languid from morning until night.; they feel as tired in the morning when they get up as they were in the evening when they retired. If we tell them that it is entirely due to negligence of their own persons in not using vaginal washings regularly, they will undoubtedly feel surprised. In the great majority of these cases, this is owing to putrefactive changes going on in the cavity of the vagina. In the process of fermentative decom- position, the so-called ptomaines are developed; these are chemical poisons, which are absorbed into the blood, and by their depressing influences on the nervous system are the cause of the weakness and tired feeling. There are no remedies which, when taken into the stomach, will do the slightest good for this condition, and it is a waste of both time and money to expect relief from drugs. This can easily be remedied by cleanliness, so that the secretions are not long enough retained in the vagina, to decompose and develop these ptomaine poisons. During and after confinement is another important time 84 HOME TREATMENT FOR WOMEN. for the employment of vaginal washes. The loch ial discharge, which is one of the ordinary accompaniments of the newly- delivered woman, is a discharge from the uterus, which con- tinues for several days, growing less and less, for a few weeks, when, in a normally healthy state of affairs, it should cease entirely. The lochia is the oozing from the mouths of the blood-vessels of the womb where the placenta or after- birth was attached, together with the passing off of the old lining membrane of the womb, while the organ is returning to its original condition. At first the discharge is bloody, and it may retain this character for two or more days after delivery; then the color is changed, partaking more or less of a watery nature and presenting a yellowish hue; it then be- comes whitish and ultimately ceases altogether. After the first four or five days the lochial discharge often becomes very offensive; this is a sign of putrescence or decomposition, and the only remedy in this, as in all other similar instances, is to wash the vagina thoroughly with borax water, or with a preparation for which a prescription will be given further on. In every case of delivery, the mouth of the womb is more or less torn or lacerated; this is unavoidable, and it is gener- ally harmless. One of the surgical humbugs is to sew or stitch, or attempt to stitch, these little harmless tears together, not of course for the good it will do the patient, because she is more likely to be injured by this meddlesome surgery, but to make a business and a fee. The common practice of these and kindred surgical expedients is one of the crying evils of an overcrowded profession which is trying to keep itself em- ployed at all hazards. The vagina also receives more or less injury during an ordinary confinement; if the midwife or the doctor is too meddlesome or in too big a hurry to get through, he will use the forceps, which simply means, to pull the child out and through the vagina, before nature has had time to dilate or stretch the parts sufficiently, to allow the child UNCLEANLINESS A CAUSE OF DISEASE. 85 to pass through the maternal organs without injuring them. As a result of this brutal haste, frightful lacerations are in- curred, which require immediate attention, but small lacer- ations heal without any further treatment than to keep clean. After every confinement there is considerable sore or raw surface, with which the offensive discharge comes in contact, to become readily absorbed or taken up into the system, giving rise to fevers or inflammations of the womb and other pelvic organs. If one has a wound on any part of the body, the first thought would, or rather should, be to keep it clean; exactly the same treatment is required for wounds of the womb and vagina. When the discharge becomes offensive, it also becomes dangerous and poisonous, and the only and proper thing to do is to thoroughly wash out the entire vaginal cavity until all offensive smell has disappeared. The only sure sign that anyone can have of the completeness and thorough- ness of the vaginal washings, is that there is no longer any fetid or offensive smell perceptible. It requires no particularly trained nurse or expert to administer a cleansing vaginal injection, yet it is more likely to be done in a bungling, inefficient manner than in a proper workmanlike manner; for this reason, it would be well to remember a few of the necessary details of carrying out the douching. In the first place, the room in which the vaginal douche is administered must be comfortably warm, so as to preclude the possibility of chilling the patient; the windows or any other opening liable to cause draft must be closed. The nozzle of the syringe, whether it be a fountain or a family syringe, must have been thor- oughly brushed and cleansed with soap water, before and after each use ; if the instrument is old, or has been used for questionable purposes, or, perchance, made the rounds of the neighborhood, it had better be thrown into the ash barrel, and an entirely new syringe, the "Alpha," be employed, which, bv its sure and continuous stream, I consider the most suit- 86 HOME TREATMENT FOR WOMEX. able female syringe. The bulb of a syringe must be com- pressed in the palm of the hand slowly and deliberately. The position of the patient is of considerable importance; a" vessel is placed under her, which is carefully adjusted, so as not to tip too far backwards, otherwise it will overflow and drench the bed or the patient's clothing. Beneath the small of her back a few extra pillows are placed, and thus she comfortably reclines on her back, while the attendant manages the disinfecting wash and syringe, placed in a basin between her thighs. Half a gallon of the fluid is usually sufficient. The temperature of the wash is very im- portant and may range between 103 and 106 degrees Fah- renheit. The recumbent position is only intended for women who are confined to their beds; others, who are around and about on their feet, can sit comfortably over a chamber, on the edge of a low chair, having the vessel underneath them, and the wash of course in a separate basin. In the course of my experience I have been called to mothers, five to eight days after delivery, who were in a raging fever, presumably from the ptomaines which had developed in the vagina and poisoned the blood. After a few vaginal injections, some- times after the first, the fever subsided entirely. These re- markable results we owe to the antiseptic treatment of dis- ease, and when it once becomes generally known that this is only another word for cleanliness, infectious diseases will grow correspondingly less, and the cure for those that exist will be less experimental and more reliable. CHAPTER VI. MARITAL EXCESSES AND PREVENTION OF CONCEPTION. In a previous chapter, the physiology of conception was explained, and it was shown to be an organic function, in- dependent of and remote from the sexual act, and over which the parties to the act have no control. From this scientific statement of the actual fact, it becomes at once apparent that conception or pregnancy may result without natural sexual congress, by simply injecting the sperm of the male, by means of a uterine syringe, into the womb of the female, while she is in a state of unconsciousness. It is also quite probable that a criminal conspiracy of this nature could be carried out, without any violation to the delicate anat- omy that is involved in the natural process; a detailed account of all the probabilities which the ingenuity of a scientifically-trained mind could devise, belongs more prop- erly to the department of medical jurisprudence. It is, howT- ever, of sufficient general importance that the reader should have at least an idea of the door that has been unlocked through physiological researches. What we are at present endeavoring to make clear is, the great distinction and difference between coition and fe- cundation or conception; while one is but the result of the natural instinct aroused by the senses, the other reaches out into the realm of the Creator. When man undertakes to destroy the product of conception, he has interfered with the prerogative of God and is guilty of murder. The question may now naturally arise in the minds of pure ami morally-disposed persons, whether there is any (87) 88 HOME TREATMENT FOR WOMEN. time, without doing violence to God's law, that the children of men have the moral right to control, or regulate, the pro- creation of the human race? If I answer the question in the affirmative, I will then proceed to inquire into the ways and means to that end, and also into the pernicious methods that are employed, to accomplish this result. It is true, that the Divine command was to be fruitful and multiply, but before this command was given, man was a free agent and a reasoning being, which implies that he is after all to be the judge as to the degree in which this com- mand is to be carried out. That is, that there are mitigating and qualifying circumstances, which man has not only a right to consider, but which he is expected to take into account in propagating the species, by virtue of his reason- ing faculties. If this command were absolute and universal, chaste celibacy would be a cardinal sin, yet it has always been held by the canons of spiritual growth and morality, to be a Di- vine virtue, and even the loving Jesus knew not woman, be- cause the forces that are thus expended will exert their power in other directions and towards developing powers of a higher order. I believe that a moral code, which is too exacting to be observed by the average person, fails to accomplish the re- straint or reform that is desired, so that, after all, it becomes essential to lay down such rules as the average men or women can follow as guides for their actions. A reformer, who starts out with the broad declaration that it is im- moral to take human life, and a murderous act to destroy a half-formed human being in its mother's womb, and that it is equally murderous to prevent the recent products of the sexual act from becoming a viable being, fails to make the impression he desires. The first half of the proposition neu- tralizes the second of its sacred essence, in placing on the same level the organic function of conception and the ani- mal function of the sexual act. PREVENTION OF CONCEPTION. Si I This view is so manifestly absurd to the person of even ordinary perception, that I feel assured, that it would neither lessen feticide nor sexual excess. Spermatozoa on the one hand, and the ova of the female on the other, are, even in the natural and uninterrupted course of nature, destined for destruction, for whenever the female menstruates, these ova are discharged, and whenever the male copulates, hundreds of spermatozoa are found swimming in the spermatic fluid, which in case there be no ripened ovum are nothing more than so much waste secre- tion. Both are a means to an end, and that end is the reproduction of the species. It appears to me a flight of fancy, from the sublime to the ridiculous, to assign to the sexual act the same importance as to the passive function of conception, and I believe that doctrines of this nature lack not only the least scientific support, but weaken any argu- ment in favor of the moral or spiritual aspect, which alone raises the question of feticide from a social evil to a mortal sin. Man is prompted by a powerful instinctive desire for the use of the sexual organs, that draws him involuntarily to the opposite sex, not for the continuance of the race, be- cause the passion arises much oftener without the remotest thoughts of any fruitful results. I have the greatest regard for the life of the unborn child, yet I am far from agreeing with those who would stamp as libidinous every thought of the sexual instinct, that has not as its stimulus the pro- creation of the species. While the average man is in the flesh, he is an animal man, and there is no use of trying to make a spiritual saint out of flesh and blood, and when we do find that, we have a very exceptional and remarkable person. But what, as reasonable beings, we should do, is to bridle the animal passions with moral reins, so that we can stand up, in full-statured manhood, with the respectful ap- proval of our own conscience, able to rise above the mere animal appetites, to the dignity of reasonable beings. This 00 HOME TREATMENT FOR WOMEN. instinct, like other propensities, is excited by sensations, and these may originate either in the sexual organs themselves, or may be excited through the organs of special sense. In man the passion is most powerfully aroused by impressions conveyed through the sight or the touch. It often happens that localized sensations will excite the sexual desire of either sex, so that many cases of excessive sexual desire can be traced to some local disease of the genital apparatus: chief among the numerous causes that may be cited, is pruritus or local itch, erythema and active congestion of the womb and ovaries. "This tendency cannot be regarded," says Dr. Carpen- ter, "as a simple passion or emotion, since it is the result of the combined operations of the reason, the imagination, and the moral feelings: it is in this engraftment of the physical or spiritual attachment upon the more corporeal instinct, that a difference exists between the sexual relations of man and those of the lower animals. In proportion as the human being makes the temporary gratification of the mere sexual appetites his chief object, and overlooks the happiness aris- ing from spiritual communion, which is not only purer but more permanent, and of which a renewal may be anticipated in another world,—does he degrade himself to a level with the brutes that perish. Yet how lamentably frequent is this degradation." This quotation gives the entire physical and spiritual aspect of the question, by one of the most eminent physiologists of our time, so that in the natural course of our investigation Ave are led to inquire into the currents of thought, which would tend towards developing moral re- straint. Moral restraint means the restraint of the animal man by his spiritual or higher self; the will must possess its due pre- dominance to exercise its determining power in curbing the passions of the one, and directing the course of the thought in the other. The cold, calculating materialist, whose ideal is circum- PREVENTION OP CONCEPTION. 91 scribed by the laws that have been deduced from the phe- nomena of the material world, can scarcely appreciate the higher sentiments that are involved in this investigation, unless he becomes changed in thought and feeling to the things that are about him. To accomplish this result is hardly within the scope of this work. With the average man as we find him, my observation has taught me that it makes, after all, little difference, whether he believes in a spiritual nature or is avowedly materialistic. The great majority of men and -women live, so to say, in the turbulent waters of their own passions, wafted hither and thither by the impulses of emotional excitement and instinctive desires. There is little or no hope for reform, if they have not sufficient force of character to cry halt, and stop to think a little upon questions which, are to them of the greatest importance. Marital excesses are the mainspring of so much disease, that ordinarily is attributed to quite different causes, that this chapter would be very deficient were I to omit to call the attention of my readers to this fact. The men on the whole are oftener the victims of the ill effects of unbridled lust than the women, which shows itself by violent and un- controllable temper, in the one case, and stupid docility in the other: by a lean, hungry, nervous appearance, or a brut- ish, sanguineous obesity; extremes of the different tempera- ments and habits are but the natural outgrowth of the con- stitution inherent in each individual case. Women, as a rule, are more passive, less amorous and more chaste in thought and feeling than men, and if we define emotion as an idea associated with pleasurable or painful feelings, women are, as far as appertains to their sexual nature, contrary to the generally-accepted opinion, much less emotional than men. Continence, among the unmarried women, is the rule, while among the men it is the rare exception; this is because her will is by nature stronger, while her reason is weaker, she intuitively arrives at conclusions that are her guide and saviour. 02 HOME TREATMENT FOR WOMEN. It is a prevalent idea among men that the marriage cere- mony removes all restraint from the exercise of the sexual function; this not only neutralizes and destroys all sentiment of true love, which seeks for the happiness of the object it loves, but breeds Imtred and contempt. To be permanently happy and mutually respectful, there must be love beyond the pleasure of gratifying the mere sexual instinct, there must be love in the realm of thought and a spiritual com- munion above the instincts of the flesh. "Any warning against sexual dangers," says Dr. Acton, " would be very incomplete if it did not extend to the ex- cesses so often committed by married persons in ignorance of their ill effects. Too frequent emissions of the seminal fluid, and too frequent excitement of the nervous system, are in themselves most destructive. The result is the same within the marriage bond as without it. The married man and woman who think that because they are married, they can commit no excesses, however often the act of sexual con- gress is repeated, will suffer as certainly and as seriously as the unmarried debauchee, who acts on the same principle in his indulgences—perhaps more certainly, from their very ignorance, and from their not taking those precautions and following those rules which a career of vice is apt to teach the sensualist, Many a man has, until his marriage, lived a most continent life; so has his wife. As soon as they are wedded, intercourse is indulged in night after night, neither party having an idea that these repeated sexual acts are ex- cesses which the system of neither can bear, and which to the man, at least, is absolute ruin and to the woman a source of disease. The practice is continued till health is impaired, sometimes permanently, and when a patient is at last obliged to seek medical advice, he is thunderstruck at learning that his sufferings arise from excesses unwittingly committed. Married people appear to think that connection may be re- peated as regularly and almost as often as their meals. Till they are told of their danger, the idea never enters their PREVENTION OF CONCEPTION. 93 heads that they are guilty of great and almost criminal ex- cess; nor is this to be wondered at, since the possibility of such a cause of disease is seldom hinted at by the medical man they consult. Some go so far as to believe that in- dulgence may increase these powers, just as gymnastic ex- ercises augment the force of the muscles. This is a popular error, and requires correction. Such patients should be told that the shock to the system, each time connection is indulged in, is very powerful, and that the expenditure of seminal fluid must be particularly injurious to organs pre- viously debilitated. It is by this and similar excesses that premature old age and complaints of the generative organs are brought on." Wives of men of great vital force are not long before they become delicate, sickly and nervous, and, entirely igno- rant of the real cause of their feebleness, seek relief by tak- ing "a good iron tonic," which does them about as much good as if they had left it alone, the tonic effect of iron being entirely overestimated, but the delusion is created by associating the word iron with the idea strength. After the different tonics have been tried, the patient consults a phy- sician, who, on general principles and after a hasty exam- ination, informs her that she has "womb disease." These two words for the time being settle the question; she now be- gins "to doctor," and from the general or family doctor she finds her way to the female specialists/Avho, as a rule, be- long to the recognized magnifiers and humbugs of the day. Here she becomes one of the regular habitues of the special- ist's waiting room, disappointed and not a little discouraged. She makes the rounds of the most prominent of them, until she has been doctored out of her dear patience and her still dearer money. Hope is often a forlorn consolation, and if by chance she now takes a trip to the country or undertakes a long visit at some distance, to her folks, which gives the poor woman respite from the "marital rights" other Lord and Master, she recovers her former health, strength and 94 HOME TREATMENT FOR WOMEN. buoyancy. Of course everybody congratulates her upon the wonderful effect of the climate, when the climate had no more to do with her recovery than the moon. The re- markable change was owing to having been let alone by husband and doctor. i That the attempt to call attention to these flagrant abuses of the dishonesty and ignorance of the one and the blind animal instinct of the other will be decried and stigmatized as " cranky," I know beforehand, but I know also, that those who criticise these sentiments are fully convinced of the truth of the statement. The diseases that belong to this class are, like most uterine diseases, of an inflammatory nature, and for that reason rest is one of the most essential features in the treatment. But as this class belongs to the avoid- able causes, prevention is much better than cure. I there- fore advise, as of first importance, to abandon the American custom of man and wife occupying the same bed, which is only customary among the poorer classes of Europe, who can- not afford to have separate beds or chambers. The advan- tage of the European custom in segregating one's self on retirement, to avoid the sexual instincts being unduly ex- cited, can be borne out by remembering the physiology of the instinct, which Ave were told is excited by sight and feeling. Besides these, there is the possible undue familiarity, which the joint occupancy of the chamber or bed of man and wife may engender, and that, too, is likely to lead to excessive re- lations. All efforts to exercise voluntary control, by prolonging the sexual act or extending the venereal orgasm, are fraught with the most pernicious results to the nerves, termina- ting in a partial or complete paralysis of the different or- gans of the body, or a low grade of inflammation is excited, which offers a fruitful soil for the development of various diseases. A man who has become the husband of a woman should never cease to be a gentleman on that account, nor should PREVENTION OF CONCEPTION. 9-") he become lost to a consideration of those delicacies of re- finement, which smooth the common relations in the exer- cise of daily duties. Continence is the complete restraint from sexual indul- gence, Avliich in its fullest sense does not apply to the married state, but it comes within the scope of every mar- ried life to cultivate and practice it as one of its virtues. Every married couple should be continent for days and weeks at a time, and when one or the other is not feeling well, abstinence should be practiced, as the rule, not only to avoid a nervous shock, which may have serious results, but because conception in an abnormal physical condition, Avill perpetuate itself in the child, Avhich is quite likely to inherit a nervous or sickly constitution. When pregnancy super- venes, undue sexual excitement of the mother often has the most serious consequences to the fetus, "and may result in its death, or induce abortion. Diet is to be regulated, to assist a firm determination to lead a chaste and purer life. Stimulating and highly- seasoned food, and alcoholic beverages, are not to be used, be- cause they increase the circulation of the blood and stimu- late the nerves to inflammatory activity. Meat should be eaten only once a day, and the supper should be bland and light. Nature has set a time during which continence should be practiced for the purpose of preserving the health and con- trolling the reproductive function, that is, the menstrual period. Menstruation in women corresponds to the ripen- ing and discharge of the human ovule. The aptitude for impregnation* is a day or two before and six to eight days after the courses cease. This is a rule which applies to the great majority of women, and if the sexual relations are sus- pended from a few days before the onset of the menses until six or eight days after the Aoav has ceased, the chances for pregnancy are reduced to the minimum. This physio- logical relation of the organic function of conception to 96 HOME TREATMENT FOR WOMEX. the sexual act is to be recommended as the most wholesome check to reproduction in early married life, although I be- lieve that there is no time better calculated to raise a family than Avhile you are young and hopeful. Children are common objects of love and hope for both parents. Life and health are ever changing the relations of our surroundings, and when newly-married people put off' to the dim future the hopes of rearing a family, they are often doomed to everlasting disappointment. Nature is ca- pricious and jealous of her prerogatives, and those who trifle with her functions must expect to be frustrated in the end, and have no one but themselves to blame if she fails to re- spond to their capricious wishes. Children make trouble of course, so were Ave as troublesome in our time, but there is also a great deal of pleasure in watching them grow from day to day in bodily strength and mental perception, which no amount of selfish enjoyment can compensate. The diseases that are brought upon women by the differ- ent practices and mechanical devices to prevent conception are too numerous to mention in a work of this character. Some of the methods are absolutely loathesome to all sense of decency and reduce sexual intercourse much below the instinctive indulgence of the brute; these debauches of the conjugal bed not only sap the vitality of the participants, but must lower or destroy all mutual respect, and ultimate in dissension and strife, which the divorce court will finally assuage. Referring to the practice of conjugal onanism or inter- rupted or incomplete coitus, Dr. Franklin Devay says: " However, it is not difficult to conceive the degree of per- turbation that a like practice should exert upon the genital system of woman by provoking desires which are not gratified; a profound stimulation is felt through the entire apparatus; the uterus, Fallopian tubes and ovaries enter into a state of orgasm, a storm which is not appeased by the natural crisis; a nervous super-excitation persists. There occurs, then, what PREVENTION OF CONCEPTION. 97 would take place if, presenting food to a famished man, one should snatch it from his mouth after h-aving thus violently excited his appetite. The sensibilities of the womb and the entire reproductive system are teased for no purpose. It is to this cause, too often repeated, that We should attribute the multiple nenrose.% those strange affections which originate in the genital system of women. Our conviction respecting them is based upon a great number of observations. Fur- thermore, the normal relations existing between the married couple undergo unfortunate changes; this affection, formed upon reciprocal esteem, is little by little effaced by the repeti- tion of an act-Avhich pollutes the marriage bed; from thence proceed certain hard feelings,certain deep impressions, which, gradually growing, eventuate in the scandalous ruptures of which the community rarely know the real motive." This is in every respect as hurtful as the vicious practice of solitary vice, although that is comparatively less common among young virgins than among those of the opposite sex. Nevertheless, this is a frequent cause of hysterical symptoms and uterine disease. Stop it at once; there is no burden that a large family of children can impose upon you, be it even poverty and want, as great as the inevitable results of these unnatural habits. The use of caps or tissue coverings, made of thin rubber or gold-beater's skin, are not only suggestive of the licentious- ness of the brothel but their employment causes physical le- sions from their irritating friction to the Avails of the vagina. I have had under my treatment obstinate ulcerations of the vagina which were due to their use, and in one instance it degenerated into cancer. The use of the "womb veil," which originated in France, has been denounced as a fruitful source of ulceration of the Avomb, by modern French writers, who are more familiar with their indiscriminate employment than Americans. There has been also a plug or stem pes- sary employed for the purpose "of sealing up the womb," which is partly introduced into the mouth and cervical canal 98 HOME TREATMENT FOR WOMEN. of the organ; this obviously adds insult to injury, by also irritating the cavity of the womb and exciting inflamma- tion of its lining membrane. There are other devices for a similar purpose, that have the same tendency of irritating and wounding the genitals of the female. There is nothing that could be said, to intimidate some women, by forewarning them of the danger of their preven- tive measures; they will continue to make business for the specialists, and drain the purses of their husbands, but there is a great majority of good, noble, matronly women avIio are pure in heart and mind, that appreciate the value of the in- formation that I impart. What I desire to further suggest, is a preventive measure that is entirely harmless and con- sistent with chastity and cleanliness, for I believe that Avithin certain bounds, a woman has a moral right to limit or con- trol the conception of her womb. But right here the option ceases. If she pushes her measures beyond the portals of the womb, if she employs medicines or mechanical devices to bring around her courses, when she suspects pregnancy or conception, she becomes a murderess in the eyes of the Creator. The bowl of tanzy tea, or any of the many quack nostrums, advertised in the public prints, are as much an instrument of murder as the probe of the abortionist. It would be the height of sophistry to make a distinction between the embryo of an hour or a day old, and that of any future period. The potentiality of a human being is established at the moment of conception, and the destruction of this, at any period, is homicide. No one can deny less importance to the cause, which is conception, than to the effect, AA'hich is the human embryo, for without the one, the other is impos- sible. Hence, not to bear a child implies not to conceive a child, for if once conceived, it must be born. The reasons that may exist for limiting the progeny of each particular pair cannot be formulated into a code, for these are questions of conscience, between the individuals and PREVENTION OF CONCEPTION. 99 their Creator, on the one hand, and on the other, they should be influenced by economic conditions and physical or con- stitutional taints of the progenitors. I do not believe in the truth of the law of Malthus, that there is a tendency for population to increase faster than the means of subsistence, but I am inclined to the view held by John Stuart Mill, that "no one has a right to bring children into life to be sup- ported by other people." But Avhen the same eminent au- thority designates the procreative act as brute instinct, I think he is in great error, for that is not so. Conjugal affec- tion and the sentiment of love spring from the reproductive systems, through the reflex action of the brain, and these have their moral significance, and should not be branded as brutal, for upon their normal functions depends the perpet- uation of the race, and as it was so ordained by the Creator, it cannot be an unholy passion. To be physically strong and well are the prerequisites for happiness, and if Ave cannot transmit to our offspring this essential quality, it \Arould be much better for society if we Avere not instrumental in bringing defective children into the world. The competitive struggle for existence is hard enough for the vigorous and robust; how much greater must it be for the constitutionally infirm? When these con- ditions of infirmity exist, they should influence our course as progenitors; this appears to me self-evident, and I trust in the Avisdom that is innate to the human soul, that only the best ends Avill be subsen*ed. An expedient that is to accomplish the object in view, must be in the nature of a wholesome sanitary measure, that violates no laAV of nature. The inordinate use of any preventive, coupled with excessive indulgence, cannot be without ill effects. Excesses must be studiously avoided, so as not to incur the diseases of which mention has already been made. The employment of a vaginal douche of the proper temperature, medicated with a little pure alcohol, is not injurious and is the most reliable of all preventives, 100 HOME TREATMENT FOR WOMEN. provided it is intelligently used and without delay. The quantity of fluid to be used is a quart of warm water, of 103 to 105 degrees Fahr., to which two tablcspoonfuls of alcohol is added ; of this, three-fourths or all is to be douched through the vagina. The vaginal irrigation is to be undertaken immediately after the act; if sufficient time is allowed to pass, the sper- matozoa will have entered the mouth of the Avomb; then they are clearly beyond the reach of the Avash. The warm water and the necessary paraphernalia are to be held in readiness so as to lose no time in making the toilet, nor should there be unnecessary exposure to the danger of catch- ing cold. The nozzle of the syringe should always be of hard rubber, because that is not likely to rust or corrode. The syringe is to be kept scrupulously clean by means of occasional brushings in soapy water. Vaginal injections should never be taken in the morning, if the person is re- quired to exercise on her feet, and for the same reason, should any husband have marital relations with his Avife before rising in the morning, the wife is likely to suffer all day, either by soreness or pain or by a dragging sensa- tion of the womb and vagina. The same rule is to be followed in vaginal irrigation as for other purposes, the main point being to throw the fluid well up into the vagina, and that can only be done if the nozzle is carried directly backward and not upwards. No violence or force is to be used, under any circumstance. CHAPTER VII. CRIMINAL ABORTION OR FETICIDE. I have so far endeavored to give a cursory description of avoidable causes, which were inadvertantly or thoughtlessly encouraged, and it is to be hoped that my friendly reproof and counsel Avill incite my readers to modify their pernicious habits and direct the currents of their thoughts into chan- nels more or less in harmony with the hygiene that I have been at liberty to suggest. There are few persons, if any, who would voluntarily act and think in a manner that would be prejudicial to their physical or moral Avelfare, if they were educated to a stand- ard of knowledge that gave them an insight into the evil consequences. The law of self-preservation is innate in our natures, so that we are ready to cultivate the good and use- ful and shun that which may do harm. Among the avoidable causes there is none so prolific of disease as that which is traced to the premature expul- sion of the ovum or fetus from the mother's womb. This appears self-evident, when Ave stop to consider that the function of reproduction is at once by far the most com- plicated of the physiological processes of the female economy, so that its sudden interruption Avill naturally induce any one or all of the physical or pelvic ailments which we are called upon to discuss. For our purpose it Avill not be sufficient to consider the subject from a medical standpoint alone, because the thoughts drift involuntarily, as it were, from the physical into the metaphysical, from the material into the spiritual part of our nature. (101) 102 HOME TREATMENT FOR WOMEN. It is not Avithin the scope of this Avork to enter upon an inquiry into the scientific evidence of the existence of the soul or advance any argument whatever in support of that doctrine, but I assume the existence of an immortal soul to be a fact. What I will endeavor to explain is Avhen and where this mystic union of the soul Avith the body takes place? Here the speculations of the medical philosophers have been con- tradictory, on account of attributing to the fetus different kinds of life, that is, an organic or vegetating existence at- tached to the mother's womb, and as such not possessed of sentient principle, until the real or spiritual life imbues the fetus, Avhen it becomes a living soul: Hippocrates, the most famous physician of antiquity, who, even in the light of the nineteenth century, looms up as one of the most brilliant intellects that the world ever had, lent the weight of his judgment to this very unreasonable doctrine. He supposed that animation occurred from thirty to forty-two days after conception. The Stoics went still further and maintained that there was no vitality until after birth and the establishment of res- piration. The Academicians Avere of the opinion, that life was im- parted to the fetus during the period in which the mother carried it in the womb, but they could not agree on the time when it began. Even the Roman Church, which, in the main, is right on this question, speaks of animtde and inanimate fetuses. When it is remembered that there was no scien- tific physiology upon which the ancients based their opinions, it is not at all surprising that, in the light of modern research, they are shown to be all wrong. , There is no time during the child's sojourn in the mother's womb that life is less active than at another, and any opin- ion to the contrary is manifestly absurd and unscientific. I appreciate the distinction between physical life, or vital CRIMINAL ABORTION OR FETICIDE. 103 activity, and spiritual life, but the one must necessarily be in the other. A central fountain of physical force is consistent with scientific deductions, and physicists are inclined to admit such a source. Many of the phenomena of the material Avorld are explained upon this hypothesis. The sun is sup- posed to be that central fountain of physical force Avhich in- spires activity in matter on this planet. Matter in itself is inert and motionless; the globe Ave inhabit has no energy in itself Avhich could keep it in motion, but the forces playing on and around it impart to it its motive power. The life of any complex organism, such as that of man, is in fact the aggregate of the vital activity of all its com- ponent parts, and each elementary part of the fabric has its own independent power of growth and development. If Ave contemplate the history of the life of a plant, we perceive that it grows from a germ or seed to a fabric, sometimes of gigantic size,—it multiplies its species, by the production of germs similar to that from Avhich it originated. This it performs Avithout feeling or thinking or any effort of its own. All the functions of which its life is composed are grouped together under the general designation of organic functions, or vegetatiA'e life. In the building up of the animal structure we have pre- cisely the same operations taking place, one minute cell added to the other, like the stone mason running up a brick Avail, each brick representing a cell, until the structure is completed. The question that Ave are particularly interested in is Avhether this "animal life" which stimulates the growth of the fetus from its first inception, can be any the less sacred at one time than at another? There is a general impression among a large portion of the community that the fetus first becomes endowed with life at the period of quickening, which is betAveen the fourth and fifth month of pregnancy. The time when the mother 104 HOME TREATMENT I'OR WOMEN. first feels the motion is considered the period when the child becomes animated, that is, when it receives its spiritual nature into union with its human nature. The English law recognized the truth of this infamous doctrine, in varying the punishment of an attempt to procure abortion according to whether the woman be "quick with child or not," and in delaying execution Avhen a woman can be proved to be so, though the execution is made to pro- ceed, if she be not "quick," even if she be unquestionably pregnant. This was a most barbarous penal provision and hardly excusable in a savage nation, much less among a Christian people, because it is contrary to all fact, to all anal- ogy, to reason, and at variance with biological science. If the embryo or fetus is simply an animal growing in the mother's womb, until the period of quickening or birth, it would not be a crime to procure an abortion, at anytime, before these events take place. No sacrifice of a human life would be involved, so that the act wrould be simply a "mis- demeanor" regulated by the degree of injury which the mother sustained as a result of the operation. This was the prevailing opinion for many centuries, until, in the year 692, the Roman Empire so amended its law that the procuring of an abortion at any time during the period of gestation was homicide, murder, to be punished with death. France patterned after the Roman laAv for a time and made criminal abortion punishable by inflicting the death penalty; during the French resolution this law a\ as amended by imprisonment for life; and later, under Napoleon, in 1810, the law Avas again changed, and the punishment lessened. In England there has been a gradually growing moral sentiment to protect the defenseless child in its mother's womb, so that to-day England has so amended her laAv that the fetus has the same protection in the uterus before as after quickening, so that a conviction for the procurement of criminal abortion at any time during gestation from con- ception until birth is felony and punished by imprisonment or transportation. CRIMINAL ABORTION OR FETICIDE. 105 In Germany the law makes abortion a State prison of- fense, and public opinion is in such a healthy state there that anyone justly accused of this crime is quite sure to meet with a punishment, In America legislation on this subject differs widely in the different States. In Massachusetts the barbarous dis- tinction, " before quickening and after," Avas still recognized a few years ago, so that the crime of abortion before quick- ening Avas not an indictable offense. In some of the States the laws are stringent and conform with the physiological tacts of fetal life, but, like most of our "good laws," they are observed only in the breach. The essential peculiarity in the process of reproduction is the absorption of a small cell of the male, the spermato- zoon, by another small cell of the female, the ovum. This coalescence of the tAvo, male and female cells, is the fertiliza- tion of the ovum, and constitutes conception. The spermatic fluid of the male holds in suspension a large number of very small bodies, or cells, which, from their usually remaining in active motion for some time after they have quitted the human body, haATe been erroneously con- sidered animalcules. A more thorough familiarity with these bodies, and careful microscopic examinations, can dis- tinguish nothing in the nature of structure "within them. The}r are simply little oval, flattened, transparent cells be- tween the one-six-hundredth and one-eight-hundredth of an inch in length, having a little thread-like "tail," grad- ually tapering to a fine point. These measurements make the spermatozoa consider- able larger than the average red blood-corpuscle, which is one-thirty-two-hundredths of an inch in diameter. The spermatic fluid of a single emission of a healthy male contains thousands of these little ciliated cells, the cilia or tails of which are seen in an active vibratile undulatory motion, in the field of the microscope, Avriggling hither and thither, like a school of frightened fishes. This lashing mo- 106 HOME TREATMENT FOR WOMEN. tion is continued for hours, and under favorable circum- stances for days. In the cases of microscopical examinations of vaginal secretions of married women, for causes of sterility, I was able to establish their activity thirty-six hours after marital relations. Through this peculiar lashing motion the ciliated cells are propelled onward and upward, through the mouth and cervix of the womb, thence along its body to the openings of the Fallopian tubes, along Avhich they migrate to the ova- ries of the female. In a healthy condition of the female gen- erative organs, hundreds of spermatozoa arrive at the OA'a- rics about the same time, a few hours onlays after copulation, but as the ova ripen and are discharged only at regular in- tervals, the hundreds of ciliated bodies that travel thither are doomed to disappointment, and gradually lose their vi- tality, and perhaps are removed by absorption. Of all these hundreds of germs it requires only a single one to combine with an ovum, or a similar little cell of the female, to constitute conception. When this combination has been accomplished, a new being is inaugurated, another hu- man soul is started out, by the magic wand of nature, to go through the different spheres of evolution, of whose ultimatum we can have no clear conception, but this is per- fectly clear, that after this coalescence of the two germs, the die is cast and the female becomes then only the vehicle in which the creative forces are effecting their elaboration. Coition and conception are widely different processes, and require to he separately analyzed to be understood. Coition is always a physical act, a gratification of the senses, and, like many other human passions, is often abused by excessive indulgence, degenerating into lust. Conception, on the other hand, is purely passive, an or- ganic function, without consciousness on the part of the fe- male. Thus far there is a similarity in the organic processes of conception in all mammalia, so that their embryos cannot CRIMINAL ABORTION OR FETICIDE. 107 be classified and assigned to their respective species in the early stages of their development. Physiologists are unable to say whether the one belongs to and will ultimately de- velop into a brute animal or a human being, yet one has the attributes of mental force, the elements of a soul, while the other is to follow a blind instinct, without the possibility of spiritual perception. Conception, in the one case, is simply a vegetative or organic function, while in the other there is, in addition, a spiritual effort to individualize a human soul. The creative energy of nature is separate and independ- ent of the sexual act, for it does not take place during copu- lation of the sexes, nor immediately after it, but hours or days after the act is accomplished. I am often called upon to say when and where the hu- man soul becomes associated with the human body? There is a divine life, or spiritual energy, that animates the soul from the spiritual realm. It is the correspondency of the physical force that animates the physical body. The term or phrase Avhich I employ to designate this force is of less importance than the definition which is given to it, and upon this, of course, Ave must agree. I recognize in such an energy or poAver, the primal cause or force, behind and beyond the phenomena of nature. This force must be universal and omnipresent, hence spiritual; it must be the central source of supply for all spiritual things, so that the doctrine of Paul is scientifically in harmony with a ration- alistic vieAV of the subject, when he says " in Him wTe live and move and have our being." The science of the conservation of forces teaches, that forces are never lost, that they are indestructible and eternal. ' We derive our spiritual existence from this central spiritual sun and inherit the quality of eternity with it. Mind is spirit and the soul is mind: this is the view of Spinoza, who, in the second part of his work " Ethics," employs the terms synonymously throughout the chapter " Of the Na- ture and ()rigin of the Mind or Soul." Mind differentiates 108 HOME TREATMENT FOR WOMEN. man from the inferior animal creations, and can make him what he will. Professor Carpenter in his " Principles of Human Physiol- ogy," tells us, that when avc first discern the primordial cell, which is to evolve itself into the human organism, avc can trace nothing that essentially distinguishes it from that which might give origin to any other form of organic struc- ture. The earliest stages of its development consist in simple multiplication of cells by "duplicative subdivision," so that a mass of cells comes to be produced, amidst the several components, of which no difference can be traced; and this also finds its parallel among the simpler organisms of both kingdoms. There is nothing at this period to dis- tinguish the germs of man from that of any other verte- brated animal, yet in the course of nine short months a human being is developed possessing all the faculties of its progenitor, and hoAV could all this come to pass, if not in- stituted at the moment of conception?. It is at this time and moment, that an atom of the uni- versal spirit becomes separated and individualized, and the germ of a human soul is implanted, deep in the dark re- cesses of nature's laboratory. The ovum of the female and the germ of the male coalesce, imbued by the in- carnation of the immortal spirit, and no time can be more opportune for that union than at the very inception of our being, because the soul and the body must interact, one on the other. In the reproduction of man, there is a higher purpose than simply to multiply the species. The Creator can only manifest Himself, if he has intelligent souls or spirits as his creatures, and the reproduction of the human species is the natural means of bringing this about. The mystic union is accomplished at the time and mo- ment of conception, when a unit of the universal spirit be- comes individualized into a human soul. In the dark recesses of the mother's womb the ovum of the female and the germ CRIMINAL ABORTION OR FETICIDE. 109 of the male, imbued by the immortal spirit, begin their growth and development together, this constitutes the triune of nature, from which the evolutions of body and soul take their beginning. Sexual instinct is not an unholy and depraved action of the human mind, but the necessary means to an end, a fi- nite instrumentality of the Divine mind to procreate the body, as an abode for the human soul. One of the attri- butes of the Creator is, in the very nature of things, to create, and he has thus endoAved us, His creatures, for the manifes- tation of His creative power. He perpetually and eternally creates, and this has no reference to time, place or space: just as in the beginning, God created all things, so Ave rec- ognize the supreme hand, iioav, to-day, and forever, ever active in His natural element. The operation of nature's law may be contravened by the selfish, sordid, criminal acts of the human heart, but it cannot be frustrated. No one can console himself, that the invincible hnv of evolution is at the capricious behest of fi- nite man, and can be neutralized and obstructed at will; that would place a limitation on the Creator; it would con- tradict the omnipotence of the Divine mind; it would place every life or soul at the mercy of the sordid conscienceless abortionist, and it would reduce the Divine origin of man and the soul's immortality to an absurdity. After the fetus is murdered, its soul continues to grow in the spiritual realm, an undying witness of the criminal infamy which deprived it of that earthly experience which nature intended for the children of men. It is the greatest crime against nature to kill off a human fetus, and perma- nently hurl into eternity a human soul, which has the same right to human experience as those already born, and, in the eves of God, it is no less a crime than the murder of an adult. " Dust thou art, to dust returnest, Was not spoken of the soul." k 110 HOME TREATMENT FOR WOMEN. The meaning of the term abortion is etymologically not to be born or not to be carried out, or, in other Avords, the premature expulsion of the fetus from its mother's womb, Avhich is any time before it is capable of independent existence. This is according to the construction of the laAv of France, Avhich means any time previous to the termina- tion of the sixth month of pregnancy. Abortion may be accidental, that is, it may be due to a casualty which was entirely beyond the control of the person suffering or going through an abortion, or it may be due to disease affecting either the embryo or the mother. The word " miscarriage " is generally preferred to that of " abortion " under the misconception that only the latter implies criminal culpability; this, of course, is an error, be- cause each word means exactly the same thing, with this difference, that one is of Latin origin, while the other is a plain Anglo-Saxon term. An abortion that is brought about, from other than natural causes, for the deliberate and avowed purpose of escaping from the inconvenience, privation, and cares of maternity, is always qualified by the adjective crim- inal. In the early months of pregnancy, it very seldom, though it occasionally does happen, that complications arise Avhich place the life of the mother in imminent danger; that the em- bryo shares this danger in a corresponding degree is self- evident, because the fetus is unable to live independently of the mother any time before the expiration of the sixth month of gestation, so that the death of the mother means death to the fetus also. Through a fall, heavy lifting, or a sudden jar, a partial detachment is liable to occur between the placenta of the fe- tus and the wall of the mother's womb, that being the place where the blood of the one is exchanged into the blood of the other; from this, a hemorrhage may result, which will not yield to rest nor to other means which experience has taught to be useful. This loss of blood may be so great that, if it continues, the life of both will be sacrificed. CRIMINAL ABORTION OR FETICIDE. Ill In some women pregnancy may become complicated with convulsions; these may he so violent, and recur so often, as to threaten life, and they are obstinate to all medicinal resources. Contingencies of the above nature evoked the scientific inquiry, whether abortions are ever justifiable. The answer must invariably be, that when it is clearly seen that the mother Avill surely die, and her fetus Avith her, an induced abortion becomes a justifiable obstetric resource, and under tliese circumstances it is not a crime nor even a sacrifice of the embryo, which would haAre perished Avith the mother. This rule of practice has been indorsed by the very highest authority in obstetric science, and the competent conscientious physician aatII readily draw the line between cases where so radical a measure becomes necessary, and where •milder conservative measures Avill save the life of both mother and child. This cannot be a license for crime, except that the sor- didly depraved time server may often try to stretch the threatening danger, but when this is done it is no less a crime of murder in the eyes of God, than if he had premed- itatedly and willfully slain a fellow-being. Such persons would not shrink from the perpetration of any crime, be it ever so heinous and black. These wretches are too cowardly to thrust a poinard into their A'ictims on the highway, but ever ready to operate in secrecy in the abortion chamber, Avhich is hidden from the eyes of man. I have known abortions being sought and abortions being committed, upon the flimsy pretext of being too weak, or too sick at the stomach. These are shalloAv subterfuges, that should not be countenanced by any conscientious prac- titioner. Many reasons are either imaginary or pretended, and I • have often proved the fallacy of pretensions of an inability to carry a child, after women had gone through the abor- tion mills, by persuading them to become reconciled, for 112 HOME TREATMENT FOR WOMEN. the time being, and that I would see them through to a happy end, and in no case were their fears justified by sub- sequent developments. There is a great deal in controlling the minds of these women, and directing them into whole- some channels of thought, and after that they become much happier and contented than ever* before in their married lives. If the proposition is generally accepted, that abortions are justifiable as a therapeutical expedient, you open the door to the criminally inclined. Wily women will impose upon inexperienced practitioners by feigning physical suf- fering as a result of pregnancy, for the purpose of getting rid of their fetuses. There is a certain amount of hardship and discomfort associated with the average pregnancy for a part of the period at least, but this should be suffered with a mother's fortitude. The testimony of the early canons of the Catholic Church is very decisive on the crime of abortion, namely, "that the destruction of the fetus in the womb of its parent, at any period from the first moment of conception, is a crime equal in turpitude to murder." In Protestant countries abortions are on the increase, and in America it is one of the crying crimes of society, which has so thoroughly tainted and defiled the moral sense of American communities, that it has become next to impossi- ble to get a jury of twelve men who will agree on a verdict to punish this dastardly foul crime of murder, and the abor- tionist is thus encouraged in his iniquitous vocation. Professor J. Taber Johnson, of Maryland, stated in his annual oration before the State Medical Society: " The diffi- culty of conviction for producing abortion is shown in the statement of the Attorney-General of Massachusetts, that of thirty-two arrests and trials of abortionists in that State, in a period of eight years, not a single conviction resulted; and this fact is equally true of other States." This is indeed a sad commentary on the jury system, which often degener- ates into a farce or travesty on justice. CRIMINAL ABORTION OK FETICIDE. 