TRANSCRIBER’S NOTE:

—Obvious print and punctuation errors were corrected.

JOHN A. MILLER, M. D.

FEMINA,

A WORK FOR EVERY WOMAN

ILLUSTRATED.

A perfect woman, nobly plann’d,
To warn, to comfort and command;
And yet a spirit still, and bright,
With something of an angel light.

—Wordsworth.

——BY——

JOHN A. MILLER, M. D.

Graduate Medical Department University of California, also holding
Credentials from the Universities of Berlin and
Heidelberg, Germany.

SAN FRANCISCO,
THE FEMINA COMPANY,
1893.

Entered According to Act of Congress, in the Year 1893
BY JOHN A. MILLER,
In the Office of the Librarian of Congress,
at Washington, D. C.

TO
THE LATE
DR. CARL SCHROEDER,
PROFESSOR OF DISEASES OF WOMEN
IN THE FREDERICK WILLIAM UNIVERSITY, BERLIN
MY TEACHER AND FRIEND.

PREFATORY NOTE.

The publication of this volume was suggested by the astonishing ignorance displayed and the antiquated ideas entertained upon questions of health and disease by most persons with whom I came in professional contact, even by those who were accomplished in other subjects of a scholastic and scientific nature. The practical importance of the subject naturally led me to the consideration of diseases that are essentially inflammatory, for over seventy-five per cent of all diseases of women are of an inflammatory nature. In this respect the book differs from other works on similar subjects.

In discussing this class of diseases I have aimed to present a treatise simple in style, and easily understood by the casual reader. While I have endeavored to impart strictly scientific information, I have tried to impart it in familiar language, avoiding the use of technical terms as far as possible, and carefully defining them when their use became indispensable.

JOHN A. MILLER, M.D.

No. 1137 Geary Street, San Francisco, Cal.

BY THE SAME AUTHOR.

MEDICAL EDUCATION IN THE UNITED STATES AND AN OUTLINE OF THE GERMAN SYSTEM. Essay read before the Alumni Association of the Medical Department of the University of California, March, 1886.

EROSIONS OF THE VAGINAL PORTION OF THE CERVIX, OR ULCERATION OF THE SAME PART. Pacific Medical and Surgical Journal, January, 1887.

RETROVERSIO-FLEXIO AND A NEW INSTRUMENT FOR THE REPOSITION OF THE UTERUS. American Journal of Obstetrics and Diseases of Women and Children, February, 1887.

UTERINE HEMORRHAGE AND LIGATION OF THE UTERINE VESSELS AS A THERAPEUTIC EXPEDIENT. The New York Medical Record, September, 1889.

PHLEGMASIA ALBA DOLENS, OR MILK LEG; ITS PATHOLOGY AND TREATMENT BY MEANS OF COLD WATER COMPRESSES AND ICE BAGS. Pacific Medical Journal, June, 1891.

CONTENTS.

CHAPTER I.

THE REASON WHY.

I see a large field of usefulness which has not been covered by competent authorities. I propose, therefore, to offer a plain, simple statement of the most common causes of physical suffering in women, and a simple and reliable method of home or domestic treatment, to be carried out by the patients themselves, which, in the great majority of cases, is easily applied.

The first nine years of my professional life was an untiring and incessant devotion to the arduous demands of a large family practice, after which I decided to go to Europe, and there prosecute such studies in two German universities as my experience as a practitioner had fully convinced me to be of the greatest practical and scientific importance; hence, I offer no excuse or apology for aught I may say on a subject with which I have taken especial pains to familiarize myself. Having in a measure established my identity, I am more fully prepared to proceed in a more congenial way.

In the realm of thought there is no monopoly, and it is, after all, at the bar of public opinion that a final judgment must decide the merits of my course.

The question is not what to teach, but whom to teach. This may seem, at first sight, an easy matter to determine, but a more careful inquiry will show the complexity.

The platform of a medical college is considered by some the only legitimate place from which a medical man may impart his knowledge, but here the opportunity is limited, notwithstanding the abnormally great number of these institutions. This, however, is not the only reason. Medical colleges are becoming so numerous, that they should be discouraged by all honest and high-minded medical men, because in this country they are private institutions, with very few exceptions, and subserve sinister purposes, in furthering the interests of their promoters either as advertising schemes or money-making institutions, or both.

Of course they are incorporated under State laws, which make them quasi-public institutions, but the State exercises no authority over them, and their self-constituted professors conduct them to suit their own private ends. They are not limited by law, nor is a required course for their students imperative, so that the public have no guarantee of the fitness or competency of their graduates. There is, also, an unhealthy rivalry among our colleges for students, improper material is taken in, and correspondingly poor material is turned out; this in turn causes a rivalry among their graduates in making spoil of the sick.

Every self-respecting and competent medical man has an utter contempt for these doctor mills. This will never be different in this country until we follow the plan of European governments, and make medical colleges State institutions, and their professors officers of the State, with liberal salaries.

The medical press has a comparatively limited opportunity for imparting information to the public, unless the editor of the secular press happens to make a quotation.

The exclusiveness that has characterized the learned professions generally, and the medical profession particularly, is rapidly passing away. Only half a century ago, the medical lectures in Germany were mostly delivered in the Latin language, and, while we now often suffer, in listening to medical lectures in bad English, the latter may still be the lesser evil. In fact, so great is the deference to public opinion in favor of diffusing knowledge that medical faculties court popular favor by delivering a course of lectures on medical subjects, and consider these the best-drawing card of the institution.

Information that is not sensational nor untruthful cannot fail to do incalculable good to the class for whom it is intended, namely, our wives, mothers, daughters, and sisters, so that they may avoid errors, that entail suffering and disease; information that will teach them how to cure themselves of the commoner and simpler ailments, and thus avoid running to the doctor, who cannot always afford to tell them the truth. Some would not if they could.

The Darwinian theory is of wider application than to mere animal or plant life; it extends itself to the overcrowded professions, and the increasing “struggle for existence” in the ranks of the profession makes men dishonest and greedy for any opportunity to raise a fee, so that patients are being treated for diseases which are created for them by the cunning and dishonesty of their doctors.

A little common sense and a knowledge of the elementary principles of disease would be the best protection against these deceptions; but, as a rule, sick persons are inclined to throw aside all good sense, and give themselves up entirely to their feelings or to their doctor. This is a very wrong thing to do, and opens the door for all manner of impositions.

The general practitioner of thoughtful and studious habits finds that, in the course of years, a diversified reading on the different diseases which in the routine of his work he is called upon to treat makes him a generally well-informed man, but not a thoroughly exact man, either in theory or in the details of his treatment.

Fifty to sixty years ago the entire field of medicine was comparatively so small that it was easier for a brilliant mind then, to comprehend all that was believed to be known, than it is for the same quality of mind to understand any of the subdivisions of medicine to-day.

Those were the days of doctrines and rules. Little that was absolutely correct or true was then known about disease, otherwise such absurd theories as the “dynamization or spirit-like” influence, causing disease on the one hand, or that the “great source” of chronic diseases was psora, or itch, on the other, as Hahnemann would have them believe, could never have gotten a foothold.

These are the days of scientific deductions from microscopical and physiological research, in laboratories connected with great universities, and the result is, that any of the specialties or subdivisions of medicine is as large and interesting a field as the entire area was some time ago. It thus happens, that some thoughtful persons, after years of general practice, drift almost involuntarily into some one department of medical art and science. To this they become gradually wedded, and in it they grow in knowledge and experience far beyond their previous anticipations. What they read on the subject is better understood, and new ideas are constantly formed, which enlarge the scope of their knowledge. In this manner the writer drifted into the domain of diseases peculiar to women, which was as unhappy on the one hand, as it is interesting on the other, for the phrase “diseases of women” has fallen into disrepute because every superficial practitioner professes to know all about them, and it often is but another name for criminal abortion.