113 The practice of abortion is on the increase. This is not due to a single cause, but to a number, operating separately or co-operating jointly to the same end. Boarding-house or hotel life exercises a pernicious influence on the habits and morals of women. They sit all day in their apartments with indifferent occupations, or Avalk the streets between meal hours, Avithout the inspiring thoughts Avhich a cozy home alone can inspire. The maternal instinct languishes or dies completely out, and if women become pregnant while transiently domiciled, they scruple not against com- mitting this great crime, because their surroundings and accommodations may not be suitable for the changed rela- tions AA-hich motherhood brings about. If these people had their oavh little homes, Avere they ever so humble, their minds Avould run in different grooves, their lives would be much happier and offspring longingly desired, to fill the nooks in the little household. Want of domestic training in childhood lays the foun- dation for this crime. The American girl is trained Avith a vieAv to display so-called refined accomplishments. This is done by totally ignoring domestic duties; these are to be shunned as menial and degrading; and when girls grow into womanhood and are married, they naturally look upon the ordinary household duties as drudgery, and quite un- becoming a woman of their attainments. There is nothing in their bosoms to arouse a pride in their homes; quite the reverse; that principle has never been inculcated in their youth, so that it is quite natural, that they hie to a boarding- house ; here they patronize the abortionist, or acquire pro- ficiency in that art themselves, from lack of nobler occupa- tion. Changed relations of the sexes destroy the maternal in- stinct, A man in a man's place, and a woman in the sphere for which God and nature intended her, is for the best interests of society. There is useful and profitable work for everyone, but each should labor in his or her re- 8 114 HOME TREATMENT FOR WOMEN. spective field of natural adaptability, in which there is plenty to do. There is, in tin1 very nature of things, never anything gained b}r a woman doing a man's work, because there are always plenty of men around to do that, but while a woman is doing a man's work, she is necessarily neglect- ing a woman's, which it is physically impossible for any man to do for her. There is, consequently, an irretrievable loss to society from misapplied labor. When the great Napoleon was asked bj Madam de Stael whom he consid- ered the greatest woman in France, his curt reply Avas, " Sic who bore the largest number of children." This is a tribute to motherhood, which no one can ridicule, for whom should we honor and respect more than the faithful, loving mother, Avho makes her life subservient to that of her children? There is no comparison between the self-denial of parental devotion and the devotee to amusements and fashion, or the slothful wife, who imposes sterility upon herself for the sake of pandering to depraved appetites and frivolous pleas- ures. Depraved associates pave the way to i'etieide. Some married women are so brazen and callous, that they have no delicacy in narrating their exploits of child murder with a triumphant air, whenever their acquaintances are patient and foolish enough to listen to them. These gad- ding persons often contaminate the minds of ncAvly-married women, who had never for a moment entertained the thought of such an awful crime, and who would have made happy and contented mothers, were it not for the seeds of discontent and crime which were sown in their early mat- rimonial career. I have known mothers who had lost the delicate maternal instincts, without which a mother becomes a monster, advise their daughters and encourage them in the perpetration of this crime. Women of this type should be avoided like the dreaded mancanilla tree, for they poison the bod}' and soul of pure, virtuous women, Avith whom they come in close contact; CRIMINAL ABORTION OR FETICIDE. 115 they should be shunned by the young housewife like a pes- tilence, because their hands are scarlet with the blood of their own children. Unprincipled physicians are too often instrumental in abetting criminal abortions, and this for two reasons, namely, for the immediate lucre which is to them in hand paid, and also for ingratiating themselves into the confidence of their patrons, so that they may become their physician in other ailments. These are the pariahs of the profession, but, viewed from a business standpoint, they are very successful. It is through the looseness with which medical colleges are conducted in this country, many of them not deserving the name of college, but more properly denominated a rendez- vous of self-constituted professors and ingenious advertising sharps, that the ranks of the profession are overcrowded, be- cause there is no scrutiny of moral character or professional attainments. These once labeled M. I)'s are determined to make a professional living, and nothing deters them from becoming particeps criminis, but OAving to the corrupt and depraved jury system such a thing as punishing a physician for feticide is hardly ever heard of. I would advise my readers to shun each and every one of these criminal mon- sters as they would a pestilence. In general, "female spe- cialist" is but another name for abortionist, for the great majority of these self-constituted specialists do not know the rudiments of the science of gynecology; and Avomen should exercise great precaution in whose hands they place themselves, or, rather, their lives. I know of no calling that is capable of rendering more good to humanity than the profession Avhich I have made my OAvn. The honorable physician occupies a position where he can do a great deal to improve the tone and morality of the community. He can do more than the pulpit in prevent- ing feticide, because he can depict the physical dangers and the moral turpitude, for it is to him that the deluded Avoman first goes for advice. It is Avith him to become an oracle of 11 (> HOME TREATMENT FOR WOMEN. heaven; in the great majority of instances he can be instru- mental in saving human life and prevent the mother from murdering her oavii child. Maternity is the function of Divinity in human nature. Who can look upon a neAvly-born babe without seeing some- thing truly Divine, a manifestation of the Divine mind to create in his image, through the instrumentality of man, an innocent human flower, planted upon this earth to enjoy the fullness thereof, and what-miscreant shall deny it its inher- itance ? That husbands are often the instigators of this crime is a fact well known to every physician of experience. I have known of a number of cases where wives came to my office with a woful tale of discontent on the part of their hus- bands, who did not want an " increase." Such men are not worthy the name of father or husband. They should have been emasculated before they ever approached the marriage altar, for they are below the brute creation and have no claim on human affections. The luxuries of life should not be considered as Aveighing against the birth of children, nor the expense of maintaining a large family considered as an excuse for feticide; expenses had better be reduced and econo- mized in other directions, so as to meet the little extra in- crease, which the little stranger may cause. It is a fact, that among thrifty people, large families are no barrier to mate- rial success, for the blessedness of heaven rests upon them. I invariably solicit an interview with the recalcitrant spouse, and take the opportunity to tell hinTof the responsi- bilities Avhich married life imposes upon married couples; that the simple gratification of the carnal senses i< lust, which can and should be controlled by every person, and more in particular by married men. Matrimonial relations based only on libidinous pleasure are transient and eva- nescent ; incompatabilities arise, which cause conflict and dissension, ultimating in estrangement and divorces, but when soul is wedded to soul, then they are in harmony with CRIMINAL ABORTION OR FETICIDE. 117 the music of the spheres, and children constitute the cement of an eternal wedlock which no man can rend asunder. Abrupt termination of pregnancy constitutes in itself a diseased process in the tissues of the womb. We have al- ready learned of the gradual growth of the body of the womb to accommodate the growth of the child; A\4ien abortion takes place there is a sudden check to this groAvth in the tissues of the womb, and a Ioav grade of inflammation in- vades the entire structure. This inflammatory process fixes or hardens the womb so that this acquired enlargement often becomes permanent. The result is, that women can often trace the beginning of a long series of complaints and a shattered constitution to a so-called miscarriage. For this reason, the after-treatment of an abortion is of much greater importance, than after a regular normal delivery. After the close of a natural gestation, the child is born, and nature immediately sets to work to restore the Avomb to its healthy normal size. Xo violence having been done to the organ, there is no extra effort necessary on the part of nature to restore it, In a premature expulsion of the fetus, it is altogether different, the cell growth and the necessary physiological action to build up the womb, to house the rap- idly-developing fetus, Avas suddenly interfered with, and the shock Avhich the vital activity sustains, diverts their ener- gies into a diseased process. Inflammation is to be guarded against, for it constitutes the root of all pathological condi- tions; chief among them is its prevention of fatty degenera- tion and absorption of the superfluous tissues of the organ, so that the womb remains heavy and enlarged. This en- tails a series of consequences; its size and Aveight may force it to occupy an unnatural and painful position, such as a falling of the womb or procidentia, or it may turn or even bend on itself into abnormal positions, called versions and flexions; these become obstinate to treatment in proportion to the time which elapses from the occurrence of the disease to the time when they fall under proper treatment. 118 HOME TREATMENT FOR WOMEN. Inflammations are limited sometimes to only portions of the organ; this may be to the lining mucous membrane of either the body or neck. It may also invade the entire or- gan and even extend to the neighboring tissues and liga- ments. From the uterus along the Fallopian tubes to the ovaries inflammation may spread itself, causing abscesses in its Avake and other complications which may require surgi- cal skill of a special nature to give permanent relief Sterility is often the result of disease caused by abortion, and this should be another warning to thoughtless, giddy women, who desire no children in their early married life, because it Avonld interfere Avith their regular pleasure rounds, and so resort to abortions, which will, in all probabil- ity, make them entirely unfit to ever become pregnant or bear cliildren. I ha\Te made an attempt to impress on the reader tAvo things; one of these is the flagrant violation of or- dinary and simple rules of health, the other the enormity of the crime of induced abortions, and to accomplish this I have a\Toided screening the subject by employing ambiguous or finely-selected phrases, but have used plain terms which will not shock the pure or noble in heart and mind, but may the hypocritical, under the gauze of a false modesty. PLATE I. The Bony Pelvis in its relation to the entire body, From the author's orig-inal drawing. CHAPTER VIII. ANATOMY OF THE FEMALE ORGANS. The bony part of the skeleton which is of particular interest to women, is the pelvis, so called, because it forms a basin or cavity Avhich contains the most important female organs of generation. All the organs that are liable to the diseases of women, bear certain anatomical relations to the pelvis, so that the phrase, pelvic diseases of women, is often employed instead of the phrase, diseases of women, and pelvic surgery means also, surgical procedures, that may be employed for the relief or cure of these diseases. In confinement, the pelvis again comes into more or less prominence, for when the diameters of the pelvic canal have not their normal measurements, there is likely to be an ob- struction to the passage of the child into the world, so that mechanical means must be employed to overcome the obsta- cle. A broad pelvis in a woman is always a guarantee that there will be no insurmountable difficulty in the parturient act. Plate I shows the shape and locality of the bone in the human body, and gives also an approximate idea of the relation of the pelvis to the rest of the body. While the pelvis was referred to above as a basin or cavity, this'isonly partly true, for it is also a canal or pas- sageway, through Avhich the child is born. The pelvis is divided by a prominent line into the false and true pelvis. The False Pelvis is all that expanded portion of the pelvic cavitv which is above the rim or line that forms a (119) 120 HOME TREATMENT I'OI! WOMEN. circular ridge, wnich marks the beginning of the bony canal to Avhich the term true pelvis is applied. The True Pelvis constitutes the lower subdivision of the pelvic cavity. The circular ridge, which marks the division, constitutes also the inlet of the true pelvis, which is much smaller than the upper or false pelvis. Its Avails are more perfect and their lower circumference is very irregular and forms Avhat is called the outlet. Between the inlet and the outlet we have what is called the true pelvic cavity, in Avhich the internal female generative organs are contained. These organs are located in the following order from before backwards: first, behind the pubis there is the bladder, and behind this is the uterus, and thirdly and a little to the left is the rectum. On each side of the womb, but also in the small or true pelvis, are the Fallopian tubes and ovaries. In this order the anatomical relations are easily remem- bered, and I believe that every woman should make it an object to learn at least as much of her own anatomy as I have laid down; because there is just little enough, so as not to make it tiresome, and quite enough to insure intelligent reading in the subsequent chapters. The points of differences between the male and female pelvis are entirely on the principle of adaptation to natural functions. The female pelvis has a broadness or greater prominence of the hips and a correspondingly greater pelvic cavity, Avhile that of the male is altogether more massive. Its cavity is deeper and narrower, and the muscular eminences and impressions^on the surfaces of the bones are much stronger marked. Plate II. This illustrates a cut or section, through the middle of the pelvis, from before backwards, so as to give a side view of the capacity of the true pelvis and of the organs that it contains. A careful study of this plate will per- manently fix the anatomy in the reader's mind. The lines a and b show the planes of the inlet and out- PLATE 11. A Median Section of the female Pelvis and of the Organs that are centrally located. This plate is anatomically correct; the uterus resting normally on and being elevated by the distended bladder. ANATOMY OF THE FEMALE ORGANS. 121 let of the true pelvis, and it will be seen that Avithin these lines the most important organs of the female are located. THE BLADDER. The bladder is situated at the anterior part of the pehns. It is in relation, in front Avith the sympltysis pubis, behind with the womb, some convolutions of the small intestines being interposed; its base lies in contact with the neck of the uterus and with the anterior Avail of the vagina, The bladder is said to be larger in the female than in the male, and is very broad in its transverse diameter. THE URETHRA. The urethra is a narrow membranous canal, about an inch and a half in length, extending from the neck of the bladder to the external orifice. It is placed beneath the symphysis pubis, embedded in the anterior wall of the vagina, and its direction is obliquely downwards and forwards. Its diameter, when undilated, is about a quarter of an inch; behind the bladder and urethra, there is in regular order the uterus and vagina, and behind both of these, the rectum. THE PERINEUM. The Perineum is the muscular triangular body between the vagina and rectum; it constitutes a segment of the female pelvic floor; it is the prop for all the pelvic organs, and for that reason every woman should knoAV precisely what it is, and study the plate carefully until she understands it. The skin covering it is of a dark color, thin and freely movable over the underlying parts. There is no part of the pelvic anatomy so vulnerable, because in confinement during the passage of the child's head into the world, the perineum is put on a great stretch, and if the delivery progresses too quicklv or is hurried, then the tissues have no time to stretch themselves so as to accommodate the child's head, and they must naturally tear. The awkward and officious use of instruments will do the same thing. I have seen the perineum torn asunder from this cause, from the vagina and back into the rectum. •122 HOME TREATMENT EOR WOMEN. Plate III is one of the most instructive draAvings that I could devise. It gives the reader a practical illustration of the internal generative organs and their anatomical re- lations to each other. This was a drawing from my own dissection, and the clearness and artistic reproduction is due > to the skill of the engraver, Mr. H. X. Van de Casteele, of this city. the vagina. The vagina is a membranous canal, extending from the vulva or intra it us to the uterus. It is situated in the cavity of the pelvis, between the bladder in front and the rectum behind; its direction is not in a straight line, but curved from below backAvards and upwards. When distended it is cylindrical in shape, but naturally it is flattened from before backwards, so that its Avails are ordinarily in contact with each other. In length it averages about four inches in its anterior wall, while its posterior wall describes a segment of a larger circle, that makes it between one and two inches longer. At its commencement it is constricted, and at its upper extremity, where it is attached to the womb, it is dilated, so as to surround the vaginal portion of the neck of the womb (see Plate III, c) this is a short distance above the mouth of the womb. The attachment extends higher up on the posterior than on the anterior Avail of the womb, which makes the posterior lip of the womb longer than the anterior. The mucous membrane is continuous above Avith that covering the vaginal portion of the uterus; beloAv it begins at the vulva. Running longitudinally along the anterior and posterior Avails are distinct ridges or raphe; these are the columns of the vagina. The relations of the vagina to the neighboring organs can be studied to better advantage by referring to Plate I. Its anterior surface is concave, and is in relation with the base of the bladder and with the urethra. Its posterior surface is convex and connected to the anterior Avail of the rectum for the lower three-fourths of its extent, the upper PLATE III. The Vagina slit open to the neck or Cervix of the Uterus, showing the insertion of the latter into the former. From the author's own design, beautifully illustrating: a. Fundus (or Base) of the Uterus. b. Uterus' Body. r. Cervix, or Neck. d v. Vaginal part, forming the Anterior and Posterior Lips. /". Mouth of the AA'omb. iff. Interior of Vagina, illustrating the nn. Fallopian Tubes Vaginal Folds. oo. Ovaries. h. Perineum. it. Round Ligaments. ti. Broad Ligaments. //. Uterine Vessels and Nerves. mm. Fringed Extremity of the Fallopian Tubes. ANATOMY OF THE FEMALE ORGANS. 123 fourth being separated from the tube by a fold of the,perito- neum, the recto-uterine fold, which forms a cul-de-sac betAveen the vagina and rectum. Its sides give attachment superiority to the broad ligaments, and inferiorilv to the Levatores Ani muscles and recto-vesical fascia. THE UTERUS OR AVOMB. The uterus is the organ of gestation, receiving the fecun- dated ovum in its cavity, retaining and supporting it during the development of the fetus, and becoming the principal agent in its expulsion at the time of parturition. In the vir- gin state it is pear-sliaped, flattened from before backwards, and situated in the cavity of the pelvis, between the bladder and the rectum. It is retained in its position by the round and broad ligaments (Plate III,/?' and kk) on each side, but also by virtue of its anteverted position, and by the vagina and perineum. Its upper end or base (a) is directed upAvards and forwards; its lower end, or apex, is directed downwards and baekAvards in the line of the axes of the inlet of the pelvis. It therefore forms an angle with the vagina. The uterus measures about three inches in length, tAvo in breadth at its upper part, and an inch in thickness, and it Aveighs from an ounce to one and a half ounces in its healthy con- dition. The fundus or base is the upper broad extremity of the organ («); it is convex, covered by peritoneum, and placed on a line below the level of the brim of the pelvis. The body (b) gradually narrows from the fundus to the neck. Its anterior surface is flattened, covered by peritoneum in the upper three-fourths of its extent, and separated from the bladder by some coils of the small intestines; the lower fourth is connected with the bladder. The posterior surface of the body is convex, covered by peritoneum throughout, and separated from the rectum by some convolutions of the intestines. Its lateral margins are concave and give attachment to the Fallopian tubes (n), above. 124 HOME TREATMENT FOR WOMEN. The round ligaments (/) are attached below and in front of these, while the ligaments of the ovaries (o) are attached be- hind and below these structures. The cervix or neck of the womb (c d e) is the lower rounded and constricted portion of the uterus; around its circumference is attached the upper end of the vagina, which extends upwards a greater distance behind than in front. At the vaginal extremity of the uterus is, in the virgin womb, a round, but after childbirth a transverse aperture, the os uteri or mouth of the womb, bounded by two lips, the anterior of which is thick, the posterior narrow and long. THE FALLOPIAN TUBES. The Fallopian tubes, or oviducts (n) convey the ova from the ovaries to the cavity of the uterus. They are tAVO in number, one on each side, situated in the free margin of the broad ligament, extending from each superior angle of the uterus to the ovaries. Each tube is about four inches in length; its canal is exceedingly minute, and commences at the superior angle of the womb by a minute orifice, the os- tium internum, or internal mouth, Avhich will hardly admit a fine bristle; it continues narrow along the inner half of the tube, and then gradually Avidens into a trumpet-shaped ex- tremity, which becomes contracted at its termination. This opening is called the ostium abdominale, or abdominal mouth, because it communicates freely with the abdominal cavity. The margins of this extremity are surrounded by a series of fringe-like processes, termed fimbriae, and one of these proc- esses is connected with the outer end of the ovary. This part of the Fallopian tube is called the fimbriated or fringed extremity (m). THE OVARIES. The ovaries are analogous to the testes in the male. They are two oblong flattened and oval bodies, situated one on each side of the uterus, in the posterior part of the broad ligament behind and below the Fallopian tubes. Each ovary ANATOMY OF THE FEMALE ORGANS. 12") is connected, by its anterior margin, to the broad ligament, by its inner extremity to the uterus by a proper ligament of the ovary, and by its outer end to the fimbriated ex- tremity of the Fallopian tube by a short ligamentous cord. The ovaries are of a whitish color, and present either a smooth or a puckered uneven surface. They are each about an inch and a half in length, three-quarters of an inch in width, and about a third of an inch thick, and weigh from one to two drams. CHAPTER IX. MENSTRUATION AND MENSTRUAL, DISORDERS. The first appearance of the menses marks an epoch in the life of the girl which ushers in womanhood. It is the harbinger of the fruit fulness of the maiden, whose limbs now become rounder, and her hips widen out, Avhile the broasts increase in size and the entire aspect undergoes pe- culiar changes, which all point to the approaching condi- tion of maturity. The term is derived from the Latin plural menses, meaning month, from moon, and it is an actual fact that the lunar forces seem to influence this physiological function, inas- much as it recurs every four weeks; most women menstru- ate during the first quarter, and only a very few during the new or full moon. During infancy and childhood, the sexual system of the female is inactive. The menstruation begins, in a temperate climate, about the fourteenth or fifteenth year of life, and ceases at the age of forty-five or a little later. The climate exerts a marked influence in determinating the first appearance of menstruation, which is further in- fluenced by the conditions of life and society in which the child is brought up. The diversity in the ages at Avhich children menstruate in different countries cannot be laid to any constitutional pe- culiarities of the races. Observation has established that, when children of the same race and family are brought from a hot to a colder climate, the advent of the first menstruation changes. These girls menstruate not so young as their older -sisters, but begin about at the same age as those who are born in the colder climate. (i-'ii) MENSTRUATION AND MENSTRUAL DISORDERS. 127 In hot countries, for instance in Africa, the negroes and girls in East India begin to have their periods at the age of ten to twelve years. In Sweden and Norway the average age for the first menstruation is sixteen, while further north, in Lapland, the ages vary from eighteen to twenty years. Xext in order of importance, influencing the menstrual epoch, are the surroundings and food. In the same climate there are differences in the ages of children that are entirely due to these causes. Children who are pampered and Avho are nurtured in ease and luxury menstruate earlier than those of the poor or even of the middle class, who are brought up in habits of industry. We observe again a difference in the ages betAveen those who are reared in the country or rural districts and the dwellers in the cities, whether it be in luxurious apartments or in tenement houses. The former grow older and stronger than the latter before the show begins. The temperament also greatly influences the development of the function; children who are nervous, irritable, and of a sanguineous temperament, menstruate earlier than those of sedate habits. The color of the hair and complexion are also indices of the respective appearance of the menses in the brunette and b'onde. It has been observed that the dark-complexioned girls menstruate sooner under similar conditions than the blondes. Weakly children, who are delicate from some con- stitutional habit, or whose organism has suffered from dis- turbances of indigestion or suffered severely from teething in earlv childhood, menstruate earlier than their stronger and robust sisters. The quantity of the natural menstrual discharge, as well as the time or duration, varies greatly in health with differ- ent individuals. We first notice a slimy discharge, which soon becomes tinged with blood, and after one or two days it is almost of pure blood. The flow generally lasts three or four davs, very seldom only one day, and sometimes a week to ten days. 12s HOME TREATMENT FOR WOMEN. The monthly recurrence of the menstrual periods averages thirty years; intemperate climates it may overreach this fig- ure a little, while in hot climates it comes much below this average. It does not follow as a rule that because a woman began to menstruate quite young, the change of life will take place earlier. This also depends much upon temperament, habit and mode of life. Physiologists have established, by carefully-prepared sta- tistics, that the average period of menstruation for women who began to menstruate early is thirty-three years, while those who commenced late have' an average of only twenty- seven years. When a woman is forty-five years of age, we may, how- ever, as a rule, look for the change of life to set in; if she goes beyond this age, she may be taken as the exception. The cavity of the womb is the principal source from which the blood comes; while the ovaries and tubes are also greatly congested with blood, the amount that comes from them must be very small. The blood that comes from the womb is not different from blood coming from any other source; the changes and peculiarity of the menstrual show are due to its passage through the vagina, where it becomes contaminated with vaginal secretions. It is supplied from the blood-vessels of the womb| oozing through the mucous membrane of that organ, just as in a case of nosebleed. The entire womb is more or less swollen, and more especially the mucous lining, so that it corre- sponds, in many instances, to an inflammatory process, and for that very reason, a sudden check of the menstrual Aoav Avill often result in a regular subacute or acute inflam- mation of the womb. If the discharge of blood from the uterus' is in small quantities and a gradual, steady flow, it becomes so altered by the secretions in its passage through the A'agina that it does not coagulate, but when it is poured MENSTRUATION AND MENSTRUAL DISORDERS. 129 out more rapidly or in larger quantities, the menstrual blood coagulates or congeals in the same manner as if it Avere derived from other sources. If a Avoman becomes pregnant, the menses as a rule are suspended during the child-bearing period, and usually re- main absent after the child is born so long as the woman nurses the child. I have known one Avoman Avho menstru- ated during her entire pregnancy, and another who had had eight children and never menstruated in her life, yet she Avas, and always had been, in perfectly good health: thus we see, that there is no rule without exceptions. An essential part of the menstrual function is that in which the ova or female germ cells ripen and are expelled from the ovary. The menstruation is only a reflex or side issue, to a more important part that is going on in the fe- male generative system; this is termed ovulation, or the rip- ening and expulsion of the human egg from the tissues of the ovaries. In the physiological process that operates in the economy of nature for reproduction, the ovaries are the prin- cipal organs. The other organs are simply accessory, and indeed many of the lower animals have no other organs than the ovaries for the perpetuation of their species. In the human female, the ovaries consist of a tough fi- brous tissue, between whose meshes are little cysts, which are called (iraajian vesicles, and these little vesicles serve as the nests in which the ova or little germ cells mature.. These ova Avhich are imbedded in the Graafian vesicles are so small that they can only be seen by a high magnify- ing poAver. The activity of the ovaries begins at puberty, and ceases with the change of life, or menopause. The approach of the menses is signalized by a certain group of symptoms, Avhich clearly indicate a congestion of the pelvic organs. There is generally a drawing sensation in the back and thighs, and a sensitiveness upon pressure in the regions of 9 130 HOME TREATMENT FOR WOMEN. the ovaries and the womb. There is a feeling of lassitude and weakness of the limbs, sometimes hot flushes changing off Avith chills, and often a feverish condition, which will last until the flow is fully established. Professor Dalton says: " In many birds, for example, the plumage assumes at this period more varied and brilliant colors; and in the common fowl the comb or ' crest ' en- larges, and becomes red vascular. In the American deer, the coat AA'hich, during the first year is mottled with white, becomes in the second year of a uniform tawny or reddish tinge. In nearly all species, the limbs become more com- pact and the body more rounded; and the whole external appearance is so altered, as to indicate, that the animal has arrived at the period of puberty, and is capable for repro- duction." In the human subject, the child now becomes conscious of the sexual instinct, however chaste or virtuous her mind, for we must not dull our intelligence with the idea that the sexual function is unholy; it is no more so than to say our prayers; so that an additional duty is now incumbent upon mother^or guardian. The child must be made to know that she must be more reserved and guarded in her relations with the male sex; that she no longer can romp or play on the knees of male friends or visitors, and that it is dangerous and unbecoming to be left alone with them. A little later on, she must be apprised that she too may become a mother, and that that would be a great disgrace for one so young and not married. The child thus learns to protect herself against the insid- ious smiles and snares of the seducer, for he is ever abroad, and often family friend and trusted adviser. There are beings Avho are men in form only, but at heart are black villains, and selfish brutes. When the mis- chief is done, then it is too late to repent of a mother's neg- ligence, or to bewail a child's disgrace and man's perfidy; the three combined make one of the most distressing scenes that it has ever been mv misfortune to behold. MEXSTRUATIOX AXI) MENSTRUAL DISORDERS. 131 Successive crops of vggs ripen, and are discharged by the adult female at each menstrual period. I have already said that the ovum is contained in the Graafian vesicle, in Avhich it grows and matures, as the fruit ripens on a tree, so the Graafian vesicle gradually ripens for the expulsion of the ovum, which gradually makes its way to the surface of the ovary. Within the Graafian vesicle the serous fluid accumulates, so that it ruptures and discharges its little ovum, which is taken up by the fringed extremity of the Fallopian tube, and carried, along the ovi- duct into the womb, from which it escapes into the vagina, and is lost, provided conception has not taken place. Investigations have been made as to the number of ova certain mammalia discharge, and it has been found to cor- respond with the number of young that the animal pro- duces at birth. Where a litter consists of from three to twenty, as in the bitch and the sow, a similar number of eggs ripen, and are discharged at the period of cestruation. In the cow or mare, and in the human female, as a rule, only one egg is discharged at each period of ovulation. The discharge of ripened ova does, however, occur in ex- ceptional cases without any sign of the menstrual show, and the person may be susceptible to conception, so that we may reasonably infer, that ovulation constitutes the most impor- tant function of the menstrual period. MENSTRUAL DISORDERS. These are designated by different terms, not because each name signifies a particular disease, but simply an indefinite symptom of a diseased condition. In other cases menstrual disorder may produce symptoms that are common to Avidely different diseases. In other words, the phrase menstrual disorder, without being qualified as to its particular cause, means, from a practical standpoint nothing upon which a treatment can be intelligently based. Not any more than a cough which is simply an irritation of the bronchical nerves, 132 HOME TREATMENT FOR WOMEN. and may be due to a bronchitis or pneumonia, or it may not be due to any pulmonary affection at all, as, for instance, in the case where an aneurismal tumor presses on the bron- chial nerves, and excites severe paroxysms of coughing. A great many menstrual disorders are due, not to any disease of the generative organs, but to an affection of the nervous system. Menstruation may be precocious in some girls, and if the discharge is not accompanied with the usual symptoms of backache and some of the other symptoms that charac- terize the normal appearance of the menses, or if the girl is otherwise not fully developed, and has in this climate not reached her twelfth or fourteenth year, it constitutes a sign of a.disease. If, however, the show recurs at certain inter- vals, it is not to be considered with the same degree of apprehension that it would be if it recurred at irregular intervals. The sanguineous discharge Avhich shows itself at the genitals during an acute attack of an infectious disease, has no relation Avhatever Avith the menstrual function; this may take place in children at any early age. We often see girls Avho are not yet thirteen, Avho still wear short clothes and go to school, that menstruate regularly, but Avith this precocious menstruation there is also a corre- sponding development of the body which gives them a womanly appearance. Such girls should not be permitted to expose themselves to the inclemency of the weather, because they are much more liable to take cold, which may result in inflammations, than girls in whom the menses have not appeared. Girls of a scrofulous taint or other hereditary habits of constitution, often begin to menstruate prematurely; out- door exercise and cod liver oil with cold sponging on retiring at night are the proper resources for building them up. AMENORRHCEA. This term is employed for the purpose of designating an MENSTRUATION AND MENSTRUAL DISORDERS. 133 absence of the menstrual flow in persons Avho are old enough to menstruate, and in whom there is no physiological reason for its suppression, such as being too young, after the change of life, or during pregnancy and Avhile nursing the child on the breasts. We find this disorder of the natural function of men- struation more among the women of the rich and affluent whose lives are spent in indolence and luxury; this is to be ascribed to lack of sufficient exercise to stimulate the nervous and sanguineous systems to the performance of their healthy functions. The amenorrhcea, or a retarded menstruation in young girls, is oftener the result of a general debility than of a dis- ease of either the Avomb or OATaries. "We have here again about the same causes playing their pernicious role as in precocious menstruation in weakly children; that is, that the same causes produce directly opposite results. The scrofu- lous and hereditary taints always interfere Avith the proper and healthy development of the system; in amenorrhcea they appear to be a hindrance to the formation and growth of the red blood corpuscles. In some girls the suppression of the courses appears to be a Avise conservative provision of nature, because the girls are already so weak and bloodless that even the loss of a very small amount would only in- crease the anaemia, so that in these cases it is not so much a question of " bringing on the courses " as of building up the constitution, and enriching the blood in order to bring about the desired result. Chlorosis, or the green sickness, is not simply an anae- mia or a bloodlessness, but a physiological incapacity of the system to prepare the required blood cells for the san- guineous fluid, and this is, indeed, the most frequent cause of the disorder under consideration. Chlorosis is a disease that is peculiar to the female sex, beginning as a rule at the ao-e of approaching puberty, between the fourteenth and twentieth year, so that there appears to be a physiological 134 HOME TREATMENT FOR WOMEN. relation between the blood genesis on the one hand, and the development of Avomanhood on the other. In some cases we can trace the impoverished condition of the blood to unhealthy dwellings, impure air, want of exer- cise, improper diet, nervousness, the reading of exciting, am- orous novels, and the practice of masturbation or self-abuse. On the contrary, the disease is often developed under the most moral and exacting discipline and hygienic surround- ings. I have known girls who lived in the country, enjoyed horseback riding, ate nutritious and wholesome food, and Avhose solitary moments Avere beyond suspicion, yet at the age of puberty they commenced to fade in color, and fail in strength, gradually growing paler and weaker, until they be- came chlorotic and bloodless. This can only be explained on the theory that the period in which nature Avas preparing the system for the purposes she had in view, caused a shock to the nervous system, which so disarranged the functions that the sanguineous system did not respond to the growth of the generative system. Then there is another class of cases, where girls men- struate before they are old enough, and without their bodies showing any visible evidence of developed womanhood, who belong to the most obstinate cases for successful treatment. The relative diminution of the red blood cells to the healthy standard is in some cases truly alarming. In the average healthy blood, there are, in one thousand parts of blood, one hundred and thirty parts of red blood cells; this falls to sixty, and even forty parts in the thousand in the chlorotic patient. It is one of the peculiarities of this disease, that while the muscular tissue wastes away, the fatty tissue is not only preserved, but it sometime increases, so that in a family of several girls, the chlorotic girl is considered the lmmt fleshy] but as fat is not flesh, the appearance is deceptive. When we stop to think a moment, that the red blood cor- MENSTRUATION AND MENSTRUAL DISORDERS. 135 puscles are the messengers Avhich absorb the oxygen in the lungs during the respiratory movements, and carry it to the different organs and tissues of the body, Avithout which all tissue change would cease. And that the same red blood cells must return again to the lungs for exhaling the car- bonic acid, one of the Avaste products of tissue groAvth, then the diminution of the red blood cells in the proportion above given, must affect the entire system very injuriously. This is indeed the case; the natural respiratory move- ments are insufficient on the slightest exertion, so that patients tell us that when they walk a little fast, go up the stairs, or even sweep the room, they feel a shortness of breath. There are other symptoms that point to carbonic acid poisoning, which it Avill be interesting to review. A great majority of these symptoms are to be found in every case of chlorosis. The muscles become Aveak at first, because their nutrition is interfered with, and they Avaste away, and sec- ondly they become irritable from the poisonous presence of the carbonic acid, and so are often very painful. The patients are easily tired out; some, indeed,feel tired all the time,get- ting up in the morning as worn out as Avhen they retired at night. The nervous system suffers as much, because the princi- pal nerve food is oxygen, and if there is no blood, there can be no oxygen; a starved nerve is a painful nerve. We find neuralgias, affecting the different parts of the body, the rule; when these are located in the external muscles, they are eaisily recognized, but Avhen located in the deep organs, as the ovaries or the womb, they are generally mistaken for something else. The nerves of these individuals being in such an irritable state, it is natural to infer, that hysteria is often to be found as one of the complications, so that habit- ual sadness, and abnormal longings after chalk, lead pencils, and other indigestible articles are prominent symptoms. The circulatory system suffers derangements that are 136 HOME TREATMENT FOR AVOMEN. characteristic of chlorosis. Palpitation of the heart is a prominent symptom ; this is partly due to the irritation of the carbonic acid on the cardiac nerves, and partly to sensi- tiveness of the patient, owing to a morbidly-increased sensi- bility Of the whole body. Chlorotic patients blush up at times, only to be folloAved by a green paleness that is pecul- iar to the disease. Pain in the region of the heart, and dis- turbances of the digestion, are sometimes prominent symp- toms. There is no feeling of hunger; eating is not so much from hunger, but more from a sense of duty to keep up the strength. A heavy or full feeling is often experienced after a meal, and a sourish eructation will give relief to the op- pression, because the walls of the stomach are relaxed and in sympathy with the general debility. But in all cases of chlorosis the sexual functions are the seat of the greatest disturbance; amenorrhcea or the sup- pression of the menses is the most prominent symptom. The ovaries no longer seem to expel ripened ova, for there are no indications that point to their activity, because there is not only an absence of the show, but also an absence of the other signs that were noted when we considered menstru- ation and ovulation. There are a great many other diseases of which amen- orrhcea is a prominent symptom; these will be referred to when separate diseases become the subject of special inquiry. The treatment of amenorrhcea is, indeed, in the great majority of cases, the treatment of chlorosis, and that should be conducted on common-sense principles. If the child has vicious practices, the}*" must be corrected, and everything else that has been mentioned as a cause must be abandoned. Children who Avere once robust and strong require electrical treatment, while those who were naturally weak require nourishing food and tonics. If there is in the entire phar- macopcea a remedy that deserves the name of a specific, it is to that one which I suggest in amenorrhcea due to chlorosis or anaemia. Iron preparations are very numerous; every MEXSTRUATipN AND MENSTRUAL DISORDERS. 137 physician has his favorite prescription; some are to be praised more for their elegance and flaA-or than for any virtue that they possess. If in tliese cases any positive and decided re- sult is to follow the administration of iron, it must be given in such a mild form that it can be taken in great quan- tities without irritating the stomach or interfering with di- gestion. If the contents of the Avhole alimentary canal are saturated or impregnated with the ferruginous medicine, there will be astonishing curathre effects. I have often observed chlorotic cases who have made the rounds of the different iron springs, and who have taken the numerous and various fancy elixirs, Avithout the slightest perceptible effect, bloom up, after being fed, so to speak, on some harmless iron preparation, Avhich Avas astonishing to themselves and surprising to their friends. The follow- ing is my faA'orite prescription for chlorosis or anaemia: NO. I. Take: Powd. Carb. of iron, sacch. (Germ.)...... 1 ounce Powd. Aloes..........................20 grains PoAvd. Tragacanth.....................20 grains Mix Avith sufficient A\rater to make into a hard mass and divide into one hundred and fifty pills, and roll in pow- dered cinnamon. Take three pills three times a day and after three days increase to four pills at one dose three times a day, then after another three days increase to five pills as many times a day as before; if these doses are not at first borne, begin with less, and if there is no costh^eness or tendency thereto, omit the aloes. If there is reason to believe that the impoverishment of the blood is partly or Avholly due to scorfulous taints, then it is advisable to take fresh, pure cod liver oil in conjunction Avith the iron pills; three boxes of pills are, as a rule, necessary to effect a cure. It happens quite often in chlorosis or anaemia that there is a distressing dvspepsia or indigestion with loss of appetite. 138 HOME TREATMENT FOR AVOMEN. In these cases I would first advise to put the stomach in order; this is done by first avoiding all indigestible food, such as cakes, pies, and puddings, and taking the following medicine: NO. II. Take: Bicarbonate of soda.................2 drams Subcarbonate of bismuth............2 drams Tr. of mix vom.....................2 drams Fluid ex. of rhubarb................3 drams Simple syrup.......................1 ounce Peppermint Avater sufficient to make, 8 ounces Take a tablespoonful three times a day, and if the bowels move freely take less. Hygiene in the treatment of every disease is to be an important factor; all vicious habits must be abandoned. DYSMENORRHEA. Difficult or painful menstruation is the definition of the above word; all painful menstrual disorders that take place either before or during the menstrual floAV come under this designation. The seat of the pain, when of a colicky nature, is in the uterus; when a continuously dull ache is in the small of the back, it is located in the nervous plexus in the small of the back. The pain is very often in the ovaries and in that portion of the peritoneal membrane which folds over all the pelvic organs and extends on the sides of the womb, consti- tuting the broad ligaments; when the pain is confined to these structures, it is principally felt beloAv the stomach and over the lower part of the bowels. Painful menstruation is a prominent symptom of a great many diseases, and it often strains the ingenuity of the most clever specialist to trace the symptoms to their real cause. Obstructive dysmenorrhcea, as its name implies, is due to some hindrance or obstacle to the escape of blood from the cavity of the womb. The obstruction may exist in the neck of the Avomb, at its mouth, or in the vagina. When the MENSTRUATION AND MENSTRUAL DISORDERS. 139 obstruction is in the neck of the womb, it may be congenital or date from birth. The constriction or narrowness may be due to an acquired inflammation of the lining membrane of the neck of the womb. Every inflammation causes a savcII- ing of the tissues, and if the inflammation continues, the swelling becomes permanent and a stricture is the result. Such strictures are often the result of the applications of strong caustics and meddlesome tampering by the ignorant specialist and abortionist. The application of the electrical current by means of the uterine electrode is the most mod- ern and effectual method of treating these cases successfully. Flexion of the womb is understood to be a condition in which the uterus is flexed or bent upon itself at a sharp angle, just as a rubber hose that is bent sharply on itself becomes compressed at the kink so as to shut off the flow, in this man- ner the flow of blood from the cavity of the womb is partly shut off, and the obstruction is the cause of the painful menstruation. In some women who have flexion or a bent womb there is no obstruction, because the probe passes the canal freely; in these cases dysmenorrhcea must be traced to some other cause. If it is clearly established that flexion is the cause of the obstruction, the most successful treatment is the elec- trical current. I have often had cases where little mucous growths no larger than a small marble, grew in the canal and obstructed the free escape of blood; after these were removed, the dysmenorrhcea ceased at once. Other obstructions may be due to a stricture of the vagina or some deformity of the hymen; a very slight surgical op- eration will permanently relieve both of these hindrances. There is a much larger proportion of cases that suffer from painful menstruation in whom the uterine organs are perfectly healthy, but who are systematically injured by dis- honest or hungry specialists, by being subjected to local treat- ments. I have had cases of this nature fall into my hands very often. They had made the rounds of the specialists 140 HOME TREATMENT FOR WOMEN. and had been made the innocent prey of avaricious pro- fessional competition, so that it is of the greatest impor- tance to distinguish this class of cases from those in which the pelvic organs are the seat of the difficulty. Nervous and congestive dysmenorrheeas are particularly adapted for the hygiene of home treatment. Nervous or neu- ralgic dysmenorrhcea is very often overlooked, and treated as a local lesion of the womb. The psychical exaggeration which many women experi- ence 'at the approach of the menses is abnormally height- ened in dysmenorrhoea. The pains in the back, in the hips, and in the lower part of the abdomen disturb the normal operations of the mind. The irritation of the nerves of the womb is often reflected to distant organs, and pain is felt in remote regions. Some women suffer only just a day or two preceding the flow, while others suffer severely during the entire period, so that they are forced to keep to their bed the greater part of the time. Professor William Goodell, one of the most profound and original female specialists in America, has this to say in a recent publication: " I have learned to unlearn the idea— and that was the hardest task of all—that uterine symptoms are not always present in cases of uterine disease; or that, when present, they necessarily come from uterine disease. The nerves are mighty mimers, the greatest of mimics, and they cheat us by their realistic personations of organic dis- ease and especially of uterine disease. Hence it is that even seemingly urgent uterine symptoms may be merely nerve counterfeits of uterine disease. I have, therefore, long since given up the belief,' which, with many, amounts to a creed, that the womb is at the bottom of every female ailment. "Nerve strain, or nen-e exhaustion, comes largely from the frets, the griefs, the worries, the carks and cares of life. Yet although the imagination undoubtedly affects it, it is not a mere whim or imaginary disease, as all healthy women and physicians think; but it is the veriest of realities. When MENSTRUATION AND, MENSTRUAL DISORDERS. 141 some flippant talker or some slipshod thinker scoffs at nerv- ousness as a sham disorder, I say to him: 'Can the bribe of a principality keep you from blushing AA'hen you are ashamed, or from blanching when you are afraid ?' Under the flitting sense of shame or of fear these vasomotor dis- turbances are momentarily beyond your control; and so they are in the nervous woman, Avhose vital organs are, as it Avere—not transiently but—perpetually blushing and blanching under deficient brain-control over the lower nerve centers. " Strangely enough, the most common symptoms of nerve disorder in women are the very ones which tradition and dogmatic empiricism attribute to womb disease. " They are, in the order of their frequency, great weari- ness and more or less of wakefulness and inability to walk any distance, a bearing-down feeling, headache, nape- ache and back-ache, scant, or painful, or delayed, or sup- pressed menstruation, cold feet, and irritable bladder, gen- eral spinal and pelvic soreness, and pain in one ovary, usually the left, or in both ovaries. The sense of exhaus- tion is a remarkable one; the woman is always tired, she passes* the day tired, and she goes to bed tired, and she wakes up tired, often, indeed, more tired than when she fell asleep. She sighs a great deal, she has low spirits, and her arms and legs become numb so frequently that she fears palsy or paralysis. " There are many other symptoms of nerve strain, but since they are not so distinctly uterine, and, therefore, not so misleading, I shall not enumerate them. Now, let a nervous woman with some of the foregoing group of symptoms recount them to a female friend, and she will be told that she has womb disease. Let her consult a physician and ten to one he will think the same thing and diligently hunt for some uterine lesion. If one be found, no matter how tri- fling, he will attach to it undue importance, and treat it heroically as the offending organ. If no visible disease of 142 HOME TREATMENT FOR WOMEN'. the external organs be discoverable, he Avill lay the blame to the invisible endometrium, or on the unseeable ovaries, and continue the local treatment. In any event, Avhatever the inlook or the outlook, a local treatment is bound to be the issue." The nervous variety of painful menstruation is fre- quently due to impoverishment of the blood, which, as we have learned, is often the direct cause of irritable nerves. The same treatment as for'chlorosis will give the desired relief: the treatment with iron pills. If the stomach is deranged from dyspeptic disorders, then my dyspeptic mix- ture, No. II, is to be given. But there are cases that are purely neuralgic without any apparently serious lesion of the blood; cases in which the neuralgia of the womb or ovaries is probably due to exposure to cold or some other indiscretion; here the following recipe will effect a cure in the course of several months: NO. III. Take: Fluid ex. of black cohosh...........'... J ounce Fluid ex. of ergot.....................J ounce Tr. of guaiacum ammoniated...........3 ounces (ilycerine...........................2 ounces Mix. Take a teaspoonful in a tumblerful of milk three times a day, between meals. Congestive dysmenorrhcea is oftener in the nature of an acute or sudden attack, except when it is due to a chronic inflammation of the lining membrane of the womb. It is often brought on by a sudden or inadvertent exposure, just at the time when the menses should make their regular ap- pearance. Persons of a plethoric habit and those who have been the subjects of inflammations either of the womb or in the tissues surrounding the womb, are more liable to this form of dysmenorrhcea than others. It will often be ushered in with a chill, followed soon with fever. There is head- ache, the skin becomes dry and hot, and often there is con- MENSTRUATION ANT) MENSTRUAL DISORDERS. 143 siderable irritability of the bladder, straining of the rectum and diarrhoea. Unless the pain is due to an obstinate dis- placement, it yields to proper treatment. For the straining and irritable bladder one of the following suppositories is to be introduced into the rectum, and if the pain does not cease, the suppository should be repeated every six or eight hours, until three have been used: NO. IV. Take: Sulphate of morphine................1 grain Ex. of belladonna....................1| grains Cacao butter, grated.................. 1^ drams Make into three egg-shaped suppositories. Towels wrung out of hot water should be carefully folded and applied to the lower region of the abdomen, and then covered over with a thickly folded flannel cloth so as to retain the heat and moisture; when the toAvel has cooled oft', repeat the dipping in hot water. To relieve the congestion of the womb, and establish the menstrual Aoav, I recommend this prescription: NO. A'. Take: Fluid ex. of hyoscyamus..............1 dram Tr. of opium, deodorized...............2 drams Fluid ex. of ergot.....................^ ounce Simple syrup.........................1 ounce xMix. Directions, a teaspoonful in a little water every four hours until relieved; keep the patient in a warm bed betAveen woolen blankets. MENORRHAGIA AND METRORRHAGIA. By menorrltagia is meant, as the composition of the term implies, an excessive flow of blood at the regular monthly period; by metrorrhagia, a flow of blood from the womb at any time irrespective of the regular menstrual periods. Neither of these forms can be called a disease, as they are solely tlie symptoms of several kinds of uterine affections. In the course of our investigations, we will find that one 144 HOME TREATMENT EOR AVOMEX. of the most prominent and common symptoms of different womb diseases is hemorrhage of the Avomb. If the hemorrhage is the result of general debility from protracted nursing, the child must be Aveaned, and recipe No. I, with a nourishing diet, will effect a cure. Hemorrhage may be due to the presence of a fungoid in- flammation, tumors, or affections of the mouth or neck of the womb, or congestion of the ovaries. It is very often due to a "bad getting up" from confine- ment, where the womb has never returned to its original size. Sometimes it is due to a portion of the afterbirth that was retained in the cavity of the womb. It is also a symptom of cancer. As I have already said, it may be the symptom of so many different diseases that the proper course to pursue is to find an honest and competent physician to make a thor- ough examination, for the purpose of deciphering the real cause, and when that is discovered, it is as a rule, an easy matter to remove it and thus afford the patient permanent relief. There is no remedy Avhich on the whole is so effectual in controlling hemorrhage, no matter from what cause, as: NO. VI. Take: Fluid ex. of ergot..................•. . .1 ounce Dose: a teaspoonful in a little water every four hours until the flow ceases, or until a physician is consulted to diagnose the case. In pregnancy, the administration of ergot is not admissible; cold Avater compresses are also use- ful in checking uterine hemorrhage, and the utmost quie- tude should be observed. Nervous exhaustion from protracted confinement, or mental worry from the loss of a child or the death of a friend, may also cause uterine hemorrhage. The ergot is useful in these cases, with a change of air and scenery. CHAPTER X HISTOLOGY OF INFLAMMATION. Inflammations of the various tissues assume different forms as far as the gross appearances are concerned, but the underlying condition is precisely the same. The various types of inflammations that are produced by one and the same process are of considerable scientific interest, but to the practical and inquiring reader, Avhose principal object is to obtain sufficient information to be able to cure herself, it Avould be confusing were I to attempt a description of their differences. There is no word that is so often employed as inflamma- tion, as a designation of disease, and when we learn that there is only one kind of inflammatory process, whether of the brain, the lungs, liver, kidneys or boAvels, the entire sub- ject of inflammatory diseases at once becomes greatly sim- plified, because if you understand one you must understand all. I will in the subsequent chapters speak only, or princi- pally, of inflammatory affections of the different organs that come Avithin the province of this specialty, and I am con- vinced that if the reader Avill bear with me, so that I may take sufficient time and space to explain the most advanced scientific vieAvs of inflammatory processes, she will be more than compensated, by a clearer understanding of Avhat AA'ill be said in succeeding pages. Inflammation comprises a series of phenomena, which partly take place in the vascular apparatus or blood vessels and partly in the tissues comprising the structure of the or- gan. Inasmuch as inflammation is not a single process, a definition of a few words is insufficient to convey to the 10 (345) 146 HOME TREATMENT FOR WOMEN. mind its real meaning. If I were simply to describe the pe- culiarities of the circulation, that characterize the inflamma- tory process, avc should only have an incomplete idea of the changes that were taking place. Since the time of Galen, who lived two hundred years after Christ, inflammation Avas recognized by four cardinal symptoms, namely redness (Ruber), swelling (Tumor), pain (Dolor) and the increased temperature (Calor). To these modern pathologists ha\re added a fifth symptom, which is lessened or diminished function (Functio l.esa). The above five cardinal symptoms can be established in the majority of the acute stages of inflammation: in the chronic or subacute variety, one or the other symptom may be absent, or so obscured as to escape notice. The nature and structure of the tissue materially modify some symptoms and exclude others, so that redness, pain and even perceptible swelling may be absent. Galen already in his time attributed the redness to an increased blood sup- ply and the swelling to an exudation of lymph or serum, through the walls of the blood vessels: this was as near the truth as scientists arrived, until within our own time. The discoveries in this field of science ha\re been greatly en- riched in the last twenty years through the researches of the German school. Various theories have been advanced from time to time, as to the probable causes or processes that are going on in the tissues while inflammation is active. One observer believed that he had found the solution of the inquiry in a supposed spasmodic contraction of the capillary blood vessels, another in their paralysis, while still another adhered to the belief of a neurotic affection. Professor Vir- chow, the father of the modern school of pathological science, ascribed the conditions of the tissues to an irritable state of the inflammatory process, inducing an exaggerated cell growth; while his former pupil, Cohnheim, through an ex- tended series of newly-devised experiments, has conclusively proved that none of the theories advanced are supported by demonstrable facts. HISTOLOGY OF INFLAMMATION. 147 Our present thorough knowledge of the combined dis- turbances and phenomena, that play their part in the vessels and tissues, of the body during the inflammatory action in living tissue is due to the unremitting toil of Professor ('ohnheim. He was the first to speak from facts, as they presented themselves to his eye under the microscope. It was he who had the genius that suggested the examination of the Avhole process of inflammation, in the living tissues under the microscope. This he accomplished by narcotizing a frog, and while alive, but insensible to pain, a portion of the peritoneum or mesentery, which is almost transparent, so that the circulation may be plainly seen, was fastened with pins upon an ingeniously-devised rack or stage. The inflammation is now excited by etching the membrane with a little acid and a sharp needle, and then the object is placed under the microscope. If the operator is careful, so as not to tear or crush the vessels or tissues, and preserves the moisture, by spraying with warm water from time to time, the circulation and the abnormal processes of inflammation that are going on, may be observed and studied with great exactness for several hours. I will now describe what may be seen in the field of the microscope. The first change to be observed is in the vascular sys- tem and within the vessels themselves; this begins with a widening of the small arteries, then of the smaller capillaries and veins. This increases the current of blood with greater velocity through the widened vessels. Sooner or later this rapidity of the current lessens; there is a marked slowness to be observed in the stream. The single or separate blood cells, Avhich in the beginning of the observation could not be distinguished, can now be distinctly seen, especially in the veins and small capillaries, in which, from the slowness of the current, the blood accumulates. In the veins there now appears at the periphery of the current a pellucid plasmatic layer,in which there are white blood cells, that have separated themselves from the main current; the white cells either 148 HOME TREATMENT FOR WOMEN. float slowly along or adhere to the Avails of the vessels. This phenomenon the Germans term "Randstellung der Farb- losen Blut Korperchen," which means, bordering of white blood corpuscles. Not long after the "bordering" of white cells, a change takes place in the cells themselves, that is very interesting. The Avhite cells become elongated and spear-shaped at one extremity, which pierces the Avail of the vessel, and after a little while the sharp extremities will appear on the outer surface of the wall of the vessel, and a little later on, indeed, the entire protoplasmic cell will have emigrated into the tissue, outside of the vessel. Or, in other words, the colorless blood cells will have passed through the walls of the vein or capillary, and this constitutes an extravasation. The first extravasated cells will soon be followed by oth- ers in great quantity, so that in six to eight hours veins and capillaries are surrounded with white corpuscles. In their normal destination these become organized into fibrous or granulation tissue; and for this reason, an organ that is the seat of chronic inflammation becomes immensely enlarged from this inflammatory accretion. We can now readily ap- preciate why the womb, liver or kidneys become augmented in size from inflammatory processes. Indeed, this applies to all groAvths and even to bone, and if a part is injured by a cut, accident or disease of some sort, precisely the same proc- esses are at Avork to repair the lost tissue. It cannot fail to become apparent at once, that to understand the. phenomena of inflammation is to possess the key that opens to our un- derstanding the operations not only of most diseases, but of the healing processes of wounds and injuries. In the course of the experiment we see also red blood corpuscles transude, which are always accompanied Avith more or less fluid or plasma. The above detailed account seems to explain in a clear manner the different cardinal symptoms that have become recognized features of inflammation since the time of Galen. HISTOLOGY OF INFLAMMATION. 149 The great vascular activity explains the redness, swelling and increased temperature. The pain can be traced to the pressure from the exudation, to which the delicate nerve fila- ments Avere exposed, while lessened function would be the natural result of nerves or tissues so compromised. I made an attempt to initiate the reader into the science of inflammatory processes and if I have succeeded in mak- ing myself understood, then I am satisfied Avith having im- parted a most useful lesson, because there is no process in the entire field of disease that is so general; it is almost safe to say that with the exception of functional diseases, there is perhaps no class of diseases with which an inflammatory process is not more or less associated. This is true of con- sumption, which is an inflammatory process excited by and around the bacilli or micro-organisms, and these inflam- matory nodules are called tubercles. The growth of a can- cerous tumor is associated Avith an inflammation. The development of a common boil is an illustration of an inflam- mation, breaking down or destroying part of the tissue which is inflamed. It is the same in inflammation of the lungs or pneumonia as it is in ordinary catarrh; the differences that are presented to the eye are only modifications of de- gree and peculiarities that are due to the difference of the tissues of Avhich the organ or membrane is composed. CHAPTER XL URETHRITIS AND NEURALGIA OF THE URETHRA. Inflammation of the canal by which the urine is con- ducted and discharged from the bladder is termed urethritis. There is no organ of the female anatomy that is oftener the seat of local inflammation. The acute and chronic inflammations that affect the male urethra, also affect that of the female, only perhaps to a more limited extent, owing to the comparative smaller mu- cous surface of the tube, it being only from an inch to an inch and a half in length. Inflammation is oftener confined to this portion of the urinary apparatus than is generally supposed, because any derangements of these parts is at once attributed to the bladder, and it is an actual fact that many women have doc- tored uselessly for years, for the one, when it was the other that Avas diseased. Symptoms of urethral inflammations are so very similar to inflammations of the bladder that the points of distinction are easily overlooked. The trouble begins with frequent desire to void urine and a continual bearing down or straining sensation, which may be accompanied Avith a sense of heat suggesting to the minds of the most chaste and pure women, sexual desire, which the gratification of that indulgence does not relieve nor satiate, but, on the contrary, the sexual passion becomes only exaggerated. It is only the strongest force of character and Christian fortitude that keep some of these unfortu- nate women in the path of rectitude and virtue, and it is only the scientific specialist Avho can appreciate the real cause. In many instances women, truly noble in character, (ISO) URETHRITIS AND NEURALGIA. 151 have fallen from their high estate, because uncontrollable impulses swept them into the maelstrom of licentiousness, which might have been averted, if they had known of Avhom to seek proper advice. This irritation is often innocently and ignorantly ac- quired in early girlhood by fingering the parts, or practicing masturbation, which sets up an inflammatory condition of the urethra that becomes chronic, and in time may entail the terrible consequences to which I have already alluded. For that reason mothers should not be over-delicate; they should not only keep a watchful eye on their children when in se- clusion, but should make it their holy duty to gradually ini- tiate their children into a knowledge of physiology and of the diseases that may result from any violation of youthful virtue. Why is it that many children Avho have been reared in an atmosphere of sanctity, children who have enjoyed from their earliest recollection moral and spiritual administration, have fallen into vice and depravity? The reader should stop to answer this question for herself, while I too will an- swer it for her. It is because moral teachers overlook the fact that human beings are dual; that we are all animal, hoAvever spiritual, and that the functions of the animal nature must be under- stood in order that the spiritual nature can control them. A false delicacy has entirely neglected this part of the education of our children, Avhich I stamp as the height of stupidity and hypocrisy. Among other causes of this malady is hot and acrid urine, or gravelly discharges from the bladder, cutting and irritating the mucous membrane in its passage; abrasions of this nature often lay the foundation for ulcers. When the urine is in that condition, it is probably due to a com- plication of diseases of the bladder, the kidneys and the liver. A chemical and microscopical examination of the urine will be the only means of settling these questions. 152 HOME TREATMENT FOR WOMEN. The urethra often takes on the inflammations of the neighboring tissue or organs; disease of the vulva or of the vagina will spread itself to the urinary canal. I have seen cases in which the whole trouble Avas traceable to a catarrh of the neck of the Avomb. Gonorrhoeal infection of the vagina will in the great majority of cases extend itself to the urethra as Avell as to the cavity of the womb and neighboring organs. If treatment in these complicated cases is to be success- ful, it must be directed to the disease in all of its strongholds; this, of course, can only be done under the direction of a skillful specialist. There is a predisposition on the part of the mucous sur- faces to become infected by eruptions of the eruptive fevers, and the urethra is particularly liable to this invasion. Children who have had the measles and scarlet fever will often be troubled with frequent and smarting micturition and after convalescence from all the other symptoms of the respective fevers, they are still more or less annoyed for weeks or months with a urethritis. I have had cases of this nature that dated back years. If the early treatment is neglected and the case becomes chronic, it generally spreads to the bladder, which also becomes similarly affected. Smallpox pustules are apt to break out in the urethra during the acute stage of the disease, and excite a ATery itching and painful urethritis. Dysentery in children may give rise to the disease. In adults I have noticed the affec- tion in connection with typhoid fever, but this generally passes off with convalescence. Hemorrhoids or piles give rise to urethral inflammation which does not yield to treat- ment, but subsides at once after the removal of the piles. The application of a Spanish-fly blister to any part of the body may also cause a stranguary or a urethritis. Mothers may become uneasy, as to the cause of the muco- purulent discharge from the urethra of their little girls. I have known them to entertain suspicion of some specific URETHRITIS AND NEURALGIA. 153 infection being introduced into the genitals, in some myste- rious manner; a little inquiry into the historv of every ease, dispels these absurd delusions, and it will be found that pin- worms have caused the inflammation. In adults, however, the subject should be made the object of particular inquiry. During delivery, the passage of the child's head exerts great pressure on the urethra, so that it may be crushed or torn across. Women may be troubled with derangement from this cause for a long time, or for their Avhole lives, if the real cause of their ailment is not recognized. Displace- ments of the womb in different directions, principally when it is tipped baekAvards so that its neck impinges on the urethra or neck of the bladder, compresses the canal, so that its caliber is diminished, and a painful obstruction and re- tention of urine ensue. Papillated groAvths and mucous polypoids that Avere so small that they were hidden from external sight, but readily detected by scientific methods of examination of the urethra, by means of the urethral specula, AATere the exciting causes of some cases that came under my treatment. The unfor- tunate victims were under the impression that their kidneys or their bladders avc re diseased. The numerous quack medicines advertised for the cure of these maladies were copiously consumed, doing, of course, more mischief than good. The removal of the growths in each instance at once put a stop to any further inconvenience. In pregnancy, after the third month, the womb rises out of the pelvis, so as to accommodate its increasing size. This naturally drags the bladder upAvards, and so stretches the urethra that it becomes sore and extremely irritable. To relieve this an opiate should be given for a feAV days, until the parts have accommodated themselves to their new relations. This recipe will answer for this purpose:— NO. VII. Take: Sulphate of morphine..................1 grain Fluid ex. of belladonna................4 drops Cinnamon water......................1 ounce 154 HOME TREATMENT FOR WOMEN. Mix. A teaspoonful to be given to an adult every four hours till relieved. The symptoms of inflammation of the urethra are al- ways very pronounced, because the mucous membrane of the urethra is the most sensithre part of the bladder. In the healthy state the coloring of the lining membrane is of a pale red; when inflamed or catarrhal, it assumes a dark red, or a cherry color. The membrane is also considerably swelled and puffed, and feels hot to the touch, and imparts a burning sensation to the patient. The mucopurulent se- cretion excoriates or chafes the skin, so that the parts look angry and red in the neighborhood; this is oftener observed in children. The characteristic symptom of frequently uri- nating is neArer absent, while very little is passed at a time, yet the straining to pass Avater continues, after the last drop is voided. The treatment is cleanliness to begin with. In grown people, the entire vulva and vagina must be rinsed out Avith a warm borax solution, in the proportion of one teaspoon- ful of the powdered borax dissolved in a quart of Avater. In little children the same object, that of cleanliness, is to be accomplished Avith a small ear syringe. After the external parts and the vagina are thoroughly cleansed, then, by means of a hard rubber syringe, No. 1, three or four syringefuls of clean borax wrater are injected into the urethra for the purpose of cleaning that too. To relieve the straining and frequent desire to micturate, which is accompanied with more or less pain, I give:— NO. VIII. Take: Fluid ex. of gelseminum...............1 dram Sweet spirits of nitre.................7 drams Mix. A teaspoonful in a wineglassful of Avater three or four times a day for an adult; children in proportion. The patient must confine herself to a bland liquid diet, principally of milk, raAv eggs beaten up in bouillon or broth. Vegetables may be eaten, but they are ndt to be seasoned with URETHRITIS AND NEURALGIA. loo anything but salt; and alcoholic liquors, Avine or beer must also be suspended for the time being. NEURALGIA OF THE URETHRA. The female urethra is sometimes the seat of simple neu- ralgia, by which is meant a painful condition in Avhich there is no apparent disease or inflammation of the tissues. This pain assumes often a spasmodic character; that there is a cause for this is certain, but it is as a rule remote from the sensation which attracts attention. It is often found to be the symptom of some of the diseases to which I have already referred. These are ulcerations, displacements, or inflammation and congestion of the neighboring organs. Abnormal growths or tissues will often be painfully reflected on the nerves of the urethra. I remember a case of internal hemorrhoids, which Avas never suspected by the patient be- cause there were no painful symptoms pointing to the rec- tum, but in Avhich the urethra Avas very painful in its entire extent. The suffering from this urethral neuralgia had lasted for years, but disappeared at once, on the removal of the piles. I have called attention to a catarrhal inflamma- tion of the urethra, from stretching occasioned by the as- cending womb after the third month of pregnancy; there is a similar pathological process after the seventh month of gesta- tion, Avhen the pregnant womb begins to descend again into the pelvic cavity, and this is particularly marked in the preg- nancy with the first child, a\ hen the pain is often very severe. If in a first pregnancy there is no abnormal dispropor- tion between the dimensions of the child's head and the maternal pelvis, or if there be no abnormal position of the child, then there is an obstetric rule that the womb, or rather the child's head, begins to descend into the pelvis after the seventh month of gestation, so that it can accommodate or conform itself to the maternal parts. This occasions a drag on the urethra downwards and baekAvards, Avhich is painfully annoying, and there is a constant inclination to pass Avater. 156 HOME TREATMENT FOR AVOMEN. There are two mechanical methods of relieving this dis- tressing symptom; one is to obtain as much rest as possible in the recumbent position, and the other is to \vear an ab- dominal supporter or bandage around the lower abdominal region, so as to take the weight off the urethra. The in- ternal medication consists of an occasional dose of prescrip- tion VII. In the newly married, the urethra becomes sometimes the seat of a painful spasmodic contraction; this is due to a tense hymen, Avhich should be slightly nicked with a pair of scissors. Exposures to colds will also cause neuralgia. Fresh beer and sour wine make the urine irritating, and also occasion painful symptoms. A thorough examination of the mucous membrane of the urethra which does not reveal any inflammatory condi- tion or abnormal growth, establishes its neuralgic character. The next step will naturally be to make such a careful ex- amination of all the surrounding tissues and organs, for the purpose of ferreting out the real cause. When the cause is remoA'ed or cured, it will also relieve the urethral pain. In the absence of a clear comprehension of the true nature of the malady, the treatment must be palliative. The sitz-bath is always one of the most palliath'e measures for all sorts of pelvic pains and aches. Vaginal injections of hot water, not too hot, from 105 degrees to 108 degrees, are another sort of general panacea,—the quantity of fluid should be large, from half to one gallon, in Avhich a teaspoonful of pulverized borax has been dissolved. If the pain is very severe, then a rectal injection of one pint of very warm Ger- man chamomile tea, to which half teaspoonful of McMunn's elixir of opium is added, should be thrown into the rectum and retained as long as possible. If the urine is irritating, a cupful of buchu tea three or four times a day, or German chamomile tea, should be drunk between meals. If these measures do not give relief, then consult an honest, competent physician, in whose integrity you can rely. CHAPTER XII. INFLAMMATION, CATARRH, AND OTHER DIS- ORDERS OF THE BLADDER. The female bladder is easier approached than that of the male. This is clearly illustrated in the anatomical Plate II, which should be thoroughly studied before this chapter is read. The bladder lies directly behind the symphysis pubis, above or in front of the vagina. On account of the com- parative shortness of the female urethra, to that of the male, the cavity of the bladder is also much more accessible through this channel, and if access through this communi- cation does not suffice, then the interior of the female blad- der may be exposed by an incision through the anterior wall of the vagina, but this resource becomes rarely neces- sary. Formerly we had to content ourselves Avith external appearances, that were confined to the external anatomy of the urinary canal on the anterior vaginal wall, aided only by a delicate sense of touch. Valuable as these means of examination sometimes Avere, they were far from satisfactory to either physician or patient. Now avc are able to examine with the finger, aided with the eyes, almost the entire lining of the bladder. Professor Simon, of Heidelberg, Avas the inventive genius of this improved method of examination, by means of a series of graded specula or hard rubber bougies, which are known bv his name. The specula are simply small, smooth, pin- shaped, hard rubber bougies, about three inches in length, beginning with a size that is three-tenths of an inch' in di- ameter, to the largest, which is eight-tenths of an inch in (157) 158 HOME TREATMENT FOR AVOAfEX. thickness. These are carefully introduced into the urethra, commencing Avith the smallest size, which is retained for a few minutes and then withdrawn, and the next size inserted, and this continued until the largest one has been inserted, or the required dilatation accomplished, either for the purpose of in- troducing the finger into the bladder, or exposing its lining membrane for inspection. While this procedure does not fall into the sphere of home treatment, it is of sufficient interest to women in general that they should know what can ac- tually be accomplished by the expert specialist. Were I to revieAV the malformations, or dislocations, of the bladder, or the history of stones in the bladder, or other foreign bodies, that the female specialist is very seldom called upon to treat, I should only worry the patience of the reader with things that she would not readily understand. The same is true of growths and tumors of the bladder, which have princi- pally a scientific interest for the practitioner of medicine, but for the casual reader they are too profound in their de- tails for a clear understanding. INFLAMMATION. Inflammation of the bladder is in medical language termed cystitis. It presents itself under two Aarietiesor sub- divisions, acute and chronic, depending on the duration, whether recent or protracted. The disease begins in the mucous membrane, and the acute inflammation comes on suddenly. It rarely occupies the entire mucous surface of the bladder, but usually occurs in irregular spots. Some spots are as large as the palm of the hand, while others are only the size of a ten-cent piece. The parts that are most frequently affected, are the neck of the bladder and its posterior wall, although no portion of its lining membrane is exempt from inflammation. It rarely happens that the inflammation spreads over the entire extent of the bladder, or that it invades the mus- cular tissue: if it should complicate the latter, it would involve DISEASES OF THE BLADDER. 159 the peritoneum; this would add a very serious complication, namely, a peritonitis. Cystitis may be due to an extension of gonorrhoeal infection from the vagina and urethra, or from other purulent affections. Women who are unable to pass Avater after confinement, may be liable to the disease from retained urine, decomposing in the bladder and caus- ing inflammation. On the other hand, a filthy catheter used by a midwife or doctor Avho is careless or ignorant of the necessary antiseptic precautions, and who fails to brush and boil out the catheters, and uses one.catheter on differ- ent patients, Avithout the precaution of even thoroughly rinsing it, may give rise to dangerous cystitis. The most serious case that I ever haA'e seen was directly traceable to this cause. If impure air gets into the bladder this will also excite cystitis; to prevent that, is to close with the finger the outlet of the catheter that is used for drawing off the urine, when withdrawing the instrument, a precaution seldom ob- served. NeAvly-brewed malt liquors, alcoholic stimulants taken in excess, diuretics of spirits of turpentine and cantharis, or highly-seasoned and rich food, are among the exciting causes; irritating injections into the bladder or vagina, and even cold-Avater injections into the vagina, must be added as exciting causes of this painful affection. Venereal excesses operate in exciting \usceral inflammation, and when the slightest symptoms are felt, prudence and good common sense dictate continence. The first feeling that manifests it- self is a dull, heavy, aching sensation, immediately after uri- nating, and an involuntary inclination to further relieve or emptvthe bladder by pressing or bearing down. Soon after the first indication to void urine, there is another desire to empty the bladder, and the same symptoms repeat them- selves, only in a more aggravated form. The distress of micturition gradually becomes continuous so that during the short intervals betAveen the times that urine is voided, and as the disease progresses, the pain becomes sharper. This is 160 HOME TREATMENT FOR WOMEN. accompanied by a kind of gnawing uneasiness in the region of the Avhole bladder, Avhich has intermissions, but is greatly increased when the desire to make water is felt. If the dis- ease progresses, the pain is now felt in the neighboring or- gans and a general constitutional disturbance manifests it- self. The patient wi 11 now generally have a severe chill; this is followed with heat and thirst and an increase in the pulse. The desire to \Toid urine at shorter intervals becomes more prominent and only drop by drop, accompanied with distressing spasm and a burning sensation along the urinary canal. The region of the bladder becomes in the advanced stages of inflammation extremely sensitive and tender, and if the peritoneum is involved, even the weight of the bedclothes becomes intolerable. The limbs are drawn up and the body is inclined forward to relieve the tension of the abdominal muscles and their pressure on the bladder. The neighboring organs begin to sympathize Avith the advanced state of the inflammation at this stage; cutting pains are felt in the rectum, Avhile darts of pain shoot from the bladder toAvards the groins and ovaries. Owing to the spasmodic action of the urethra, the bladder is never completely emptied so that the urine gradually ac- cumulates in abnormal proportions; the retained urea rap- idly decomposes into ammonia and the urine becomes very hot and irritating, thus greatly augmenting the suffering. Under these circumstances, the bladder may become greatly distended and feel as a sensitive globular tumor above the pubis. The retention of the urine may be complete, owing to a partial paralysis of the bladder and now complicated with spasmodic stricture. Nausea and vomiting are rarely absent in this stage, the tongue becomes coated and dry, while the expression is anxious and the fever very high. In the commencement of the disease there is some differ- ence in the svmptoms of inflammation of the bladder which arises from the nature and seat of the inflammatory process. DISEASES OF THE BLADDER. 161 If the neck of the bladder is mainly affected, the spas- modic desire to urinate is more pionounced, and the pain is felt Ioav down in the vagina and anus, while the symptoms are higher up in the rectum, with constant inclination to go to stool, if the base or posterior wall of the organ is princi- pally involved. Acute cystitis runs its course in six or eight days; under favorable circumstances and appropriate treatment all pain- ful symptoms will in that time have subsided, and the pa- tient will have entered upon a course of permanent recovery. If through a constitutional habit, or through neglect or improper treatment, the disease is not curbed, the result will be quite different; the inflammation may pass into a suppurative stage or assume the chronic form. The treatment in the acute stage will resolve itself into two different measures of relief; these are first to subdue the spasmodic pain and nervous excitement, and secondly, to quiet the local irritation. The pain is best controlled by morphine powders, one-fourth of a grain each, given every four hours. Warm teas of German chamomile or flaxseed, so as to dilute the urine, may be freely given. Hot vaginal injections of borax water have a remarkably soothing influ- ence; the hot sitz-bath is another useful adjuvant. It has been customary in this country and England, to apply hot water compresses or hot poultices over the hypogastrium, which is that part of the lower abdomen corresponding to the region of a distended bladder. After eight years of extended experience in this country, and a thorough trial of hot fomentations for inflammatory affections of the abdomen, I became convinced that the Ger- man method of cold-water compresses gives more relief and is more in the nature of an abortive, hence curative. I recommend to my patients, instead of the hot-water applications, a rubber bag, filled with broken pieces of ice, and applied over the region of the bladder. The boAvels should be freely moved with castor oil or a dose of salts and senna, or by an enema of warm soapsuds 11 162 HOME TREATMENT FOR WOMEN. The food should be bland and of a fluid nature as nearly as possible, broths with an egg, milk gruels or bread and milk. CHRONIC CYSTITIS. If the acute attack of cystitis in the course of eight or ten days becomes modified, but convalescence is not estab- lished, then it is quite probable that the disease is drifting into a chronic stage. The mucus or slime that formerly accompanied the urinary discharge is now assuming the character of matter or has become muco-purulent. While this is a very rare symptom of the acute variety of cystitis and usually of brief duration, in chronic inflammation it is one of the charac- teristics of the malady, and often lasts for a long time; the muco-purulent fluid is occasionally remarkably profuse. The pus is not always furnished by the free surface of the mucous membrane, but may be traced to small abscesses, situated in the tissue between the mucous membrane and the muscular wall of the bladder. The locality for the for- mation of these abscesses is principally at the neck of the organ, although there is no part of the organ that is entirely exempt from them. Fortunately, the abscesses generally point inwards or towards the cavity of the bladder, but it not infrequently happens that they break through and empty into the vagina or even into the adjacent bowel or abdomi- nal cavity. The occurrence of pus or suppuration is by itself so grave a process that it is always accompanied with certain well marked and stereotyped symptoms, which are cold chills, alternating with flushes of heat, increase of heat or fever, anxiety and restlessness. The pain now becomes dull and throbbing in character, and the burning or stinging is only felt when the patient urinates. When there are ab- scesses, the nervous derangement may be so great as to cause the mind to wander in delirium. Before the appear- ence of pus in the urine, nothing but a skillful examination can establish the existence of an abscess. DISEASES OF THE BLADDER. 163 The treatment for suppuration of the bladder, when limited to the surface of the mucous membrane, is always curable with intelligently-directed treatment, which is the same as that for chronic catarrh of the bladder, to be de- tailed further on. ULCERATION OF THE BLADDER. This is perhaps seldom a condition by itself, but rather a complication of the preceding disease. The ulcers occupy the place of what were formerly little abscesses, that have broken into the cavity of the" organ. Foreign bodies in the bladder by their direct pressure on the delicate tissues of the membrane have been the cause of ulcerations, that gave rise to dangerous hemorrhage. Earthy concretions or stones Avill naturally form in the bladder, and the end of a gum catheter has also been found in the bladder broken off in the bungling act of draAving off the urine, or, what is more likely, by boring and poking within the cavity of the blad- der, with a catheter or bougie, by persons ignorant of pelvic anatomy or in the belief that the bougie was in the cavity of the womb, for the purpose of inducing an abortion. Ulcerations will always be accompanied with more or less inflammation or visceral catarrh, so that the symptoms will fall under that head which has already been considered. CATARRH OR SUBACUTE INFLAMMATION. The mucous membrane of the bladder, like that of the nose, mouth or bronchial tubes, has its natural "secretion of healthy mucous. When any of these membranes become irritated or congested from any cause, this natural secretion becomes so increased as to make a perceptible flow of the secretion of mucus, and this is what the term catarrh sig- nifies. Catarrhs always presuppose the existence of inflam- mation, which in its nature is subdued or mild, so that it has been qualified as subacute, which is intended to convey the idea that the tissue need not be red nor hot and SAvollen as is alwavs the case in the acute form of inflammation. 164 HOME TREATMENT FOR WOMEN. Chronic catarrh of the bladder is traceable to any or all the causes that have been enumerated in the acute processes, because every acute inflammation of the bladder may termi- nate in a chronic form. It occurs at any period of life, but it is most common in elderly subjects; it is always an at- tendant of ulceration of the bladder or some abnormal growth in the bladder. If the disease is once established and is due to a complication, it is liable to become aggravated or re-established after a brief subsidence by exposure to cold, excesses in diet and drink, or diseases of the vagina, uterus or rectum. The secretion of catarrh is white and glairy and resem- bles the discharge of leucorrhcea or whites. When disas- sociated Avith acute inflammation of the bladder, it comes on gradually, or in a slow, insidious manner; for this reason the term subacute inflammation is sometimes employed by authors, because there are no fiery symptoms at the onset of the affection. The urine is always more or less altered in character, because the inflamed mucous membrane predisposes the urine to speedy decomposition. There is frequent and diffi- cult micturition, and the entire region, but in particular the affected organ, is more or less sensitive and sore. The quantity of mucus which passes off with the urine varies greatly at different periods and in different cases. In the early stages it may entirely escape notice, being so small that if the urine is not saved in a vessel and accu- mulated for the twenty-four hours the mucus can hardly be detected; thus, the entire quantity of the abo\*e period may often not exceed tAvo teaspoonfuls. When the disease becomes more advanced, the quantity of mucus may be equal to the quantity of urine that passes. The secretion is very thick and sticky, and settles to the bottom of the vessel or adheres to its surface. If there is pus mixed Avith the mucous secretion, it becomes a more serious question, and it may then be inferred that other organs are involved, the DISEASES OF THE BLADDER. 105 conductors of urine from the kidneys to the bladder, for instance, or the kidneys themselves. If the disease is con- fined to the bladder, the prospects for a cure are very favor- able; only Avhen diseases of other organs in the neighbor- hood are the exciting causes of the malady are the chances for a cure correspondingly limited. The success of any treatment will depend in a great measure upon the nature of the exciting causes. These re- quire to be removed, if within the possibility of medical skill, before the catarrh can be made to subside. Should the mucous or muco-purulent secretion be very abundant, the bladder must be thoroughly rinsed out; first once every tAventy-four hours, and afterwards every other day, so that the mucous membrane Avill be cleansed from all foreign irritating elements. I am employing for this purpose Thiersche's Boro-Salicylic solution. This of course can only be carried out by a skillful physician. When the disease is in its incipient stage it is amen- able to intelligently-directed home treatment. The most perfect rest of mind and body is one of the essentials to success, the entire suspension of stimulating drinks of an alcoholic nature, of which beer is the most irritating, and tea or coffee must be discarded. A milk and vegetable diet is the most beneficial to subsist on, and all condiments except salt must be dispensed with. If the boAvels are costive they must be regulated either by means of enemas of warm Avater or the folioAving recipe should be taken:— NO. IX. Take: Fluid ex. of senna....................2 ounces Bitterless elix. of sacred bark...........2 ounces Mix. Half to one tablespoonful once or twice a day for adults: children in proportion. Demulcent drinks of flaxseed tea, or slippery-elm water, should be drunk freely, and for the catarrh of the bladder there is no prescription that ever gave me the same satis- factory results as this one:— 166 HOME TREATMENT FOR AVOMEN. NO. X. Take: Borate of soda......■..................2 drams Fluid ex. of gelseminum................1 dram Fluid ex. of belladonna.................x drops Fluid ex. of buchu...................U ounces Fluid ex. of senna....................H ounces Distilled water.......................2 ounces Syrup of orange peel sufficient to make 8 ounces Mix, and take a tablespoonful three times a day. Wear flannel drawers and woolen hose, so as to guard against sudden changes of the Aveather. NEURALGIA AND NERVOUS IRRITABILITY. The bladder is often the seat of functional derangements that are characterized by a morbid sensibility and pain. The principal symptom of this disease is a frequent de- sire to urinate. A careful examination of the urine reveals nothing abnormal in the fluid that would point to the slightest affection of the bladder, nor are any of the symp- toms that characterize inflammation present. There is no mucous sediment, but in a large proportion of cases there is an abnormal deposit of the phosphates that would point to nerve waste. There is often a similar irritability in the vaginal canal, in fact, there is such a mutual sympathy be- tween the two, which can hardly be located in any one par- ticular organ. Hemorrhoids and constipation are sometimes found to be the cause. In that case, recipe IX will give decided relief. In women of a nervous temperament the bladder often becomes the seat of a steady neuralgic pain. Sometimes this pain is periodical, recurring every day and about the same hour and lasting the same period. This pain is of a lancinating character, and radiates from the bladder to the neighboring organs. I have noticed these symptoms, par- ticularly in women who had lived in malarial districts, and whose blood had become impoverished by malarial fevers, or from excessive hemorrhages due to some uterine trouble. DISEASES OF THE BLADDER. 167 Sexual excesses and other abuses that lower the tone of the nervous system will also develop a neuralgic condition of these parts. Persons who seek relief from this distressing complaint must first abandon their vices before they can expect alleviation from any treatment. This affection is not in itself dangerous, but the frequent recurrence of par- oxysms of pain render life miserable. If the general system requires toning up, I would recommend the iron pills after Formula I, Avith a good liberal diet of eggs and milk. For immediate relief of the painful spasms, the sitz-bath and hot vaginal injections are of great value. And for the irri- table bladder I can recommend:— NO. XI. Take: Bromide of sodium...................3 drams Fluid ex. of gelseminum................1 dram Water sufficient to make...............8 ounces Mix, and take a tablespoonful three times a day. The gouty and rheumatic bladder is so very rare that a detailed description is hardly necessary. But it might be well to remind the reader that if she is of a gouty or rheu- matic disposition and has also bladder trouble, it may be due to the bladder being compromised or influenced by gout or rheumatism. In that case, appropriate treatment directed to the rheumatic diathesis will also cure the bladder. PARALYSIS. The female bladder becomes paralyzed from various causes; some of these are located in the organ itself, while others are due to disease of the brain or spinal cord. An obstruction to the flow of urine through the urethra causes the bladder to become overdistended with urine and in- duces paralysis. A prolonged pressure from the child's head during delivery is oftener the cause of transient paral- ysis than any other. It happens that lying-in women can- not pass their urine for several days after confinement. Violence from without, as a blow or a kick, may have a 168 HOME TREATMENT FOR WOMEN. similar effect. This results from the pressure to Avhich the bladder Avas subjected. Operations on the rectum, vagina, or any of the pelvic organs, are frequently followed by a partial or complete paralysis. In all these cases, there is only one precaution to observe, and that is to draw off the urine at regular intervals so as to avoid an enormous accu- mulation of fluid. The paralysis becomes dangerous and obstinate to treat- ment, in proportion as the bladder becomes abnormally dis- tended, and the length of time that the muscular tissues are under the excessive strain. In those cases where the paralysis is due to spinal or brain disease, there is little prospect of a cure. In other cases, as for instance after confinement or an operation on the rectum for piles or fistula, it generally passes off in a few days. Great care and cleanliness must be exercised in using the catheter, so that the bladder is not infected from filth or virus from another patient. A catheter that has been em- ployed on a patient who had her urine drawn off while she suffered from purulent catarrh or puerperal fever, will inoc- ulate a healthy person wuth the same disease, and in this manner diseases are often communicated. The bladder is exceedingly liable to infection. HEMORRHAGE. A discharge of blood from the bladder is not of frequent occurrence, but it occurs often enough to make it noteworthy, and women should at least know that there is such a thing. It oftener takes place in men than in women, as a symptom of some grave or serious disease, or it may be only a trivial disorder. Hemorrhage of the mucous membrane takes place very readily, OAving to the delicacy of the tissues and the great vascularity of the submucous layer, and there is amuch greater tendency to hemorrhage in some persons than in others. Persons who are weak and debilitated bleed much easier ✓ DISEASES OF THE BLADDER. 