But for all that, there is a legitimate and scientific specialty of women’s diseases. The time-serving specialist must be exposed in every department of medical science. Whether the pretender is labeled, a professor in a college, or labels himself through glaring newspaper advertisements, one is just as much a catch-penny as the other.

The object of educating the laity cannot be reasonably confined to a few medical truths, but the perversion of the truth must also be understood, so that the false can be detected. It is necessary to point out the dangers and frauds which are the unhealthy outgrowths or excrescences of established truths, and there must be no veneering of the wicked and sinful with ambiguous phrases to shield the guilty; the truthful and innocent require no apologist.

The honest observer can pursue no middle way in a work to which he has devoted the best years of a studious life, and hence he may seem radical in his opinions. While policy often dictates a conservative course, that which conscience and reason dictate to be true is prompted by loftier motives, namely, to subserve the highest purpose of moral integrity.

It has often been said that this is a mechanical age. How true is this even in the furtherance of science! How true is this of the science of astronomy, which was revolutionized by the construction of good telescopes! Mechanical genius has perfected a lens for Mount Hamilton thirty-six inches in diameter, and one is now in course of construction for Mount Wilson, in Southern California, which is to measure forty inches. Through these means scientists hope to decipher the complexion of remote planets.

Microscopic lenses have been equally perfected, and, by means of achromatic condensers and immersion lenses, great magnifying power can be obtained with perfect distinctness. That this mechanical spirit of the age should also have obtained a foothold in medical art and science, is but natural. Surgical and other mechanical methods have entered so boldly into the field of diseases of women that the writer feels constrained to sound a note of alarm. Great strides have been made in a more perfected technique in abdominal operations, and, by favorable recoveries from grave and severe operations, the field of surgical usefulness became enlarged, but this has degenerated into a license for notoriety and personal aggrandizement of not over-scrupulous and selfish surgeons who are over-anxious to operate so as to be able to boast of the great number of their capital operations, or laparotomies.

I was enthusiastic in abdominal and pelvic surgery, but not until I entered the field as a specialist in this department of medicine did I see and hear of daily abuses and misuses of this branch of surgery. In many instances it degenerated into criminal malpractice. It will be instructive information to cite a few cases which occurred under my observation, and present the actual facts to the reader.

It was in the month of February, in the year 1888, that a business trip to the southern part of the State forced an absence of several weeks upon me. Some two months before this time I had been called to see a young woman, who had then been sick for several months. She informed me that she had been married nine years, and, not having had any children, she concluded to see a noted specialist of female diseases. By this physician she was told that her sterility was owing to a closure or contraction of the mouth of the womb. This was obviously a wrong diagnosis, and for these reasons: she had always menstruated regularly and without pain, which excludes a constriction; and, secondly, no physician can honestly call a woman sterile until he has examined her husband, who, in the majority of instances, is the cause of his wife’s sterility, because it is he who is sterile. This woman and the doctor agreed, however, on a course of treatment, which was to forcibly open or stretch the mouth and cervical canal of the womb. This by itself is neither a dangerous nor a severe operation, if carefully performed, but care in this case was evidently not exercised, because the young woman was taken with severe inflammation, which caused a pelvic abscess.

I found her after two months of suffering. The discharge had become extremely offensive, her body emaciated, and her strength exhausted.

I enlarged the opening of the abscess, placed a large drainage tube in the cavity, through which it was washed out, by means of an antiseptic solution of bichloride of mercury, 1 part to 2,000 parts of water, and, by further giving her simple, nutritious food, she improved rapidly, so that the day before I left the city she was at my office, and told me that she felt as well as ever, although not thoroughly recovered. I was absent two weeks, and a few days after my return I incidentally met her husband, who told me that a week after I had left, his wife felt unwell and called in one of her former doctors, who, by the way, rides a hobbyhorse on surgery. This man found a few pimples on her body, which can be found on almost any healthy person, these, he said, were signs of blood poisoning from her abscess, and that an operation to extirpate the abscess, with one or both of her ovaries, was of urgent necessity to save her life from blood poisoning. The deceived woman was of course frightened into giving her consent to the operation, which was undertaken immediately, and, as luck would have it, she recovered; but she might have easily died, which she undoubtedly would have done had this knife-man got her sooner, or before I had restored to her a splendid physical condition, which withstood the unnecessary butchery to which she was induced to submit.

Some doctors seem to have a perfect mania for cutting operations, just as though the entire science and art of medicine were exhausted in surgery alone. To assume this for an instant is manifestly ridiculous. More lives are annually saved by a scientific application of other methods of cure than the most elaborate and brilliant statistics of surgery can approach. There is science and skill in selecting proper medicines, in the employment of hygiene or the rules of health, in the practice of obstetrics, and in a variety of other ways to demonstrate the triumphs of the art of healing.

The rash and unnecessary resort to the knife has brought surgery into general distrust, so that some patients would rather die, or wait until they are almost dead, before they allow an operation to be performed on them, in cases where surgery is, indeed, the only possible method of cure.

A lady recently called at my office for a consultation. I found her uterus and other pelvic organs in a perfectly healthy condition, although she suffered pain there. This was due to neuralgia from a generally exhausted and debilitated condition. I was not a little surprised to learn, from her own lips, that she had been treated for womb disease, and was about to undergo an operation for a tear in the mouth of her womb. This was manifestly absurd, because no laceration existed at all, and if there had it might not have been necessary, because it is quite natural for women who have borne children to have the scars of old lacerations on the mouths of their wombs, and they are not any the worse for them.

It is important for mothers to know something about themselves and of the common diseases to which they are liable, for then they will not be so easily persuaded to permit the use of caustics, or the cutting, stitching, or scraping of their wombs, which is quite likely to excite complicated inflammations, more serious in their results than the diseases for which these operations were performed. I know of what I write, and there is no one who can successfully deny it.

Dr. William Goodell, who stands as high in the department of diseases of women as any American, had an article in one of the medical journals on “The Abuses of Uterine Treatment.” He says: “From a large experience I humbly offer to the reader the following watchwords as broad helps to diagnosis: 1. Always bear in mind what another has pithily said, that ‘woman has some organs outside of the pelvis.’ 2. Each neurotic case will usually have a tale of fret or grief, of cark and care, of wear and tear. 3. Scant or delayed or suppressed menstruation is far more frequently the result of nerve exhaustion than of uterine disease. 4. Anteflexion of the womb, per se, is not a pathological condition. It is so when associated with sterility or painful menstruation, and only then does it need treatment. 5. An irritable bladder is more a nerve symptom than a uterine one. 6. In a large number of cases of supposed or actual uterine disease, which display marked gastric disturbance, if the tongue be clean the essential disease will be found to be neurotic, and it must be treated so. 7. Almost every supposed uterine case, characterized by excess of sensibility and by lack of will-power, is essentially a neurosis. 8. In the vast majority of cases in which the woman takes to her bed, and stays there indefinitely, from some supposed uterine lesion, she is bedridden from her brain and not from her womb. I will go further, and assert that this will be the rule even when the womb is displaced, or it is disordered by a lesion or disease, that is not in itself exacting or dangerous to life. Finally, uterine or womb symptoms are not always present in cases of uterine disease, nor, when present and even urgent, do they necessarily come from uterine disease, for they may be merely nerve counterfeits of uterine disease.”

There is not a physician of any extended experience in the land who, if he be true to his better judgment, will not indorse every word of Professor Goodell’s propositions. But the chances are they will never accomplish the good for which they were intended if the mothers, wives, and daughters are not permitted “a little peep” behind the curtain, and learn for themselves. For those who are wealthy and have plenty of money, doctoring may be a luxury or an amusement, but there the line must be drawn for the benefit of the deserving poor, with whom any treatment is a hardship. Stupidity of the masses is one of the causes of the abuse of surgical treatments, for they always look upon a surgical or bloody operation as one of the greatest achievements of modern medical art. Then there is the cupidity of the professional classes, who trade upon this popular error and delusion, and charge correspondingly large fees, which, as a rule, are exorbitant, particularly when the working classes are the sufferers.