169 than strong, vigorous ones, because the blood may become so thin or poor in fibrin that it greatly loses its property of coagulating. Some diseases bring this particular diathesis about, such as scurvy, also measles, scarlatina or small- pox. Worms have been found to make their AA'ay from the rectum into the cavity of the bladder, and caused profuse and even fatal hemorrhage. A violent fall of the body, rupturing an artery in the bladder, seA^ere horseback riding, and venereal excesses, ha\7e all caused almost fatal hemor- rhages, to which must be added ulceration of the mucous membrane. The most profuse hemorrhage of the bladder that I Avas ever called upon to witness, followed drinking a strong decoction of Avormwood; irritating diuretics, like spirits of turpentine or tincture of cantharides, are also liable to cause bleeding. Hemorrhage is ahvays accompanied with frequent desire to pass urine and spasmodic pains at the neck of the bladder. The blood may also coagulate in the bladder, causing an obstruction. The treatment con- sists principally in keeping the patient very quiet, and a rubber ice bag should be applied over the region of the bladder; nothing but bland liquid food is advisable, but no hot drinks are permissible. If the urine does not pass, a soft rubber catheter should be employed for the • purpose of drawing it off. Hemorrhages of the mucous membrane, whether of the bladder, the boAvels or lungs, generally yield to the follow- ing mixture:— NO. XII. Take: Gallic acid..........................4 scruples Tr. of digitalis.........................J ounce Fluid ex. of ergot......................1 ounce Simple syrup...................'.......% ounce Mix, and give a teaspoonful in a little water every four hours; children in proportion. URINARY FISTULA. By this is meant a permanent unnatural opening into he bladder from without, through which urine escapes. 170 HOME TREATMENT FOR AVOMEN. The situation of the female bladder, just in front and over the vagina, and also its attachment to a portion of the cer\ix or neck of the womb, exposes it to injuries, especially from pressure of the child's head during delivery. By re- ferring to Plate II, it will be seen at a glance Iioav easily an accident can take place from this cause. It Avas at one time supposed that delivery by forceps was the most fruit- ful cause of this lesion. That this is likely to happen only Avhere the instrument is in incompetent or bungling hands, there is no reasonable doubt. A thorough acquaintance with the entire subject has proved that there are other causes that are the mainspring of this, sometimes very se- rious accident. Indeed, the opposite view is now entertained by the pro- fession ; that is, that prompt delivery by forceps will prevent the parts from being injured, when the soft parts, and par- ticularly the bladder, is under severe and prolonged pressure by the child's head. There is no question that there is greater peril to the mother and child, in undecisive delay, provided the attendant has the requisite judgment and ex- perience to act intelligently. The hypothesis upon which this is based is the restora- tive property that living tissue possesses, to regain its vi- tality, after it has been subjected to severe and inordinate pressure. This we may observe in our daily experience; when, for instance, we jamb or crush our finger, or a child has its fingers momentarily crushed between a closing door, the fingers are sometimes crushed flat, but upon being re- leased, they rapidly regain their shape and vitality. If the pressure were continued for any length of time, the blood in the tissues would have become congealed, and the circula- tion permanently shut off, so that recuperation would have been impossible, and the tissues would have sloughed or- mortified. If the bladder, under the direct pressure of the child's head against the pubic bone, be subjected too long, the DISEASES OF THE BLADDER. 171 same results would naturally follow: the tissues could not regain their vitality, and they would either tear or subse- quently slough or mortify, which causes the fistula. The vagina and bladder, like every other tissue of the body, except that of the brain or nerves, will suffer a great deal of contusion for a short time, but if protracted beyond a reasonable length of time, it will be permanently destroyed or injured. A urinary fistula is always a serious malady, since it ex- ercises a deleterious influence upon the patient's health. If the opening is only small, a spontaneous cure may take place, but if it reaches considerable dimensions, it requires to be accurately adapted and stitched together. The best time for the repair of the injury, is six to eight weeks after the receipt of the injury. Rupture of the female bladder is comparatively rare, for the reason that women are not exposed to the same seri- ous accidents as men; but if women will persist in doing everything that men ought to do for them, the statistics may be reversed. When the bladder is distended and violence is brought to bear on the abdominal walls, corresponding to the region of the filled bladder, a rupture is likely to result. Surgical measures should at once be resorted to, so that the injury can be repaired before inflammation of the perito- neum sets in. CHAPTER XIII. ACUTE AND CHRONIC INFLAMMATION OF THE VAGINA. When speaking of inflammation of the vagina, reference is had to its mucous lining alone. R undoubtedly happens that structures or tissues beneath the mucous covering be- come involved in the inflammatory action, but this occurs so seldom that it is not of sufficient moment to make it the subject of an inquiry in a practical work. The mucous membrane of the vagina, like all other mucous surfaces, has its natural secretion for the purpose of lubricating and keeping its surface moist. In a perfectly healthy state, the color of the vaginal mucous membrane is a pale red, this becomes scarlet red upon irritation. In girls Avho are not irritated or Avomen who have not been abused by sexual excesses nor infected by disease, the normal secre- tion is just sufficient to preserve the moisture of its surfaces, but not in such an excess as to be noticed as a secretion or discharge outside of the vaginal canal. There is a phys- iological exception to this normal rule, a few days before and after the menstrual period, when the mucous membrane of the vagina sympathizes with the general congestion of the pelvic organs. The mucous secretion becomes then greatly increased, amounting to a catarrh or flow/this, how- ever, is only transient and subsides with the cessation of the menses. This might with propriety be termed a natural or physiological catarrh. For convenience of description and corresponding with the anatomical changes and the sources of their origin, in- flammation of the mucous membrane of the vagina may be acute or chronic, simple or specific. (172) INFLAMMATION OF THE VAGINA. 173 Acute inflammation in this instance is no different in its characteristic symptoms from inflammations elsewhere; it develops suddenly, and there is congestive swelling and pain. There is considerable heat in the parts, increased red- ness, and the canal is very sensitive. In the beginning the mucous membrane is dry and contracted, but after a few hours or a day, relaxation and moisture supersede. The secretion is very scant at first, but becomes more abundant as the disease progresses, its character also changes from a white, glairy mucus to a creamy, muco-purulent or yellowish discharge. The urethra may also become involved, and then the symptoms that were detailed in connection with urethritis are also present. Acute vaginitis may arise from a great variety of causes, but the worst case that ever came under my notice was the scalding effect of a hot-Avater injection, given under the ad- vice of a physician who had ordered the patient to use the water "as hot as she could stand it," and also told her "the hotter the better." This profoundly wise suggestion was carried out by the patient with a vengeance, for she used nearly boiling hot water, Avhich she had tested by putting in her finger and quickly withdrawing it. The steaming fluid so scalded the vagina that a most pronounced acute inflam- mation of the vagina was the immediate result. I have had other cases of the chronic form come under my notice that were aggravated by similar advice, so that a word of warning against the thoughtless and indiscriminate use of hot-Avater injections will not be without value. The vaginal irrigations of hot Avater, as a general stimu- lant to the mucous surfaces, or as an alterative to stimulate the absorbents to increased activity in removing old pelvic exudations, deserve a recognized place as a useful therapeu- tic measure, often of the greatest value, but too hot or "as hot as the patient can bear it," is superlative nonsense and absolutely injurious. No water injections into the vagina that are kept up any 174 HOME TREATMENT FOR WOMEN. length of time should be warmer than 110 degrees Fahr. and never should vaginal injections be employed without using a thermometer to gauge the heat. When the solution is medicated, 103 degrees should be the average temperature, but it should never exceed 107 degrees Fahr. Exposure to cold and moisture especially during the menses is promi- nent among the causes of acute vaginitis; injury from pes- saries or coition, retained putrefying secretions in the vagina, or the application of chemical preparations, or injury during confinement, will all induce this disease. Prolonged nursing causes anaemia, which predisposes the system to catarrhs. During the child-bearing period catarrhs of the vagina are quite common, and excessive coition excites a very painful inflammation of the A'aginal mucous membrane. Gonorrhoeal infection arising from a specific contagion gives rise to a very painful and dangerous vaginitis. The character and nature of the specific virus admits of no par- ticular description, because its infectious quality of a specific nature does not at all depend upon the physical appearance of the infectious discharge from the male. Whether it is yellow or greenish, muco-purulent or a glairy mucous dis- charge, establishes no criterion, but the presence of microbes, the gonococcus of Neisser; this, of course, a careful micro- scopic examination can alone establish. This much is true, that careful researches in Europe, by competent and reliable authorities, have established the fact, from carefully-prepared statistics, that this is a far more fruitful source of uterine diseases than was formerly dreamed of. A specific vaginitis has a greater tendency to spread it- self along the mucous tract of the genital organs of the fe- male than a simple non-specific catarrh. In the former the womb and Fallopian tubes become successively affected, as we shall learn more definitely when we have occasion to in- quire into the diseases peculiar to these organs. Acute inflammation of the vagina has pronounced symp- toms, and when any one of them is felt by the patient, she should lose no time in resorting to treatment. INFLAMMATION OF THE VAGINA. 175 The first symptom that is generally perceived by the patient is a sense of heat and burning in the vaginal canal; this is also reflected in the neck of the bladder during mic- turition. As the disease develops, there is a constant desire to pass water frequently, and this becomes sometimes a prominent sign. A dull aching weight is felt between the vagina and rectum. After these have lasted for some days. an offensive discharge from the vagina ushers in the second stage, excoriating the skin around the vulva, and if the dis- ease should spread itself to the neighboring organs, there is a violent throbbing pain in the Avhole pelvis. Women Avho are suffering with acute painful vaginitis should take to bed; all pelvic diseases of any acuteness at all are treated at a great disadA'antage when the patient is running around and on her feet. The disturbance in the circulation, the exposure to cold from cold floors or damp side- walks, and the impossibility of preserving an equable tem- perature of the body, when out of bed, only aggravate the malady. To relieve the pain, no matter from Avhat cause, a half teaspoonful of McMunn's Elixir of Opium every four or six hours is always indicated until the pain is relieved. A rubber ice bag applied over the region of the bladder or laid against the vulva is among the best palliative expedients The vagina is to be thoroughly syringed out several times a day with warm borax water, one teaspoonful to the half gallon, and when the canal is thoroughly rinsed I employ: NO. XIII. Take: Goulard's ex. of lead.................4 ounces Directions.—A tablespoonful to a pint of warm water, which is to be injected subsequently to the borax-Avater rinsing. If there is the slightest suspicion that the disease is of a specific nature, the treatment must be antiseptic in its na- ture. Your physician should be reminded of the possible nature of the disease, for doctors as a rule are ignorant of the dangers that ordinarily accompany gonorrhoeal infection. 176 HOME TREATMENT FOR WOMEN. Oppenheimer in Germany made experiments for testing the germicidal properties of various drugs on the specific germs of gonorrhoea, and he proved that a corrosive subli- mate solution of 1 part to 20,000 Avill kill the gonococci. Corrosive sublimate is the corrosive chloride of mercury, one of the most powerful of the mineral poisons, and Avhile it.is perfectly safe in the dilutions that it is employed in, the greatest precaution must be constantly exercised to keep the drug isolated and out of the reach of children, especially the "antiseptic tablets," of Avhich mention will be made be- low, because little cliildren and adults also might at first sight believe that they Avere candy. I am accustomed to employ the corrosive sublimate much stronger than the Oppenheimer experiments demand, a prac- tice Avhich I base upon practical observations, while in the Berlin clinics, and that is in the proportion of 1 to 2,000. John Wyeth & Bro., of Philadelphia, and other manufactur- ing chemists, make compressed tablets or wafers, which are very convenient and easily handled by any person of average understanding. These are sold by the druggists in little wide- mouth bottles, properly labeled, so that the required strength, 1 to 2,000, is obtained by dissolving one or Iavo according to their strength in a half gallon of warm water. Whenever gonorrhoea is suspected, the vagina should be thoroughly rinsed out several times a day Avith the corrosive solution. If the patient fears mercurial poisoning, the antiseptic irriga- tion can be followed by plain warm-Avater rinsings as a safe precaution against mercurial absorption. CHRONIC CATARRH, LEUCORRHCEA OR WHITES. An acute inflammation of the mucous membrane of any organ may drift into the chronic or subacute form, so that any of the causes which give rise to the acute variety are among those that are to be looked for in chronic catarrh. The general characteristics of catarrh are the same, whether acute or chronic or whether located in the nose, throat, INFLAMMATION OF THE VAGINA. 177 bronchial tubes or vagina. This fact greatly simplifies the whole subject of catarrhal inflammations, so that the gen- eral reader Avill find no difficulty in acquiring the necessary information for successful home treatment of this very common class of diseases. Chronic vaginal catarrh has been divided into two va- rieties, vaginal and uterine. The distinction depends upon its origin or complication. Vaginal catarrh has its origin in and is limited to the vaginal canal. I have already called attention to a purely physiological catarrh that accompanies the menstrual flow and which subsides with the cessation of the menses; in addition to this, there is probably no woman who goes through life without at some time during her nat- ural existence having this disease or symptom. Often the discharge is so scant that it entirely escapes her notice, and not until it becomes annoying by its constancy and abun- dance do women seek assistance. In ancient times and until quite recently, it was consid- ered as a distinct disease, attributed to constitutional debil- ity or an indication of impure blood; tliese theories are hoav entirely discarded. The modern school of Gynecology has given it quite a different interpretation, and considers leucorrhcea rather a symptom of some local disease than a disease itself. Experience, and careful research in, the sick chamber fully corroborate the correctness of this view, so that a simple local chronic catarrh is the exception to the rule. The exception applies oftener to children than to adults. We find it in young babies or little girls of all ages as a result of diarrhoea! discharges Avhich are acrid and filter themselves into the vagina and by their sharp, irrita- ting action on the mucous membrane, excite at first an acute, and afterwards a chronic catarrh of these parts. Eruptive fevers have induced a similar effect upon the mu- cous membrane of the child's vagina and also upon that of the bladder; obstinate catarrhs are frequently traced to these fevers. I have known pinworms to make their way 12 178 HOME TREATMENT FOR AVOMEN. from the rectum into the vagina and by their irritating presence excite in the little child a very distressing vaginal catarrh. The irritation or itching which the inflammation and decomposed secretion cause, makes the child involuntarily dig or scratch her vulva, which of course only aggravates the disease, and which has already been mistaken for pre- cocious masturbation, and will undoubtedly often be so con- sidered again by superficial observers. In later years a subacute inflammation of these parts will undoubtedly de- velop this pernicious practice, and I have known several cases myself where young girls became physical Avreeks from a combination of chronic vaginal catarrh and self- abuse, no one ever dreaming of the real morbid condition, but attributing their decline to everything else but the right cause. There is another complication that may arise from ca- tarrhal inflammation in little children, and that is an ad- hesive inflammation of the vaginal walls; that means that the sides of the vagina may partly or completely grow to- gether, and thus change the normal diameter of the vaginal canal. In after years this may entail frightful suffering, either by mechanically obstructing the escape of the men- strual blood or otherwise interfering Avith the normal func- tion of the canal. There are many diseases from Avhich Ave suffer in adult life for which the foundation was laid when we were young, through the ignorance of our parents. The stormy symptoms that usher in the acute form are absent in the development of the subacute or chronic vari- ety. This disease begins sometimes so insidiously that the patient may not be aware of its existence for quite a while. The secretion may not be at first changed in its character, save that it is noticed in greater abundance. In the course of time, the nature of the secretion will be greatly changed, from a white glairy discharge into a grayish opaque se- cretion ; this will be tinged greenish some days and be of a INFLAMMATION OF THE VAGINA. 179 muco-purulent aspect. In the great majority of cases it is a whitish cheesy discharge from Avhich the names leucorrhoea or whites have been derived. The color of the vaginal mucous membrane in chronic catarrh is of a bluish red tint, and its surface presents in places granulated patches, that bleed easily when they are touched. The vaginal walls are relaxed, so that women often complain that they have a sensation of "feeling open; " this is indeed the real state of affairs; the Avails of the vagina may become so relaxed as to constitute a prolapse of the anterior portion or Avail of the vagina, dragging the bladder and Avomb doAvn witli it. A great many of the so-called "falling of the womb cases" . are no falling of the womb at all but simply a relaxed va- gina, in which the wearing of pessaries or any other me- chanical uterine supporter will actually do a great deal of harm. The treatment of vaginal catarrh is principally local, when there is no prolapse of the vaginal walls and no other complications. Thorough cleanliness by syringing the va- gina Avith Avarm borax water at bedtime will generally ef- fect a cure. I employ one teaspoonful of borax to the half gallon of warm Avater. If there are granulated patches or sore spots, then I rec- ommend cocoa butter suppositories, made after the following recipe:— NO. XIV. Take: ('ocoa butter, grated..................6 drams Subnitrate of bismuth.................2 drams Ex. of hyoscyamus.....................h dram Mix, and divide into 12 egg-shaped suppositories. Directions.—Introduce one suppository into the vagina after each vaginal injection, always keeping in the recum- bent posture for at least half an hour after its introduction, so as to give the warmth of the body ample time to melt the cocoa butter. If the suppositories do not melt from the 180 HOME TREATMENT FOR WOMEN. heat of the body, they are improperly prepared and should be returned to the pharmacist, so that he can correct the cause of their hardness. When the patient feels a dragging sensation or such symptoms as would indicate a prolapse (falling doun) of the vaginal walls, from weakness or relaxation of the columns and muscular tissue which give them their support, then I recommend the subjoined powder, which is astringent, strengthening, healing and disinfectant. NO. xv. Take: Powd. permanganate of potassium...... .2 drams Powd. sulphate of aluminum...........4 ounces Mix. Dissolve a teaspoonful of this powder in a half gallon of warm water, and use the entire amount as a vag- inal wash at bedtime. Be sure that the nozzle of the syringe sweeps the entire vaginal cavity, and if the above quantity of fluid should not be sufficient to thoroughly cleanse the vagina, then use double the quantity of powder and fluid. With this prescription I have cured cases of leucorrhoea of twenty years' standing which had gone through the ordeal of all the different treatments that they were capable of un- dergoing. I would recommend to those patients who feel their wombs dragged down, the knee-chest posture, that means, to kneel down on the floor with the hips elevated as high as possible and the chest close down to the floor. This position rolls the abdominal organs upwards and forAvards, and thus naturally draws the womb and vagina into their normal positions, much better than any mechanical appliance or operator can possibly accomplish it. It simply allows the relaxed organs, through the natural law of gravitation, to gravitate where they belong. It is necessary to retain this kneeling position for only ten or fifteen minutes, repeated twice a day, say night and morning, and the curative effect is trulv wonderful. INFLAMMATION OF THE VAGINA. 181 When I speak of the curative measures of displacements in general and of falling of the Avomb downwards and baek- Avards in particular, I will give a detailed description of the knee-chest position. There should be a choice in selecting a vaginal syringe or a syringe for vaginal bathing. The "fountain syringe'' has seA'eral objections that are insurmountable. In the first place, the quantity of fluid that is to be used is limited by the capacity of the reserA'oir, or in order to replenish it, the even tenor of the rinsing is disturbed. Another objection is, that the convenient peg upon which to hang it is not always present, or a shelf upon Avhich to rest it not high enough; then there is not the control over the stream that is desirable, so that considerable confusion arises at times from the fluid Avetting things that had better be kept dry. For these reasons I prefer a bulb syringe. The "Alpha" continuous-flow syringe is to my mind the most satisfactory instrument in the market. This syringe produces a continuous Aoav by means of an elastic outlet tube; it is also provided Avith hard rubber fittings which are non-corrosive, so that the various chemicals can neither rust nor corrode them. The chapter on hygienic measures for catarrhal diseases contains part of the treatment for this affection. CHAPTER XIV. HYGIENIC MEASURES FOR CATARRHAL DISEASES OF THE FEMALE ORGANS. No treatment for catarrhal inflammations in general and of the pelvic organs in particular is certain and complete without special attention being given to certain laws or rules that are laid down for the preservation and attainment of health, and these comprise one of the collateral departments of medical science which is termed hygiene. What the skin or integument is to the exterior of the body, the mucous membrane which lines the respiratory passages and other organs is to the interior of the body. The mucous membrane is only a modification of the skin, and while it differs in its glandular composition in the different organs that it lines, in the main, it retains the com- mon characteristics of the skin or outer covering of the body. The corium or fibrous layer of the mucous membrane is analagous to the derma of the skin; and it is in fact a con- tinuation of it at the orifices of the body. The corium of the mucous membrane supports an epi- thelial layer of cells that are of various forms, differing in the different organs that it lines. Underneath the corium of the mucous membrane there is the fibro-vascular layer, which contains the blood vessels, lymphatics and nerves and embedded in the epithelial cells supported by the corium are the numerous mucous glands or follicles. In some portions of the mucous tract and pro- jecting out of it are little elevations called villi or papillse, analogous to the papillae of the skin. (182) HYGIENIC MEASURES. 183 These glands and papillae exist only at certain parts and are modified according to the function that the organ per- forms. The mucous glands of the stomach differ from those of the intestines, and those of the mouth from those of the bronchial tubes. The mucous membrane of the womb dif- fers from all the rest, by having no submucous or fibro- vascular layer; the mucous glands of the womb are im- bedded and extend directly into the muscular tissue of the organ. The secreting glands, which form a special feature of mucous membranes, are abundantly supplied by small capil- lary blood vessels and nerves, so that any disturbance of the general or systemic circulation or a derangement of the nervous system will at once greatly influence the healthy or normal secretion of the membrane, just exactly as the skin is affected by cold or fright. In order to appreciate all the causes that operate for either good or evil, we must pause for a moment and con- sider the sympathy with and the close relation of the mucous membrane to the circulation of the blood and the nervous sys- tem. The mucous membrane of the different organs is often made the safety valve through which obnoxious materials or morbid conditions of the blood are eliminated from the system, and for that reason I have long ago discarded the usual harsh measures in the treatment of sudden or acute catarrhs. I have found that, by carefully watching and giving close attention to the details of certain rules of health, catarrhs speedily disappear of their own accord: on the other hand, if irritating local remedies are constantly used, catarrhs continue to grow worse. This demonstrated fact so very often repeated, impressed upon my mind the importance of hygienic measures for the successful treatment of catarrhal inflammations, whether they are of the respiratory organs or of the female pelvic or- gans. The most prominent and efficacious measures are to be found in intelligent precautions for preventing colds and inuring the system to changes of temperature by appropriate outdoor exercise. 184 HOME TREATMENT FOR AA'OMEN. By far the greater proportion of female complaints are catarrhal inflammations, and these fasten themselves upon all the pelvic organs—on the bladder, vagina, womb and Fallopian tubes. We generally know how we contract a bronchial catarrh or bronchitis, a nasal catarrh or sore throat; in precisely the same manner do women contract most of their pelvic ca- tarrhs, that is, from a common cold or sudden chilling of the body or part of the body. Dr. Thomas F. Humbold, in his work on the ''Hygiene and Treatment of Catarrh," says : " The history of every case of chronic catarrh attests that the complaint commenced Avith colds in the head and that the disease grew upon the patient almost imperceptibly, the first colds being so trivial in character as to attract but little attention." * This statement is as true of the great majority of cases of vaginal and uterine catarrh as it is of catarrhs of the air passages, and for this reason the measures and precautions for the prevention of colds must be one of the features in the successful treatment of female complaints. The particulars of the causation of colds and the hy- gienic precautions for their prevention are hardly ever given the attention which their importance demands in the treat- ment for catarrhal complaints of women, so that a great deal of suffering is left unrelieved and a great deal of ex- pensive and useless doctoring is endured. Altogether too much reliance is placed upon a Avash or some local appli- cation made by the doctor to the affected parts, and, indeed, the mainspring of the catarrhal affection is entirely over- looked or neglected, Avhich is, the susceptibility to the re- currence of fresh colds. The injurious effects of taking cold or chilling the body or any part of it, have been the subject of special inquiry in Germany. The mucous membrane and the skin seem the most sensitive to sudden changes from a warm to a colder atmosphere, but observations have already proven that be- HYOIENIC MEASURES. 185 sides the usual catarrhal inflammations, there are other in- flammatory conditions that are developed. The kidneys, lungs, and liver have been found to be the seat of inflam- mations in a series of experiments that were made Avith rab- bits that Avere removed from a warm to a much colder apartment, and from this may be inferred that these condi- tions originate similarly in the human subject, The logical conclusions, of these researches have been, that the chilled or cooled blood becomes chemically altered and acts as a direct irritant in the small capillary vessels, and by that means all the phenomena of inflammation of the tissues are excited, and these of course develop wherever the cold may strike or locate. When we speak of a slight or a bad cold, Ave cannot form the least idea of the remote effects that the cold may bring about. It may lay the foundation of a nephritis or Bright's disease of the kidneys, or some other lesion, and that it often gives rise to vaginal and uterine catarrh is as certain as that it gives rise to nasal catarrh or a cold in the head. An aptitude to take cold grows Avith each repetition of the attack and the prolonged duration of the acute catarrhal symptoms. And for that reason persons grow into the habit of taking cold upon the slightest exposure or change of temperature. At this stage of catarrh there is an abnormal sensitiveness of the mucous membrane and skin, in Avhich the slightest draught of air or even passing from one room to another occasions an attack of sneezing or a chill and other svmptoms that Avill indispose the patient for several days. The great majority of individuals have a natural predis- position to certain diseases. In anatomy the body has been divided into systems. A svstem is an assemblage of organs composed of the same tissues and intended for similar functions, as the circulatory svstem, the nervous system, the muscular system, the cuta- ISO HOME TREATMENT FOR AVOMEN. neous system, etc.; these systems are all liable to particular diseases. In one person the mucous membrane of the respi- ratory system is the most sensitive part of the body, while in another, and especially in women, it is the mucous mem- brane of the genito-urinary system. In other words, one person will take a cold and it will settle in the head or on the bronchial tubes, while another from the same exposure will get a catarrhal inflammation of the bladder or womb; this is only explained on the theory of natural predisposi- tions, and, perhaps, hereditary taints. If a person once knows the weak or vulnerable points, he can outgrow them, by employing such rules of hygiene as experience has taught to be useful. There is much more benefit to be derived in an educational treatment directed to the prevention of disease, for this is also in the nature of a cure, than in a blind obedient faith in the treatment or remedy of a physician who may be ignorant, and generally is, of the laws of health or the science of hygiene. To promote health and to antagonize disease is greatly within one's own poAver, because there is no doubt that most diseases are the result of imprudence that cannot be attrib- uted to ignorance, because persons commit these errors with a full knowledge of their evil effects. A healthy habitation, that has all the advantages of pure air and sunshine, is an essential feature in regaining health and encouraging a cure. There are hundreds of persons who have been sick and miserable for years, and who have made the rounds of all the doctors they ever heard of, with- out the least benefit to themselves, because they were never told how to live, and their living rooms are dark and sun- less and poorly ventilated. The even and equable temperature of all the rooms of a house should be kept in constant view, so that sudden and extreme changes of temperature are avoided. Warming a dwelling artificially should be one of the important features in the construction of a completely-fur- HYGIENIC MEASURES. 187 nished residence. This subject has been somewhat neg- lected, owing to the temperate climate of California, but not- withstanding this, the moisture of our climate and the close- ness with which dwellings are built to each other in our larger cities, so as to exclude the rays of the sun, make houses that are shaded too cold for health and comfort. In our climate we become more sensitive to the cold air, than those who live in drier regions. In shaded houses and rooms, especially in damp weather, we need artificial heating as much as they do in colder cli- mates, so that architects should make it a study to introduce a system of heating that will insure an equable temperature throughout the entire building, at a minimum of expense. The fireplace or open hearth, which has become so pop- ular Avith us as the pleasantest and healthiest mode of heat- ing and also insuring ventilation, should be discarded for something much better. The fact that the fire is directly beneath the chimney flue explains the fact that eighty-seven per cent of the total heat yielded by coal or coke and ninety-four per cent of that yielded by wood escapes through the chimney. This enormous loss of temperature arises from the current of air necessary for combustion, carrying with it a large quantity of the heat produced which is lost in the atmosphere. This of course is a means of ventilation, but a little reflection will convince almost anyone that it cannot be the most practical, and in this State where coal is very high it is equally expensive. The smoke, soot, and ashes that are inseparable from the open fireplace make it trouble- some and dirty, not to say anything of the coal gas, which poisons the atmosphere of a room, and I have often noticed its noxious influence on infants. Iron stoves are more cleanly and the combustion can be regulated at will. The amount of heat that is derived from a well-constructed stove is much greater than can be ob- tained from an open fire and they do not require near the fuel. Iron heaters, as they ordinarily go, should not be over- filled Avith coal so as to overheat the apartment 1*8 HOME TREATMENT FOR WOMEN. Heating by hot air consists in heating the air in the lower part of a building, from Avhence it rises to the higher parts by virtue of its lesser density. The stove or furnace is placed in the cellar, from which tubes carry the heated air throughout the entire building. There are registers or reg- ulators in each apartment, so as to have the regulation of the temperature at one's command. I believe that hot water heating is preferable to any other system, and it avoids the objections that have been already mentioned. It is claimed that this method is less healthy than grates or fireplaces; this I deny, because the dust and soot of a hearth are anything but healthful; and as for ven- tilation, the proper place for that is on the Avails near the ceiling, and up in the walls to the roof. These openings should be provided with registers, so that the ventilation shall be entirely under control, which is certainly an im- provement on that incidental to a fireplace. In Germany they haAre heaters or stoves which in beauty of design equal our mantelpieces, and for cheapness and permanency of warmth excel anything in this country. The)7 are built of fire brick, usually in some corner of the room, about one and one-half feet wide, three feet deep and eight feet high, and covered with porcelain or terra-cotta tiles. These are artistically ornamented with raised figures of the same material. A small fire is started in these stoves in the morning, and when the coal is in a glow, all draft is shut off, then a moderate warmth is radiated for twelve or fourteen hours. This is to my mind the most practical and economical heater for a single room that can be devised. But there are objections against warming one or tAvo rooms of a house and leaving all the others cold. To have a blaz- ing fire on the hearth of the sitting room, while the halls and bedrooms remain cold and chilly, is a very fruitful source of cold and catarrhs. The proper way to heat a house is to have the various rooms heated from a single source. HYCIENIC MEASURES. 189 The most comfortable average temperature for living rooms is from 65 to 70 degrees Fahr., for hospitals and sick rooms a higher temperature is generally required, say from 75 to 80 degrees Fahr. Dr. Horace Dobell, of London, in his work entitled "Winter Cough," makes some very practical and useful re- marks, when he says: "But before leaving the subject of sud- den changes of temperature, I must not forget to speak of sleeping rooms. It is quite astonishing Avhat follies are committed with regard to the temperature of sleeping rooms. On Avhat possible ground people justify the sudden transi- tion from the hot sitting room to a Avretched cold bedroom, Avhich may not have had a fire in it for weeks or months, it is impossible to say, but it is quite certain that the absurd neglect of properly warming bedrooms, is a fruitful source of all forms of catarrh. We cannot too much impress this upon our patients." There is another source of clanger in artificial heating, and that is, in having the air of the house ahvays much warmer than the most favored temperature of the open air. This is a great mistake because it is under these circum- stances almost impossible to go from an overheated house or apartment into the open fresh air without catching cold, and for this reason the thermometer should be found in every Avell-regulated household. Women avIio are under treatment for female disease should never get into a cold bed, even if there has been fire in the sleeping room during the day. In damp and cold weather there should be greater precaution in this respect. The best bed Avarmer is one or more earthenware jugs, like the German seltzer water jugs,, filled with hot water. Earthenware radiates the heat better and retains the warmth longer than glass, while there is no danger of the heat cracking the jug, as it will glass bottles. One or two of these jugs filled with hot water and put into a bed an hour or so before retiring will bring the temperature up to an agreeable Avarmth. 100 HOME TREATMENT FOR WOMEN. Proper clothing is perhaps from a sanitary standpoint of equal importance Avith that of artificial heating and ventila- tion. With appropriate clothing, the body can be pro- tected against the inclemency of the weather and the sud- den changes of the atmosphere so that no ill effects are experienced from the great changes of temperature to which we are exposed. Women are dressed less Avarmly than men, although they do not possess the bodily strength to re- sist cold in the same degree as men. Their garments are not only made of lighter material, but the loose, fluttering manner in Avhich they hang around the limbs does not pro- tect their bodies in the same thorough manner that similar material made after the style of men's clothing protects men. This does not imply that women should don men's cloth- ing, because the present costume or outside apparel of women of civilized countries, is both graceful and modest. A reform, hoAvever, in her underclothing is not only desir- able but in many cases absolutely necessary to insure per- manent relief from catarrhal affections. All women who are suffering from uterine or pelvic diseases, and who are still wedded to the injurious costume of open draAvers and skirts, have an important lesson to learn. A warm and complete covering for the loAver extremities and pelvic organs is paramount to any medicine or treatment that can be given. It is during the menstrual period that the pelvic organs are more susceptible to congestion and inflammation from exposures than at any other time, and from the manner in which women dress, it is surprising that there is not more sickness among them than there really is. Wide and open cotton drawers, and skirts hanging loosely around their limbs, with cotton hose, are no protection against drafts and sudden changes, so that it often happens that the extremities are chilled and cold, Avhich is in itself sufficient to cause uterine diseases. When this exposure continues, Avith some already existing disease, it will neutralize the best-directed efforts to accomplish a cure. HYGIENIC MEASURES. 191 It is said of the celebrated Boerhave, that among his effects there was a carefully-sealed prescription, which con- tained the secret for preserving health and vigor to a ripe old age. In his last will and testament it Avas provided that the prescription should be sold to the highest bidder at public auction. A physician who was anxious to procure the recipe of this renowned Dutch doctor, bought it for a very high price. On breaking the seal and anxiously unfolding the paper, he found tliese Avords: "Keep the head cool, the extremities warm, and the abdomen free." The buyer was greatly cha- grined at the simplicity of the supposed panacea, but, if the profession and the public only appreciated the real worth of the advice, there would be much less sickness. This strikes at most of the evils in dress that pave the Avay for diseases of women. It comprises the evil effects of tight lacing and compressing the abdominal organs by improper support for the skirts. A corset should never be Avorn so tight that the hand cannot be passed through the 'waist line. In the absence of a waist or shoulder straps for the support of the skirts from the shoulders, shoulder straps should be fastened directly to the corset, so as to relieve the hips and abdomen from the weight of the clothing. The Bates' Avaist is not only a perfect substitute for a corset, in supporting the bosom and preserving the form so as to give a handsome figure, but it supports the skirts with- out restricting the circulation and respiration, or compressing the abdominal organs. In buying or making a waist or bodice, particular attention must be paid to the shoulder bands, so that these bands are short enough to give the waist or bodice support from the shoulders. If, then, the skirts are buttoned to the waist, the weight is taken from the hips, where it injuriously depresses the abdominal organs, and falls on the shoulders, where it cannot do any harm. There is a good deal of humbuggery about these new devices, and those who make it a business to sell them, never take the pains, or are incompetent, to properly fit the waist. If one 192 HOME TREATMENT FOR WOMEN. only bears in mind that, if the waist does not support the skirts from the shoulders, there is nothing gained over wear- ing an old-style corset, imposition is impossible. The dressing for the feet should be warm and comforta- ble. Women Avho go to balls and parties should always wear overshoes in going to and coming from an enter- tainment. Thin and light shoes must be avoided in cold and damp \veather; in fact, there is nothing that women should be more careful about than too light and low shoes which do not keep the feet warm. For comfort and keep- ing the feet warm, there is nothing like a loosely-fitting leather shoe, with wide and thick soles, and a low, flat, En- glish heel. It is also the best "corn remedy" I know of. When the Aveather is Avet and cold, rubber overshoes should be Avorn, and these should be removed when enter- ing the house. Women who have a tendency to cold feet, will find the cork or felt soles worn inside of the shoes, a great source of warmth and comfort. The coldest stratum of air is invariably on the floor of the room, and there is, perhaps, no easier or more unsuspected way to take a cold than to exchange a pair of high, warm shoes that fit closely around the ankles, for a pair of light, low slippers. If you desire to rest your feet in a pair of light slippers, then add a pair of heavy woolen socks over the stockings, this will greatly lessen the chances of taking cold. Women avIio are suffering from pelvic or Avomb diseases, and who are anxious to get Avell, and those who are troubled with painful menstruation, and menstrual irregularities, should Wear Avoolen hose. Thin cotton, silk-mixed, or silk hose are not sufficiently warm, nor do they retain the nat- ural heat of the body like woolen stockings. Those Avho have once accustomed themselves to woolen hose, should not discard them in the summer months for cotton, linen or silk goods, and this is to be particularly ob- served on this coast, but the hose should be exchanged for thinner and lighter goods of the same material, correspond- ing to the demands of the season. It Avould not be Avise or HYGIENIC MEASURES. 193 prudent to wear the same quality and amount of clothing in warm weather as in cold; otherwise the excessive clothing in the summer months will induce perspiration on the slightest exertion, and thus the system becomes most sus- ceptible to cold Avhen the weather changes or becomes cooler. Elastic garters to maintain the tops of the stockings in position should be avoided. Rubber bands make a contin- uous compression on the vessels and nerves, although al- most every woman claims that she does not wear her gar- ters tight, yet at night Avhen she removes the elastics there are deep furrows marking the constriction of the garters. The spring-Avire garters are just as injurious, for they also exert a continuous pressure. The veins of the legs are, for the most part, superficial, and this steady and gradual compression is very injurious to the venous circulation, so that the blood is prevented from returning from the limbs as readily as it should; this induces cold feet, and when the circulation is already weak, it often imparts a feeling of heaviness to the limbs, for Avhich women doctor but Avithout getting any relief. The only proper support for the hose is elastic straps that are supported from the waist; they are now so well known and for sale in every dry goods store that a description of them is unnecessary. To keep the legs and body warm is not a question of quality or quantity of skirts or wraps. If the limbs under them are not separately enveloped and are only covered with thin cotton or silk hose and open cotton drawers, women are continuously exposed to the cold, damp emanations from the ground and to the drafts caused by the motion of the skirts, and blasts of Avind. The most intelligent suggestions for Dress Reform are those that are directed toAvards reducing the weight or dis- placing the heavy, stiff, and unwieldy skirts and clothing the extremities of the female in divided garments, so that they are no longer exposed to the dangers of cold and drafts. The divided skirt is in the direct line of a modest and desir- 1 ° 194 HOME TREATMENT FOR WOMEN. able improvement of woman's dress, and it is growing in popularity among the most intelligent of reading and think- ing women. If the specialists of female diseases were to study the interests of their patients with the same ardor that they study the methods how best to fill their offices with patients, on whom they perforin useless and dangerous operations, they would be of some actual benefit to our Avives, mothers, and sisters, and our women could be dressed am gracefully as at present with less than half the underclothes to pack around with them. I am decidedly opposed to anything approaching in style or shape the bloomer costume; the present style of outside dress cannot possibly be improved for a comely garment, but it is underneath this that an entire change should be speedily effected. The divided skirt is cut like drawers that have a width of thirty to forty inches of goods in each leg. I believe that the width of each leg should not be more than twenty-five to thirty inches; this makes the skirt warmer and lighter. , This is not attached to a band to fasten around the waist, but to a yoke, Avhich should be but- toned to the bodice waist, suspending the skirt from the shoulders. The material will be a matter of individual taste; the two qualities that should be always looked for are softness and warmth, and for that reason Jersey flannel and ladies' cloth are the most suitable material; in summer or warm climates, pongee or Avash silks may be substituted. The skirt is cut on the bias to fit the hips, where it is fulled in and attached to a yoke instead of a band and in the back it laps about two or three inches. The advantage of the divided skirt is that it protects the limbs and body against drafts and cold emanations, and takes the place of all underskirts and petticoats. This1 skirt alone, however, would be insufficient to accomplish all that is desired by way of guarding against exposures; for this reason there is also a so-called Union suit worn under the divided skirt to complete the covering of the limbs. Union suits, as the name implies, unite a pair of closely- HYGIENIC MEASURES. 195 fitting drawers with an undershirt. There is no particular advantage in uniting the underdrawers with the undershirt, but there is certainly no disad\rantage. The principal ob- ject that is to be attained is not in unionizing drawers and shirts, but wearing such closely-fitting undergarments that the extremities are permanently protected, and in having them so lapped or closed that the abdomen and pelvic organs are securely protected against cold. Equestrian tights are made on the same principle and for a similar purpose as union suits, namely, to properly and surely cover the limbs and in a measure displace the great load of petticoats that women usually wear. They come in drawers and also in combination suits with the un- dershirts; a choice may be left to individual taste. There are different brands of these goods on sale in ail the dry goods stores of our large cities, the prices being regulated by material and quality of the goods from which they are made. The woolen goods are preferable for practical purposes. Women Avho do not like the woven closely-fitting drawers can take their choice between the latter and home-made flannel drawers, the French flannel for the lighter and the English bully for heavier and Avarmer clothing will be found to be the most serviceable materials; patterns for making up closed or button drawers may be had at the leading pattern stores of any city. Women who cannot grow up to an appreciation of the divided skirt should by all means Avear equestrian tights or buttoned flannel draAvers, under cotton or linen ones; this will enable them to throw off one or two petticoats or skirts because the drawers will safely substitute the skirts and be much lighter. Some women dread the absence of skirts on account of appearing too scant; a little extra fullness and drapery to the dress make the absence of skirts not notice- able. If this were not quite so, there appears no satisfac- tory reason Avhy a woman should feel embarrassed to mod- estly display the contour of her form any less than a man. CHAPTER XV. METRITIS OR INFLAMMATION OF THE WOMB. This is an inflammation of the entire substance of the womb, which, like all inflammatory processes, is acute or chronic. Inflammation does not always affect the Avhole body of the womb, but it is quite oftener limited to one or the other layer or membrane that enters into its architectural Avhole. Then, again, there is the anatomical division of the organ into a body or corpus, and a neck or cervix; of these either one may be affected, Avithout the other, so that inflammation of the cenux should be the subject of a separate inquiry. Most of the diseases of the womb are due to inflamma- tion. This Avas the opinion of J. H. Bennett, of London, as long ago as 1845, in which year the first edition of his Avork on "Inflammation of the Uterus" was published. Up to that time, the subject had never been practically pursued to the same logical conclusions, so that the opinions of the leading professional minds were far from unanimous on this question. But the vigor and energy with Avhich the young author defended his views, forced attention and con- viction upon the greater part of the profession, in this coun- try and Europe. He started out with a vieAv to prove: "1. That inflam- mation is the prirnum mobile in uterine affections, and that from it follow, as results, displacements, ulcerations and af- fections of the appendages. 2. That menstrual troubles and leucorrhoea are merely symptoms of this morbid state. 3. That in the vast majority of cases, inflammatory action will be found to confine itself to the cervical canal and not to affect the cavity of the body." (196) INFLAMMATION OF THE WOMB. 197 Since the appearance of the first edition of Dr. Bennett's work, Avhich is now forty-six years ago, there have been many careful and clever observers in this field of pathology, but there is yet to appear a successful contradiction of the truth of his inflammatory doctrine. Twenty-six years after Dr. Bennett wrote the above book, he read a paper before the British Medical Association on the same subject, in which there is no modification of his first conclusions on the importance of inflammatory lesions. He says: "1. Uter- ine displacements are by many too much studied per se (by themselves) independently of the inflammatory diseases that complicate and often occasion them. 2. That the exami- nations made to ascertain the existence of inflammatory com- plications are often not made with sufficient care and mi- nuteness, as evidenced by the fact that I constantl}'' see in practice cases in which inflammatory processes haAre been entirely neglected, and the secondary displacements alone treated. 3. That inflammatory lesions are often the princi- pal cause of the uterine displacements through the enlarge- ment and increased Aveight of the womb, or a portion of its tissues, which they occasion. 4. That when such inflam- matory conditions exist, as a rule they should be treated and cured and then time given to nature to absorb morbid enlargements before mechanical and surgical measures are resorted to." If these propositions could be engrossed and a copy sent to every doctor in the land, as a safe and sure guide in his treatment of diseases of women, it would prove a great boon to the suffering women of this country. One of the notori- ous abuses of the profession, is the penchant for the employ- ment of mechanical means, either by means of instruments or the surgeon's knife. Women are Avantonly subjected to painful and tedious treatments which in many cases only aggravate their original suffering, Avhile a feAV simple rules of hvofienic treatment would not only restore them to health and vigor, but would save them the privation of paying fees 198 HOME TREATMENT FOR WOMEN. to incompetent, unscrupulous or avaricious doctors, who have only one ambition, that is, to get the patient's money. I have known an instance where this barbarous course under the guise of scientific treatment, broke up the home of a once happy and prosperous couple, and finally when the resources were so low that the expense incident to housekeeping and a nurse could no longer be defrayed, the household effects were disposed of, and, as a last resort, the overdoctored woman was taken to a hospital, where her last hopes were lulled into an artificial sleep, while the surgeons performed an operation from which her depleted body and squandered vitality could never recover. She died. I am convinced from observations in large female clinics in Berlin, and from my own studies in the pathological laboratory while a student abroad, that Dr. Bennett's con- clusions are corroborated by actual facts. The freedom with which dangerous operations are undertaken for compara- tively trivial complaints is degenerating into a license that is criminal and which in some cases is nothing less than murder. In the absence of a high moral sentiment which should control the profession, but does not, the State must step in and say who shall practice medicine and surgery, and by limiting competition, the evil propensity to make the most of one's opportunities will not be elevated into a fine art, and men, although unscrupulous, may be at least indifferent honest. Acute metritis comes on suddenly, and this occurs quite often during the menstrual period. Women as a rule are altogether too careless during menstruation; they seem to forget that at this time the womb is congested and swollen, and that if the natural flow of the blood is interfered with, this congestion will turn into an inflammation. Exposure to cold, or getting the feet damp, or inordinate exercise that overheats the system, will bring this about. Some- times there may be a tumor or SAvelling in the womb Avhich occludes the cervical canal, so that the menstrual fluid can- INFLAMMATION OF THE WOMB. 199 not escape; this will also cause inflammation. A stricture of the cervical canal, occasioned by the womb being flexed, will interfere with the egress of the menstrual flow, and this also may give rise to inflammation. Vaginal injections either too hot or too cold, and particularly immediately after copulation, when the pelvic organs are still in a high state pf congestion, is quite liable to excite metritis. Gonor- rhoeal infection is another source of inflammation, but this is invariably preceded by an endometritis, which I will con- sider separately. Large, ill-fitting pessaries worn in the vagina for a sup- posed retroflected or prolapsed uterus, or a stem pessary, are fruitful causes of metritis. Other causes are criminal abortion, complicated with blood poisoning from the unclean probes or instruments, that the abortionist has employed on previous operations with- out thoroughly cleansing and disinfecting them; the appli- cation of strong caustics to the cervix of the womb, as well as injections into the cavity of the uterus. Meddlesome doc- toring by means of the unskillful and unnecessary use of in- struments, like the probing of the womb without proper an- tiseptic precautions, or the scraping, stretching or operating on the womb Avithout the essential antiseptic precautions Avhich a scientific comprehension of the subject demands, has frequently caused this affection. It occurs very often as a part of the general inflamma- tion produced by the absorption of putrid or septic matter during the childbed period. This indicates a lack of clean- liness on the part of the attendants during confinement; in- flammations of this nature constitute one of the types of puerperal or childbed fever. The most prominent symptom is pain. This is greatly aggravated on the slightest pressure, or on moving or turn- ing in bed. Upon a digital examination, the Avomb is found enlarged or swollen, and when the organ is tilted up on the examiner's finger, there is a sharp lancinating pain radia- ting from it in all directions. 200 HOME TREATMENT FOR WOMEN. The first symptoms of pain are always accompanied with fever, and this may have been ushered in or alternated with a chill. The pain may be first felt rather deeply in the pel- vis, and this is increased by a frequent desire to pass urine and a straining of the rectum. It may further become com- plicated with a looseness of the bowels, or an obstinate con- stipation. Nausea and vomiting is a frequent symptom dur- ing the course of the disease, and if the metritis is developed during menstruation, the flow may suddenly stop, but, on the other hand, the hemorrhage may become alarmingly profuse. Standing, walking, coughing and straining at stool excite the most excruciating pain, so that a recumbent quiet position is the only comfortable way for the patient to maintain herself, with the head as low as possible to insure the most easy recumbency. The treatment for acute metritis depends somewhat on the cause in each individual case. There are, however, two indications that require to be met, and these are common to all inflammations, namely, to relieve the pain and check the inflammatory process. The former is quickly relieved by introducing into the rectum a suppository prepared after the formula No. IV., re- peated every four or six hours, until the pain is sufficiently alleviated to occasion no suffering; then one suppository should be employed every night until cured or until restless- ness requires that something must be done to calm the patient. If the metritis is due to suppressed or checked menstrua- tion from cold or exposure, then, and only then, are hot fomentations over the entire abdomen the most appropriate application, and if the patient is plethoric, I advise a half- dozen leeches to the inguinal region of one or both sides to be of unequaled value for checking the disease. Until my experience and observation in German hos- pitals, I was in the habit of employing hot applications for all acute inflammations of the abdominal organs. These were either in the form of hot-water fomentations or flax- INFLAMMATION OF THE WOMB. 201 seed poultices. Hot applications undoubtedly give relief, but I doubt whether they ever cut short or abridge the in- flammatory process in any case. I am inclined to believe that in a great many instances hot fomentations have the tendency to encourage suppuration, and that an abscess is often the result of their use. I have seen decidedly better results from cold applications, and the colder the better, so that I now -employ them universally in all acute inflamma- tions of the pelvic organs except in the noted exception in which the inflammation is due to a sudden check of the menses from exposure. As a*preventive of inflammations, after delicate operations on the uterus, I apply the rubber ice bag Avith invariable success. The most suitable rubber bag for this purpose is a size of six by twelve inches; it should be filled with broken pieces, and then securely tied. I prefer to envelop the bag in a thin layer of flannel, so as to take off the cold, clammy sen- sation which the rubber imparts to the skin. There should be two of these bags, in case of accidentally tearing one, and so that the reserved one may be in readiness when the other is removed. The cold does not only check and control the inflammation,but it also benumbs the nerves, so that it greatly relieves pain. I keep these ice bags, applied over the region of the womb, until all the acute symptoms disappear. The vagina, however, should be irrigated with medium hot borax water, once a day, so as to remove any irritating discharge from the uterine cavity. The digestive derangements that so often accompany acute metritis; the nausea and vomiting of this and kin- dred diseases, are alleviated by this formula:— NO. XVI. Take: Subcarbonate of bismuth...............2 drains Bicarbonate of sodium.................2 drains Tr. of opium, deodorized...............2 drams Tr. of nux vomica.....................1 dram Simple syrup..........................1 ounce Peppermint water, sufficient to make.... 0 ounces 202 HOME TREATMENT FOR WOMEN. Mix, and take a tablespoonful every one or two hours until relieved; to allay the thirst and dryness, take small pieces of ice. Constipation of the bowels should be relieved by taking formula IX, or by administering a clyster of warm water impregnated with a little soap. / CHAPTER XVI. CHRONIC METRITIS OR CHRONIC INFLAMMATION OF THE WOMB. When from neglected or improper treatment, the acute inflammation is not checked, so as to restore the organ to its normal condition, the inflammatory process assumes a chronic character. As inflammation is an abnormal vital activity, which results in the proliferation or building up of fibrous tissue, it must be naturally inferred that if the in- flammatory process is active in an organ for a considerable length of time, the tissues of this organ must grow or in- crease, so as to augment its size and AA^eight. This is in- deed so, hence the other names that have been given to this disease to distinguish it from the acute or transient form, all imply tissue growth, as hypergenesis of the connective tissue, engorgement or inflammatory hypertrophy of the uterus. The entire organ may be thus affected, or it may be lim- ited to either one or the other anatomical divisions of the uterus, namely, the body or the neck. Of all the different varieties of chronic inflammation of the womb, that of the neck or cervix is the most fre- quentl}'' met. This is due to the fact that in married women and those who have born children the cervix of the womb is exposed to mechanical injury from coition, friction against the vaginal walls in walking and from lacerations during delivery. The body of the Avomb is further removed from all these mechanical agencies to which the cervix is exposed, for the body is within the abdomen of'the female, and for that rea- son it is less liable to be injuriously affected by influences that cause inflammatory enlargement. But notwithstand- ing all this, it is a common disease. 6 (203) 204 HOME TREATMENT FOR WOMEN. A great many cases of womb complaint that do not yield to ordinary treatment are really of this nature, but OAving to carelessness or incompetency are never recognized. The symptoms of this disease, which are obstinate leucorrhoea, falling of the womb or displacements, are mistaken and treated for the disease itself. Women who suffer with this complaint are extremely liable to go on for quite a Avhile feeling comparatively well and in hopes that they are recov- ering, when some extra exertion or exposure to cold brings on a relapse, which lights up an acute inflammatory process. This passes into the old troublesome disease and this re- sumes its chronic form. After a repetition of the general routine treatment, the patient may again live under the de- lusion that she is going to get well only to have her hopes blasted by a sudden reappearance of the former painful symptoms, that are alike discouraging to herself and a puzzle to her friends. The cause of inflammatory enlargement of the uterus is usually connected with parturition or abortion. There never can be either the one or the other without more or less vascular activity, which is essential to the repair of the womb and its restoration to its physiological or healthy condition. All the uterine tissues are at this time in a high state of irritability, and if there is a natural pre- disposition to inflammatory diseases, then the slightest ob- stacle to an uninterrupted recovery will kindle an inflam- matory action, that will fasten itself on the uterus. In the very nature of things this results in a deposition of inflam- matory material, with a consequent increase of intermuscu- lar fibrous tissue which increases the size and weight of the uterus. What our mothers termed in former days "a bad get- ting up," that is, when women get up from their confine- ment weakly and with more or less pain and dragging in the pelvis on walking or the slightest exertion, is generally owing to the above-described condition. This disease is CHRONIC METRITIS. 20o now almost as common as ever. I can always trace tliese cases to a confinement or an abortion. It is very rare that it is due to a depreciation of vital forces from improper food, over-exertion, a prolonged nerv- ous depression or a constitutional tendency to tubercle, scrofula or some other hereditary diathesis, although these undoubtedly predispose the patient to the disease. Abortions stand at the head of all the causes that excite this affection. When the uterus is pregnant and its natural growth is abruptly checked by the destruction of the em- bryo, then the organ becomes at once the seat of a conges- tion and great vascular activity, for the purpose of repairing the injury that the premature expulsion of the,embryo or fetus inflicted. If this congestion is delayed from improper care or treat- ment which fails to recognize the important fact that an abortion or interruption of pregnancy is a much greater shock to the system than a delivery at full term, it must result in arrested involution or permanent inflammatory enlargement. This most persons fail to appreciate, and, as a result, they do not take the same precautions that they would after the delivery of a living or fully-developed child. I am well aware that criminal abortionists are in the habit of deceiving their patrons by assuring them that there is no danger or bad results to be feared from their criminal operations. This is a vicious falsehood, and, coupled with the statement that there is as yet no living being in the womb, the crime of manslaughter is added to that of malpractice. In every case of abortion, whether accidental or criminal, the same care and attention must be given to the Avoman as during any natural lying-in period. There is a class of chronic inflammations that I have noticed in women who have always suffered from painful menstruations or from excessive or prolonged hemorrhage at the regular monthly period. This is complicated with some ovarian disease, which yields, however, to appropriate treatment. 206 HOME TREATMENT FOR WOMEN. There is quite a series of symptoms that denote the ex- istence of chronic metritis; these are not all present in each particular case but quite enough of them to diagnose the disease. Some of these symptoms are in the nature of com- plications, which in themselves may be mistaken for an indi- vidual disease, but upon a careful inquiry they can be traced directly to a chronic metritis, which if removed dis- poses of all the lesser ailments. The following are the most noted signs of this affection: painful copulation, and pain on defacation; a dull, heaA'y, dragging pain through the pelvis, much increased by walk- ing; during menstruation the mammae are sensitive or painful; several days before the approach of the menses there is a dull pain, which lasts during the menstrual flow; around the nipples, there is pigmentration or darkening; sometimes nausea and vomiting, and dyspepsia, headache, and languor; pressure on the rectum with tenesmus and hemorrhoids; leucorrhoea from catarrh of the womb; pressure on the bladder with tenesmus or straining. This disease may continue for years uninterruptedly, and, if there is not a cure accomplished, or successful meas- ures for its relief are not employed, it will continue until the menopause, or change of life, which may effect a sponta- neous cure. The enlargement is most noticeable in the-cervix or neck. This is sometimes so great as to extend one or two inches into the vagina, and this condition is often mistaken for falling of the womb or prolapse, which is far from a correct diagnosis. A growing of the womb from chronic inflam- mation is the proper explanation. The hygienic suggestions given in a former chapter, form an important auxiliary in the treatment of this com- plaint, and for that reason it should be carefully studied. The treatment of chronic metritis has been, up to within a very recent period, anything but satisfactory in its results. This was. owing to an inadequate knowledge of the real nature of the disease, which was marked by so many symp- CHRONIC METRITIS. 207 toms that were in themselves obscure and hard to separate as such, from the main affection. This confusion of the true nature of the pathological proc- ess, resulted in a great many vague therapeutical resources, s(» that the treatment is eAren yet far from uniform and thor- ough. Many of the recognized resources laid down in the text-books, on diseases of women, are not only useless, but absolutely injurious, and, in order to save the reader time and money, I will make a brief mention of the most promi- nent of them. Depletion, or the abstraction of blood in chronic metritis, effects no permanent benefit in the inflammatory process. I am convinced that, in the long run, the patients grow worse, because this treatment lowers the vitality and reduces the recuperative forces, which are so important, in the treatment of all chronic complaints. Scarifications or puncturing the cervix with a sharp lance or pointed knife, will not sufficiently impress the morbid process, so as to stimulate it into a healthy action. Some authors speak very highly of cauterizations and blisters upon the neck or lips of the womb; this I have re- peatedly tried, and in not a single instance was it of the slightest use, but it aggraA^ated the symptoms, and in one case it excited a severe, acute metritis that proved almost fatal. Specialists, as a rule, fall into routine practice, and exer- cise neither originality or intelligence in practice, outside of the text-book on their shelf. They inject strong fluids or caustics into the cavity of the womb with a view of checking the inflammation in that manner. This treatment is dan- gerous and delusive. If the patient endures the treatment, she may be stimulated for a time with the idea that some- thing very curative is being done, but my experience has been that the disease only becomes worse, because the womb is too delicate and sensith'e an organ to improve under these repeated irritating assaults. There is a home treatment for mild cases Avhich I recom- mend to my patients, with satisfactory results. It consists 208 HOME TREATMENT FOR AVOMEN. principally of copious hot-Avater vaginal injections, in a manner that has been detailed in a former chapter. These irrigations are to be taken every night, and ten or fifteen minutes later a suppository of iodoform is to be introduced high up into the vagina, by first oiling the finger and sup- pository with a little vaseline. NO. XVII. Take : Iodoform............................2 drams Cocoa butter.........................4 drams Mix and make into eight egg-shaped suppositories. In obstinate cases I have used electricity with the great- est success. This is administered by means of a broad dis- persing electrode applied on the abdomen, and another electrode, covered with a sponge, is carried up the vagina, to the womb. In this manner I employ an intensity of sixty to one hundred and fifty milliamperes, for ten to fifteen minutes. This is repeated several times a Aveek, and from three to six weeks, and with other hygienic treatment the patient recovers. When women are in moderate circumstances, and can spare' neither time nor money to visit the office, for the length of time that is required for the electrical treatment, I follow the plan of the Berlin clinic, which originated in Vienna, with Prof. Carl Braun, and is strongly recom- mended and practiced by Dr. Martin, in Berlin. This con- sists in an amputation of the cervix, or, in other words, the abnormally elongated and enlarged uterus is trimmed down, and the diseased membrane is scraped out. While the cervix is recovering from the operation, there is also a dim- inution in the size of the body of the organ, and the chronic inflammation subsides with it. This operation is not dangerous to life, and in my experience I have as yet never had a bad symptom to. interrupt the recovery. In ob- stinate cases, it is, perhaps, one of the most useful surgical measures that was ever devised, and Ave OAve it to the genius of Professor Braun, that all obstinate cases of this nature are amenable to successful treatment. CHAPTER XVII. ENDOMETRITIS OR CATARRHAL INFLAMMATION OF THE WOMB. Endo means within, and metritis signifies womb and in- flammation, and when all are combined, the compound term denotes imflammation of the lining membrane of the womb, which is the affection that I am now to consider. It would be impossible to find a single person of middfe age who has not experienced sometime during life the dis- comforts of a catarrh or cold of some part of the respiratory passages, whether in the head or bronchial tubes. The mucous membranes are especially sensitive to nox- ious influences, and sound a timely note of warning by an acute catarrh, which, if heeded, will in many instances save the person from a dangerous, if not fatal sickness. The adage, "Prevention is better than cure," is one of the most truthful sayings in the English language, and, if persons would profit from the admonitions of sl" slight cold" many a fatal pneumonia or bronchitis could be averted. What is true of the mucous membrane that is common to both sexes is true of that which is peculiar to the female organs alone. There is no mucous membrane that is more liable to catarrhal inflammations than that lining the uterus. There never was a woman who was not some time in her life afflicted with a transient uterine catarrh. It may have been of so mild a form that the symptoms which it occa- sioned were hardly noticed, or, perhaps, ascribed to some other ailment. There are several varieties of endometritis; some of these are based upon the length of time that the affection has 14 (209) 210 HOME TREATMENT FOR WOMEN. lasted, while others owe their classification to the anatomical division of the uterus into body and cervix. Those that re- late to the duration of the disease are either acute or chronic. Acute endometritis is the most common form; it has also been described under the names of acute uterine leucor- rhoea, acute uterine catarrh, and acute internal metritis. It usually runs a rapid course, ending in recovery or in the chronic form. It undoubtedly passes unrecognized in many instances, and in this way many cases of painful menstrua- tion or suppressed menstruation are explainable. It can be said that at each and every menstrual period there is a physiological catarrh, which belongs to the natural process of the menstrual function. During each menstrua- tion there is a hypersemia, or congestion of the mucous membrane, so that the turgent blood vessels rupture, and this constitutes the menstrual flow. Before this congestion reaches the point of bursting the capillaries, and about the time that the sanguineous flow ceases, there is an increased and altered mucous secretion of the mucous membrane. If this secretion is prolonged beyond the normal" period that constitutes healthy menstruation, or if it continues to be present at any time between the menstrual periods, it con- stitutes a disease or a catarrh. Now when we consider the close relation that the normal functions of the womb have to those that are abnormal, and that the one may be the stepping-stone to the other, we need not be surprised that endometritis, or catarrh of the womb, is one of the most com- mon affections to which women are liable. Chronic endometritis is where the disease has lasted for a long time; some authorities consider it a rare affection, but this is a great error. Any disease so frequent as acute endometritis must, in the very nature of inflammatory proc- esses, become chronic, in a large proportion of cases. Endometritis of the body of the womb, in contra-dis- tinction to a partial inflammation, located and confined to the mucous membrane of the neck or cervix of the womb, ENDOMETRITIS. 211 forms another or third variety of this affection. This disease has been described under the names of chronic corporeal endometritis, uterine catarrh, uterine leucorrhoea, and inter- nal metritis, and the seat of it is confined to the lining mem- brane of the cavity of the Avomb, Avithout complicating the cavity of the cervix; but there is no doubt that when either the one or the other is the seat of a stubborn catarrh, the remaining portion of the uterus must become sooner or later more or less compromised in the diseased process. Chronic cervical endometritis is where the inflammation affects the membrane of the neck; this has been described under the names of cervical catarrh, cervical leucorrhoea, and endocervicitis. These terms are all derived in composition from the Latin word cervix, neck. The uterus is really divided into two cavities that run into each other; one of these is the cavity of the body, Avhile the other is the cavity of the cervix, a fusiform canal, meas- uring about one inch and a quarter in length. The cervix partly projects into the vagina, and, as a result, is liable to injury and irritation, to which the other portion of the organ is not exposed. Friction and other influences aggravate the inflammatory process, so that erosions, granular and cystic degenerations, follicular ulcers and chronic enlargements, become complications of the catarrhal inflammation of the cervix. To return again to a consideration of the general aspect of catarrh of the womb, for it is one and the same patholog- ical process that underlies the different forms. There is a simplicity in the relation of cause and effect, that will strike the casual student as one of the most instructive lessons that it is possible to learn, because it also suggests the sim- plicity of the measures of which persons can aArail themselves for the prevention or cure of this affection. From the physiological reasons that were mentioned as a cause of endometritis, it follows, as a natural consequence, that the predisposition to catarrh of the womb, varies greatly 212 HOME TREATMENT FOR WOMEN. with the age of persons, so that before the age of puberty, at a time Avhen there are no periodical congestions of the womb from the menses, it occurs very rarely, while from the period of pubescence, and during the functional activity of the pelvic organs, it is very prevalent, but at the approach of the menopause and sexual decadence the predisposition is again lost. As far as the character and nature of uterine catarrh is concerned, that which in technical language is termed the pathological anatomy is no different from what it is in catarrhal inflammations in other organs, so that the remarks that were made on similar affections of other organs, apply with equal correctness to catarrh of the uterus. There is, however, one exception of which I desire to re- mind the reader, and that is a hemorrhagic or granular variety of inflammation. In this form of the disease the mucous glands, and the blood vessels that are distributed between these glandular tubules, increase or multiply enor- mously, so that I have seen the mucous membrane in some places a quarter of an inch in thickness. This is the most obstinate variety to yield to ordinary remedies, and as it oc- casions excessive and at times dangerous hemorrhage from the womb, it should not be treated as conservatively as the other varieties of which I have spoken. There is only one sure method of cure that proved in my hands a success, and that consists in the entire removal of the diseased mucous surface. Dr. Duvelius of Berlin made the discovery and demon- strated the fact that the mucous glands of the uterus pro- ject into the muscular tissue of the organ, and that if the diseased mucous membrane is removed or scraped off, down to the muscular layer, a healthy membrane is regener- ated from the terminal glandular ends that remain im- bedded in the muscular tissue. This seems to have been proved by experience, for I have performed this operation in several obstinate cases of uterine catarrh, and in several ENDOMETRITIS. 213 instances the Avoman,became subsequently pregnant, which proves at least that the regenerated mucous membrane is capable of performing its physiological function, as though it never had been interfered with. With proper antiseptic precautions and in skillful hands, there is absolutely no danger in this operation, but the technique should be thor- oughly understood by the operator. The etiology or causation of uterine catarrh resolves itself into predisposing and exciting causes. Predisposi- tions are defined as that constitution or condition of the body Avhich disposes it to the action of disease under the application of an exciting cause. Persons who possess a thoroughly healthy constitution may be exposed to exciting causes without the slightest danger of contracting diseases, to which others who are predisposed fall victims. The pre- disposing causes of endometritis are a naturally enfeebled constitution; the existence of a scrofulous or tuberculous habit; impoverishment of the blood from chlorosis; pro- longed mental depression; improper and insufficient food; prolonged lactation; frequent parturition under unfavorable surroundings; any indiscretion after delivery which inter- feres with the regeneration of the womb; styles of dress that depress the uterus; want of fresh air and wholesome exercise- Professor T. G. Thomas, in his work on Diseases of Women, asks the question why most of these influences should produce this affection more than others. His ansAver is that " they do not do so." "Sometimes they cause chronic pneumonia; at other times granular lids, and again at other times chronic endometritis." The exciting causes laid down by the same eminent authority are "displacement of the womb; excessive or in- temperate coition; the use of intra-uterine pessaries; puer- peral endometritis; exposure or fatigue after confinement; efforts at production of abortion and prevention of concep- tion; vaginitis either simple or due to gonorrhoeal infection; painful obstructive menstruation; exposure during men- 214 HOME TREATMENT FOR AVOMEN. struation; sudden checking of the menstrual flow; and tumors in the uterine cavity or walls." Some of the causes here enumerated are much more fruitful of the disease than others. A woman whose constitution has been Aveakened, and whose digestion is deranged, by habits of indolence and luxury, whose style of dress so depresses the abdominal viscera that her uterus is pressed down into the vagina, is particularly liable to develop a catarrhal inflammation from connubial approaches. When these are not Avithout pain, then there is some predisposition that should be in- quired into and righted. Uncleanliness is not spoken of by authorities as among the causes of uterine catarrh, yet it is a very frequent one. I have succeeded in curing so many catarrhal affections of the vagina and uterus by simply advising the use of vaginal irrigations with borated warm water, that I am convinced that a lack of personal cleanliness is a very prolific cause of this affection. The accessible generative organs, both of the female and male, should be the object of thorough rinsings so as to reduce the possibility of infection to the least degree. All mucous membranes have their natural secretions, and these are on light provocations abnormally increased. The vagina is always the seat of more or less bacterial fermenta- tion or decomposition, and if this is retained for any length of time, it becomes not only putrid and offensive, but also a direct source of infection to the mucous membrane of the womb. This is more so in a married Avoman, who is ex- posed to the carelessness of her male consort, who has not been apprised of the dangers of septic infection, that may be innocently communicated to the wife by negligence of his own person. The wife is exposed to all and every impurity that the male has on his person, and thus she is in constant danger of having her internal organs infected, from the outer organs of the male. There is no doubt that many women become infected from this source, and that obscureand stubborn catarrhs of the ENDOMETRITIS. 215 vagina and womb are strictly traceable to personal unclean- liness of the male. From the researches of Dr. Noeggerath of New York, it would seem that in a great many cases of pelvic diseases in women, the affections can be traced to a latent gonorrhoea in the male. This phrase means a gon- orrhoea in the male apparently cured, which even two years after the supposed cure infects a healthy vagina, causing a discharge and a complication of the uterine mucous mem- brane. I have seen some cases that fully corroborate the views of Noeggerath, so that before we put the blame of uterine disease solely on the shoulders of the wife, let us find out Iioav much the husband is to blame. Specialists in particular, but doctors in general, often forget that a Avoman has other organs besides a womb and ovaries; there is a relation of cause and effect between val- vular lesions of the heart or diseases of the lungs, that ob- struct the return of the venous systemic circulation to the right cavity of the heart, and catarrhal diseases of the pel- vic organs. Biliousness or an affection of the liver, that interferes with the portal circulation, or the pressure of tumors or swellings on the uterine veins, are also among the causes, while the accumulation of feces or habitual constipation is often over- looked as too trivial to deserve professional notice, and yet its removal is often the only successful means to cure the patient. The various eruptive and infectious diseases, like small- pox, scarlatina, measles or typhoid fever, may excite in their course a uterine catarrh, that will remain behind as a chronic complaint, after the acute affection has subsided. The acute variety of endometritis is much more preva- lent as a disease than is commonly supposed, but, owing to an absence of specific or definite signs, pointing directly to the mucous membrane, which the woman herself can recog- nize, it is generally mistaken for something else. The disease begins with signs of an acti\Te congestion in 216 HOME TREATMENT FOR WOMEN. the pelvic organs; such as drawing pains in the small of the back and in the groins, and a feeling of fullness and weight at the bottom of the pelvic floor. The urine is voided with pain and there is a sensation of heat in some parts of the urethra. Pressure on the lower abdominal region is painful, and the sensitiveness diminishes from the middle towards one or the other side. In mild cases these symptoms are not ac- companied with fever, headache or a disturbance of the nerv- ous system; there may be diarrhoea due to reflex irritation of the rectum, and the stools are accompanied with bearing- down pain. After three or four days there is usually a dis- charge of a viscid liquid, which in t eight or ten days be- comes creamy, purulent and often tinged with blood. The fluids that are discharged from the vagina sometimes be- come so acrid and irritating that, when they come in contact with the skin of the vulva, abdomen or thighs, it be- comes irritated and inflamed, which leads to excoriations and an itching, that may spread over the entire body. The reaction of this discharge is either acid or alkaline, depend- ing upon whether the discharge of the uterus or that of the vagina predominates; as the discharge from the uterus is always alkaline and that from the vagina always acid, there is nothing of a practical diagnostic value in ascertaining the chemical reaction of the secretion. The vagina will gen- erally be found to be hot and more or less swollen as in or- dinary vaginitis. The womb itself, however, will be en- larged and sensitive, while the cervix is gaping or open. Through the speculum, it is seen to be red and congested, and from the gaping mouth there issues a clear, albumi- nous-looking fluid or a muco-pus.' In the subacute or chronic form the symptoms are by no means always so prominent as to indicate the existence of the affection, or they are so marked, by some of the nu- merous complications, which are in the nature of cause or effect, that its recognition will become extremely difficult. The effect which the disease has on the general organism ENDOMETRITIS. 217 Araries greatly in different individuals. Some women of ro- bust appearance have an aggravated form of uterine catarrh without any immediate ill effects on their nutrition or gen- eral health. Other women lose flesh early and become weak and worn; they become pale, and the face assumes a yellowish ashen hue with dark rings under the eyes. Through reflex irritation from the nerves of the uterus other nerve centers become in\Tolved, so that a general neurasthenia becomes developed with its characteristic con- comitants of neuralgia, muscular spasms, uterine colic and hysteria. With a third class the inflammation spreads from the lining membrane to the substance of the womb itself, caus- ing an enlargement of the uterus, which induces displace- ments and a dragging sensation in walking, pain in coitus and painful defecation. The inflammation does not limit itself to the Avomb, but an ichorous discharge creates dis- tressing symptoms of \raginitis, inflammation of the bladder, and pruritus vulvae. When the uterine cavity is the seat of an abnormal vas- cular activity, there often exist symptoms of pregnancy that may mislead the patienti or physician. Nausea and vomit- ing are sometimes present, the darkening of the skin around the nipples, and an enlargement and sensitiveness of the breasts, meteorism, or a swelling of the abdomen, caused by the accumulation of air in the intestinal canal from reflex nervous irritation, and when this symptom is added to the irregularity of menstruation, it is easy to fall into the error of diagnosing pregnancy. Sterility on the one hand, and habitual abortion on the other, should direct attention to the probable existence of endometritis. Very often barrenness has led to an investi- gation of the condition of the uterus which disclosed the ex- istence of the disease. A woman who conceives, and then loses her child in the first months of pregnancy, is afflicted, in all probability, with a chronic endometritis. In these 218 HOME TREATMENT FOR WOMEN. cases, where conception takes place, it is to be presumed that the sensitiveness and irritability of the inflamed mu- cous membrane is not suitable for the permanent fixation of the ovum, so that the slightest shock will open the flood gates of a congested uterus, and thus the embryo is sepa- rated from its attachment, and lost. The cervix is sometimes the seat of a special feature of uterine catarrh, that is due to the chronic inflammation of the cervical mucous membrane, stimulating a growth or proliferation of its own tissue or structure. This growth causes an enlargement and elongation of the entire cervix, and a spreading of the lining membrane of the cervical canal to the vaginal surface of the cervix. This encroachment of the cervical lining on the vaginal lining is the displace- ment of the j>avement epithelial cells of the vaginal portion by the cylindrical or columnar epithelial cells of the cervical canal, and this gives rise to erosions and follicular ulcers. These erosions have a glandular arrangement, and are often mistaken for cancerous or malignant growths. There is no doubt in my mind, that most of the so-called success- ful cures of cancer were nothing but cures of erosions. The microscopists, Avhose lively imaginations nlake them see things that do not exist, would make us believe that they can take a small section of the suspected growth, and establish the existence of cancer by microscopical examina- tion; this is utterly impossible, because the cancer cell is no different from normal cells, and in erosions we often find the follicles so close to each other, and their cells so closely packed, one on the other, that no candid mind can say whether it is a malignant or an innocent growth. The claim that "nests of epithelium cells," as the stereo- typed phrase goes, constitute scientific evidence of cancer, is utterly absurd. Such eminent authority as Professor Arnold, of Heidelberg, makes the assertion that positive diagnosis of cancer, from a small section or scraping, is impossible. I am myself fully convinced of the truth of this assertion, for while ENDOMETRITIS. 219 I was making microscopical studies in Germany, I had abundant evidence of the truth of this statement. It is indeed very unfortunate, both for science and suffering humanity, that as yet there is no absolute means of diag- nosing cancer positively, and for that reason the quacks, and those Avho are not quacks, will continue to fleece their victims for supposed cancer. I believe that the cause of cancer is either due to a pto- maine or organic poison that is generated in the body, or to a specific germ or bacillus. If it be due to the latter, and the germ theory of disease makes that highly probable, there is no doubt that a method of staining will soon be discovered, that will make the specific microbe recognizable in the field of the microscope, but as yet most cancer diagnoses by mi- croscopy are only surmises. TREATMENT. (1ontinence in sexual intercourse is one of tne prerequi- sites to the successful treatment of all uterine diseases. This is so often overlooked by those giving advice in such matters, that their otherwise appropriate suggestions for treatment are frustrated. The women who are suffering, appreciate the value of this interdiction without further ar- gument, but the average man does not appear to have the common sense to readily comprehend that the mechanical irritation incident to the sexual act, and the accompanying physiological congestion, will surely aggravate an inflam- matory process, no matter of Avhat nature. Men, whose an- imal instincts dominate their entire being, so that reason. if they ever had any, is dethroned, should stop to consider their immoderate conduct, Avhich perpetuates the suffering of their Avives from ailments Avhich men themselves have often inflicted, and for which women are innocent martyrs, The acute variety of uterine catarrh is to be treated like all other acute inflammatory diseases. 220 HOME TREATMENT FOR WOMEN. The patient should at once take to bed, so that she may keep herself warm and quiet. If the inflammation is due to cold or exposure during menstruation, and the menstrual flow has been suddenly checked, then three or four leeches, applied to the inguinal regions on both sides, Avill be of decided advantage. Over the lower abdominal regions hot compresses should be applied; these are made by Avringing cloths or a large folded towel out of hot Avater, over which a piece of oiled silk, rubber, or oil- cloth is laid to retain the heat and moisture. At other times, that is, Avhen the inflammation is not due to cold and a sudden stoppage of the menses, the application of ice bags is preferable to the hot compresses, in the manner else- where described. The pains Avhich are felt in different parts of the pelvis are all relieved by one and the same thing; that is, an opiate, either in the form of a solution by the mouth, or a rectal suppository. If there is no nausea or Aromiting, then give a teaspoonful of No. VII every four hours until relieved. Should the stomach not be in a condition to take the in- ternal anodyne, then the suppositories No. IV should be used instead; one may be introduced into the rectum, or, if that is too sensitive, then it should be introduced into the vagina, and repeated every eight hours, until the pain is relieved. If there is straining or diarrhoea, I prefer to employ an enema of one pint of warm German chamomile tea, to which half a teaspoonful of McMunn's elixir of opium or laudanum is added. If the pain and straining are very severe, one teaspoonful of either is not too much; by re- questing the patient to retain the enema for ten or fifteen minutes, the medicine is directly absorbed, and the effect is both soothing and healing. This may be repeated several times a day, if the pain does not subside after the first in- jection. ENDOMETRITIS. 221 The bowels are sometimes found to be in an opposite state, namely, constipated; this must be relieved at once. An enema of warm soapsuds answers the purpose, or a half- tablespoonful of warm water, in Avhich a half-tablespoonful of glycerine is dissolved, makes an excellent injection for constipation. Hot vaginal irrigations should be at once commenced, and repeated as often as twice or three times a day. I al- Avays dissolve a teaspoonful of poAvdered borax in the hot water, of which no less than half a gallon is used at one time; this is antiseptic and healing. After six or eight days, once a day will be sufficient. Chronic uterine catarrh or uterine leucorrhoea does not require the active treatment which was recommended for the acute form. It depends quite often on causes, whose re- moval is absolutely necessary to the intelligent and successful treatment of the affection. The causes that have been enumerated must be carefully and repeatedly reviewed, so that each individual case can be traced to its source. Those causes that are improbable must be eliminated from those that are probable, so that by a gradual process of exclusion we narrow the number down to those that actually exist. This simplifies the treatment to actual conditions that can be intelligently met. Vaginal irrigations constitute in the chronic form of the disease an accepted and most useful therapeutic resource. There is nothing that will ever contraindicate a thorough cleansing of the vaginal canal, so that the organ may not be bathed in its own morbid and irritating secretion. It is a wholesome auxiliary to any course of treatment that may be adopted. It avoids self-infection and places the pelvic or- gans in the best possible condition for the healing poAvers of nature to Avork out a cure. If the uterine catarrh is the result of a venous obstruc- tion due to a congested liver and a general derangement of the digestive apparatus, then any local treatment will be of no avail without first removing the hepatic derangement. 222 HOME TREATMENT FOR WOMEN. Costiveness or constipation is a very common complaint with women and a very painful cause of Avomb disease, but it is so simple and ordinary in its nature that the wise Avill not deign stoop to notice such trifles, but if it required for its removal a surgical operation, for which a handsome fee is the inspiring motive, then we should hear of it as often as Ave do of lacerations or flexions of the cervix as a cause of uterine catarrh, and its removal would then indeed be- come absolutely necessary for effecting a permanent cure. Why is it that the treatment of uterine disease has de- generated into "professional faking" that is alike disgrace- ful to the profession and a daylight robbery of the patient. A woman, for instance, is suffering from what she supposes to be womb disease. She consults a doctor, or what is still worse, a time-serving specialist, who examines her and sees at once signs of uterine catarrh. He at once applies a little tincture of iodine or carbolic acid diluted Avith glycerine or a solution of nitrate of silver to the cervical canal. The woman is now informed that this application must be repeated two or three times a week, for which she must call at the office that number of times every week, for an indefinite period. At each visit she is subjected to the same routine humbuggery for local medica- tion, but does she get any better? In my earl)- professional experience I innocently and ignorantly tried these methods myself, and I say no! But, as a matter of fact, this constant irritation and poking around and into the womb will in- flame any healthy uterus, and much more one that is al- ready slightly irritated, so that patients lose their hope and become convinced themselves that they are no better, but feel worse than when they first commenced treatment. This inefficient treatment, like the examination, is con- jectural and mechanical and therefore incomplete and unscientific. The cause of her entire trouble is never approached. The woman suffers for years from constipation, which also inclines her to piles, because the pressure of the ENDOMETRITIS. 223 hardened feces on the hemorrhoidal veins obstructs the flow of venous blood and the same pressure on the uterine veins congests the mucous membrane of that organ and gives rise to the symptoms of endometritis. All these conditions should be inquired into, and many others, before local treat- ment is decided on; simply running to the doctor's office and having these medical applications made to the cervix or canal of the womb amount to nothing; this, as a general rule, does only harm, and is as superfluous as if one were to take a nasal douche of salt water or some other catarrh remedy, Avhenever he feels a little cold in the head. The proper course to pursue in this and similar cases is to prescribe an appropriate diet, and regulate the bowels. It is precisely in this way that women Avho have made the rounds of the doctors, happen to take some patent laxative or nostrum that relieves their constipation, and accomplishes the wonderful cures of which Ave often hear and that were no doubt Godsends to the sufferers that were cured, after all the first-class doctors failed. By far the greatest proportion of cases of uterine catarrh are of a simple and transient nature and are only intensified by probing and local treatment. When I first began the practice of medicine, I made the same mistake in following the advice of books and those who should have known better, for they have had ample opportunity to be convinced of the fallacy of these local measures in the great majority of cases, but some minds are incompetent to learn from experience, for that requires close obserA'ation, and logical reasoning. I soon discovered that the catarrhal inflammations got worse, in proportion to the trouble and pains 1 took to treat them locally, so that I became ashamed of my ill success and abandoned the local treatment entirely, and this I shortly discovered was the means of curing them. Instead, I simply directed patients to rinse themselves with quite warm salt water, that is, a tablespoonful of ordinary cooking salt dis- solved in a gallon of Avater. Noav I prefer pulverized borax 224 HOME TREATMENT FOR WOMEN. to the salt and about half a tablespoonful to the same quantity of Avater. I particularly advise them to keep their feet and lower extremities warm, regulating their diet and keeping their bowels open. I noticed that the patients be- gan to improve, and that the improArement continued until they were fully restored to health and vigor. I Avas busi- ness man enough to know that this method of treatment would not keep the office crowded with patients, but it got those that came well, which Avas then, as it is now, my chief ambition. My favorite prescription for habitual constipation in women is formula No. IX. In taking a laxative patients must feel their way as to the proper dose to take in their own individual case; constitu- tions differ very much in this respect, so that it is impossi- ble to lay down one and the same rule for different persons. It is not good practice to give medicines three or four times a day in cases of habitual constipation, for it is liable to de- range the digestion and interfere with the appetite. The proper method is one dose at bedtime and this should be increased or diminished until the suitable dose of the remedy has been ascertained; when this is accomplished, the dose of the remedy should be gradually lessened, a few drops every day, till it can be entirely dispensed with. If the ordinary dose fails to relieve the bowels, an additional treatment of glycerine enema at or about the time that the stool is to take place is to be employed. One or two teaspoonfuls of glycerine should be diluted with an equal quantity of water, and by means of a hard rubber piston syringe thrown into the rectum. The stimulating effect of glycerine on the nerves and mucous membrane, materially assists in relieving the torpor of the rectum, which has become insen- sitive to the irritation of its natural contents.' Patients who are costive must get into regular habits of relieving themselves, that is, have a regular hour every day when to go to stool, then the medicine will in time cure the most obstinate cases of constipation, otherwise it is impos- ENDOMETRITIS. 