A little cutting or stitching is much more quickly done, and the patient may be dismissed as cured, or left under the impression “that everything was done that could have been done,” than a conservative medical or hygienic treatment, which involves more thought, labor, and patience, qualities which are not as eagerly cultivated as the art to wring out a good fee by a little surgery, with less labor and skill.

There is not only too much mischievous doctoring, but there is too much of every kind, whether good, bad, or indifferent. The trouble is there are too many in the ranks of the medical profession; and this is not only true of this country, but is raising a cry of warning in Europe. The struggle for existence is a natural law, and nature is immutable. I do not mean to say, that it is a humane law, or that competition is a virtue; in fact, I believe quite the reverse. But much that is natural from a physical standpoint might not be so from a moral or spiritual plane; thus the two natures are distinct.

It is reasonable to suppose that, if the natural crop of diseases falls short of supplying the demands of those who hunger for an opportunity to treat disease, and it lies within their power to create disease, they will certainly do so. The deficiency must be supplied, or one of two things must be done by the doctor: he must either starve, or go to work at something else. This may be cruel logic, but I know that these are the actual facts.

Now let me ask how many persons who have some sort of a diploma will be self-sacrificing enough or sufficiently unselfish to prefer to starve or honestly work for a living, if they can avoid either, by defrauding someone out of a fee, for pretending to cure some manufactured disease? It seems almost a waste of time to argue such a self-evident proposition. I have known physicians of high standing who treated women for womb diseases which never had a real existence, and surgeons of large incomes to remove the female breast for a “supposed cancer;” and, that being the case, what would you expect from a less fortunate brother practitioner who is eking out a miserable existence?

How many a case of simple sore throat or tonsilitis is being paraded as a case of diphtheria. Why, I know of doctors who built up their reputations in that way. It is quite an easy matter, to call an ordinary, simple case of bronchitis, pneumonia. Harmless swellings, no matter of what sort, are treated and palmed off every day as cancers. The quack cancer doctor is almost ubiquitous. Some would much rather part with the village parson, or their regular old town doctor, than to part with the cancer doctor. Diseases that are conjured up in the minds of susceptible or hypochondriac persons have for them a real existence, because if a person believes he has a certain disease, it becomes a reality, as far as his own state of mind is concerned, and as far as the treatment is concerned to him who created the delusion, it is much more desirable than if the disease were real, because you can cure an imaginary disease, which may be impossible when a real one comes under treatment. This is another method of making a reputation for extraordinary cures that really never occurred.

When I contemplated writing a book, which I hoped to make a vade mecum for those who felt interested in the subject, I felt that it would be a duty which I should reluctantly perform, for it would be a criticism on the status of the medical profession of this country. I was convinced that whatever I said that would lower the tone of the profession in the estimation of my countrymen would naturally reflect on me as unfavorably as upon any other member, for I never claimed to be anything else but an American physician, and, as such, I have an ambition to elevate the rank and file to honor and respectability.

There is also a motive that underlies a work of this nature which should appear justifiable to the author. It is absolutely necessary that side-lights should be thrown into dark corners and recesses that are usually screened from public notice. If there is a growing deterioration in methods of proficiency and morals, the public should know it, for who is the greater villain, he who trifles with human life through officious ignorance and venturous operations, or the midnight assassin, who, under cover of darkness, waylays his unwary victim? The title “doctor,” from the Latin doceo, “I teach,” has a halo of learning that it derives from the original significance that was attached to it when it was first sanctioned at Bologna University, about the middle of the twelfth century, where it first passed into the faculty of divinity. It was afterwards introduced into the universities of Northern Europe, and remained ever since a degree of distinction in theology, law, philosophy, and medicine. In the German universities doctor implies also a license to teach within the university, as a privat-docent.

When we now consider that no person can matriculate in a German university who has not graduated from the gymnasium or high school, it is clear that, under the above conditions, the title “doctor” guarantees that the possessor is an educated person, not only of the high school, but added thereto is the accomplishment in the specialty of which he holds the doctor degree.

What may a “doctor degree” mean in this country? The title of an illiterate and utterly incompetent person, who was by natural environment and occupation a teamster, saloon keeper, barber, tailor, or patent-medicine vender, etc.

If a woman, she may be retraced to an ignorant nurse, midwife, or quacksalver, the conceited wife of a man who indulges her in the freak of “learning to be a doctor,” for she had demonstrated her genius for the profession by successfully treating a case of measles, which started the doctor’s bee a-buzzing in her bonnet, until she passed through a medical college; last, but not least, are the winsome daughters of the millionaire or successful business man, who imagine themselves too smart to make useful housewives and good mothers.

There is not a medical college in this State, and there are few, if any, in the United States, that would not eagerly take in all of this material, and guarantee to them beforehand, that they can graduate as medicinæ doctor in twelve months to three years, a five months’ course being considered a year.

The above comparison is a disgraceful commentary on the degree of doctor in this country, and the public should learn to know the difference.

“The United States and Its Doctors” is the title of an editorial in the July number of the New York Medical Record, and it says: “There is certainly no more curious social phenomenon than that of the extraordinary popularity of the medical profession in this country as a means of securing a livelihood.

“This subject is one that is often dwelt upon, but we doubt if many even yet realize the grotesque misproportion which medicine in the United States holds to other bread-winning occupations. Here are some of the naked facts in the matter:—

“France has 38,000,000 of population, 11,995 doctors, while it graduates 624 medical students in one year. Germany has 45,000,000 of population, about 30,000 doctors, and graduates 935 students in one year. The United States has about 60,000,000 of population, 100,000 doctors, 13,091 medical students, and graduates 3,740 students in one year.

“Germany, which has relatively less than half as many doctors as America, is already groaning over its surplus. When one compares France with this country, the excess of medical men here seems most astonishing.

“A comparison of the United States with European countries, in whatever way it is made, leads one to think that there is something almost alarming in our medical productiveness.”

In connection with the above comparison, in which it is shown that Germany has proportionately less than half as many doctors as the United States, it will be interesting to learn the views of the German profession. The Berlin correspondent of the Medical Press writes that the “Deutcher Ærztebund,” Society of German physicians, felt it to be their duty to warn the guardians of young men studying in the gymnasiums or high schools, against entering the medical profession, the state of overcrowding being so great as to insure disastrous consequences. In glancing over the above figures, there is one very important point which is greatly in favor of the German profession and militates against the Americans. It is the enormous patent-medicine trade and quacking that is done through it in the United States; on the whole, this has been calculated to amount to at least fifty per cent of all the doctoring that is done; that means, that where one hundred doctors now practice for a living, fifty more could make a similar living, were it not for the patent and quack medicine trade, which, in some of the German States, is almost prohibited, and in others I know it is entirely inhibited.

When the Society of German physicians warns the German people that an overcrowding “insures disastrous consequences,” what does it mean?

This is a question which, we presume, was answered in Germany, and it is certainly worth our while that we should answer it here, and in this we have decidedly the advantage, because in that country the answer was entirely based upon what was anticipated, while in this we can answer from what we have already realized, namely, disastrous consequences to honor and to integrity on the one side, and to health and security against imposition on the other. To this I have already referred. Everyone competent of judging, and who has lived in that country, knows from study and observation that the arrangements and conveniences there for treating the sick are in a much higher state of perfection than with us. Hospitals and physicians are as accessible to all classes as the most humane and philanthropic heart can desire, and now we learn that if this wholesome state of affairs shall continue with less than half the proportion of doctors that we have here, there must be no further increase of physicians, or it would insure disaster. This statement and warning a close and careful observer clearly appreciates. The writer was personally acquainted with a large number of German practitioners while in that country, and knows as an actual fact that while their fees were and are much smaller than anything ever paid in this country, they had not overmuch to do, and were only leisurely employed. This applies to some of the greatest and world-renowned medical professors, as well as to the ordinary general practitioners. But there is a reason for all this, too. These men as a rule are honest, they are no money grabbers, they are thoroughly competent and scientific and manufacture no diseases to suit emergencies nor conjure up complaints that have no real existence. If their number were doubled, if the normal proportion were disturbed, the disaster would surely follow, professional demoralization would ensue. So the German profession sounds a timely note of warning ere the canker of selfishness has destroyed the noble altruistic principles of physicians, without which the doctor is as likely to be a messenger from hell as a ministering servant from heaven.