225 sible to cure it. It takes a constant amount of effort to get well, so that those who are too indolent or think it too troub- lesome to exert themselves, cannot hope to recover. If there is great debility and impoverishment of the blood, then I would advise prescription No. 1, which are the iron pills, of which three pills should be taken three times a day. The moderate use of wine, either claret or Riesling, with the food, instead of tea or coffee, is very beneficial, be- tween meals a glass of Porter to relieve the gone-in feeling, until the system has recovered sufficient strength to do with- out it, that is when ordinary exertions are no longer a burden. The small percentage of cases that do not yield to the above treatment, become legitimate subjects for an honest specialist, for there may be extensive lacerations of the cer- vix that require surgical treatment, or an elongated cervix that should be amputated, or a granulated hypertrophied membrane of the uterine cavity that should be scraped out; all these operations are without danger if the operator has thoroughly mastered the details of antiseptic surgery and has the manual skill to do the work properly. 15 CHAPTER XVIII. THE NATURAL POSITION OF THE UTERUS AND HOW IT IS SUPPORTED. The uterus is not a stationary fixture in the female pel- vis, but enjoys a mobility within physiological bounds, which in itself explains the great diversity of opinions which may and do arise respecting the normal or abnormal position of the womb in any given case. When the surrounding organs and tissues of the womb are in a healthy condition, and the abdominal walls are not compressed by the weight and pressure of skirts, nor the liver or diaphragm forced down towards the pelvis by a tight- fitting corset, the organ is movable in every direction, with- out the slightest pain or suffering. The uterus is not tied down by any ligaments, as one might imagine from a description of the several ligaments that constitute only in a small degree its support, for it changes its position in retching, coughing, breathing, sing- ing, walking and all other violent movements. The question now naturally arises: What is the normal position of the uterus, and what constitutes its natural sup- ports? To answer this interrogation is to controvert one of the most baneful fallacies in gynecological practice, for the amount of torturing and useless doctoring to Avhich women are constantly subjected, owing to some fancied displacement of the womb, illustrates the force of precedent or of accepted opinions, that were fortified by years of erroneous teaching. It was supposed until quite recently that when the body of the womb was inclined horizontally forwards, this was unnatural or a sign of disease, until Prof. B. S. Schultze, (226) POSITION AND SUPPORT OF THE UTERUS. 227 director of the gynecological clinic of Jana, successfully controverted this doctrine. In his work "Die Pathologie und Therapie der Lageversenderungen der Gebsermutter," Avhich is the most classical work extant on displacements of the uterus, says: " From the post-mortem findings it was inferred that the uterus occupied in the living woman the same position as in the cadaver; such an assumption did not take into ac- count the actions of the muscles on the position of the uterus in the living subject nor the intra-abdominal pressure which is entirely absent after death, so that the dead organ natu- rally gravitated backward after the remains had lain for several days on the back." ' Another observer, Dr. Hach, found in a number of cases that he had examined during life, the uteri bent forward or antiflexed; twenty-four hours after death he discovered the same uteri in an opposite di- rection or retroflexed. This and similar subsequent researches have demon- strated the fact that when the body of the womb rests on the bladder it is not in an abnormal position as formerly supposed and called anteversion or anteflexion, but that it is natural for it to be so, and when the body is elevated and its axis forms an obtuse angle with the horizon, the inclina- tion is a post-mortem condition. With these precursory remarks I am now able to answer the first clause of our query, and would say that the uterus is in its normal position when its long axis is nearly parallel to the horizon or at right angles Avith the perpendicular or long axis of the body. The normal position of the uterus is modified when the bladder is full or distended, for this lifts the body of the uterus upwards, thus temporarily mak- ing an acute angle with the vertical axis of the body, which was formerly considered to be the permanent and natural pose of the organ. In referring to the bony pelvis, Plate I, it will be ob- served that the same is in the nature of a canal, for the pas- sage of the child into the world. At other times than dur- 228 HOME TREATMENT FOR WOMEN. ing the child-bearing process, this canal must be effectually closed to perfectly retain its contents. To accomplish this purpose it is provided with a bottom or floor, Avhich is to give this necessary support, not only to the organs that the pelvic cavity contains but also to the abdominal viscera that are superimposed upon them. In order to accomplish this, its outlet must be as effectually closed as the bottom of a box or barrel in which material things are stored for the purpose of carrying them from place to place. In the hu- man subject this bottom is called the pelvic floor, because it serves the purpose of a bottom or floor to the pelvic canal. The pelvic floor is not a simple structure but a complicated arrangement of organs and tissues. If we begin to examine it from below upwards, we first have its outer covering in the skin; then, the superficial and deep fascias, the * 'angu- lar ligament of the bladder and a group of interlacing mus- cles. The organs that enter into the composition of the pelvic floor and interwoven with the preceding structures, are the bladder, the vaginal Avails, the rectum and connec- tive tissue. Examine Plate II. Through this floor there are several openings, which are guarded by a special set of constrictor muscles that are termed sphincters. These' are sufficiently strong in the blad- der and rectum it in the vagina they would be entirely insufficient to close this canal effectually. The vagina, or, for our purpose, it will be clearer if we say "vaginal canal," divides the pelvic floor into an anterior and posterior segment, and it is by means of this division that the whole structure of the pelvic floor is weakened; this will be perceived at a moment's reflection, when we compare it Avith the pelvic floor of the male, who has no vagina; and for this reason men are never troubled with the prolapses to which women are liable. Nature, however, has made an attempt to compensate this physical defect in a manner that reduces the weakness occasioned by the vaginal canal to its minimum. The vaginal canal does not enter the pelvic POSITION ANI) SUPPORT OF THE UTERUS. 229 cavity in a directly upward or perpendicular course, but obliquely upwards and backwards, as may be seen by re- ferring to Plate II. The result is that the intra-abdominal pressure falls on the vaginal Avails from above, and thus compresses and approximates the anterior and posterior walls of the vagina to each other, so that it constitutes a self-closing valve, but, notwithstanding all these provisions, this slit or opening through the pelvic floor still remains the weakest point of the inclosure for the pelvic and abdominal viscera. When the causes are sought that underlie the va- rious displacements of the uterus, they are generally to be found in an impairment of the pelvic floor, through some changes or accidents that are peculiar to pregnancy and de- livery. As we are also to inquire in the succeeding chapter into the displacements to which the womb is liable, it would greatly assist our understanding if we first got an idea of what constitutes the natural supports of the uterus? The word ligament is defined as anything that ties or unites one thing or part to another; a bandage; a bond. This is the idea in the popular mind, so that when the terms broad and round ligaments of the womb are employed it is supposed that they are for the same purpose for Avhich ligaments are usually intended. This is, unfortunately for a clear under- standing of the subject, a great mistake, because these liga- ments are an exception to the generally accepted meaning of the term, for they neither tie nor support the uterus in its natural position. One may readily imagine that this erron- eous conception would lead to a mistaken course in the treatment of most cases of displacements, because too much importance is bestowed upon structures that have no physio- logical bearing on the disease. Drs. Hart and Barbour, of Edinburgh, in their " Manual of Gynecology," which is the most scientific and practical work that has lately appeared in the English language, have this to say in speaking of the support of the uterus: "The 230 HOME TREATMENT FOR WOMEN. question of the support of the uterus is still disputed. The broad and round ligaments have nothing to do Avith its support, they are only useful as giving fixed points for the contracting uterine muscles during parturition. The chief support is the compact unbroken pelvic floor, on which the uterus rests just as one sits on a chair. It is the Avhole pel- vic floor that supports the uterus and viscera, not the peri- neum alone." The perineum (see anatomical Plate II) is only a small though strong part of the pelvic floor. If the reader will now patiently review the organs that, together with the other tissues, constitute this floor, and this can be most profitably done by studying Plate II, there can be no confusion of ideas whatever. In the following pages I have occasion to refer to what is understood by the term pelvic floor. CHAPTER XIX. PROLAPSUS OR FALLING OF THE WOMB. If one desires to familiarize himself with a thorough understanding of this subject, it is absolutely necessary to bear in mind what was said of the natural support of the uterus, for unless one has a full knowledge of the foundation of a structure, how can he comprehend its defects and remedy them when the structure falls? The workman who potters on a building that has shifted from its foundation without first devising means for a new and solid basis for it to rest upon, would be considered a fool. The term " fall- ing of the womb" has no longer the significance that it once had, for it is only a symptom that something is wrong, and in the present state of our knowledge it is misleading and a misnomer, inasmuch as it conveys the impression that it is due to an affection of the uterus, when as a matter of fact it is not due to any disease of the womb at all. If the prolapsed uterus has become involved in a morbid process, it is the result of the abnormal conditions that have brought the prolapsus about, and in which the uterus was in no way concerned. Professor Schroeder, of Berlin, takes a similar view of these cases, and he groups into one chapter three distinct varieties, yet, because one is depending on the other, he considers them all as one disease. These affections are: prolapse or falling of the womb; prolapse or falling of the vagina, and an inflammatory elongation or hypertrophy of the cervix or neck of the womb. He says " that the dis- placement of the womb is very seldom a primary affection, but that it is oftener the consequence of a prolapse or falling of the vagina, and a giving Avay of other structures, or of the (231) 232 HOME TREATMENT FOR WOMEN. pelvic floor, and, as such, 'falling of the AA'omb' cannot be properly separated into an individual affection of the womb." Falling of the vagina is principally due to a widening of the vaginal canal, a relaxation of its walls, and injuries or lacerations of the pelvic floor. Lacerations of the peri- neum generally occur during confinement, in which the vagina tears through the vaginal orifice baekAvards towards, or into, the rectum. This so weakens the pelvic floor that it becomes inadequate to support the pelvic organs and tissues, and this predisposes to all the varieties of prolapsus that have been enumerated above. It is during the period of gestation that the vagina grows considerably longer and wider. In the latter months of pregnancy the womb as- cends and its body inclines greatly forwards, which naturally tilts the cervix high up in the pelvis, and also draws that portion of the vagina to which the cervix is attached with it, but notwithstanding this upward dragging of the vagina, the lower portion of the vaginal canal has so augmented its proportions that it often protrudes' between the lips of the vulva during the last period of gestation. The normal relation of the vagina to the neighboring organs is more or less disturbed, that is, its attachment to the bladder and rectum is stretched and loosened, so that under the most favorable circumstances the mucous membrane of the lower portion of the vagina falls out of the vulva or prolapses, of course in the majority of cases only in such a degree that it neither inconveniences nor is it noticeable by the pregnant woman. Immediately after confinement, in a healthy state of affairs, nature should rectify these abnormal proportions, that were only designed by her to serve a temporary pur- pose, namely, to accommodate the child and provide for its safe passage into the world. Medical writers have invented a special term to designate this process of regeneration, namely, involution. This means to infold or grow less so PROLAPSUS OR FALLING OF THE WOMB. 233 as to assume the former natural proportions of organs. Unfortunately, nature is often contravened in her whole- some regenerative purpose, by adventitious circumstances that completely frustrate her intentions, and the reparative process being thus balked, the organs and tissues remain in their abnormal proportions, which constitutes now a disease, and this uncompleted effort to repair is termed sub-involution. It takes at least from six weeks to three months after delivery for the reparative process or involution of the or- gans and tissues to be completed. And women cannot ex- ercise too much care after confinement to avoid any possible check to the regenerative process. If the involution has been arrested, the vagina retains its large, flabby proportions, so that its relaxed walls naturally protrude or prolapse, and that entails all the other consequences. Intra-abdominal pressure should be explained in con- nection with this subject, for it constantly encourages pro- lapsus of the organs under consideration. By that is meant the pressure which the contents of the abdominal cavity exert on its walls, and this is greatest at its most dependent part, which is the pelvic floor. This pressure is continuous on the organs of the pelvic floor while the woman is stand- ing, and greatest at the point of least resistance, which is the relaxed and enlarged vagina, so that it bulges out at the vaginal orifice. When the patient resumes a recumbent position, this point is greatly relieved from pressure, and the vagina may regain its normal relations, but whenever the woman is in the upright position, the intra-abdominal pressure will again force the Aveakened pelvic floor and vaginal walls downwards. After a time the prolapse no longer subsides after the pressure is reduced, for the tissues have lost their recuperate power, and the prolapse be- comes permanent. When the intra-abdominal pressure is supplemented by the action of the diaphragm and the con- traction of the abdominal muscles, as occurs in a long par- oxvsm of coughing, repeated vomiting, and inordinate and 234 HOME TREATMENT FOR WOMEN. prolonged bearing down at stool, a prolapse may take place quite suddenly, precisely as in a rupture or hernia, and for these reasons some authorities (Drs. Hart and Barbour, of Edinburgh) have described prolapsus of the womb as a sacro- pubic hernia. A permanent distension of the bladder or an accumula- tion of feces in the rectum facilitates the development of a prolapse of the vagina, because the former pushes the an- terior wall of the vagina downwards, while the latter de- presses the vaginal wall. A large or subinvoluted uterus is by some considered as a fruitful cause of prolapse; this Professor Schroeder denies, and I am convinced from experience that he is right. A uterus that is simply enlarged is not inclined to prolapse, because the enlarged pregnant uterus never prolapses if the pelvic floor is in a normal condition. But a chronic en- dometritis or uterine catarrh may in time involve the vagina in a vaginal catarrh and this may induce a prolapse. A chronic vaginal catarrh or leucorrhoea can so relax the vag- inal walls that its lower folds protrude from the vaginal orifice. Women who are beyond the change of life and in whom the lost elasticity of the tissues and a general absorption of fatty and connective tissue has destroyed the natural sup- port which retains the vaginal walls, may be annoyed with partial prolapses of the vagina. The most aggravated types of prolapses are found among the working classes, who cannot avail themselves of the comforts and hygiene of the lying-in chamber that are so essential for a complete and permanent recovery. Elongation or hypertrophy of the cervix of the uterus is the third variety of prolapses that Professor Schroeder in- cludes in the group. This form is consequent upon a fall; ing or prolapse of the vagina, and it occurs in the following manner. The body of the uterus being retained by its natural supports or by adhesion of a former inflammatory PROLAPSUS OR FALLING- OF THE \ArOMB. 235 process in the pelvic cavity, remains stationary where it naturally belongs, while the upper end of the vaginal canal being attached to and surrounding the cervix or neck of the womb, gradually draws or stretches the cervix out, so that it grows one or two inches longer than it is natural for it to be. The cervix of the womb projects under these circum- stances down into the vagina, and in some cases it may be seen between the lips of the vulva. This condition is mis- taken for falling of the womb, when in reality it is a falling of the vagina with an incidental lengthening of the cervix of the womb. To recognize and make these distinctions is of the greatest practical importance, for thus alone can the measures adopted for the relief of these distressing com- plaints be successful. The symptoms of prolapsus grow principally out of the changed relations of the uterus to the surrounding organs and tissues. The mechanical interference and pressure of the womb on neighboring parts, and the changes that are induced in the organ itself by the altered circulation in its tissues, cause the inflammatory enlargement or hypertrophy that is characteristic of one variety of the affection. In some persons the development of the disease is so gradual that it has progressed for years without any serious inconvenience and the symptoms that did exist were gener- ally attributed to other causes. In the course of time there is such a combination of morbid processes, like painful men- struation, inflammatory enlargement of the womb and ero- sions of the cervix with profuse leucorrhoea, as to render the parts painful and sensitive to pressure and friction. These symptoms excite in the end suspicion, so that the sufferer may seek advice that will reveal to her the real con- dition of her case. Other signs of these affections are a dragging down or a feeling as though a Aveight pulled the pelvic organs down- wards; there is also traction on the bladder, making this vis- cus exceedingly irritable, so that there is a frequent desire 236 HOME TREATMENT FOR WOMEN. to micturate; the rectum suffers also from similar traction. There is another sign that is very often present, and partic- ularly in the early stages, and this is a feeling as if the va- gina was open; this is due to the relaxation of the vaginal walls. Walking for any distance becomes burdensome and causes great fatigue; pain in the back and loins is hardly ever absent. There is an inability to lift weights, because the pelvic floor cannot endure the extra strain that is super- imposed on the intra-abdominal pressure; ascending or de- scending stairs aggravates the symptoms much more than walking on the level floor. TREATMENT. This must be directed to the accomplishment of two ends, without which no relief, much less a cure, is possible? and these are, first, to return the displaced organ to its nor- mal position, and, secondly, to retain it there. The course first indicated is, as a rule, not difficult to follow out; in fact, if the patient is placed in a favorable position, the uterus re- places itself through the natural forces of traction and grav- itation, unless it has become so enlarged that it is a physical impossibility. The "knee-chest" or " knee-elbow posture " is the term that has been given to this position, and it is assumed in the fol- lowing manner. The woman gets down on her knees, the thighs being kept in an upright or vertical line; the object of this is to keep the pelvis as high as possible, while the chest is bent or inclined forwards until the head rests on the floor; the shoul- ders must be as low to the floor as it is possible for the pa- tient to endure. This position at once reduces the intra-abdominal pres- sure on the pelvic floor to the least degree, and besides this, the abdominal viscera gravitating towards the diaphragm the prolapsed uterus and surrounding tissues are drawn up- wards and forwards Avith it. If the prolapse was complete or nearly so, so that the organ almost protruded through PROLAPSUS OR FALLING OF THE WOMB. 237 the vulva, then the patient should retain this posture for ten or fifteen minutes before an attempt is made to replace the organ; for the intense congestion should be first allowed to subside. No sudden or violent force should be employed, but a gentle, steady pressure. In cases where the organ has simply descended into the vagina, the knee-chest posture alone will replace the uterus. Those displacements that are due to a chronic catarrh of the vagina are particularly suitable for home treatment, because the patient can surely cure her vaginal catarrh, and combining with this the knee-chest pos- ture, which should be practiced night and morning, for at least ten minutes, and until the catarrhal inflammation has entirely subsided, she has at her command the most useful and beneficial resource to accomplish a cure. The chapter on vaginal catarrh gives all the information that is appli- cable in these cases. Prescription XV should be used as a vaginal wash, at bedtime or when retiring.' I have recom- mended a suppository that has given great satisfaction in strengthening the relaxed and weakened tissues. This is my formula for them:— NO. XVIII. Take: Tannin............................1| drams Sulphate of quinine..................2 scruples Cocoa butter (grated).................1 ounce Make into twelve egg-shaped suppositories. Directions: Introduce one each night into the vagina, ten to twenty minutes after the vaginal wash has been used. - The fatigue or lassitude which makes every physical effort of some patients a great hardship, can be greatly re- lieved, if not cured, by this formula. no. xix. Take: Tincture of nux vomica..............2 drams Fluid extract of ergot................4 drams Fluid extract of golden seal...........1 ounce Compound elixir of calisaya sufficient to make............................8 ounces 238 HOME TREATMENT FOR WOMEN. Directions: A tablespoonful three times a day, between meals. When the prolapse is due to some of the structural de- fects that were enumerated in the causation of displace- ments, and that were traced to the accidents of childbirth, then no permanent relief can be hoped for, until these de- fects are remedied. Pessaries or rings that are introduced into the vagina for the purpose of stretching or spreading out the relaxed folds of the vagina, that they cannot prolapse or fall down, and thus indirectly support the uterus, were suggested by the ancient fathers of medicine. In view of the fact that they were wholly ignorant of the causes that were responsi- ble for prolapses, the remed}^ was quite practical and in- genious, but to-day, when we are acquainted with the causes that operate in bringing the prolapse about, they are, to my mind, a very unsatisfactory makeshift, and afford only a temporary amelioration. A woman who is compelled to wear a ring»or pessary is certainly not well, and if she has any hard work to do or must be on her feet a great deal, the pessary will sooner or later so.irritate the vagina that it must be removed. Be- sides this, I always contended that, in the long run, this extra strain on the vaginal walls would only relax them more, and, instead of ever being able to dispense with the use of a pessary, she must increase the size after a while. There are a great many devices in the form of pessaries; some of them are absurdly ridiculous, and more in the nature of instruments of torture than of remedial expedients. Since I learned to know better, I no longer recommend them, and those who desire a radical cure for a prolapse of any kind, will surely be disappointed if they pin their faith to them. I am convinced that they are a great source of evil, and a sure index of ignorance on the part of those who habitu- ally recommend them. The German school of gynecolo- PROLAPSUS OR FALLING OF THE WOMB. 239 gists have of late years greatly perfected the plastic operations of the vagina, in fact, it is almost a sub-specialty in itself, to which they have given the term prolapse operations. A specialist, who is competent in the details of these prolapse operations, can hold out the very best possible chance for a radical and permanent cure, and while the operation re- quires a certain degree of skill and special training, Avhich should be obtained by practicing these operations on the cadaver, in order to save time, and not bungle the operation on the living subject, as too often, unfortunately, happens. In skillful hands, the operation is entirely without danger, and under proper antiseptic precautions, the results are very satisfactory. The question is simply this: If the knee-chest treatment, and the remedies that have been suggested, do not give per- manent relief, then there must be some such defect in the pelvic floor as I have heretofore described. If the vagina is too wide, it should and can be narrowed to its normal dimensions, by removing the excessive tissue; if the vagina is torn into the perineum, this too must be united. Should the cervix of the uterus be abnormally elongated, so that it makes it physically impossible to return it to its natural position, it should be shortened or ampu- tated, and if all these three complications coexist, then an operation combining and remedying all these defects, should be performed at one sitting. This method alone will restore the patient to health and usefulness. CHAPTER XX. VERSIONS AND FLEXIONS OF THE UTERUS. Version, in the nomenclature of diseases of the womb' means that the entire organ without any deflection in its normal axis turns, inclines or leans either forwards, back- wards or sidewards. The prefix ante is used in the sense of forwards and in composition with version we have the word anteversion, which in conjunction with the term uterus, signifies that the organ is inclined forwards. The prefix retro, signifies backwards, and in composition with the word version and in connection with the word uterus, it implies that the womb is turned backwards. The word flexion differs from version, inasmuch as it sig- nifies a bending or bowing, which breaks the normal axis of the womb. The neck or cervix of the uterus may retain its normal position, while its body is abnormally deflected or bent in any direction. The prefixes ante and retro are also used in composition with the word flexion as they are with version. These distinctions should be remembered. ANTEVERSION OF THE UTERUS. In anteversion the uterus has so far changed its normal shape that the cervix of the organ is stretched out or ex- tended in a line with the axis of the body. This occurs when the uterus is unusually swollen from inflammatory enlargement. The normal location of the body does not materially change in these cases. It is a little more de- pressed on the fundus of the bladder and the cervix is correspondingly elevated, so that the latter stands consider- ably higher than in health. If the bladder is empty, and (240) VERSIONS AND FLEXIONS OF THE UTERUS. 241 the patient bears down or does anything that increases the intra-abdominal pressure, the body of the womb is forced doAvn, upon the anterior vaginal wall, which prolapses into the vagina, while the cervix is raised, so as to point upwards and baekAvards. When the bladder is full, the body of the uterus is naturally raised, and the cervix correspondingly depressed. And this is attributable to a rigidity or stiffness about the organ, that is characteristic of a chronic inflam- matory enlargement of the uterus. Sometimes the organ is permanently fixed by inflammatory adhesions, that lessen or prohibit these movements. The symptoms of anteversion are what may be expected from an enlarged congested organ. This enlargement is due either to a subinvolution of the uterus or to an inflam- mation of the intermuscular substance, a chronic metritis. One of the most annoying symptoms of the anteverted uterus is the feeling of looseness in the pelvic cavity. This is partly due to the relaxed state of the surrounding tissue, and partly to the abnormal size of the womb. The patient feels the organ roll from side to side, as she changes her po- sition. This causes unnatural sensations and mental suffer- ing that disturbs the nervous system and induces hysterical complications. And the patient complains about something moving in her abdomen. The inflammatory adhesions that sometimes tie down the organ in an anteverted position, compromise the nor- mal expansion of the bladder; this induces an irritation, which causes a frequent desire to urinate. The treatment must be directed to the removal of the cause. This disease is really only a symptom or condition of chronic corporeal metritis or subinvolution, and as such, it is only amenable to the measures that will cure this dis- ease. The employment of rings and pessaries to remedy this evil is contrary to good sense and of no permanent value. The intelligent employment of electricity, so as to stimu- 16 242 HOME TREATMENT FOR WOMEN. late the absorption of the hypertrophic enlargement of the uterus and cause the absorption of the inflammatory adhe- sions, will often giATe permanent and positive results. ANTEFLEXION OF THE UTERUS. This was considered at one time the most frequent of all uterine displacements, not because it existed formerly oftener than at present, but because the natural or normal position of the womb was confounded with that which was supposed to be abnormal. The discovery that in the living subject the body of the uterus naturally inclines forward, so as to rest on the bladder, and that the body makes quite an angle with its cervix, altered the conception of things very materially To-day an actual aggravated anteflexion, that occasions no impediment to the menstrual discharge, is not a proper ground for treatment, although this is as yet by no means familiar to physicians in general, for many of them have not learned to make the distinction. The reader should carefully study Plate II, which dia- gramatically illustrates how the body bows over the bladder so as to show its natural anteflexion. If the angle between the body and neck of the womb becomes too sharp or acute, so that the canal of the uterus becomes compressed at the point of flexion, in a degree that obstructs the escape of the natural secretions of the uterine cavity, then the anteflexion becomes a source of disease. This degree of flexion is hap- pily very rare, and we find it in about equal proportions due to a congenital defect, that springs into prominence when the girl arrives at puberty, for then the obstruction to the men- strual flow is first realized. The other class acquire the affection in adult life, after a once healthy or natural menstruation has been established. Of this class there are two species, which must be separately analyzed, so as to avoid a confusion of ideas, that often makes this subject, which is the most simple, one of the most intricate, in the text books in gynecological practice. VERSIONS ANI) FLEXIONS OF THE UTERUS. 243 One variety of the acquired affection can be described, in common with the congenital form, to which I first re- ferred : because the anteflexions in both cases are due to precisely the same pathological conditions, namely, a loss of muscular tone in the uterine walls, so that the organ be- comes flabby and weak, like a green wilted stalk, allowing the body of the uterus to topple forwards. The relaxation of the uterine walls is usually more pro- nounced at that portion which is distinguished as the isth- mus of the uterus, and corresponds to that part of the organ where the cervix goes over into the body, forming a sort of natural hinge joint between body and neck. If the bladder is empty, the body of the womb will naturally drop, not necessarily fonvards, for it may fall backwards, but in the majority of cases it drops forwards, because the womb is already inclined forwards in its natural position, so all that is necessary to induce an excessive anteflexion, is for the body of the uterus to sink lower than it is natural for it to be. A kink or sharp bend will cause in any canal an occlusion. Take a small rubber tube, for instance, and bend it sharply at right angles; the result will be at the corner of the deflection, that the tube will be flat- tened, and its walls will come together. In the case of the ■ uterine canal, where there is an abnormal flexion, there is precisely the same condition, and as a result an obstruction not only to the menstrual fluid, but to the mucous secretions, which are pent up in the uterine cavity. The retained fluids decompose and irritate the mucous lining; and this entails a complication of inflammatory diseases, Avhich can never be cured, unless the flexion is remedied. The other variety of the acquired flexion is due to a pelvic cellulitis. This is an inflammatory process, entirely outside of the uterus. The womb is surrounded by a great deal of loose cellular tissue, that fills out the interspaces between the different ligaments and pelvic organs. This tissue often becomes the 244 HOME TREATMENT FOR AVOMEN. seat of an inflammation. The exudation from the inflamma- tion may be of such a nature that it forms strands of fibrous tissue, running from the isthmus of the uterus backwards to the sacrum. These strands contract or shrink in the course of time, and this draws the isthmus of the uterus backwards, and fixes or attaches it to the posterior pelvic Avail. By this contraction of the fibrous tissue the cervix is constricted and the body falls unnaturally forwards. The prominent symptoms of anteflexion are painful men- struation and sterility. Dysmenorrhcea or painful menstrua- tion is the first sign of the existence of anteflexion at the age of puberty. It happens that young girls are thus tor- tured for days with violent uterine colic, that is occasioned by spasmodic efforts of the uterus to force through the con- stricted canal the pent-up secretion. This lasts until the menstrual fluid has sufficiently dilated the cervical constric- tion to allow its escape. These painful paroxysms of uter- ine colic repeat themselves at each recurring menstrual period, and through these repetitions of pain and suffering, the general health becomes greatly deranged. The nervous system becomes the seat of functional disturbances, and hys- terical disorders are not uncommon. The organ becomes involved in chronic inflammatory processes that make the uterus exceedingly sensitive, so that the colicky pains become aggravated and prolonged far beyond the cessation of the menses. Some of these pa- tients suffer for several weeks, from the time the courses ought to begin, so that they are actually sick half the time. Sterility is not an absolute certainty in all these cases, but it is traced so often to an aggravated flexion, that it may be accepted as one of its most prominent signs. Conception has taken place in extreme flexions, because the spermatozoa can gain admittance into the uterine cavity for several days after the uterine colic and menstrual fluid have forced the canal open. And if the uterus has not become involved in inflammatory processes, then conception is the means by which nature effects a cure through her own resources. VERSIONS AND FLEXIONS OF THE UTERUS. 245 During the menstrual period, the anteflected uterus be- comes greatly congested and swollen, and, having already groAvn considerably larger from the chronic inflammatory conditions which the anteflexion has induced, it impinges on the bladder, so as to interfere with its free expansion. Thi$s occasions a frequent desire to void urine, and this becomes a very distressing symptom in a certain proportion of cases. Treatment for this affection is not within the sphere of the original purpose of this work, for the efforts at home treatment must be aided by mechanical methods of the physician. From what avc are taught of 'the physical cause of this affection, the fact seems self-evident that the acute or sharp flexion must be modified to give permanent relief. The employment of rings, pessaries, sponges or medical ap- plications are nonsensical, and the method of introducing a stem in the uterine cavity, for the patient to wear for an in- definite length of time, is not without great danger. Even though a woman cannot give herself all the proper treat- ment, it must be a great satisfaction to her to be informed of the proper methods that should be adopted. The vagina should be thoroughly rinsed before each and every treatment of the uterus, so as to guard against the possibility of infecting the cavity of the uterus. If the manipulations that are required for the purpose of carrying out some of the mechanical or surgical treat- ments of uterine diseases, Avere always preceded with thorough cleanliness, which implies asepsis, or without putrescence, then all these operations would be shorn of their greatest danger, namely, that of exciting inflammation and suppuration. If a probe of the usual curve can be readily introduced into the supposed anteflected uterine cavity, then there can- not be sufficient flexion to constitute an obstruction, hence the flexion is not the cause of the disease. In genuine an- teflexion, the cervix and body of the uterus are doubled up On each other, often like the letter V, the cervix repre- 240 HOME TREATMENT FOR WOMEN. senting one line of the V, and the body the other; bi- mammal palpation in the hands of an expert clearly estab- lishes this conformation. When the diagnosis is established, the treatment should be as follows : The patient is inclined on a table, either on her back or side, a Sims' speculum is introduced into the vapina and the cervix exposed. The posterior lip of the cervix is now seized by means of a tenaculum forceps, and gently drawn downwards and backwards, which, greatly re- duces or obliterates the angle or flexion between the cervix and the bodv of the womb, this greatly facilitates the in- troduction of a uterine electrode. After two or three treat- ments, the forceps are no longer required, because the elec- trode can then be readily introduced into the uterine cavity without them. The other electrode is spread on the ab- domen. (See this illustrated on Plate V.) A current of electricity is now passed through the uterine tissues for ten minutes; this is gauged all the way from sixty to one hun- dred milliamperes. The operation is repeated only once a week, and the cure is effected in six weeks to three months. Great care must be exercised during the treatment, to avoid exposure and undue exercise. Those forms that are due to inflammatory deposits and strands outside of the organ, should be preceded with an electrical treatment twice a week, somewhat modified from the preceding course. This is done by employing a vaginal electrode, properly protected and gently pressed against the adhesions. The other electrode is applied to the small of the back. A current some fifty milliamperes stronger is passed directly through the adhesions; when these are absorbed, the intra-uterine electrode is employed, as in cases that are not complicated with them. RETROVERSION OF THE UTERUS. This consists in a posterior inclination of the uterus, so that the body of the womb approaches the posterior Avails of the pelvis, while the cervix of the Avomb is raised against the base of the bladder. PLATE IV. Retroflexion of the Uterus, or the Womb, bent backward. This plate elucidates the womb bent or turned backward and pressing on the rectum. This condition is generally traceable to the vicious custom of lying on the back after confinement or during childbed. The natural position of the organ, in- clined forward and resting on the bladder, is also shown. VERSIONS AND FLEXIONS OF THE UTERUS. 247 As a permanent pathological lesion, this form of displace- ment is very rare, but as a forerunner of retroflexion it is of frequent occurrence. The length of time that elapses for a version to take on a flexion depends on the degree of indu- ration or stiffness of the uterine walls. The chronic inflammatory enlargement of the uterus predisposes the organ to posterior displacement, and the dis- placement favors the development of flexion. This takes place in the following order: After the uterus is displaced baekAvards, and its cervix has become fixed by inflamma- tory adhesions, the body of the womb gradually glides down on the posterior pelvic wall, from gravitation and intra- abdominal pressure. And in this very simple manner a retroversion is converted into a retroflexion. The causes, symptons, and complications that characterize this variety of displacement, with its subsequent modification into flex- ion, are the same as those of retroflexion, to which the reader is referred. RETROFLEXION OF THE UTERUS. This form of uterine displacement exists when the body of the Avomb is bent towards the posterior wall of the pelvis, which is in an opposite direction to that Avhere it naturally belongs. I have already pointed out, in speaking of the normal position of the uterus, that the body is directed for- wards and rests on the bladder, while its cervix points dowiiAvards into the pelvic cavity. I now refer you to Plate IV, in which I plainly show the uterus in a directly oppo- site position to that in health, namely, turned back, resting on and depressing the rectum. In retroflexion the cervix of the uterus continues to point downwards, into the pelvic cavity, in almost the same di- rection as in the natural position, Avhile the body is directed backwards, or backwards and downwards. AVe seldom, if ever, find this condition as a. congenital affection, but as an acquired displacement it is undoubtedly more frequently 248 HOME TREATMENT FOR WOMEN. met with in gynecological practice than all other displace- ments combined. The round ligaments of the uterus were at one time, and are even yet by some, supposed to be the means that retain the womb in its normal anteflected posi- tion. Upon this theory a new surgical operation sprung into prominence for the relief of this class of cases. It Avas reasoned, that if the round ligaments actually tied the uterus down, and retained it in its natural anteflected position, that to shorten these ligaments by opening the inguinal canal in the groin, and drawing them out, would remedy a displace- ment of the womb, whether a prolapsus or a retroflexion. This operation was performed, it was claimed successfully, and if the view that the round ligaments retain and support the uterus were a correct one, it must be admitted that the operation would have been ideal. I convinced myself, how- ever, of the utter fallacy of this position, in dissections on the cadaver, where in several instances the round ligaments could not be reached without opening the abdominal cavity, and even then it Avas impossible to trace them. These views were expressed in an article in the American Journal of Obstetrics and Diseases of Women and Children, and as the operation fell shortly afterwards into merited disrepute, I partly claim the credit of having been instrumental in bringing that about. I said: "That this ligament has nothing to do in fixing the uterus in its normal anteverted position, is proven from many facts which occur in daily practice. The insertion or origin, whichever one chooses to call it, of these cords at the groin, is somewhat irregular and sometimes so rudimentary that it cannot be found upon a most careful and tedious dissection. It may be found divided into a number of proc- esses, one being connected with Poupart's ligament in the inguinal canal, the other being lost in the labia majora, and another may be traced to the sheath of the rectus muscle. " If these cords were so important as the advocates of the Alexander-Adams operation try to make us believe, in bind- ing the uterus forward, and, as we are recently informed, have a strength equal to support four and one-half pounds VERSIONS AND FLEXIONS OF THE UTERUS. 249 weight, a great deal of uneasiness, if not actual pain, Avould be felt and located along the inguinal canal, following this structure to its points of insertion, in sudden dislocations of the uterus backwards. This is, however, not the case; when sudden painful symptoms arise, they are invariably referred to the sacral region. In sudden retroversions or flexions, as in the pregnant uterus, occurring accidentally or those retroverted or flexed uteri Avhich are so often met with in a state of subinvolution after confinements, there are no symp- toms pointing to a tension of these cords at all, but all symptoms point to uterine pressure on the posterior pelvic wall, which can be precisely located. And tkese pains dis- appear as soon as the offending member is put right." There is no doubt that the uterus retains its abnormal retroflected position by the same forces that keep it in a normal or anteflected state; these are (1) intra-abdominal pressure, and (2) the force of gravitation of its own weight. In some women there are' certain predispositions to the occurrence of a retroflexion. If the walls of the uterus are weak and relaxed, especially that portion where the cervix unites with the body of the womb, then the body may fall in any direction, and, as the bladder is liable to be dis- tended, and thus raise the body of the uterus upwards, folds of intestine are likely to intervene, so that the organ is in- clined backwards, and the abdominal pressure, now falling on the anterior surface of the body, presses the womb back- wards and downwards into a flexion. A fall backwards or a violent push or jump may cause retroflexion any time during life. Retroflexions of this na- ture are not as a rule injurious, and if the circulation is not compromised, nor the uterine canal obstructed, women may go through life Avithout feeling any the worse because their womb occupies an abnormal position. It is only when the organ is congested and swollen, so that its own tissue is pain- fully sensitive, and the surrounding tissues are compressed by the foreign body, that it requires measures for relief. In those women avIio have borne children, and those who have gone through a miscarriage, retroflexion is fre- \ 250 HOME TREATMENT FOR WOMEN. quently met. A little reflection will make this clear, for when we remember how the pregnant uterus at any time from conception to final delivery becomes congested and the seat of a corresponding growth of its OAvn tissue to ac- commodate the growing fetus, Ave at once perceive that either after an abortion or on delivery at full term, the en- larged and congested uterus is in the best possible condition, to lose its normal place and sink baekAvards. The per- nicious custom in vogue in most countries, of keeping a woman on the,flat of her back after delivery, has never been as vehemently opposed by the intelligent members of the profession, as the gravity of the subject demands. Some women have an idea that the longer and quieter they re- main on their backs, the surer they are to make an excellent recovery from the lying-in chamber. American and En- glish practitioners are incline'd to recommend this as the most proper way to lie, but there is no doubt that this not only favors the occurrence of retroflexion, but that it actu- ally causes it. The woman who rests on her back gives to the heavy body of the womb an opportunity to sink backwards, after the distended bladder has pushed the organ high enough up so that its own weight may throw it over, until it finds resist- ance on the posterior wall of the pelvic cavity. Many nurses insist on the dorsal position for days, and never permit the patient the privilege of lying upon one or the other side. Aside from the injurious effect that this has on the position of the uterus, it is exceedingly tiresome to be compelled to remain for several days in one position. Women should be allowed to lie on all sides, after delivery, and no longer on one side than on another. And to insure against a retro- version or flexion, she must also lie on the abdomen a cer- tain length of time during each twenty-four hours. Tight bandaging after delivery, for " preserving the fig- ure," greatly aggravates the displacement; the binder should be so applied that it feels comfortable but not too tight, its VERSIONS AND FLEXIONS OF THE UTERUS. 251 purpose being to offer a gentle support to the suddenly re- laxed abdominal muscles, and thus stimulate them to con- tract to their normal form. The symptoms of retroflexion are greatly varied by the pathological conditions that affect the uterus, or by the com- plications that may have caused the flexion. It is indisputable that the uterus may be retroflected for an indefinite length, of time Avithout causing any inconven- ience. From this it may be inferred that the retroflection itself does not constitute the disease, but the inflammatory processes, in which the organ is involved, or the relaxation of the adjacent structures, as we find them immediately after confinement, constitute the actual diseased conditions. One of the most constant symptoms is pain in the back, and this is severe in proportion to the swelling and sensi- tiveness of the organ, Avhen it presses on the sacral nerves and rectum. As a result of the flexion, the circulation in the organ is interfered with, so that the congested uterus feels heavy, and there is a sensation of fullness and bearing down, that greatly hinders walking. Uterine catarrh and hyperemia place the organ in such an irritable state that prolonged and excessive menstruation is the rule. This may last for fourteen days, so that the patients become anaemic and greatly debilitated from the excessive loss of blood. The menstruation is always more painful, especially at the be- ginning of the flow; this pain may be interrupted or spas- modic, so that it assumes the form of a uterine colic; the lower abdominal region becomes painful and the pain radi- ates toAvards the groins. The degree of suffering is very seldom as great as that which characterizes anteflexion, be- cause the obstruction in the latter flexions are much greater than in retroflexions. Those women Avho have borne children suffer less pain during menstruation than those who have never been preg- nant. It may be presumed that, in the latter class, the flex- 252 HOME TREATMENT FOR WOMEN. ion was congenital or acquired in early childhood, Avhich makes the obstruction or constriction more complete and obstinate, and for that reason it induces sterility. With those who have once borne and afterwards acquired the flex- ion, the possibility of conception is much greater. When the enlarged and swollen body of the uterus is pushed backwards and doAvnwards, it presses on the sacral plexus of nerves; this is a bundle of nerves that supplies branches to the legs, and from this pressure the lower ex- tremities become lame or paralyzed either on one or both sides. The paralysis subsides after the removal of the of- fending body. There is quite a number of other neurotic affections that can often be traced to a retroflected uterus. These are all of a functional nature, and appear in the form of hysteria, epilepsy, St. AAtus' dance and neuralgias of almost any part of the body. Dr. Chrobak, of Vienna, reported a case of asthma that had resisted all the treatments that could be suggested, until it was finally traced to a retro- fleeted uterus; that being rectified, the asthma subsided. Irritability of the bladder is not so frequent a symptom of this variety of displacement as of others; should there be inflammation complicating the bladder, then, of course, there would be considerable annoyance from this source, Habitual constipation is often very prominent and in some of the cases it is the only sign that leads to an exam- ination, which reveals the retroflexion. Hemorrhoids or piles, due to a compression of the veins of the rectum, are another complication included in the signs of this displace- ment. TREATMENT. There is a small proportion of cases in which the system has become accustomed to the retroflected position of the womb, and if the abnormal condition is rectified, a great many painful symptoms spring into prominence, that are attributable to the interference. This is particularly the case in women who are in those years that we term " change of life," and for this reason they should be let severely aloii3, VERSIONS AND FLEXIONS OF THE UTERUS. 253 Excluding the above class of cases, the question arises in other cases whether the uterus can be replaced without violence, or whether it is fixed or grown to its surroundings by inflammatory adhesions. It is not always an easy matter to dispose of this question at once, because the en- larged and congested body is often so firmly wedged down between the posterior pelvic wall and the vagina, that any attempt to dislodge it is accompanied with such acute pain that one feels constrained to desist for a time. When there is great pain or sensitiveness, the patient should take to bed, sp as to give the pelvic organs every chance to get rid of the inflammatory irritability. Hot-water compresses should be applied to the lower abdominal or pelvic region, and hot vaginal irrigations thrown into the vagina; these should be copious, no less than a gallon of water at once, at a temper- ature of 107 to 110° Fahr., repeated twice daily. The bow- els should be kept loose, say several operations each day, for three or four days; after that once a day will be suffi- cient. Prescription IX is the most suitable purgative for this purpose. In the course of several weeks the congestion will have subsided, so that, in the great majority of cases, reposition can be readily accomplished. If the resistance of the womb still persists, then it is reasonable to infer that the organ is tied down by old inflammatory adhesions; these, then, should be treated with galvanism, after the manner described for removing adhesions in anteflexions. The statistics show that, out of every five women who are suffering from female diseases, one has a posterior dis- placement, either a retroflexion or retroversion. The great- est number of these are traceable to their last confinement. All these displacements, as well as those that are accidental or induced by a fall, jumps or the like, should be replaced as soon as possible, otherwise inflammatory adhesions may complicate and greatly obstruct the replacement. The reposition or replacement of the womb may be ac- complished through natural agencies, that can be employed 254 HOME TREATMENT FOR WOMEN. by the patient herself. These are, in a great measure, the same forces to which the womb's posterior displacements are to be attributed, namely, intra-abdominal pressure and grav- itation. To employ tliese for the purpose of remedying the evil, the so-called knee-chest position must be assumed by the patient. The first step towards assuming this position is to get down on the bended knee, the thighs in a vertical position, then the body is gradually inclined forwards until one or the other shoulder touches the floor or level of the knee. If this position is retained for ten minutes it will alone replace the organ fonvards, sometimes suddenly, at other times gradually, provided the organ is moveable and not squeezed into the pelvis or adhered by inflammatory ex- udation. Dr. Henry F. Campbell, of Georgia, introduced this nat- ural therapeutic agent into the profession, but it appears to be very little known or understood by the profession, per- haps because it is so very simple. Dr. Munde, in an article on "Uterine Displacement and Its Curability," in the Amer- ican Journal of Obstetrics, indorses the knee-chest or knee- shoulder position in the following language: "A moment's thought will demonstrate the utility of this combined vis a fro ate (gravitation of the abdominal viscera towards the dia- phragm) and vis a tergo (air suction into the vagina and pres- sure against the vaginal roof). This position is to be as- sumed several times daily, and maintained each time as long as the patient can bear it, continued for months, if neces- sary; the best time is at night at retiring, when the lateral position is to be taken for the night" In a certain proportion of cases the knee-chest position alone will not dislodge the retroflected uterus, so that man- ual aid is required to effect that purpose. There js a num- ber of methods that have been suggested from time to time, but none are so good as that in which the knee-chest position is combined with the manipulation of the operator. Reposi- tion may occur spontaneously, and it undoubtedly does in a VERSIONS AND FLEXIONS OF THE UTERUS. 255 large proportion of cases, in Avhich the retroflected organ be- comes pregnant. A\ nen the retroflected organ occasions symptoms of retention of urine, the bladder should first be emptied with a soft No. 8 catheter, then the patient is di- rected to kneel on both of her knees, her thighs remaining perpendicular, AAdiile her body inclines forward until one or the other shoulder touches the floor or level of her knees. The operator may then gradually lift the womb and elevate the body sufficiently so that it will fall forward into its nat- ural place. When there is no bladder trouble from compres- sion, and the womb resists even mild force to replace it, I have accomplished gradual reposition by keeping the woman in bed for three or four weeks, Avith the instructions that she resume the knee-shoulder position two or three times a day, and from five to ten minutes, also that she shall lie on her side and chest and never on her back. In this manner I have accomplished in time and without force what could not have been accomplished with forcible attempts without inducing an abortion. It curiously happens that there are cases of retroflection Avhich are never .suspected nor recognized until the patient has become pregnant. After 'the woman is about three months gone, the growth of the pregnant uterus can no longer be accommodated in the pelvis, because the direction of its growth is in the direction of the retroflected organ, namely, baekAvards and doAvnwards (see Plate IAT) which makes it a physical impossibility to escape from or grow out of the bony pelvis. The symptoms are retention of urine or a constant dribbling of urine^and a .straining q,t stool or pain in the rectum or pelvis, and, of course, the absence of the menses since the commencement of pregnancy. Retro- flection may be also acquired during the first three or four months of normal pregnancy, from a jump or fall on the back in which all the symptoms that indicate this condition are suddenly manifested. In pregnancy, the course that is to be pursued, in order 256 HOME TREATMENT FOR AVOMEN. to rectify, the displacement, must be obviously different from that pursued Avhen the woman is not pregnant. The pregnant uterus is a "touch me not";'' it permits of no tam- pering Avithout running the fearful risk of inducing an ab- ortion, and no one but a tyro or an ignoramus will ever meddle with the pregnant womb. The replacement of the retroflected uterus, that is posi- tively not pregnant, and there must be no question about it either, will admit of introducing a sound into its cavity. This sound is used as a lever upon Avhich the organ may be lifted out of its abnormal position and inclined over the bladder in an anteflected position, Avhich is its natural one. The sound Avhich I employ, and which is my own invention, for replacing the uterus is screwed into a thimble, and from two and one-half to three inches long. The object of this is to artificially elongate the finger so that it can be intro- duced into the womb. The force which one employs by using this instrument is keenly appreciated by the operator, hence there can be no undue strain, that otherwise might be exerted on adhesions which are too strong to be safely lacerated or even stretched, while slight and recent adhe- sions might be torn without any bad results. Truax, of Chi- cago, manufactures my repositor. Before introducing any sound into the uterine cavity, it is absolutely necessary that the vagina should be thoroughly cleansed with borax water. The inflammatory enlargements of the womb, subinvo- lutions, uterine catarrhs, and any of the complications that may exist at the time that the organ is replaced, should be treated on the same principles that have been laid down in the respective chapters on these diseases; in fact, these com- plications constitute part of the after treatment for retrover- sion or flexion. The other treatment is to be directed toward retaining the womb where it naturally belongs. The daily exercise in the knee-chest position should never be neglected, and in cases in which this is insufficient, it is very probable VERSIONS AND FLEXIONS OF THE UTERUS. 257 that the pelvic floor or natural support of the uterus has been injured or lacerated during confinement, and this may require a plastic operation as a preliminary to a cure. In obstinate cases there is no cure so effectual as pregnancy and a full-time delivery, provided precautions are taken so that the mother will not acquire a new retroflexion during her lying-in period, from the cause that has been already de- tailed. The patient must accustom herself to sleep either on the chest with face turned to one or the other side, or in a semi-prone position on either the right or left side. Persever- ance in sleeping in this manner for a few weeks cultivates the habit that gives more refreshing sleep than lying on the back, which most persons are inclined to do. 17 CHAPTER XXI. DISEASES OF -THE FALLOPIAN TUBES. The Fallopian tubes are the ovi ducts, along Avhich the spermatozoids pass from the womb to fertilize the ovum, and along which the fertilized or non-fertilized ovum, as the case may be, is carried to the cavity of the uterus. They are two small canals, between three and a half and Tour inches in length, and constitute the Only means of com- munication between the Avomb and ovaries; their caliber is exceedingly small and lined with a delicate mucous mem- brane. The diseases which affect the Fallopian tubes are inflam- mation, stricture, distention and displacements. The inflammation is distinguished as salpingitis, from ■salpinx, Fallopian tube,and ^/s,in composition, inflammation j vthis consists of a catarrhal inflammation of the lining mem- rjrane of the tubes, which rarely if ever originates in the tubes themselves, but is secondary to an inflammatory proc- ess in the neighboring organs. Chronic endometritis or catarrh of the womb is undoubt- edly the most fruitful cause of salpingitis, although this is not absolutely the rule, for there are some women Avho have had uterine catarrh for years without its affecting the tubes in the least. But there is a type of uterine catarrh that has a special tendency to spread from the womb to the lining membrane of the tubes, and this is the infectious endome- tritis. An infectious inflammation of the womb may be due to many different sources of infection; the retained products of conception after an abortion may become pu- trescent and furnish one source; carrying putrefactive germs into the uterine cavity from the vaginal canal by means of (258) DISEASES OF THE FALLOPIAN TUBES. 259 probes or instruments, that are in themselves defiled by not having been thoroughly cleansed and purified since their last employment, is another source of infection; the lat- ter is perhaps the commoner cause of blood poisoning in criminal abortions by the abortionists. Gonorrhoeal infec- tion seems to have a greater tendency than any other to spread itself from the uterus to the tubes; this has been the subject of special inquiry, and has been thoroughly con- firmed, and this may arise many months after the infected male has imagined himself entirely cured. The diseases of the tubes that I have enumerated are in the relation of cause and effect; a catarrhal inflammation is quite likely to induce a stricture or an occlusion, and this causes a distention from retention of the secretions, whether the secretions are a natural or an inflammatory product. If the inflammation has an infectious origin, then the retained secretion becomes purulent, or it may be a muco-pus secretion from the commencement. The dilated tube may also contain blood or serum; the latter constitutes tubal dropsy; or it may contain a fertilized ovum; this gives rise to tubal pregnancy. Tubal dropsy may be a distention of the tubes when both ends are sealed by inflammatory adhesions; these dis- tentions vary in size from the thickness of a finger to a large ovarian tumor, from which it is not an easy matter to distinguish it. The most dangerous form of tubal obstruction and dis- tention is where the contents are pus or purulent matter; this is liable to be poured into the peritoneal cavity from ulcer- ation or rupture of the sac, and excites fatal peritonitis. Salpingitis can only be viewed as a complication of some prior inflammatory process in some of the adjacent organs and tissues; these are the uterus and ovaries and the pelvic peritoneum and pelvic cellular tissue. The symptoms of inflammation of the tubes are not so clearly defined as to indicate the nature of the affectionj 260 HOME TREATMENT FOR WOMEN. because it is hardly ever limited to the tubes alone, the sur- rounding tissue being always more or less involved. These patients are so seldom free from pain that their lives are a constant suffering. If the pain subsides, it is only for a few days, and the slightest exertion brings about a relapse, so that walking or standing must be avoided. During men- struation the pain always increases, and the menses may be excessive at one period and scant at another ; these harass- ing pains make powerful inroads on the patient's strength; she becomes pale and debilitated, while her emaciated form and careworn expression give us a picture of the typical in- valid. Fortunately, this complication is not as frequent as one might expect from the intimate relation of the tubes to the womb and ovaries, but the possibility of the Fallopian tubes becoming inflamed should admonish women against taking any chances by neglecting the rules of hygiene, that I have laid down in another chapter, for the old saying that "prevention is better than cure" is only too true of this malady. TREATMENT. The curative measures for inflammatory diseases or ab- scesses of the tubes have not been, on the whole, until within a comparatively recent period, very satisfactory. When this affection complicates uterine or vaginal ca- tarrh, then the treatment that is recommended elsewhere for the relief of these complaints should be adopted; quietude is of paramount importance, and total continence must be practiced by the sufferer. Hot sitz baths and warm fomen- tations are important auxiliaries in the treatment. Vaginal irrigations of hot water, night and morning, relieve the con- gestion and stimulate the absorbents of the pelvic glands. Iodoform suppositories are a great asistance towards accom- plishing the same end; formula No. XVII is for that pur- pose. One suppository introduced into the vagina at bed- time should be combined with the other treatment. If these measures fail to accomplish a cure, then a surgi- DISEASES OF THE FALLOPIAN TUBES. 261 cal operation may be required as a last resort, which con- sists in extirpating the diseased tubes and ovaries. This operation has given some brilliant results, but it has also hurried a great many to an untimely grave. Fool- hardy surgeons or operators are the rule; doctors of only mediocre talent Avorm themselves into positions that give , them prestige in the community. Where nature refuses a capacity for the acquirement of solid wisdom, she seems to compensate her creatures by endowing them with faculties for cunning and intrigue, that galvanize the spurious into the apparently genuine. They have charge of hospitals and are professors in colleges, and are ambitious to imitate the operations of the European masters. On the other hand are the statistics of able surgeons, who seem to have an inborn genius for a special line of operations; such a one is Lawson Tait, of Birmingham, and Martin, of Berlin. Tait has had phenomenal success in cutting open the abdomen and removing diseased tubes and ovaries. He possesses the faculty and skill to select only those cases that are especially suited for an operation, and those that are not adapted for the knife are excluded. In the exercise of this judgment the danger of the operation is reduced to a minimum. The tubes and ovaries are often so matted and tied down Avith inflammatory adhesions, that their removal means sure death, and does the average surgeon know this? To have the genius of a Tait is to be one in ten thousand, and for this reason his statistics should be neither a guide nor an excuse for the other nine thousand nine hundred and ninety-nine, to attempt to do as he does. To assume that they can, is as absurd as to admit that our indigenous colonels of the State militia can plan or execute the cam- paigns of Napoleon. Galvanism or electricity has come to the rescue of this class of cases, as a safe and reliable method of treatment; of course it takes more time and patience. Should not this outweigh the selfish ambition of the unscrupulous surgeon 2(i2 HOME TREATMENT FOR WOMEN. who desires to boast of the number of times he has opened the abdomen, with little compunction of the confiding lives that he has sacrificed? I have myself had abundant experience to be convinced of the usefulness of electricity as a curative agent in this class of diseases, but I prefer to illustrate the treatment by quot- ing from a paper on " The ATalue of Electricity as a Substi- tute for Laparotomy," by Augustin H. Goelet, Ah D., in the Ncav York Medical Journal. He says:— " Airs. T., aged twenty-six. Severe pelvic pain referred to leftside; profuse leucorrhoea; prolonged and painful men- struation. Diagnosis: Pyosalpinx (or pus) in the left tube. Laparotomy (opening the abdomen) advised at AYoman's Hospital. Treatment: Tube emptied into the uterus by applications of positive galvanism to the left horn of the cavity of the uterus. Intravaginal applications afterwards- completed the cure. Duration of treatment, four months Complete relief of pain followed the removal of the pus from the tube. At the end of the treatment she had completely regained her health. Alenstruation was normal, and symp- toms relieved." CHAPTER XXII. DISEASES OF THE OVARIES. There is an analogy in the reproductive apparatus, run- ning through the whole animal and vegetable kingdoms. The bulb at the lower extremity of the pistil of a flower is called the ovary, and it contains the seed, which in the course of development becomes the fruit. In the human female, the ovary contains the seed, or germ, which, becoming fertilized, develops into the human embryo, or the fruit of conception. The seeds of the ovaries are termed ova, or eggs, and the organ or gland in Avhich the germs, or eggs, are prepared is the ovary. In the human female the ovaries are two follicular glands, about the shape and size of small almonds, situated on each side of the uterus. The follicles, or small sacs, of which the ovaries are composed, are cemented together by delicate fibrillar connective tissue, which is known as the stroma of the ovary, while the follicle is termed Graafian vesicle, after the name of its discoverer. Professor Barry, another investigator, gave the follicles the much better and more appropriate designation of ovisacs, because each of these capsules or follicles contains a single ovule, or little egg- It is carefully estimated that there are 30,000 Graafian follicles or ovisacs in each ovary, of which only an in- significant number develop and rupture at each menstrual period. It appears, from the researches of Valentine and Pflueger,that the Graafian follicles are formed at a very early period of embryonic life, from a series of minute tubules, (263) 264 HOME TREATMENT FOR WOMEN. that gradually become constricted from surrounding stroma, at regular intervals; the ova are subsequently developed in the interior of the follicles. Ovarian cysts or tumors cannot be considered in a work for home treatment, but a desire must be awakened in the minds of thoughtful readers, to learn the origin of these growths, and it seems to me quite appropriate at this juncture of the subject, to state that Professor Waldeyer, of Berlin, has discovered that ovarian tumors are developed from the remnants X>f the little tubules from which the Graafian follicles originate, so that the cause or source of these tumors is already laid before the patient is born; hence cannot be attributed to any fault on the part of the afflicted person. From the earliest period of intra-uterine development up to the age of puberty, the growth of the ovaries is entirely passive, but after that a continuous change takes place in the substance of the ovaries; the contents of the ovaries become active from the period of puberty, from which dates the com- mencing aptitude for procreation, until the menopause, or final cessation of the menses, which, in popular language, is termed " change of life," when the aptitude for conception ceases with the proliferation of the ova. The period of fruitfulness is characterized by the persist- ence of the menses, and this terminates, on the average, in the forty-fifth year; during all of this time the little ova, or eggs, continually ripen, and at their maturity the ovisacs, or Graafian vesicles, rupture from an increased secretion into their cavities. This ripening of an egg and rupture of a follicle corresponds with the monthly flow. The human ovum is very small; the largest does not measure above l-120th of an inch in diameter, and very often it measures ■only half that size. The situation of the ovary is not fixed in the pelvic ^cavity Avith any absolute degree of certainty, but it enjoys a degree of mobility that is even greater than that of the womb itself, to which it is attached by means of the ovarian DISEASES OF THE OVARIES. 2)5 ligament. Its usual place is about an inch from the uterus and a little baekAvards. It is partly surrounded by folds of peritoneum, and partly by the tissue that pads out the interspaces between the pelvic organs. If we remember the physiological fact, that at every monthly discharge of blood from the uterus, which is called menstruation, an ovum or egg ripens and an ovisac bursts, we cannot fail to appreciate the importance of the intimate relations that these functions must have, to the health of the individual and the perpetua- tion of the species. This process of ovulation has the peculiarity of the first stages of an inflammatory action, because the ovaries be- come congested Avhenever an ovisac ruptures. Through the nervous sympathy existing between the ovaries and uterus, this too becomes congested, so that the netAvork of uterine vessels becomes so engorged that the capillary blood vessels of the mucous membrane of the womb rupture, and the hemorrhage that is the result con- stitutes the menstrual flow. There are three physiological processes concerned in the menstrual phenomena: first, irritation and congestion of the ovary, rupturing the ovisac; second, congestion of the Fal- lopian tubes and uterus; third, consequent rupture of the blood vessels of the mucous membrane of the uterus and probably of the Fallopian tubes. There may be one or more supernumerary ovaries Avith- out disturbing the normal functions; one or both ovaries may be congenitally absent. The entire absence of both cvaries is generally accompanied by deformities of so seri- ous a nature that the newly-born infant is incapable of living. If the defect is principally limited to congenital absence of the ovaries, then there is an absence of the changes in which puberty is recognized; the mammary glands remain flat; there is not the roundness and fullness of the girl's figure that signalizes budding maidenhood. The apparently undeveloped form and girlish characteristics are prolonged 266 HOME TREATMENT FOR WOMEN. into the years of adult age, and she remains Aveakly and small. In an incomplete or rudimentary development, from an arrested or imperfect evolution of the ovaries, there is often a condition that resembles the'above very much; neither are these cases nearly so infrequent as those whose organs are entirely absent. The ovaries may persist in their fetal state, or their growth may be arrested at any time before the expected period of puberty. The diagnosis of this patho- logical condition must be inferred from the undeveloped state of the different organs and from the absence of those signs Avhich the approach of the menses communicate. Displacements of the ovaries are often the cause of suffer- ing and disease, that may excite symptoms quite remote from the seat of trouble. I remember the case of a young woman, who had suffered from obstinate dyspepsia, which subsided at once after the removal of the prolapsed ovary. It has been already alluded to, that tliese glands are naturally very movable. Anything which increases their Aveight, whether inflammatory enlargement or a dragging in con- nection with some inflammator}' adhesion to a neighboring organ, may cause their displacement in various directions. It happens that the ovary may form the contents of a hernia or rupture. A prolapse or descent is the most com- mon form of an ovarian displacement. AVe often find one or the other ovary resting in the pouch between the uterus and rectum, and if the patient should be troubled with con- stipation, the hardened feces may give rise to painful svmp- toms in the ovaries, and pain in the rectum, while it also is one of the causes of painful sexual relations. The irritation to which the dislocated ovary is exposed gives rise to in- flammatory affections, that may be the cause of continual suffering. INFLAMMATION OF THE OVARIES, OR ACUTE OVARITIS. AVhat inflammation is elsewhere, it is again here in these glandular structures. DISEASES OF THE OVARIES. 267 I endeavored to point out in the beginning of these arti- cles, that the difference of inflammatory diseases was not due to any difference in the inflammatory processes, these are identical, but the modification of the processes are due to the nature of the structure of the tissues that are involved. If the intelligent reader Avill bear this in mind, she will form a clear idea of all the inflammatory diseases that come under consideration. Pathological microscopists have recognized two forms of ovaritis, the follicular or parenchymatos, in which the Graafian follicles or ovisacs are the seat of the inflammatory process, and the interstitial, in which the intervening or interstitial connectiATe tissue, the stroma, between the follicles is inflamed. This distinction has only a scientific interest because it is impossible to distinguish one variety from the other in the living subject; this can only be done with the aid of a powerful microscope after the suspected ovary is removed from the body. AVhether the inflammation is follicular or interstitial or both combined, it is liable to de- stroy all the follicles or ovisacs Avhich contain the ova, that are essential to procreation, and the consequence will be sterility. The great functional activity to which the ovaries are sub- jected at each menstrual period, make them extremely liable to an inflammatory process, so that Avomen cannot be too careful of themselves at this precarious period. It is during menstruation that the ovaries become periodically congested, and this alone offers an excellent predisposition for inflam- mation. As a complication of other inflammatory diseases, ovaritis is very common; it seems hardly probable that there can be an inflammation of a pelvic peritoneal fold or of the pelvic cellular tissue in close proximity to or sur- rounded by it, without involving the corresponding ovary. There cannot be a serious inflammation of the womb or of the Fallopian tubes without being communicated to the ovaries, and this is always true of the infectious catarrhs, especially the gonorrhoeal form. 268 HOME TREATMENT FOR WOMEN. There is a great tendency in inflammation of the ovaries to suppurate and change the entire tissue of the ovary into an abscess. Ovarian abscesses are not much different in their behavior from abscesses in the Fallopian tubes or cellular tissue. It is claimed that they have a greater tendency to break into the bladder than other pelvic abscesses; this may be due to a displacement of the ovaryt which locates the gland near or betAveen the bladder and uterus, before the advent of the inflammation. There are no infallible signs that point to the existence of acute in- flammation of the ovaries, owing to the complication of other inflammatory processes in the majority of cases. The characteristic pain of an inflamed ovary is of a throbbing or pulsating nature. I cannot imagine an ovaritis without at least a circum- scribed peritonitis, and one can hardly suppose a pelvic peritonitis to exist without in a certain degree compromising the ovary. If the ovary has once become inflamed, whether alone or as a complication of other diseases, then the most im- portant question to decide is the existence of an abscess- This can only be recognized by an experienced and careful specialist, who has trained his sense of touch, so that he can feel the abscess between the fingers of one hand in the vagina, and the other making counter pressure on the abdomen. The history of each case must in a measure de- cide the nature of the fluctuating tumor, whether it may not be an ovarian cyst instead of an abscess, although an abscess may have been a small cyst. The development and course of different cases, present various aspects for consideration. The enlargement may become obstinate to the ordinary methods of treatment and assume the chronic form of subacute inflammation. The inflammation may spread from the ovary to the peritoneal membrane that partly covers it; these are the broad liga- ments of the uterus. This may be the means through DISEASES OF THE OVARIES. 269 which the organ may grow to the surrounding tissue and adjacent organs, so that it becomes utterly impossible to move it or even successfully extirpate it from its intimate attachments. In other cases the ovary remains entirely free from at- tachments or complications, and while it can be generally felt lower down pressing perhaps on the rectum, it is read- ily movable or replaced. In the majority of cases only one ovary is involved, but in these cases there is a predisposition which in a large proportion sooner or later compromises also the other ovary in a similar diseased process. TREATMENT. The treatment of this affection is greatly modified or in- fluenced by a knowledge of the causation of the inflamma- tion. In every case, however, the patient should take to her bed. If there is a profuse vaginal secretion it should be ascertained if the disease is of infectious origin, and where this is suspected, the vaginal canal should be thor- oughly rinsed with an antiseptic solution of corrosive chlo- ride of mercury in the proportion of one grain of the sub- limate to two thousand grains or parts of water, or about fifteen grains to the half gallon of water. There are tablets to be had at the drug stores which contain the requisite amount of corrosive when added to a given quantity of water; these are preferable and more convenient than the crude drug, and as they are a deadly poison they should be kept under lock and key. There is nothing to equal the corro- sive for an offensive vaginal discharge, for it is the most re- liable disinfectant there is in the entire pharmacopoea. Half a gallon of this solution should be used at a time, and after the vaginal canal has been thoroughly disinfected, about a pint of the same solution must be passed through the uter- ine cavity by means of a double catheter, that has a reverse flow and is especially made for the purpose. To insure against mercurial poisoning I am in the habit of following 270 HOME TREATMENT FOR WOMEN. mercurial irrigations with warm water, that was previously sterilized by boiling. One pint of the simple Avater is gen- erally sufficient to displace all the mercurial Avater that might have remained in the uterine or vaginal cavities. These medicated irrigations should have an average temper- ature of 105 degrees Fahr. and be repeated daily for about a week. If the vaginal secretion is not of a specific nature, then the ordinary borax water rinsings are sufficiently antiseptic. Ice bags applied over the regions of the painful ovaries check the acute inflammation from going into suppuration and forming an abscess. Should the latter be found to exist, it should be opened by means of a trocar or aspirator. The bowels should be kept free by taking a daily dose of No. IX ; while the pain can be relieved by administering No. VII. CHRONIC OVARITIS. If an acute inflammation does not terminate in prompt recovery or an abscess it may lose its fiery nature and tone down into a low grade of prolonged congestion Avhich does not go on to the production of suppuration. This would constitute the chronic form of inflammation. It does not follow that all chronic inflammations are pre- ceded by the acute form, for there are inflammations that are subacute from the beginning, that is, that there is not the heat nor feverishness in the tissues which is one of the principal features of the acute process. Chronic inflammation of the ovaries is much more fre- quent as an original or indi\ddual affection, than the pre- ceding form. A peculiar feature of this affection is a grad- ual growth or enlargement of the ovary, all the way from a moderate swelling to a good-sized orange. There has been some discussion as to the particular tissue of the ovaries that is involved in the inflammatory process, Avhether it is the interfollicular structure or the follicules or ovisacs them- selves: practically the solution of this question has no bear- DISEASES OF THE OVARIES. 271 ing on the treatment, although it may have an influence on the function of the organ, Avhich may be more injuriously affected by the latter than the former variety. The disease occurs almost exclusively after the age of puberty and dur- ing the period of sexual activity. It is not as often met in the unmarried as in the married, and Avith the latter it is more prevalent in the first years of married life. Inordi- nate sexual indulgence is a frequent exciting cause, and Avhen this is coupled with pernicious means that are em- ployed for preventing conception, it becomes still more fre- quent. Chronic inflammation of the vagina, Avomb, and of the Fallopian tubes is often transferred to the ovaries. The infectious catarrh to Avhich the genital tract of the female is more nr less exposed from a lack of proper clean- liness of her own person, or a gonorrhoeal infection from her male companion, shoAv a peculiar tendency to gradually spread the inflammatory processes to the ovaries. Some careful observation has established the fact that an appar- ently cured gonorrhoeal infection in the male may, after a year or two, excite a gonorrhoeal catarrh in the genitals of the female; a great many diseases of the ovaries have been traced to this source of infection. As gonorrhoea is not an uncommon affection among the male portion of the community, it is not sufficient for the intelligent members of the medical profession to know of these dangers of infection, but every man and woman should be apprised of the great danger there is of infecting the marital chamber with the pollution of the brothel. The symptoms of chronic ovaritis are more or less de- pendent on the causation of each individual case. Sometimes it is traced to the fiery stage of the acute af- fection, while in other instances it can be laid to some indis- cretion during the menstrual flow, then, again, it may have deA-eloped itself so stealthily that the greatest acumen and skill are required to detect its origin. The most important 272 HOME TREATMENT FOR WOMEN. and constant sign is a steady pain in one or both ovaries. AVhen this pain is violent, it shoots toward the back and rectum and doAvn the thighs. The pain becomes height- ened from an accumulation of feces in the rectum, which a habitual constipation entails. Marital excesses near the ap- proach of the menstrual period or shortly after the disap- pearance of the menses are quite likely to precipitate the painful symptoms. The bladder sympathizes in a certain proportion of cases, so that there is a frequent desire to pass water. In the course of time the distressful symptoms that have been enumerated derange the digestive apparatus; the patients lose their appetite and decline into a debilitated and nervous state, so that one or the other hysterical phenome- non become more or less prominent in persons of a nervous temperament. Sterility is a rule with this class of women, even if there is only one ovary affected; this would indicate that the ap- parently healthy one sympathizes with the other, or an ac- companying catarrh of the uterus or tubes may prevent the passage of the fertilizing germ. If both ovaries are inflamed, then it is quite natural to suppose that the delicate follicles and their contents, the ova, become destroyed or so altered that they no longer answer the purpose of reproduction. It is seldom that one meets a chronic ovaritis without a uterine catarrh, and how much this contributes to the ste- rility is not easy to tell. TREATMENT. The course of this affection in the majority of cases is favorable. If the treatment is intelligently administered, the pain and congestion gradually subside, and as this class of patients have generally learned from sad experience that negligence or indiscretion on their part will excite a relapse, they soon learn to avoid these, so that they enjoy compara- tive immunity from suffering for a considerable length of time. DISEASES OF THE OVARIES. 273 There is a smaller proportion of cases whose unfortunate surroundings or lack of intelligence makes remedial meas- ures of no avail. These poor women have neither respite from physical labor nor freedom from the animal passions of their husbands, and thus living in constant pain they be- come drooped in spirit and reduced in vigor, so that they fall an easy victim to any intercurrent affection that may attack them. In proportion as the patients can give their diseased ovaries freedom from irritating influences are the chances for their complete recovery increased. To accomplish this object, quietude in the recumbent posture, sexual abstinence and a free daily stool form the basis for recovery. If there is much pelvic pain, this is best controlled by means of the ice bag, 4x6 inches in size, of which one on each side, wrapped in one thickness of flannel, should be applied to the groin or region of the ovaries; cold-water compresses, thoroughly wrung, so as not to drip, and covered with flannel so as to keep the bed covering dry, are also advisable, but only a poor substitute for the ice. Iodoform suppositories greatly stimulate the absorption of the inflammatory exudation; one of these should be in- troduced into the vaginal canal each day. If the patient can get up Avithout any painful symptoms, she should take the hot eitz bath for ten or fifteen minutes daily, and as a general tonic, this is a useful prescription. NO XX. Take: Bromide of sodium...................2 drams Iodide of potassium...................1 dram Comp. tinct. of gentian...............2 ounces AVater, sufficient to make.............8 ounces Mix. A tablespoonful three times a day. There is no affection in the entire category of diseases of women, in which the confidence of women has been more abused by specialists, than by meddlesome surgical inva- sions, for the extirpation of one or both ovaries, to cure real 18 274 HOME TREATMENT FOK WOMEN. or imaginary diseases of these glands. There is a veritable mania among surgeons for this operation, but the conserva- tive portion of the profession are awakening to a conviction that this is entirely Avrong, and a presumption on profes- sional license that is altogether unpardonable. If these castrations were confined to the removal of ovaries that are unmistakably degenerated or diseased, and that had resisted intelligent treatment for some time, there would not be the same objection, but when ovaries are re- moved that are apparently healthy, but through ignorance or incompetency are supposed to be the offending members, then, I say, that is an outrage. There are a great many women who have been subjected to the dangers of a so-called normal ovariotomy, without be- ing in the least benefited by the operation. The symptoms which the extirpation of their ovaries was to relieve, per- sisted as before, and they discovered, when it was too late, that spaying is not a panacea for the ills that suffering women are heir to. The ovaries are in delicate sympathy with all the other pelvic organs, and when these are affected there may be more or less pain in one or both of these glands. They may be even the seat of a neuralgic affection without any structural change in the organ or in the neighboring or- gans. This would be simply a reflex sign of a general de- bilitated condition, and to mistake all these for ovarian disease and to make it an excuse for their removal, is not warranted by careful observation. Electricity is now com- ing to the front as one of the most valuable remedies for just this class of affections, and I will give a detailed ac- count of the nature of this remedy and the requirements for its successful application, which persons Avho speak lightly of its virtue, never acquire nor take the pains to possess. CHAPTER XXIII. PERIMETRITIS AND PELVIC PERITONITIS. The peritoneum is a delicate, thin, serous membrane, that lines the whole internal surface of the abdomen and envelopes more or less completely all the abdominal organs, so that the viscera glide smoothly against each other with the least possible friction. The peritoneum dips down al- most midway into the true pelvis, and its boundaries con- stitute also the limit of the abdominal cavity. That portion of the general peritoneum, Avhich partly invests all the pelvic organs, is distinguished from the other by the term pelvic peritoneum. AVhen the entire membrane becomes the seat of inflammation, the affection is a general peritonitis, but Avhen the inflammation is limited to the organ that it infolds, the prefix peri, signifying around, is compounded Avith the name of the organ, and the suffix itis is added, which indicates that the peritoneal covering of such an organ is inflamed, hence, the term peri-metra-itis means inflammation of the peritoneum around the womb. Pelvic peritonitis means that the peritoneum of the en- tire pelvic cavity is involved in the inflammatory process. This may include the peritoneal co\7ering of all the other pelvic organs besides that of the womb as well as the peri- toneal folds, that enter into the formation of the broad and other ligaments of the pelvic organs. Perimetritis is rarely an independent uncomplicated dis- ease, but oftener a complication of inflammation of the womb, the Fallopian tubes, o\Taries, or of the cellular tissue that surrounds the organs and in which they are imbedded. The pelvic peritoneum and the cellular tissue are so inti- (275) 2(6 HOME TREATMENT FOR WOMEN. mately connected Avith each other by means of their ves- sels, nerves and lymphatics, that an inflammation easily runs from one tissue to another. If we now inquire into the causes which induce this dis- ease, we shall find that there is not a single inflammatory disease of any of the pelvic organs that may not lead to its inauguration. Aletritis after an abortion or a confinement is a fruitful source, so are all the other causes that operate in exciting metritis indirectly concerned in this affection. Since etiology or the causation of diseases has been made a special study in connection with this subject, some startling discoveries have been made in regard to the origin of pelvic peritonitis. Dr. Noeggerath, of New York, has found in the majority of cases that came under his observation, that pelvic peri- tonitis, either acute or chronic, is due to gonorrhoeal in- fection. He claims that gonorrhoea in the male is in the majority of instances incurable; although it may be appar- ently cured, it continues as a latent affection which regularly infects his female companion. This shows itself at first as a slight vaginal catarrh, which gradually and stealthily spreads to the cavity of the womb, thence to the Fallopian tubes and ovaries and afterwards involving the pelvic peri- toneum, for it must be remembered that the Fallopian tubes open directly into the peritoneal cavity. Dr. Noeggerath has collected statistics that agree with those of the celebrated French physician, Ricord, which shoAv that on an average 80 per cent of the male population have had gonorrhoea, and, believing themselves cured, Avhen not, enter into married relations, and unwittingly infect their Avives. He says that " it has come to pass that young ladies dread to marry, because all their friends become invalids soon after the nuptial rites." The late Professor Schroeder, of the Berlin Gynecological clinic, says that "the assertions of Noeggerath are extravagant, but that he must particularly emphasize that Chronic inflammatory conditions of the in- PERIMETRITIS AND PELVIC PERITONITIS. 277 ternal female genitals, like catarrh of the vagina and uterus, metritis and perimetritis, are extraordinarily frequent results of gonorrhoeal infection." I am inclined to think, from my own experience, that the more conservative view of Professor Schroeder is perfectly safe and true, but if Dr. Noeggerath made due allowance for the number of invalids among newly-married people whose uterine diseases, especially pelvic peritonitis, were traceable to criminal abortions and monthly probing of their uterine cavities to induce the menstrual flow, his views would about coincide with those of the distinguished Berlin authority. These catarrhal affections cause sterility, and if conception supervenes, then there is a likelihood of a miscarriage or a premature birth, or a perimetritis during pregnancy or con- finement. Menstrual disorders in which the flow is either obstructed or suppressed may also give rise to perimetritis. Blood poisoning from criminal operations contributes its share in the causation. Trumatic agencies, like blows, falls, lacerations, and other injuries during labor, may result in pelvic peritonitis. Either too hot or too cold vaginal irrigations have given rise to this affection, and injections into the cavity of the womb for medicinal purposes, in which some of the fluid escaped through the Fallopian tube into the peritoneal cav- ity, has caused, in several instances, fatal peritonitis. The inflammation of the womb after childbirth invariably in- volves the peritoneum. The course and duration of this disease is by no means uniform. The disease under consideration is an example of an acute inflammation affecting a serous membrane. I have taken pains to inform the reader that the phe- nomena of inflammation are always the same, but that the results are modified by the peculiarity of the structure of which the tissues are composed. A serous membrane differs completely from a mucous 278 HOME TREATMENT FOR WOMEN. membrane, inasmuch as it contains neither mucous glands nor mucous cells, and for that reason can never be the seat of catarrh; instead of this, it possesses the power to secrete or transude the serous portion of the blood, hence its name. The serous membrane in a healthy condition has only a sufficient quantity of secretion to moisten the membrane, but not to furnish any appreciable quantity of fluid. If the secretion takes place as a result of congestion, especially when this congestion is due to an obstruction to the return of blood from heart or liver disease, it is secreted in such large quantities that it constitutes dropsy. Under the stimulating influence of the inflammatory process, a similar secretion is the result, only that it contains also fibrin, which renders the secretion or exudation sponta- neously coagulable, and, further, possesses the capability of passing into the condition of an organized tissue, either fibrous or granular, and thus forming false membranes on inflamed surfaces, or solidifying into tumors or swellings. These inflammations have their various degrees of sever- ity, from a temporary reddening of the membrane Avith barely enough effusion of inflammatory material to cause a thin layer of deposit, to extensive and violent attacks, that pour out enormous quantities of effusion or exudation, so as to fill the entire pelvic cavity with a solid mass. The na- ture of the inflammatory material may be purulent from the beginning, because its origin Avas of an infectious or septic nature. Suppuration may develop slowly and lead to an abscess; this may open or break into the peritoneal cavity, causing general septic peritonitis, which Avill cause death in a few hours or days. The abscess may also suppurate and break into some of the adjacent organs or tunnel its way in dif- ferent circuitous routes, being guided in its course by the pelvic and muscular fasciae, so that it may perforate at the groin, show itself at the inside of the thighs, or in the lum- bar region near the kidneys. It ruptures most frequently PERIMETRITIS AND PELVIC PERITONITIS. 279 into the rectum, next in frequency into the vagina and into the bladder. I had a case, that came under my treatment, in which both rectum and vagina were perforated, and puru- lent matter discharged from both fistulae; under appropriate treatment the patient recovered completely. If the inflammation is not of infectious origin, the exu- dation gradually becomes absorbed, and each day grows less, until finally nothing but a few fibrous bands can be felt, and these too may disappear in time. The symptoms of perimetritis depend in a great meas- ure on the nature and severity of the attack. There are three distinct stages of this disease, and each has its characteristic symptoms. The first stage is that of inflammatory congestion, which is generally ushered in with a distinct chill or a chilly feeling, which is speedily followed by a high fever and a rapid pulse. The lower abdominal region becomes exceedingly sensitive, and very painful on pressure; the abdomen becomes tympanitic or bloated, and it is a relief for the patient to draw her limbs up, so as to relax the abdominal walls. A vaginal examination in this stage gives only negative results; there is nothing but a painful sensitiveness, great heat, and the vaginal walls are puffed orsAvollen; there is as yet no inflammatory exuda- tion that can be felt by the finger. After the affection has lasted one or more days, the sec- ond stage of the disease is recognized, this is the effusion or exudation. The characteristic physical signs of effusion are the only absolute proof of the existence of this disease. These signs are (1st) an immovable fixed state of the womb, which is quite the contrary to its natural healthy state, that permits of a mobility in all directions; (2d) a hard, non- bulging condition of the tissues that surround the womb, so that the impression which one receives gives the idea of all the pelvic organs being cast or set in wax, because everything is glued doAvn and immovable; (3d) an indistinct fullness is felt by the patient, high up in the pelvis; this is the free 280 HOME TREATMENT FOR WOMEN. exudation of the inflammatory material, Avhich has now be- come solidified and has some characteristics of a tumor. This may push the organ forward or to either side or sur- round the womb on all sides. The third stage is that of absorption or the gradual dis- appearance of the exudation; this is usually a slow process, and may take from three to six months. I have known res- idues of the exudation, in the form of fibrous bands or adhe- sions or solid lumps to remain for years in the pelvic or peritoneal cavity. These bands may tie or fix the uterus to the rectum or to the pelvic walls, so that it Avill resist all or- dinary efforts to replace it. Pelvic hematocele, or an effusion of blood into the pelvic peritoneum, inclosed either by ana- tomical structures or previously-existing inflammations, greatly resembles the sero-fibrinous exudation of perimetritis. The pallor of the countenance aided by other signs of hem- orrhage must assist in distinguishing the affections. Chronic perimetritis is developed in numerous affections of the womb that exert a continuous irritation of its peri- toneal covering. These are fibroid and malignant tumors, painful and difficult menstruation, as well as enlargement of the tubes and ovaries. Inflammation of the uterus and a discharge of blood or matter through the tubes and into the peritoneal cayity, may bring about a chronic pelvic peritonitis from the beginning. Chronic perimetritis or chronic pelvic peritonitis, for the terms are often interchangeable, is most abrupt in its de- \-elopment, because it is not heralded by fiery, acute febrile symptoms, but a close inquiry will usually recall to the minds of patients the commencement of the trouble. The fact that the peritoneum is also reflected on the bladder, causes an irritability of this organ, to be the first and only symptom, for quite a while. There is nothing stereotyped in the development of any disease, so that the symptoms may or may not be painful from the beginning. The pains in the pelvis are more or less continual, there is an incapacity PERIMETRITIS AND PELVIC PERITONITIS. 