Medical legislation in this country has been nothing less than a farce, partly because the general public is not aware how abased the profession is, and partly that Americans are extremely jealous of what they term personal liberty. It is being attempted to remedy some of the abuses of the medical profession by regulating the practice of medicine by State Examining Boards. Experience has demonstrated that these boards are but the excrescences of the various medical colleges, who are themselves the root of the very evils that are sought to be remedied. The duties of these boards are simply to make themselves officious, and to inquire into the source of the credentials or diplomas of the applicants for a license to practice medicine, and not into the qualifications or competency of the applicants. All that is necessary under such laws is simply to present a diploma of some sort; whether it was stolen, or the diploma of a dead man, or gotten from any of the numerous worthless colleges, is not made the subject of inquiry; and as by far the greatest number of quack-salvers in this country have diplomas, the law falls short of remedying quackery.

There are, usually, enough boards of examiners, representing the different schools, so that the different interests of the diploma manufacturers are well represented. A medical examining authority whose functions and powers do not go higher or beyond the mere granting of licenses, or which does not examine into the qualifications of the persons who possess diplomas, is utterly absurd, because it is no protection against ignorance and imposition. A law that presumes that all persons holding diplomas are qualified and competent to practice medicine, is essentially wrong, or inadequate to fulfill the purpose for which it was designed. I have known graduates from what were considered good colleges who could neither write a safe prescription nor diagnose a case.

There is only one way towards an approach to an efficient and intelligent board of medical examiners, and that is, one single State board in which the different schools may be represented as to their pet theories of prescribing medicines, but in all other departments of medical science and art there must be a uniformity of talent and qualification.

There must be a standard of excellence established by the State, which is higher than and above the recognized standard of any medical college, for no medical college is trustworthy in this respect.

The State in its sovereignty must prescribe what shall constitute a medical education, and the requirements should be embodied in the statutes. A license or degree from that source, after a final examination, should be the only legitimate license to practice medicine.

Such a method would establish a system that would clearly define the status of every medical practitioner. The board must have the power, and it must be their duty, to examine each and every applicant for a license, as all candidates for the army medical service are examined. All this noise and talk about a preliminary examination and an extended course of medical study are simply the vaporings of superficial minds. It is neither the preliminary course, nor the length of time that a person consumes in trying to become a doctor, in which the public is interested, but what kind of doctor a person is when he hangs out his shingle and begins to practice, whether he is competent to do that which is expected from him in the hour of sickness or great peril, irrespective of any diploma or any medical college. Foreign graduates should be amenable to the same examination, for behind these, too, belongs the interrogation point. The gushing mediocrity of some of these diploma holders gives rise to the suspicion that their credentials are not genuine.

As an American to the manor born, I would not for a moment deny the humblest citizen an opportunity to elevate himself to the highest professional honors; but why can he not be required to thoroughly equip himself and prove, by oral and written examinations on subjects of preliminary education, that his mind has become disciplined for broader or special studies, irrespective of any course in a college? After the State has satisfied itself of the proficiency of the applicant in scholastic acquirements, it should go further, and examine into the qualifications for a degree of medicine, just as they do in the U. S. Army, only with this exception, that no diploma of any medical college should be required from the candidate, and if he has one it should not be recognized.

This would simply incorporate in the State laws the distinctive feature of the University of London, which examines and confers graduation on persons who have received instruction in such institutions at home and in the colonies as have satisfied a Secretary of State with regard to their studies.

This university also has and exercises a power of examining for degrees persons who have not been at any institution. Nothing could be more democratic than for the State to make such a provision for State medical examinations. The German Government does precisely the same thing, with the exception that it makes graduation from the medical department an essential prerequisite. It has a State board of examiners to examine all graduates in medicine of their own universities, to further prove if they are really qualified. A diploma in Germany is of no value; it is the so-called ærzliche Approbationspruefung, State’s examination, that gives the license to practice legally.

When this is found necessary, notwithstanding the high standard of German medical schools, how much more is this safeguard against incompetency needed with us? I have endeavored to prove from the methods of Germany and the course of the United States medical department that diplomas cannot be accepted as bona-fide evidence of a medical education. With us a half dozen doctors can get together any time, incorporate a medical college, call themselves professors, and start out advertising themselves and their college for the purpose of manufacturing diplomas and doctors. Why, a diploma under these conditions should not be worth the parchment it is written on, as evidence of a medical education, unless attested by a higher and perfectly independent authority!

If the public once understood that too many doctors are dangerous to the morals and health of society, they would be quite as anxious as the most enthusiastic medical educator to remedy the evil.

The question of too many doctors is one of economical and social science, not of medical science, and, therefore, it can only be intelligently considered from these philosophical standpoints. It is a well-understood and accepted law of political economy that in the industrial pursuits, whether in the manufacturing departments or in agricultural production, the surplus or glut in the market of any of the products of industry, reduces the price and stimulates consumption, which, in the course of time, is regulated by a suspended or reduced production, thus restoring a healthy equilibrium. It would be an absurdity to apply the same rule to a surplus of doctors, because human ills or diseases do not increase in proportion to the surplus of doctors, nor will fees be any less. But the surplus, in order to live, must live on the earnings of the community, and here the disastrous consequences appear.

The credulous, and those who often may imagine that they require medical advice, become the unconscious victims of the unhealthy disproportion, for the doctor seizes the opportunity to make a case, while the normal proportion of cases do not reach around. Thus, it is calculated that at least fifty per cent. of all the diseases for which patients are treated are fictitious as far as actual disease is concerned, and the remaining fifty per cent. are, in the majority of instances, overdosed and overdoctored. For this reason medical legislation would not make a privileged class of physicians, nor throw unusual safeguards around medical practitioners, but medical legislation is to protect the people themselves from imposition and quackery.

The reason for the overcrowded state of the profession is not alone the laxity of medical laws, or the low standard of medical education in most of our colleges, but the general tendency of the country population to drift into the cities. Honest labor has not the dignity which its importance demands, and a radically faulty method of common-school education is another reason. Utilitarian manual methods, in which the hands are educated for useful employment and the minds to habits of industry, are to be wished for. Young men who have acquired a technical education in mechanics and arts will learn to respect labor in every department, and their ambition in life will be greater than to swing a cane or wear a silk tile.

In proportion as the productive employments are made respectable, this questionable ambition to become M. D.’s will fall off.

History tells us that the opulence of Rome was speedily accompanied by a decline of its agriculture, after which came the fall of the Roman Empire, because the country population became too indolent and restless and flocked to the cities for an easier and luxurious living. History in this respect seems to be repeating itself. We are always talking of encouraging the beauty and growth of our cities, but not one word of encouraging agriculture; no one talks of encouraging farm life and making it profitable and attractive, so that men and women would prefer the more independent subsistence in the country to a shabby gentility in the city. Some reader may ask, What has all this to do with doctoring? I say that the answer must already have been apparent; it becomes the duty of everyone to interest himself, that the division of labor shall be apportioned so as to do the greatest good to society.

We have a national characteristic which shows itself in an abnormal conceit for everything American in a degree that is not essential for true patriotism and love of country. But when by comparisons we learn that there are abuses and errors which are destructive to a healthy intellectual and material growth, we must have the honesty and independence to acknowledge them, and busy ourselves to find a remedy for existing evils.