281 for bodily exertion, the bowels are out of order, either there is constipation or a chronic diarrhoea; these morbid condi- tions destroy the appetite and the patient becomes lean and weakly. From time to time all tliese abnormal signs be- come aggravated, so that the sufferer may be forced to take to her bed. Some Women have great powers of resistance and endure suffering with great fortitude, so that they are compara- tively free from harassing pain, although their pelvic organs are tied down by inflammatory adhesions, and unless they lift or make other unusual muscular efforts, that increase the intra-abdominal pressure, so as to drag on the adhesions, they suffer little or no pain. Another sign of chronic peri- metritis is painful intercourse, which jars the adhesions, and this is particularly the case if the womb comes down quite low. The danger to be apprehended is that no one knows at what moment some indiscretion will light up an acute attack with all its serious consequences. In view of the possibility of any local or circumscribed peritonitis becoming general, and as such may prove fatal, the importance of recognizing it in its first stage, or early, becomes readily apparent. Preventive measures of circumscribed or local peritonitis are to be found in avoiding the causes that have been referred to as inducing the affection under consideration, among which, criminal abortions are the most fruitful. It seems to me that if women Avere cognizant of the dangers that threaten them, they would not only be more careful in observing the ordinary rules of health, but they would voluntarily shrink from committing crimes that not only stain their souls with the blood of their OAvn kindred, but also entail disease and death, that unexpectedly Avaft their spirits into the presence of their Creator, whose laws they have outraged. How often have I been told by women who lay prostrated on their death bed, "O doctor, I did not know that the in- duction of an abortion was a crime and dangerous, because 282 HOME TREATMENT FOR WOMEN. the person who performed the operation told me that it was neither dangerous nor criminal." Alas! poor woman, there is no greater crime, and nothing more pernicious to your health and life; would that others would only learn and profit from the inexorable fate into Avhich your delusions enticed you. TREATMENT. The treatment in this affection, when prompt and intelli- gently administered, offers every chance of success. In the acute stage of pelvic peritonitis, we must resort to remedies that promptly conteract the inflammatory action. The in- ternal administration of opium or some morphine prepara- tion is invariably demanded, not only to relieve the pain but also to completely check or constipate the bowels, so that their peristaltic action is entirely suspended, for their motion would irritate the peritoneum. Dr. McMunn's elixir of opium in one-half to one teaspoonful doses, or pre- scription VII in teaspoonful doses, should be given every four hours, until the pain is relieved and the bowels controlled. Rubber ice bags should be applied to the lower abdomi- nal region. This course of treatment will generally limit and check the inflammatory process in a few days; then the bowels should be gently moved every day, with an enema of warm water impregnated with a little soap; after which, complete quietude in bed for another week or two, will com- plete the cure. Chronic perimetritis must be treated according to its complications; should there be a gonorrhoeal infection, then what was said of the treatment of this complaint elsewhere, applies with equal force to these cases. The patient's strength must now be an object of jealous solicitude. The diet must be of the most nourishing nature, and milk or egg punch should be the principal food, at regular intervals of four hours, alternating with strong soups or beef teas, to which a raw egg thoroughly beaten should first be added. Araginal and uterine catarrhs, if they exist, require the attention that is recommended in the preceding pages. PERIMETRITIS AND PELVIC PERITONITIS. 283 AVarm compresses or fomentations and daily hot sitz baths are of great value in chronic perimetritis, for they stimulate the healing process and the absorption. The bowels must now be daily moved, and here I prefer the patient to employ simply warm water enema in tolerably large quantities slowly injected, until a quart or more of the fluid has been thrown into the rectum; these enemas will not only move the bowels, but also stimulate the healing process. If the. patient lies on the left side while these in- jections are taken or given, the enema flows higher up, and it should be retained for a reasonable length of time. These enemas should only be taken every other day, and between days a suitable dose of purgative elixir. Tincture of iodine can be applied to the groins every second day, or iodoform suppositories introduced into the vagina. Alud baths are also very beneficial in removing old inflammatory adhesions. If the exudation suppurates and an- abscess forms, it should be freely opened as soon as possible. This can gen- erally be best accomplished through the vagina, but if there be a tendency of the abscess to point towards the groin, then this situation Avould be preferable, although I prefer, in even these cases, to make a counter opening in the vagina, for this precludes the possibility of the abscess sacking or bur- rowing further into the tissue. The cavity of the abscess should be thoroughly rinsed out Avith a 2 per cent carbolic acid or a 1 to 2,000 corrosive sublimate solution, and if there is a tendency in the abscess to close before its cavity is healed out, a rubber drainage tube should be inserted, so as to give the pus all the possible facility to escape. If the abscess breaks into the bladder or into the rectum, then a counter opening into the vagina will greatly insure and expedite reco\rery. Sometimes the ovaries and tubes become diseased as a result of the perimetritic inflammation; this, then, becomes a subject of special inquiry and treatment. It should 284 HOME TREATMENT FOR WOMEN. hardly be necessary to remind the reader that sexual rela- tions are to be suspended while there is the least sign of the affection to be discerned. Although old adhesions and dis- placements, the result of old chronic pelvic peritonitis, are often naturally and permanently removed through a super- vening pregnancy, the intelligent use of the galvanic cur- rent will also accomplish that end. CHAPTER XXIV. PELVIC CELLULITIS OR PARAMETRITIS. The term cellular was given to this tissue, because under the microscope it shows large meshes or cell-like cavities, that are also termed areolae, hence, the tissue is often called areolar tissue; it is also called connective tissue, because it com- bines all the different organs and structures of the body to- gether. It is very elastic and contractile, and by the fluid which it contains in its areolae, motion of parts on each other is facilitated. Professor Virchow has applied to it, in the region of the womb or pelvis, the term parametric tissue, from the Greek prefix para, beside, and the Latin metra, the womb, signify- ing the tissue near and around the womb, from which the Germans derive parametritis, instead of the English, who employ pclvic-cellulitis, each meaning one and the same thing, namely, inflammation of the cellular or connective tissue in the pelvis or around the womb. The female pelvic organs have interspaces between the bladder, vagina and uterus in front, and the uterus, vagina and rectum behind, also on both sides, betAveen the womb, ovaries, and the folds of the broad ligaments, and lastly, be- tween these organs and the walls of the pelvic cavity are interspaces. These interspaces are filled in or padded out by loose cellular tissue. M. Nonat, a celebrated French authority, has described this in a beautiful figure, by say- ing that "the organs of reproduction float in an atmosphere of cellular tissue." This is indeed so, and a consideration of an inflammatory condition of this structure, is to con- clude the inquiry into the inflammatory diseases peculiar to women. 286 HOME TREATMENT FOR WOMEN. Pelvic cellulitis is one of those diseases for the compre- hension of which we are particularly indebted to the re- searches of modern pathologists, who have discovered that infectious germs are the cause of numerous diseases; pelvic cellulitis is one of these, because it originates as a secondary result of septic absorption. The bacteria or putrefactive germs belong to Protophytes —the smallest and simplest of all plants, some of them are so small that it requires the highest powers of the micro- scope to make them visible. Their growth and multiplica- tion have been experimentally demonstrated by artificial cultivation, and this now constitutes one of the most in- teresting studies of modern pathology. Pasteur, Lister, Naegle and others, regard the decomposi- tion in the tissues as a direct result of the vegetation of the bacteria. "Decomposition and fungus are inseparable; the one ceases when the other is removed. Processes of this nature set up by bacteria are best distinguished as fermenta- tions." Professor Ziegler, of the University of Tuebingen, says: "The healthy organism is always beset with a multi- tude of non-infectious bacteria. They occupy the natural cavities accessible from without, and especially the alimen- tary canal. They feed on the substances lying in their neighborhood, whether brought into the body or secreted by the tissues. In so doing they set up chemical changes in these tissues. While the organs are acting normally, these fungi work no mischief to the tissues in which they lie, or to the system generally. The products of decomposition set up by such non-specific micro-organisms are either harmless or are conveyed out of the body before they begin to be active. "Settlements of this kind may, however, become of im- portance, if the bacteria proceed to develop to any unusual extent. This happens when the contents of the natural cavities in question remains unchanged for any great length of time, or Avhen (as in catarrh) the normal secretion under- PELVIC CELLULITIS OR PARAMETRITIS. 287 goes some alteration. The products of bacterial fermenta- tion may then accumulate to an excessive amount, and products may be -found which do not normally occur. Highly poisonous substances are formed in many of the bacterial decompositions. One of the most speedily fatal diseases, septicaemia, is due to blood-poisoning of the sys- tem with the products of bacterial putrefaction, or sepsis. " Putrid or septic poison may be absorbed by wounds as well as by mucous surfaces. Septicaemia, which has just been cited as an instance of septic poisoning, is generally due to wound infection. It is due to the absorption of prod- ucts of bacterial decomposition formed in a Avound con- taminated by bacteria. "Infectious bacteria have the power of settling, not merely in the ingesta and secretions or in dead tissue, but also in living tissue. This happens chiefly in the mucous mem- brane of the lungs. The uninjured skin is protected against invasion by the horny epidermis. Many bacteria can settle in perfectly healthy mucous membrane. In the case of others we must imagine that they do not find a proper soil for their development, unless the mucous membrane is in- jured or altered. Of course, injury or alteration of this kind may serve to make the outer skin or any other accessi- ble tissue, the starting-point of a bacterial invasion (wound infection). All that is necessary is that a bacterium should reach a spot that affords the conditions for its development. If this occurs, it multiplies and forms colonies or swarms. These may, according to the species of the fungus and the nature of the soil, remain in aggregation, forming heaps or masses, or may spread through the tissues. In general terms Ave may say that local settlements of bacteria Avill sooner or later bring about degeneration and necrosis of the affected tissue. AVhen this may occur, and how widely it may spread, are circumstances depending on the nature of the bacteria and of the tissue. " The inflammatory processes set up by bacterial action 288 HOME TREATMENT FOR AVON!EN. may be of very different intensity and extent in different cases. It may be slight or transient, or may be severe and issue in suppuration and an abscess." The above quotation is perhaps as concise and complete an explanation as the space in this article will permit, and if thoughtfully considered, it will be the means of under- standing what is to be said of the disease under consideration. Pelvic cellulitis is oftener found in childbirth, premature labor and abortion, for the reason that it is a wound in fection, and the female organism is always more or less wounded under these circumstances. In confinement the cervix is always more or less torn, and septic matter de- posited there often speedily spreads along the lymphatics and veins to the pelvic cellular tissue, in fact, the entire uterine surface forms a suitable soil for bacterial growth. The vagina is also more or less injured or bruised through parturient efforts; this may be in the nature of a laceration or an abrasion of its mucous surface. Outside of the above causes, the infection may be of trumatic origin, the most common causes being operative measures on the vagina or womb of a cutting, scraping or stitching nature, that were not carried out under strictly antiseptic precautions, guaranteeing the exclusion of septic germs. Dilation of the cervix with sponge tents or with in- struments or probes that Avere not perfectly cleansed, causes infection and a decomposition of the retained secretions, which, becoming absorbed, leads to pelvic cellulitis. In sur- gical operations and puerperal conditions in which infection has been positively excluded, by careful antiseptic measures, pelvic cellulitis is impossible. The inflammation in this disease is excited by the irrita- ting influences of products of septic decomposition; these may have been introduced into the system at the time of confinement or of an operation, or they may have been in the vaginal tract before the operations Avere commenced. This teaches an important lesson, which feAv seem to have learned; PELVIC CELLULITIS OR PARAMETRITIS. 289 it is this, that the strictest antiseptic regulations in a confine- ment or operation are of no avail, if the patient herself is not first thoroughly disinfected before the operation begins. In the German Empire there is a legal provision giving full instructions for the necessary disinfection of the lying-in woman and her attendant; if there were such a wise pro- vision in this country, we would not hear of so many deaths of women in childbed, from blood poisoning. At the Co- penhagen International Medical Congress (1884), Professor Esmarch, one of the most celebrated of German surgeons, said that "humanity demands antiseptic treatment of wounds and wounded." I believe that the time will soon come that antiseptic regulations in the treatment of diseases will not only be compulsory, but that a neglect of the same, causing death by blo'od poisoning, will make the attendant liable for exemplary damages. Pelvic cellulitis generally develops itself in an acute form, and the symptoms are very similar to those of pelvic peritonitis, and, like the latter affection, there is always an exudation of inflammatory material in these cases, so that the meshes of the tissues become soaked like a sponge with water. The invasion of the infection is usually signalized by a distinct chill or rigors followed by an increased bod- ily temperature and a correspondingly rapid pulse. The commencement of a parametritis is not often without dis- tinct symptoms that affect the nervous system. The patient feels uncomfortably depressed, a tired, worn-out feeling over- comes her, she loses her appetite, and there is pain in the pelvic cavity. This pain is partly due to an accompanying peritoneal irritation, or in some cases to a circumscribed in- flammation of the peritoneum. Often the pain runs down the groin, along the course of the great vessels and nerves; this is occasioned from the exudation pressing on the trunks of these structures in the pelvis. Pain in the small of the back, and painful defecation, with an irritable bladder, are due to the same cause. 19 290 HOME TREATMENT FOR AVOMEN. Phlegmasia alba dolens, or Avhat was called before the daAvn of modern pathological science, milk leg, is only an- other form or a complication of pelvic cellulitis. This oc- curs Avhere the infectious inflammatory process runs along the cellular or connectiAre tissue of the large Aressels and ner\res, to the connective tissue of the thighs; this is a very easy matter, because the vessels and nerves are imbedded in cellular tissue, and as the vessels leave the pelvis at the groin, this tissue is continuous with that of the extremities. AVhen the inflammation gets into the thighs, it invades either the subcutaneous cellular tissue, that is, the connect- ive tissue under the skin, or it runs along the trunks of the nerves and vessels; the affected limb becomes then edema- tous or swollen, hence the vague term of milk leg, because the milk has never anything to do with it. One time it was supposed that this affection is only possible after con- finement, but this is an error, because phlegmasia alba may develop at any time from purulent infection, originating from any cause. The so-called puerperal or childbed fever is also nothing more nor less than an infection of purulent secretion. The extent of the exudation varies greatly, both in the pelvis and in the limbs. In the pelvis it is sometimes only a little swelling on each side'of the womb, and between the folds of the broad ligaments, small nodules the size of wal- nuts can only be felt, while in other cases the entire pelvic roof is covered and soaked with the inflammatory effusion. The consistence of these swellings or tissues feels at first doughy or soft, but after the absorption has been going on for a while, it becomes as hard as a board. If the exudation begins to suppurate and an abscess forms; then the surround- ing tissue becomes soft again, so that the fluctuation of an elastic tumor becomes recognizable. In the majority of cases the inflammatory process be- comes circumscribed in the pelvis, the fever subsides, and the pain and sensitiveness in the pelvis disappear. The PELVIC CELLULITIS OR PARAMETRITIS. 291 exudation has ulso a circumscribed limit, becoming harder and smaller, until it finally has become entirely absorbed. In another class of cases, the swelling remains stationary for a long time and a solid tumor remains in the pelvic cavity, that may be mistaken for an oA^arian or fibroid groAvtli, but in the course of a long time, it may gradually become absorbed. In a certain proportion of cases the course of the disease becomes protracted or chronic, because the effusion is very sIoav to disappear. In these cases there is danger of general septic infection or septicaemia, and of a spreading of the cellular inflammation to the general peri- toneal membrane, Avhich Avould prove, quite likely, fatal. If the inflammation is violent and the infection intense, suppuration and abscesses will destroy the cellular tissuej and if the lower extremities become involved, the circu- lation in the affected limb may become permanently in- jured.' The cellular tissue around the veins, or eATen the veins themselves, become more or less affected by the in- flammatory process, so that the veins become compressed or constricted from the cicatrization around them, or their cal- iber may become obliterated from inflammation of the walls of the veins, thus offering a permanent impediment to the return of the blood to the heart; the affected limb now re- mains swollen, and the swelling may entirely subside in the recumbent posture at night, but during the day it returns again, to make the leg thick and clumsy. TREATMENT. Prevention in these affections is much better than cure. The treatment of a recent case of pelvic cellulitis must be energetically antiseptic. The seat of the infection must be discovered; the vagina or cavity of the uterus, as the case may be, must be thoroughly washed out with a 1 to 2,000 corrosive sublimate solution. After a thorough disinfec- tion, the inflammation and pain can be checked or con- trolled by the application of ice bags; this is the remedy 292 HOME TREATMENT FOR WOMEN. par excellence to check acute inflammatory processes. These bags are preferably of rubber, about 4x6 inches in size, and when filled with ice and before applied it is more comfort- able to the patient to envelop the bag in a thin layer of flannel, which takes off the clammy coldness. The patient should be kept perfectly quiet and the bowels daily moved by a mild purgative. After the sensitiveness and the fever have subsided, the absorption of the hardened inflammatory remnants is promoted by the daily employment of hot sitz baths and the application of tincture of iodine to the ingui- t nal regions, as well as the use of iodoform suppositories. The employment of blistering fluids or plasters is of no particular value either to check the inflammation or pro- mote the absorption. If there are symptoms of suppuration forming abscesses, these should be freely opened into the vagina and their cav- ities thoroughly rinsed out with a disinfecting solution. In the case of phlegmasia do! ens alba I have used cold water compresses fortified by ice bags with brilliant results, but only after all the other treatments that are laid down in different treatises had been tried, and failed to give the slightest relief. Among these wTere hot fomentations, large repeated doses of morphine, and liniments of everything that is usually prescribed to relieve pain ; for the pain in phleg- masia is sometimes excruciating. My experience of the beneficial effects of ice bags and cold-water compresses in the acute stages of pelvic cellulitis and perimetritis, led me to believe that the same measures would be useful when the cellulitis was in the cellular tis- sue of the extremities, which constitutes phlegmasia dolens, ignorantly termed milk leg. This appeared to be heroic treatment to the patient, who dreaded the shock and feared bad consequences, but she finally consented. The following was my method: an ordinary large towel was dipped into iced water, wrung out and clapped around the affected limb, a heavy flannel roller bandage was then PELVIC CELLULITIS OR PARAMETRITIS. 293 applied from the toes upward to the groin; flannel is prefer- able, because it does not get hard when moist and remains softer under similar conditions than cotton material. On the most painful parts, like the inner aspects of the thighs, the back of the flexure of the knee, or popletial region, and the calf of the leg, I laid rubber bags filled Avith ice in addi- tion to the cold-Avater compresses; these were kept in place by a circular binder independent and outside of the roller bandage. The patient is natural^ a little shocked when the cold towel is first applied, but the unpleasantness is only mo- mentary, and then the reaction brings ease and comfort, so that she desires the ice bags to be reneAved quite often at first, for the patient has now found a remedy that relieves the pain as nothing else has ever done before. AVhen the towels become dry and hot, the painful symptoms return, so that they should be dipped four to six times in the tAventy- four hours. If the sensitiveness on pressure and other in- dications denote that the acute inflammatory process is checked, then the compresses and ice may be discontinued. This treatment avoids suppuration and the formation of ab- scesses, while hot applications encourage them. A mild stimulating diet of milk and egg punch with ten to fifteen grains of quinine each day should be given in all infectious inflammations. CHAPTER XXV. ELECTRICITY AS A REMEDY. In a brief reference to the medical virtues of electricity in the treatment of diseases of women, only an outline of its physics can be given, so as to give the reader an approx- imate idea of its origin and phenomena. The use that is being made of electricity in the arts has convinced everybody that it is a most powerful agent, Avhich manifests itself in so many different phenomena that it is as mysterious to-day as it Avas centuries before Christ, when the Greeks first observed it in amber Avhen rubbed with silk, and from which the term has been derived. Electricity is developed in bodies from a variety of causes, among which are friction, pressure, chemical action, heat, and magnetism. AVe are acquainted with it only through the peculiarity of its action, and it behaves as a sub- tile, imponderable fluid of a compound nature, possessing opposite polarity when excited, giving rise to positive and negative electricities, but when at rest these forces seem to neutralize each other, and as such pervade all matter. Chemical action is usually the most convenient for ob- taining electricity for medicinal purposes, and the arrange- ment through Avliich this is accomplished is called a cell or battery. A battery in its simplest construction is made of a plate of zinc and a plate of copper partially immersed in dilute sulphuric acid. A disturbance of the neutral electricity now ensues, and by means of a delicate instrument, it may be observed that the zinc plate possesses a feeble charge of negative and the copper a feeble charge of positive electric- ity; at the same time there is a slight escape of hydrogen (294) PLATE V. -^^\^v^ Apostoli's method of employing intense galvanic currents Avithout discomfort or injury to the patient. The internal electrode, which he calls the excitateur intrauterin, is held in the hand of the operator. The dispersing electrode covers the abdomen. ELECTRICITY AS A REMEDY 295 from the surface of the zinc. If now the plates are con- nected by means of a metallic Avire, the chemical action in- creases and the hydrogen gas is now discharged from the surface of the copper. The wire is now traversed by an electric or voltaic current, which imparts to the connecting wire, thermal, magnetic and other properties. The electricity does not, however, correspond to that which was peculiar to the metallic plates before they were connected by the wire, but the opposite electrical conditions discharge themselves from the wire: the direction of the current in the fluid, being from the positive or copper plate to the zinc or negative plate, and vice versa, so that the wire of the zinc plate is now positive, Avhile that of the copper is negative. Poles and electrodes. The wires or terminals are called the poles of the battery; instead of the term poles, the word electrode is now generally used. From what Avas said of the origin and direction of the current in the fluid, it is impor- tant to remember that the positive electrode or wire is con- nected to the negative plate, while the negative electrode is connected Avith the positive plate. According to the extent of surface of both zinc and cop- per plates, exposed to the chemical action of the diluted sul- phuric acid, or to the number of cells that are employed, by connecting the copper plate of one cell to the zinc plate of the next, the force and quantity of the electric current is correspondingly increased. Batteries Avhich consist of one solution and two metals rapidly lose their intensity, partly from the decrease in the chemical action owing to the neutralization of the sulphuric acid by its combination with the zinc, and partly from sec- ondary currents, depositing a layer of hydrogen and metallic zinc on the copper plate, which destroys the dissimilarity of the metals, so that the electrical action ceases or the plates become polarized. For this reason these single fluid batteries have almost 296 HOME TREATMENT FOR WO.AIKN. entirely gone out of use, and batteries Avith two liquids have taken their place. Electrolysis means to dissolve or decompose, by means of electricity, an organic or inorganic substance into its original elements. If, for instance, a current of electricity of four or five Bunsen's cells is conducted to two inverted glass tubes, filled with water slightly acidulated to increase its conductivity, gas bubbles rise from the surface of each pole, and upon examination it is found that hydrogen is liberated at the negative pole and oxygen at the positive pole; and as the volume of hydrogen liberated is about twice that of oxygen, the experiment gives at once the qual- itative and quantitative analysis of water. Professor Bartholow, in his treatise on Medical Electricity says: "As animal tissues are composed of substances amen- able to electrolytic decomposition, it is obvious that they must yield up their component elements in accordance with the laws of electrolysis. Albumen is coagulated, salts are separated into acids and bases, and Avater is resolved into oxygen and hydrogen. AVhen the salts contained in the animal tissues—soda, potassa, lime—and water, are decom- posed, the acids and oxygen appear at the positive pole, and the alkalies and hydrogen at the negative. It follows that if the positive electrode be composed of metal, it will be corroded by the action of chlorine and the acids, and the negative will remain unacted on and smooth. The tissues in the vicinity of each electrode are necessarily affected by the elements brought to them in accordance with chemical laws. About the positive the mineral acids and chlorine form combinations, and hence do not attack the tissues with the same energy as those about the negative pole. If, how- ever, the positive electrode is composed of zinc, for example, the chlorine attacking it will form chloride of zinc, a very corrosive material. This principle has been utilized to pro- duce caustic effects at the positive pole. Although the neg- ative electrode remains smooth, much more than at the pes- ELECTRICITY AS A REMEDY. 297 itive are seen these destructive effects from the action of the free alkali liberated in its neighborhood. AVhen an ordi- nary electrode of carbon covered with soft sponge is made to conduct a strong galvanic current, the skin speedilv be- comes reddened, and may be made to ulcerate if the contact is sufficiently prolonged. If the carbon is applied directly, an intense burning is produced and the tissues are destroyed, leaving a slough, which is slowly detached and the ulcer re- maining is difficult to heal. The caustic action is due chiefly to the soda, potash, and lime. Some effect must also be allowed to the disassociation of the tissues, to their trans- ference from point to point and at the negative pole to the mechanical action of the liberated hydrogen." Interpolar regions. The reader must have been im- pressed with the peculiarity of each pole in possessing affin- ity or attraction for certain elements that constitute the animal tissue. Oxygen and acids accumulate around the positive pole, while alkalies are attracted to the negative pole; thus it must be an absolute fact that an actual trans- fer of particles in both directions to each pole must traverse the tissue lying between the two poles; this accounts in a great measure for the difference of the local effect on the tissues around the poles, one being in the nature of an acid the other of a caustic alkali. This naturally gave rise to an inquiry as to the effect that the galvanic current has on the structure between the tAvo poles. Dr. G. Betton Massey, author of " Electricity in the Dis- eases of Women," asks and answers this question in the fol- lowing manner: " AVhat can be therapeutically accomplished when the seat of the disease is necessarily situated beyond the direct reach of the electrode? An answer drawn from both neurological and gynecological experience is that much can be accomplished; and this is doubtless due, in the first place, to the influence upon nutrition of the chemical changes that occur throughout the circuit, in the onward progress of the particles that appear free finally at the poles 298 HOME TREATMENT FOR WOMEN. to the influence upon nutrition of the circulatory changes that result from vasomotor stimulation, and to the contrac- tions produced in unstriated muscular tissue by heavy cur- rents even at a distance. These results of quiet current transmission are governed in magnitude at a given spot by the density of the current at the situation and by the du- ration of the application. To accomplish much in the more distant parts of this region considerable strength must be employed, hence a delicate judgment is demanded in the se- lection of the size of the active pole to avoid cauterization on the one hand, and too great a diffusion on the other." To within a comparatively recent period, the methods of applying the electric current for the removal of abnormal groAvths have been somewhat crude if not dangerous. It appears that formerly altogether too much stress or weight was laid on the chemical or electrolytic effects that the elec- trodes wrought in the tissues, and very little or no credit Avas given to the passive current of galvanism as it traversed the tissues from pole to pole. Dr. Ephraim (.-utter, of New York, advocated the so-called electro-puncture, and in the galvanic treatment of fibroid tumors of the uterus, these punctures were made through the abdominal walls. The electrodes for this purpose were stiletto shaped, with blades five inches long and three-eighths of an inch at their widest part; these were inserted into the tumor from opposite points. AVounds that were thus inflicted, necessarily involved more or less danger, and, although Dr. Cutter reported a great number of cures, the percentage of mishaps was too great to make electrical treatment popular among the profession. It was not until Apostoli, a French physician, greatly modified the methods of employing electricity in the treat- ment of fibroid tumors, and sheared it in a great measure, not only of its dangers, but also of pain, that the medical profession took the question of electrical treatment in real earnest. The practice of Apostoli and his results were pub- lished in a monograph by Carlet, entitled, Du traitement ELECTRICITY AS A REMEDY. 299 electrique des tumeurs fibreuses de Vuterus, Paris, 1884.. Apos- toli evidently started out Avith a view to modify the most objectionable features of the electrical treatment. This con- sisted in reducing the number and size of the punctures and to lessen the painful sensation of the electric current to its minimum, so that the main points of difference are the shape and size of electrodes, and the site that is chosen for the puncture. In the first place he uses only one piercing or needle electrode, which is much smaller than that of Cutter, this may be attached to either the positive or nega- tive cord of the battery, according to the accompanying symptoms. AVhen hemorrhage is a symptom, the positive pole is used internally or carries the needle on account of its anti-hemorrhagic property, otherwise the negative pole carries the piercing electrode. This electrode is always used internally to puncture through the vagina or through the cervical tissue into the tumor; this is not nearly so painful as piercing the abdominal walls, nor does it wound the peritoneum. The other electrode is called the dispersing electrode, be- cause its purpose is to so disperse or scatter the current of this pole that it is hardly felt by the patient, much less produces any electrolytic or chemical effect on the skin. This electrode is made from a sheet of lead or copper nine by ten inches and covered with a layer of wet absorbent cot- ton; it is applied over the abdomen. This method is much safer than that formerly advocated by Dr. Cutter, and the results are much better. Dr. Engelman, who has accepted this method, says: " In electrolysis an intensity of 50 to 250 milliamperes may be used for from three to eight minutes. All possible precautions must be taken in the first sitting in order to discover any idiosyncrasy of the patient, and a cur- rent of 50 milliamperes will suffice, attained by slow in- crease. The patient should lie. down quietly for several hours after the application. If an intensity as high as 100 milliamperes is used at the first sitting, it is preferable that 300 HOME TREATMENT FOR WOMEN. she remain in bed for the first tAventy-four hours, and that a cold compress or an ice fcag be placed upon the abdomen, to overcome any tendency to inflammatory reaction Avhich may occur; hence the attention to details which is necessary, and the precautions desirable in a first puncture, until the sufferance of the indiA'idual patient is tested. The applica- tion is repeated, according to the demands of the case and the severity of the treatment, once or tAvice a week." The milliampere meter is a galvanometer to measure the quantity of electricity that is applied, and as a chemical bat- tery will of necessity change, a meter is the only means of judging the intensity of the current; so that Avithout one there is danger of applying the current too strong, or an in- justice may be done to the patient, and reproach cast on the treatment by not using it strong enough. At the annual meeting of the American Medical Associ- ation, at Chicago, in 1887, Dr. Martin read a paper, in which he reported three cases that were treated with the most satis- factory results without puncture. The positive or external electrode Avas applied over the abdomen after the manner of Apostoli, and the negative electrode was placed in the rec- tum, vagina or uterus, in such a way as to cause the cur- rent to traverse the largest diameter of the tumor; this method is to my mind the ideal of an electrical treatment, it is galvanism without corrosion or electrolysis. The number of eminent authorities that I have quoted, can hardly fail to convince the reader that electrical thera- peutics in the treatment of fibroid tumors are not only effi- cacious, but in the infancy of experimental growth, so that every day will add new proofs and improved methods to the history of this most interesting subject. But this treatment is not limited in its usefulness to the removal of abnormal growths, for it has proven itself equally as effectual in the treatment of chronic inflammatory conditions of the pelvic organs. I have myself attained great success in curing certain forms of these diseases since the publication of ELECTRICITY AS A REMEDY. 301 "A New Treatment of Chronic Aletritis," by the same inde- fatigable author, Georges Apostoli, of Paris. The value of electricity is noAv so firmly established that a physician who, ignorant of its virtues, and laboring under this self-imposed ignorance, brushes aside any reference to or desire for electrical treatment with a supercilious air, claiming " that there is nothing in it," advertises himself as incompetent or insincere. It must be apparent to anyone who has followed this brief outline from the beginning, that this subject requires a special and individual devotion, so as to become familiar, not only with the elementary principles of the physics of electricity, but with the technique of applying the treatment in each individual case. This, feAv persons have the honesty or ambition to acquire, and if they own a battery, it is more for show than for use. I am convinced that there are great possibilities in store for the curative value of the galvanic current, but it also requires a high order of intelligence to employ it, in order that those hopes may be realized. "The positive pole is anodyne, sedative, anti-congestive, and anti-hemorrhagic. It combats and prevents the ten- dency to excessive vascularization, and consequently relieves congestion and inflammation and the pain depending upon these conditions. ,Its local or polar action, when used within the uterus, is hemostatic or styptic, and caustic, Avith high intensities of current. " The negative pole is stimulating and has a marked electro- lytic action. It tends to produce congestion, and a deriva- tive effect which favors absorption of tumors, inflammatory deposits and adhesions. But great care must be observed in using jt in some conditions, lest a new inflammation be re- kindled." I have the record of a case Avhere the Avomb was re- troflexed and tied doAvn by old inflammatory adhesions for nine years; the retroflexion dated back to a miscarriage. This woman had been aninvalid since that time; her appe- % 302 HOME TREATMENT FOR WOMEN. tite was poor, and her digestion poorer, she Avas excessively constipated, suffered from pain during menstruation, but at other times there was a constant pain in the small of her back, which ran down the right thigh, the bladder was irri- table, and there were neuralgic pains shooting from the ovaries down the groins. All these symptoms became more or less aggravated every few weeks or months. The womb was so firmly fixed or glued down on the loAver portion of the spine, that it could not be moved an iota. This woman had tried all the remedies that I could suggest, except gal- vanism. This I concluded to try, by placing a large dis- persing electrode on the small of her back, and the other electrode, properly prepared, so that it did not burn or cau- terize, was introduced into the vagina, against the posterior aspect of the uterus. A current strength of from 90 to 120 milliamperes was applied every other day for ten min- utes; in six weeks the organ was quite movable, and in five months all adhesions had melted aAvay, and the Avomb occu- pied its normal position, and the patient was in e\rery Avay restored to health. The diseases that are curable by galvanism are the differ- ent forms of subacute or chronic inflammation of the ovaries, and the consequent enlargement of these organs, small cysts or fibro-cysts of the ovaries are also amenable to the gal- vanic puncture. Catarrhal inflammation of the Fallopian tubes, or when either or both ends are agglutinated with inflammatory exu. dation, so as to pen up their contents, which may be mucous, water, pus or blood, these fluids should be first aspirated or drawn off, and then, by means of appropriate galvanism, the normal conditions of the tubes may be restored. Chronic catarrhs of the womb are especially suited for galvanic treatment, and when the inflammation invades the muscular structure of the uterus, giving rise to what was described as chronic metritis, there is no remedy that will yield the same positive and satisfactory result as electricity. ELECTRICITY AS A REMEDY. 303 Plate V gives a practical illustration of the employment of electricity for chronic inflammation of the uterus; the in- ternal or negative pole is introduced into the uterine cavity and held there by the operator, the external or dispersing pole spreads over and rests on the abdomen. Sub-involution of the uterus. I have already referred to this affection as.an arrested involution of the Avomb after confinement at the end of the natural term, and after abor- tion. The Avomb in this condition remains permanently and preternaturally enlarged, and its entire tissue becomes the seat of a subacute or chronic inflammatory process. The vagina is also more or less relaxed, so that the heavy uterus sinks doAvn into the pelvis, imparting to the patient a drag- ging or bearing-down sensation, AA'hich makes Avalking or any other exertion exceedingly difficult. In subinvolution an extra uterine electrode is not required, but only a vaginal electrode, so employed that a current of high intensity is passed through the uterus; this varies from 50 to 150 milli- amperes. The duration of each galvanization is from eight to ten minutes, and should be repeated every third or sixth dav. I succeed as a rule in six to'eight weeks in restoring the organ to its normal size, which I ascertain through com- parative measurement at the beginning and end of the treatment. If the subinvolution is complicated with retroflexion, then intra-uterine galvanization after the organ is replaced is the most effective treatment. Old pelvic adhesions and ex- udations as a result of pelvic cellulitis or peritonitis are amenable to galvanization after hot douches, sitz baths, and other discussives have failed to excite absorption. Hemorrhoids and prolapse of the rectum; the former is a frequent concomitant of constipation, and the latter may be the result of an imperfect involution after confinement. I have employed galvanism for either with the most bril- liant results. It would be interesting for the reader were I to continue 304 HOME TREATMENT FOR WOMEN. to cite different diseases in which electricity has been suc- cessfully employed, but that would require a systematic arrangement of the subject, which would be incompatible with the original purpose of this book. I simply desire to awaken an interest in a comparatively new remedial agent, in its present field of employment. There may be a great many ways to get relief, but that course which offers the least risk to life and the least suffering to the living is the one that should recommend itself to the sufferer. What patients need is not brilliant surgical exploits to make the reputation of an ambitious operator, but the conscientious aid of the conservative physician who is content to labor in the less pretentious capacity of an assistant to nature's cura- tive energy. INDEX. A BUSES of surgery, 19 Abortion. The practice on the in- (Tease, and not due to a single cause, 113,114,115, 116 Is it ever justifiable? Ill meaning of the term, 110 criminal, 101 Catholic Church is decisive on, 112 Abrupt termination of pregnancy constitutes a disease, 117 Abscess in peritonitis, 278 in perimetritis, 278 "A bad getting up," 204 Academicians' view of fetal life, 102 Acton, Dr. "A warning against sexual dangers," 92 A husband sliould not cease to be a gentleman, 94 A little reflection, 250 Amenorrhcea, 132, 133 Anteflexion of the womb, 242 Anteversion of the womb, 240 Antiseptic precautions, 75 Anatomy of the female organs, 119 Apostoli Georges, Dr., 298, 301 Arnold, Prof., on cancer, 218 " T>AD getting up," 144 _D Bates' waist, 191 Bacteria, 286 Battery, 294, 295 Bandaging after delivery, 250 Bartholow, Prof., 296 Bennett, Dr., 196,197 Berkeley, Bishop, 47 Bladder, catarrh of, 163 inflammation of, 15S. 159 nervous irritability of, 166 chronic catarrh of, 164 hemorrhage of, 168 ulceration of, 163 paralysis of, 167 irritability of, 252 catarrh, and other diseases, 157 Braid, Dr. (discoverer of hypno- tism), 54 Braine, Dr. Woodhouse, 51 pARBONIC Acid, poisoning in \J chlorosis, 135 Carpenter, Prof. W. B., 48 Campbell, Dr. Henry F., 254 Catarrh of the womb, 219 symptoms of, 215 cause of, 213 Catarrh, vaginal and uterine, 177 Catarrhal inflammation of the womb, 209 Cancer, Prof. Arnold on diagnosis of, 218 Castration, 274 Cellulitis, pelvic, 285 in childbed, 288 Cervical endometritis, 211 Children are common objects of love, 96 Children, will of, 53 Childbed fever, my first case, 74 Charcot, Dr. Experiments in hyp- notism, 54 (305) 306 INDEX. Charcot, Dr. "Impersonal sleep," 54 Chronic inflammation of the womb, 104 causes of, 105 Chlorosis, iron in, 137 or green sickness, 133, 134 Clothing to avoid taking cold, 190, 191 Conception, independent of the sexual act, 107 Coitus, injury of interruption or incomplete, 96 Coition and conception, widely dif- ferent processes, 106 Continence, 95 Conjugal onanism, Dr. Devay, 96 Cohnheim, Prof., his theory of in- flammation, 147 Cold, injurious effects of taking, 184, 185 Cutter, Dr. Ephraim, 298 Cystitis, acute, 161 chronic. 162 DANGER of overheating, 189 Dalton, Prof., on menstrua- tion, 130 Days of doctrines and rules, 17 Darwinian theory applicable to the overcrowded professions, 17 Dame Nature, 41 "Deutscher Aerztebund," 28 Deceived woman, who was fright- ened into an operation, 21 Delusions as to the curative value of drags, 36 Descartes, 48 DepraAed associates pave the way to feticide, 114 Disease is as much a vital process as health, 37 Diseases that are conjured up in the minds of susceptible persons, 25 Divided skirts, 194 Dispersing electrode, 299 Disinfection of the lying-in woman in Germany, 289 Distinctive feature of the TJniver- . sity of London, 31 Dobell, Dr. Horace, 189 Doctoring, may be a luxury or an amusement to some, 23 Drug diseases of Hahnemann, 43 Drugs are phv.-ical agents. 44 Diivelius, Dr., 212 Dyspepsia, or indigestion, 137, 13s Dysmenorrhcea, 138 prescription for, 142 in flexion, 244 ELECTRICITY, in diseases of women, 297 Electricity, medical, 296 as a remedy, 294 without puncture, 200 in catarrhal inflammation, 302 in sub-involution, 303 Electrodes and poles, 295 Electro-puncture, 298 Elastic garters, 193 Endometritis, 209 acute and chronic, 210 Engelman,Dr., 299 i English law on "quickening," 104 Epileptic fits, cured by a "Chris- tian Scientist," 57 Equestrian tights, 195 Erosions, often mistaken for can- cer, 218 Evans, Dr., 47 Exercise, must be interesting, 63 in the open air, 62 Exclusiveness that has character- ized the professions, 16 Expectation, or attention, 50 FAITH cures disease, 55 Fallopian tubes, 124 diseases of, 258 Falling of the womb, or prolapsus, 231 Feticide, 101 Flexion, 139 Fly blister, causing inflammation of the urethra, 152 Flexions and versions due to abor- tions, 117 Fright, causes or cures disease, 58 Functional diseases, 56 G ALVANOMETER, 300 Germicidal properties of drugs, 176 INDEX. 307 Germ theory of disease, 77 German heaters, 188 Germans, river bathing of, 77 General causes of uterine and pel- vic diseases, 61 Girls should be independent to choose their choice, 66 Goodeils, Prof., on uterine svmp- toms, 140 Goodells, Prof., on ' abuses of uter- ine treatment," 22 Gonorrhoeal infection, statistics of, 276 Graafian follicles, 263 Growth of the uterus from the moment of conception, 72 HEMORRHOIDS, causing in- flammation of urethra, 152 Hemorrhoids, in irritability of blad- der, 166 Hemorrhage of the womb, 143,144 Histology of inflammation, 145 Hippocrates' view of fetal life, 102 Human ovum, size of, 264 Hygiene of gynecology, 78, 79 Hygienic measures, 182, 183 Hypnotism, 52 Hvsteria, amenable to mind cure, 56 Heroic treatment, 42 ICE bags, 291 Imagination is the realm of the soul, 49 Imprudence during menstruation, 71 Improprieties of dress, 68. 69, 70 Introduction, 15 In the realm of thought there is no monopoly, 15 Inflammation, 145 of the womb, 196 chronic, 203 Infection, 2S7 gonorrhoeal, 81 innocent, 81 Tnterpolar regions, 297 Intra-abdominal pressure. 233 Involution, 73 • Iron pills in chlorosis, 137 Impersonal sleep of Dr. Cliarcot, 54 KXEE-CHEST posture, 254 in relaxed vagina, 180 in falling of the womb, 236 LAITY, object of educating the, 19 Laws on abortion, 104, 105 Landois, Prof., on the curative force in the lower animals, 39 Leucorrhoea, 80,176 Little girls, muco-purulent secre- tion of the vagina, 152 Lochial, discharge, 84 Lying on the back after confine- ment, 73 MALTHUS, law of, 99 Man, instinctive desire of, 89 Mania for cutting operations, 21 Martin, Dr., of Chicago, 300 Marital excesses and prevention of conception, 87 Marital excesses, the mainspring of disease, 91 Married women, exposed to in- fectious contamination, 80 Massey, Dr. G. Button, 297 Measurements of the healthy uterus, 71 Medical legislation in this country, 29 Metritis, 196 acute, 198 causes of, 199 chronic, 203 treatment for, 200, 207, 208 cold applications in, 201 Mechanical age, 19 Menstruation and menstrual dis- orders, 126 Menstruation! climate and temper- ament, 127 Menstruation, diversity in ages, 126 average period of, 128 precocious, 132 source from which the blood comes, 128 suspended during pregnancv, 129 Menstrual disorders, 131 Mental phot< graphy in the hyp- notic state, 54 Mesmerism, 52 Menopause and puberty, 129 308 INDEX. Menorrhagia and metrorrhagia, 143, 144 Metrorrhagia, 143 Milk Leg, 290 Milliampere, 300 Mill, John Stuart, 99 More thought required to make good mothers than to file briefs or write prescriptions, 68 Moral restraint, 90 Morphine habit vice asthma, 60 Mucous membrane, 182 " My February trip," 20 Mystic union of the soul with the body,102 1VTERVOUSNESS, due to excess- TM ive mental application, 63 Nerve strain, 140, 141,142 Nervous system in chlorosis, 135 Nervous and congestive dysmen- orrhcea, 140 Negative pole, 301 Nine years of my professional life, 15 Noeggerath, Dr., on gonorrhoeal in- fection, 276 OBJECT of educating the laity, 18 Ovaries. 124 acute inflammation, 266, 267 chronic inflammation, 270 cysts or tumors of, 264 diseases of, 263 displacement of, incomplete or rudimentary, 266 supernumerary, 265 Ovaritis, 266. 267 treatment of, 269, 272 Ova, number discharged at the menstrual period, 131 PAINFUL sensations from im- aginary causes, 48 Parametritis, 285 Pelvis true, 120 false, 119 Peritonitis and perimetritis, 275 Perimetritis and peritonitis, 275 Peritonitis, treatment of, 282, 283 criminal abortion the cause, 281 Period of fruitfulness, 264 Perineum, 121 Protophytes, 286 Precocious talents should not bo forced, 64 Preparation of homoeopathic dilu- tions, 44 Prolapsus, or falling of the womb, 231 Psychical exaggeration, 140 Ptomaines are developed from un- cleanliness, 83 Puberty and menopause, 129 Puerperal or childbed fever, 77, 78, 290 Putrefactive germs, 286 Putrid or septic poison, 287 Pyo-salpinx, 285 QUICKENING, 103, 104 RETROFLEXION of the womb, 247 Retroflexion, replacement of, 254, 255 Retroflexion, in pregnancy, 256 treatment of, 252 Retroversion of the womb, 246 Reparative energy of nature, 38 Reparative process after confine- ment, 233 Rumbold. Dr. Thos. F., 184 Round ligaments of the womb, 248 SALPINGITIS, 259 treatment for, 2f 0,261 Sawyer, Dr., 58 Schelling, William Joseph, 47 Serous membrane, 277, 278 Sexual instinct not unholy and de- praved, 109 Sexual desire, Prof. Carpenter on, 89,90 Signs of chronic inflammation of the womb, 207 Skin or integument, 182 Somnambulism, 52 Spermatozoa, 89, 100 measurements of, 105 Sterility in flexion, 244 in ovaritis, 272 due to abortion, 118 INDEX. 309 Stoics' view of fetal life, 102 Stupidity of the masses, 23 Stricture of the neck of the womb, 139 Superfluous garments, 70 Sub-involution of the womb, 73 Sympathy will cause disease, 5S Syringe, proper selection of a, 181 TERROR causes or cures disease, 58 Temperature for living rooms, 189 The title "Doctor," 26 "The United States and its Doc- tors," 27 Thermae, 76 The State in its sovereignty, 30 Too much mischievous doctoring, 24 Tubal dropsy, 259 Tuke, Dr. Daniel H., 50 URETHRA, 121 irritation of, 150 neuralgia of, 155 in the newly married, 156 in pregnancy, 155 gonorrhoeal infection of, 152 4 inflammation of, 150 Urethrites and neuialgia of the urethra, 150 caused by eruptive fevers, 152 in pregnancy, 153 papillated growths and mucous polypoids, 153 Urinary fistula, 170, 171 Uncleanliness a cause of disease. 76 Union suits, 194 Uterus, 123 natural position and support, 226, 227 Aversions and flexions. 240 anteflexion, 242 anteversion, 240 retroflexion, 247 retroversion, 246 changes after confinement, 72 Uterus, measurements after confine- ment, 72 prolapsus, or falling of the, 236 treatment of prolapsus, 236 VAGINA, 122 catarrh of, 175 catarrh in children, 177. 178 acute and chronic inflamma- tion of the,172 knee-chest posture in catarrh of the, 180 gonorrhoeal infection of, 174 relaxed, mistaken for falling of the womb, 179, 180 Vaginal injections, directions for their use, 85, 86 Versions and flexions due to abor- tions, 117 Virchow, Prof, theory of inflam- mation, 146 WARMING a dwelling, 186 Weapon ointment, 41 What is mind cure? 46 What is termed mind cure is not mind cure, 40 Whom to teach, 15 Why crowd our girls into the pro- fession? 67 When to begin to train mothers, 65 When the soul becomes associated with the body, 107 Whites, 176 Wives who become delicate and nervous, 93 Winter cough, 189 Womb, 123 tear or laceration of, 84 Women's rights vice women's wrongs, 68 Women, after getting up from con- finement, 74 ZIEGLER, Prof., on infection, 286 i L - r, iter* ^s^m^^trrjr^ Ifctj ii',i.!.!,!-?f;;:ii,M., i i ; : ■ I ' • - ' ' l ; ! i .I'll ' •':■ \ll'l'\[l^''\ it '■; i l-',!'i 'i !!.i;!i ;.;1: ;;i ' | ': -J'ii-i ■ -d iii!l J. i n '•', ■'. i'rC li'liliiSiMjiriil iiiiJilii^!] !ii!i!.iT H :"!;ii!i.i!!!|ii ^!!::i:,!i!i!iiii!.!i.li III :) (I.I !!:l||.!!l-!!l!l! 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