The physician who can assist in the amelioration of society by administering to human ills which are the result of unwise laws, is accomplishing as much good as if he writes prescriptions or bleeds patients. The sooner everybody recognizes the fact that the time has come to deflect the current of ambition from the practice of medicine as a means of making a living, the sooner will untold suffering be lessened, and there is no honest-minded physician who does not heartily agree with me. Mercenary persons, and ignorant or unscrupulous doctors who run diploma mills, may criticise severely the honest sentiments here expressed, but the truth is so apparent, that he who runs may see the inevitable consequence of this unhealthy competition. Professors of colleges have a direct interest in the ignorance and incompetency of their graduates, because they are the means of calling them into consultation on every possible occasion in trifling ailments, and if the disease belongs to some specialty, they have the cases entirely turned over to them, because, in the mind of the incompetent and newly-made doctor, the professor who was the means of getting him a diploma, poses as the beau ideal of medical wisdom. In this way it becomes exceedingly profitable to be a professor. If there are not enough medical colleges in a community to afford places for the ambitious, it is considered to be one of the best-paying financial investments for a company of physicians to start one, and in most of these concerns it is easier to get a diploma as a doctor than to learn to be a good dressmaker or shoemaker.

Hence there is only one remedy to control the educational aspect of this evil, and that is to take medical colleges entirely out of the hands of private individuals and make the State the only source of the necessary credentials to practice medicine.

An American system of medical education fostered by the State would be productive of grand results, because, under the shadow of our free institutions, the mind transcends the circumscribed sphere of despotism. This has already been proven in numerous instances, notwithstanding unfavorable surroundings.

Forming the galaxy of great names that illumine the milky way of science, there are none brighter than a Gross, a Flint, a Sims, and some others. These were great American authors and physicians, who never pretended anything else; they never dreamt of the Don Quixotic escapade of pretending to be American professors while they appended to their names initials or abbreviations of questionable credit from foreign institutions. The brilliancy of true genius was their only passport to fame.

CHAPTER II.

DELUSIONS AS TO THE CURATIVE VALUE OF DRUGS.

Medicines that are sure cures for all the diseases to which humanity is heir, are not the spurious discoveries of the quacksalver and patent-medicine vender alone, but some very intelligent persons believe that if there is not a panacea, there is at least a remedy, for every disease. In cases where the patient does not recover, they believe that either the disease was not thoroughly understood or the medicines which were given were not properly selected.

This is a great error, because there is no such thing as a specific or infallible remedy for any disease, and, on the other hand, it is quite possible that most patients, with proper nursing and diet, would naturally recover without any drugs or medicines whatever. Outside of those drugs, like ether, chloroform, opium, or morphine, that are employed for the purpose of deadening the sensibility of the nerves, so as to render them insensible to pain, there is not another drug that is absolutely sure and true in its medical effects. Some few are very useful at times, but the great bulk of medicines do much more harm than good.

Medicine in its broad sense means a knowledge of the cause, course, treatment and ultimate results of disease. The study of medicine cannot be circumscribed by dogma or theory, nor can it be mastered in a few short years of study at the very best medical schools. It requires a mind adapted by nature for a plodding investigation of her laws, and incessant application, long after the college curriculum is ended. In fact, the student must unlearn much of the stereotyped lessons of the text-books, and this is particularly true of the supposed medicinal effects of drugs, which are always exaggerated. When physicians really have a threatening case, under their observation and care, the attributed therapeutic action of drugs is nearly always disappointing, and very often injurious, and they are forced to let the drugging entirely alone, and bring their skill to bear on measures which support the strength and vitality of the system, so that nature can effect a cure in her own way. This may seem to some simple doctoring, but I can assure the reader that it requires the highest degree of medical skill, notwithstanding the droll sarcasm of Voltaire, that “medical science is the art of amusing the patient while nature performs the cure.” There is neither skill nor much learning required to give an ordinary prescription; that the average apothecary could do with the greatest exactness. But science and medical skill can be exhausted in managing and husbanding the resources of nature, in order to effect a cure.

Medicine no longer stands alone as a simple art, based on theoretical deductions, as it was less than a hundred years ago, but it has become a department of natural science, a part of the natural history of the human race.

Disease is as much a vital process as health, only in one case the vital function is perverted, or destructive, while in health it is constructive. The germ theory of disease and cellular pathology are clearly within the domain of biological research, while chemistry has solved many physiological processes. Mental philosophy has been no less serviceable in the department of medicine, by teaching the wonderful influence of thought and emotions on the physiological functions of the organs.

A one-sided education is inadequate to appreciate the subject of healing or teaching. A comprehensive knowledge of all that bears on the subject of health and disease has several important objects in view, namely, it thoroughly acquaints the doctor with all of nature’s resources for the amelioration or cure of disease; and it gives him judgment in all cases to avoid irreparably wrong treatment, which places obstacles in the road of nature’s efforts to heal spontaneously. The quack or professional imbecile will, in the ordinary course of diseases, be accredited with remarkable cures; in fact, the cures wrought by a quack or an ignorant person are just as welcome and valuable to the patient interested as if they were accomplished under the advice of the most erudite and skillful physician, but the invalid ran the chances of malpractice or bad treatment at the hands of the quack, which might have cost him his life, because the incompetent healer does not know when his method of treatment does mischief. Every method of cure may possess merits of its own, which are beneficial when the disease or conditions for its employment are present, whether this is mind cure, water cure, or anything else that you may name. All that any system of treatment can do is simply to stimulate the curative force of nature, which is the only first cause of any cure.

The reparative energy of nature has never been duly recognized, because the selfishness and pride of the doctors will not concede this as often as they ought. The doctor should be the most useful as a monitor to the sick, in guiding and controlling thought and conduct, in harmony with the curative energy of nature. From this point of view the pretensions of anyone effecting this or that cure are only a delusion, because the doctor effects nothing, he only assists, guides, and directs towards effecting a cure. What this curative force is has by no means been understood. Some believe it identical with life or vital action, which manifests itself only in organized substances, but even if we admit this identity, we are balked again, because we do not really know what life is, any more than we know what electricity is. Descartes resolved life into matter and motion; this, however, is rather the phenomena of life and gives us no idea of the real essence of the force that we call life. There is another theory, that all life whenever or wherever found is a spiritual force, ethereal and universal. For our purpose, the discussion of this question has no particular value, were it not for the fact that life, or vital activity, wherever we find it in organized substances, whether in the lowest living thing or in the highest type of physical development, is accompanied by or is endowed with the natural tendency to repair defects or injuries in that in which it is active.

Regeneration, or the curative process of nature, is always the handmaid of vital activity. It is present at the earliest formation and division of a cell, which constitutes the unit of all organisms. Just as one brick is laid on the other with mortar or cement between them, so as to make a whole wall of a building, so are our bodies built up of minute cells, one added to the other, with cement between them, until the entire structure is completed. There is no tissue of the living body which was not at one time during its existence a cell. This curative force is beautifully illustrated in the lower animals, where parts of organs are replaced to a far greater extent than among warm-blooded animals.

Professor L. Landois, in his work on “Human Physiology,” says that “when a hydra is divided into two parts, each part forms a new individual—nay, if the body of the animal be divided into several parts in a particular way, each part gives rise to a new individual. The planarians also show a great capacity for producing lost parts. Spiders and crabs can reproduce lost feelers, limbs, and claws; snails, part of the head, feelers, and eyes, provided the central nervous system is not injured. Many fishes reproduce fins, even the tail fin. Salamanders and lizards can produce an entire tail, including bones, muscles, and even the posterior part of the spinal cord, while the triton reproduces an amputated limb, the lower jaw, and an eye. This reproduction requires that a small stump be left, while total extirpation of the parts prevents reproduction. In amphibians and reptiles the regeneration of organs and tissues, as a whole, takes place after the type of embryonic development, which is by cell division, and the same is true as regards the histological processes which occur in the regenerated tail and other parts of the body of the earth worm.” Comparative pathological anatomy clearly demonstrates the inherent curative power of nature, and this is also apparent in the vegetable kingdom, and together they deliver a lecture on the “art of healing” from the stage of creation, in silent and modest language, but eloquently instructive to the thoughtful observer.

The question now naturally arises How far this curative energy of nature operates in warm-blooded animals, and especially in man? The answer must be that, while it falls short of reproducing parts of organs or even tissues in the same degree of perfection as in the lower orders, the innate tendency towards regeneration and recovery from injury and disease is, on certain lines, practically the same. There is not the slightest doubt that ninety per cent. of all cures, whether the invalid took this, that, or the other medicine, or whether the method of treatment was homeopathic, allopathic, or mind cure, are entirely due to this inherent curative energy; and the other ten per cent. may have required some active remedy, but this, too, alone, without nature’s healing force, would have been ineffectual.

What is ordinarily termed mind cure is not mind cure in the sense that the term implies, but it is simply the mind toying or playing with the idea of a cure, for while the mind is thus engaged, nature’s energy is accomplishing the result or cure. This is the only rational explanation, and corresponds with the cures that nature is continually making in the lower orders of animals. If the recovery of the sick depended entirely upon the caprice and wisdom of the doctor, and not on the reparative forces of nature, the race would soon die out. I fully recognize the fact that the curative force can be stimulated; this may be done through the influence of nourishing food, alcoholic stimulants, a drug or medicine, or through purely mental influences. No physician can estimate how much merit he can accredit to the methods or substances he employs in any particular case that recovers, and how much to the lady physician, Dame Nature. This old lady doctor is ever active, and the most inert drugs, employed or administered with her assistance, have achieved wonderful cures; this the history of medicine confirms. The tar water cure of Bishop Berkeley is an illustration how an inert substance is capable of making for itself an enviable reputation for curing ailments, like pleurisy, pneumonia, erysipelas, asthma, indigestion, hypochondria, and other diseases. This remedy had the vehement indorsement of one of the greatest metaphysicians of the English-speaking world, and that the cures reported by him were genuine no one will doubt for a moment; but the bishop, like many of our day, was determined to have a remedy to cure disease, where none was required, but the mind had to be humored, while nature was actively repairing the disorder. To-day almost everyone is satisfied, that the virtues ascribed to tar water by Berkeley were a delusion, which was shared by all those who believed as he did.

The Weapon Ointment affords another instance where the credulity of the public was supported by abundant facts to prove the efficacy of the remedy, yet it was based on the wildest superstition. This ointment was employed for the healing of wounds, but instead of being applied to them, the weapon with which the wound was inflicted was carefully anointed and hung up in a corner, and the wound was washed and bandaged without the salve being allowed to touch it. This ointment created such a furor that eminent medical men indorsed its virtues as a healing agent. Another example of superstition and charlatanry was the equally famous Sympathetic Powder, which, when applied to the blood-stained garments of wounded persons, cured their injuries even when miles away. That dukes and knights vied with each other to obtain the secret of its preparation and ingredients is a matter of history. Instances of delusions on medical subjects could be multiplied a thousand fold, but they prove nothing but ignorance and superstition on the one side, and the inherent all-powerful curative force of nature on the other. While I wish to avoid wounding the fastidious and sensitive in the matter of their faith in their cherished system of cure, I cannot refrain from classing homeopathy as a similar delusion.

I am glad to admit at the outset that I have read Hahnemann’s “Organon of the Art of Healing” with a great deal of interest and some profit. I am convinced that his theory of infinitesimal dilutions is as absurd and ridiculous as either the Weapon Ointment or the Sympathetic Powder treatment already referred to.

If we consider the harsh, or, preferably-termed, heroic treatments, then in vogue, we need not be surprised that the pendulum of medication should have swung in the opposite extreme. Blood was drawn from the already enfeebled body, emaciated by disease; emetics were administered to sensitive and inflamed stomachs, and only aggravated into greater disorder; blisters, or the burning moxa, scorched into greater agony the suffering mortal, while large doses of drastic cathartics depleted the waning forces of nature. There was a tendency of the medical profession about that time to entirely ignore the curative forces of nature, and to attack disease as you would a midnight marauder, with the most powerful and dangerous weapons at command; and there is no doubt that with these powerful expedients, disease was destroyed, but life also. Under these conditions Hahnemann appeared on the scene, and I am frank to admit that he rendered suffering humanity invaluable service by espousing a system of cure which had the merit of being harmless. If we take into account that physiological studies were then in their infancy, and that the word “Biologie,” from the Greek words which signify a discourse upon life and living things, was made use of for the first time by Lamarck, in a work published in 1801, it will not seem altogether strange that even learned men were mystified into beliefs which, in the light of our present knowledge of the subject, appear preposterous. This was a most opportune time to fasten on the healing art any doctrine or dogma, however absurd, and on this tide of ignorance and superstition, the doctrine of infinitesimal dilutions floated into popularity. Homeopathy affords us one of the most striking illustrations of the uselessness of drugs in ordinary ailments, and conclusively proves that nature possesses inherent curative powers. Cases treated under this system make splendid recoveries, and often much better than when the powers of nature are opposed or weakened with nauseating drugs and poisonous doses, prescribed by incompetent persons.

Hahnemann truthfully observed that existing diseases are liable to become aggravated, complicated or replaced by drug diseases.

There is no doubt of the truth of this statement where drugs are heedlessly administered. When I was a student I was told that calomel was par excellence a babies’ medicine without any qualification. I was credulous enough to believe it and prescribed it for my own children for its purgative effect whenever it was deemed necessary. In later childhood, when the second dentition set in, the germs of the permanent teeth were so injured, evidently from the calomel that had been absorbed into the system, that the teeth were ragged and defective. The glands of the neck were also inclined to swell and suppurate, and there is no doubt in my mind that a great deal of what is generally supposed to be scrofula in young children, is nothing more nor less than a “drug disease.” I believe that Hahnemann was cognizant of the potency of nature under ordinary circumstances to cure disease. I believe that he absorbed this view of the philosophy of healing from the writings of Paracelsus, which he had studied, and from which he drew his inspiration, but he also appreciated the practical necessity that success depended on satisfying the superstitious belief of the times, and that consisted in offering some tangible remedy. Hahnemann proved himself equal to the emergency by formulating his doctrine of potentizing drugs or medicinal substances by reducing them to a wonderful degree of minuteness.

The preparation of these dilutions was directed to be carried out in a ceremonial sort of way. Chalk from an oyster shell, sulphur, charcoal, or any other substance, was potentized by taking one grain of the drug and mixing it with one hundred grains of sugar of milk. Of this mixture one grain was taken and mixed in the same manner with another hundred grains sugar of milk. This gave the ten-thousandth of a grain of the drug. Take one grain of this with another hundred grains of sugar of milk and the powder will contain the millionth of a grain of the substance, or the first potency, which forms the bases of other dilutions. This is reducing the doses of any drug to an absurdity, and Hahnemann was too brilliant a mind not to know this. It might be mentioned in connection with these dilutions, that if one grain of the most powerful drug, strychnine, aconitin, arsenic, or any other chemical that is known, is mixed with six hundred grains of sugar of milk, one grain of this powder, or the one six-hundredth of a grain of this substance, cannot be detected by any test or chemical reagent; or, in other words, the quantity of the drug or chemical contained is so small that the most delicate chemical test fails to show it; yet, in homeopathy, the dilutions are carried to the decillionth of a grain, from which important medical effects are expected.

Drugs are physical agents, and if they are diluted so as to destroy their chemical or physical properties, it is sheer nonsense to expect any physical result from them on the system. Chemical and physical facts conclusively prove the utter inertness of certain drugs either in themselves or in the manner in which they are employed, and the indisputable evidence of biological science demonstrates the natural curative tendency of nature observable in the lowest living thing to the highest, so that we should stultify our reason were we to arrive at any other conclusion than that the doctrine of this therapeutic creed is one of the most irrational delusions that ever befogged the mental horizon of a thinking being.

The supposed cures effected through the employment of the Weapon Ointment, the Sympathetic Powders, the endless dilutions of the Hahnemann system, and, indeed, most other remedial agents from any school or source, whether offensive powders, mixtures, or patent medicines, or the more agreeable and tasteless pellets, have but one role to play, that is, to assuage the apprehensions of the mind while nature is performing the cure; that is, to engage the mind with the thought or idea that something tangible is being done to bring about a certain result.

If the patient has pinned his faith to the curative value of mind alone, the mind is for the time being engaged with idea that mind is performing the cure. This is a delusion quite similar to the previous one, in which medicines are taken, with only this difference, that while you pin your faith on drugs in the one case, you pin it to mind cure in the other.

CHAPTER III.

WHAT IS MIND CURE?

This subject has given rise to an endless variety of contradictory discussions, and while it has won for itself fanatical devotees on one side, it has been ridiculed on the other. This is not at all surprising, when an inquiry is made into the competency of the parties to the controversy. To be informed in metaphysical philosophy, or fully equipped in scriptural lore, but without a practical study in the art and theory of medical science, precludes the possibility of presenting the theme in a logical manner, or establishing a relevancy between medical science and mind cure. A medical education that is based on strictly physical characteristics of disease, as they are studied at the bedside, or in a microscopical laboratory, is equally inadequate; for the question of mind cure goes beyond the physical into the metaphysical, and not until the operations of the mind have been closely followed to the bodily or organic functions, can the intimacy of their relations be thoroughly appreciated. Medical men betray their incapacity for observation if they contemptuously dismiss the subject of mind cure by some superficial, disparaging illustration, for there is much more in the subject than is dreamt of, even in the mind of the average college professor.

“The mind,” says Dr. W. F. Evans, “can be made the plastic or formative principle of the body, and that thought can retard, pervert, or stimulate and correct the different functions of the human organism.” The relation of spirit and matter is very intimate, and some very clever thinkers resolve all matter into spirit, in its ultimate analysis.

Bishop Berkeley affirms this in his “Principles of Human Knowledge.” In section seven he says “there is not any other substance than spirit.”

If we view nature from a materialistic standpoint, we see only one-half of what we think we do, and even that must be very imperfectly judged by our senses. Friedrich Wilhelm Joseph Schelling states the relation of matter and spirit, in very simple and plain words, so that a child can understand what he says: “Nature is spirit visible, and spirit, is invisible nature.” This may be illustrated in physical science from what chemistry teaches of the physical properties of the diamond, whose atoms or molecules are so perfectly continuous and closely aggregated that it forms one of the hardest substances known to physicists. These atoms of pure carbon may be made to repel each other, so that the diamond assumes a gaseous state, which is imperceptible to our senses.

I am aware that the definition of a gas is not that which metaphysicians would accept as applicable to spirit, and yet it illustrates the idea from a physical standpoint. It is much better to illustrate a question with something with which people are generally familiar. The body and every organ and tissue forming a constituent part of it, is simply the plain ordinary matter in motion, vitalized by what we call life, and this life principle is a mystery, and what is true of the diamond is true of the human body in its entirety. If placed in a crematory, it is reduced to a few ounces of bone ash, and, with the addition of a little acid, this too would soon disappear into invisible gases, so that the doctrine of philosophers, that matter is spirit, is, after all, not so far removed from physical evidence.

Physiological science gives abundant proof that the mind has a powerful influence over the body. By mind is meant all that class of mental phenomena called reason, and the emotions and passions. Doctor Evans says “the body is included in the being of the mind,” or, in other words, that matter is included in the being of spirit.

The thinking quality of the mind is undoubtedly the mainspring of its action, of which the formation of ideas is the highest kind of mental activity. These originate either within the mind or are brought within its sphere by transformed impressions from without, but through the power of the Will these are more or less modified, and may, indeed, be entirely suspended, so that the mind may become entirely passive and not think of anything. It is the exercise of this Will power which may make the operations of thought conducive to health or disease.

Cogito ergo sum, “I think, therefore I am,” is a maxim of Descartes. What we think and give shape to in thought has for us a real existence, and we have it in our power to create thoughts that will have either a painful or pleasurable sensation. Painful sensations have occurred to persons by the conviction of the existence of a cause which would, when present, have produced certain results. Of this several examples are given in W. B. Carpenter’s physiology: “A clergyman told me that some time ago suspicions were entertained in his parish of a woman who was supposed to have poisoned her newly-born infant. The coffin was exhumed, and the coroner, who attended with the medical men to examine the body, declared that he already perceived the oder of decomposition, which made him feel faint, and in consequence he withdrew. But on opening the coffin it was found to be empty, and it was afterwards ascertained that no child had been born, and consequently no murder committed.” The second case is yet more remarkable: “A butcher was brought into the drug store of Mr. Macfarlan, from the market-place opposite, laboring under a terrible accident. The man, on trying to hook up a heavy piece of meat above his head, slipped, and the sharp hook penetrated his arm, so that he himself was suspended. On being examined he was pale, almost pulseless, and expressed himself as suffering acute agony. The arm could not be moved without causing excessive pain, and in cutting off the sleeve he frequently cried out. Yet when the arm was exposed, it was found to be quite uninjured, the hook having only traversed the sleeve of his coat.” In this, and similar cases, the sensation was perfectly real to the individual who experienced it, but it originated in the mind by an impression through the nerves of internal sensation which created the idea or image in the brain, and the external senses to which it was referred had nothing to do in causing the feeling. Diseases are thus created every day, either by ourselves or by those to whom we go for advice. I call to mind a lady who had gone to a distinguished practitioner for a supposed womb disease for some six months. She experienced no change for the better, but kept on growing continually worse, so that she no longer had a refreshing sleep, and her appetite for food was entirely gone. On examination I found her womb entirely healthy, in fact, exceptionally so, thanks to her attending physician, because, after a certain amount of useless doctoring, the rule is quite the other way. I told this lady of her error or delusion respecting her womb, and prescribed a quieting mixture for the night and a tonic for the day. She began at once to improve, and when I saw her again, six weeks afterwards, she had so fleshed up that I failed to recognize in her traces of her former delusion. The disease of which this woman was suffering was imaginary, and had no real existence for anyone outside of herself. She was the victim of the harrowing symptoms which her mind conjured into shape, and an attempt to brush aside the disease, with the flippant remark that “there was nothing the matter with her,” would have been cruel, unscientific, and absurd. The ailment which she thought she had, had as much an existence as though the most malignant disease was destroying her life; for her imaginary disease was doing the same thing, only in a different way.

Imagination is the most powerful function of the human brain. Associated with thought, it constitutes the empire of the soul, which recognizes neither time nor space. With it we are brought into communion with everything that is grand and beautiful in nature. Imagination is the architect of our souls; it continually creates and projects into the beyond; it enlarges the sphere of our thought in building up artificial structures for our pleasure and entertainment. When it becomes perverted and abnormal from false impressions, either through the nerves of internal sensation or through the nerves of external sense, or, what quite often occurs, from morbid thoughts or ideas received from others, it becomes equally potent in causing misery and disease.

Expectation or attention influences, in a remarkable degree, the bodily functions. There are a great many persons who keep themselves in misery and disease by always thinking of their imaginary or real sickness. I had a profitable experience some years ago in my own case, which conclusively proved to my mind the aggravating tendency which constant attention has on disease. I had contracted an ordinary catarrh of the pharynx, or what is generally called a sore throat. At first I did not mind it, but in the course of time, from continued exposure in all kinds of inclement weather, at all hours of the day or night, it fastened itself upon me so that it was at times very annoying by its dryness and pain. I do not know of anything that I did not use, but, after a trial of several years, I was convinced that the more I looked at it and the more I treated it with sprays, gargles, etc., the worse it became, so that one day I resolved to let it alone, and not think about it. I took a teasponful of glycerine once in a while when it became too dry. For years I have not looked at it, and for all I know, it is perfectly well. I stopped bundling up my neck, used light bedcovering, so as not to sweat, and by this simple method accomplished what the very best selected drugs utterly failed to do.

The great English authority, Daniel Hack Tuke, in his work, “The Influence of the Mind on the Body in Health and Disease,” quotes from Unzer’s work, published in Germany in the year 1771: “Expectation of the action of a remedy often causes us to experience its operation beforehand.” And John Hunter said as early as 1786: “I am confident that I can fix my attention to any part until I have a sensation in that part.” A great number of cases are recorded where complete insensibility to bodily pain has been induced without the use of drugs. The intention of administering a certain drug was made known in this manner. Bread pills have acted as decided cathartics, and an empty chloroform or ether bottle put the sensitive into a profound stupor or insensibility.

Dr. Woodhouse Braine, of the Charing Cross Hospital, writes: “During the year 1862 I was called upon to give chloroform to a very nervous and highly hysterical girl, who was about to have two fatty tumors of the scalp removed. On going into the operating room, it was found that the bottle containing the chloroform had been removed to the dispensary, and on testing the Snow’s inhaler, which at that time I was in the habit of using, I found it to be quite devoid of even any smell of chloroform. Then, having sent for the bottle, in order to accustom the girl to the face-piece, I applied it to her face, and she at once began to breathe rapidly through it. When she had done this for about half a minute, she said, ‘Oh, I feel it, I feel I am going off,’ and as the chloroform bottle had not arrived, she was told to go on breathing quietly. At this time her hand, which had been resting across her chest, slipped down by her side, and as she did not replace it, I thought I would pinch her arm gently to see the amount of discomfort her hysterical state would induce her to bear. She did not notice a gentle pinch, and so I pinched her harder, and then as hard as I could, and to my surprise I found that she did not feel at all. Finding this was the case, I asked the operator to begin, and he incised one of the tumors, and then, as the cyst was only slightly adherent, peeled it away. At this time I had removed the face-piece, and, wishing to see the effect of her imagination, I said to the operator, who was going to remove the second tumor, ‘Wait a minute; she seems to be coming round.’ Instantly her respiration, which had been quite quiet, altered in character, becoming rapid as when I first applied the inhaler, and she commenced moving her arms about. I then replaced the face-piece, and her breathing again became quiet, and she submitted to the second operation without moving a muscle. When the water dressing and bandages were applied, in answer to the question as to whether she had felt anything, she said, ‘No; I was quite unconscious of all that was done.’” The mental phenomenon that we observe in this case clearly shows how completely the sensation of the patient was suspended by the imaginary chloroform, which existed only in her mind, yet the real drug could not have been more potent in its effects.

Phenomena of the same mental process, like the different colors of the solar spectrum coming from one source, constitute the different stages or degrees of what is generally called mesmerism or somnambulism, until the sensitive arrives at that condition of complete double consciousness now commonly called hypnotism, in which state the will power of the person becomes entirely suspended, so that he acts only from suggestions of another person, regardless of propriety or consequences. When a subject who has been completely hypnotized is restored to his normal condition, he remembers nothing of what has transpired during the somnambulistic state. We all have acquaintances of whom we speak as being easily led; by that we mean that they have no will or mind of their own. These persons are truly unfortunate, because they are at the complete mercy of every designing person or cunning rogue. They constitute the large army of dupes who support the great number of idle women and lazy men, who claim to be clairvoyants, life readers and fortune tellers. In sickness they are equally as credulous, and when they are a little out of sorts, they would a great deal rather be told that some dangerous or severe illness has hold of them than to hear the truth that, outside of not eating properly, or clothing themselves improperly, or being out late at nights when they should be in their beds, there is nothing the matter with them.

These are the dupes who fill up the chairs in the doctor’s waiting rooms, on regular days, for local or special treatment for diseases which could be much better treated by themselves at home, if they only were fortunate enough to fall into a physician’s hands who had the honesty to tell them so. This can be further illustrated by an experience of which every one of us has been a victim at least once in our lives. When we were trying on a pair of new shoes, we felt that they pinched, or were too short and generally uncomfortable; but the salesman insisted that they were a “perfect fit” and that after a little wearing they would surely suit. The shoes were bought, and we were convinced, after a few days, that our impression of the smallness of the shoes was correct, because they continued to pinch us; but we were for the time mesmerized or psychologized by the clerk into buying what we were satisfied in our own minds to be not what we wanted. This should be constantly guarded against, and our conscious will power should always be exercised on all occasions.

Parents should take particular pains to cultivate the will power of their children, in the right direction, of course. To stifle the will of children, when the exercise of it entails no bad consequences, is wrong, because it weakens their character, and makes them the prey of the wicked and selfish when they are grown to adult age. This influence which one person may exercise over another is not due to any particular force or magnetism, as was supposed by Mesmer, and which is yet claimed by ignorant frauds and pretenders, but it is simply a suspension of your own will, or a sacrifice of force of character. Dr. J. M. Charcot, of France, has lately taken up this subject, and has given it a great deal of attention. His researches have confirmed the experiments and conclusions of Braid, an English surgeon of Manchester, who, in 1841, showed that, in order to produce artificial somnambulism, there was no need of any extraneous influence, and that any person of moderate sensibility can easily produce in himself the “magnetic sleep” without any aid or act of another.

Braid discovered that to simply fix the eyes for a few minutes on some shining object, placed a little higher than the ordinary plane of vision, and five or six inches from the eyes, caused that total abstraction which Doctor Braid called “hypnotism,” and which now, in honor of the experimenter, is often called “Braidism.” This Doctor Charcot calls “impersonal” sleep, artificially produced by mechanical means. He remarks: “The psychic characteristic of the state of somnambulism is an absolute trust, a boundless credulity on the part of the subject toward the one who has hypnotized him. Take one example from among a thousand: I present to a woman patient in the hypnotic state a blank leaf of paper, and say to her: ‘Here is my portrait; what do you think of it? Is it a good likeness?’ After a moment’s hesitation she answers, ‘Yes, indeed; your photograph! Will you give it to me?’ The image being now fixed in her mind, I take the leaf of paper, with a private mark, and mix it with a score of other leaves precisely like it. I then hand the whole pack to the patient, bidding her to go over them and let me know whether she finds among them anything she has seen before. She begins to look at the leaves one after another, and as soon as her eyes fall upon the one first shown, she exclaims, ‘Look! your portrait!’” This is the latest phenomenon, and proves how the mind may print an image on a substance, as the sun prints on a negative.

For persons of casual thought or reading, hypnotism may at first appear complicated and mysterious, but if you will only bear in mind that the different mental processes operating between two persons always resolve themselves into a weaker will power yielding and a stronger will power controlling, you have a key which unlocks the different manifestations of minds in their relations one with the other. This does not relate to action alone, but to the creation and meaning of our thoughts.

The cures effected by the royal touch, which prevailed in England from the time of Edward, the confessor, to Queen Anne, were but a disguised hypnotism, or a sort of mind cure. Soothsayers, or magnetic healers, who claim a healing magnetism, are either knaves or fools, and often both. They undoubtedly can report cures, but these are due to the natural tendency of some diseases to get well, and to the hopeful thoughts which these persons inspire by their promises of a cure; sometimes these hopes are heightened by the different movements or passes which the healer makes. The greatest healer of whom we have any reliable record never claimed any abnormal power or force. Christ healed by the Word, that means by the thought or mind. Faith in anything creates a curative or healing thought in the mind of the patient, which stimulates the reparative or healing force of nature, and in this manner wonderful cures are effected.

The faith, or confidence, which you have in a physician stimulates you at once into a better or stronger feeling. This has been the experience of every sick person, but this is not due to any power or force that this person possesses, which departs from him and goes over to you, but is entirely due to the confidence, which stimulates your own nerve centers, and especially the brain. The soothing and quieting influence which the “Weapon Ointment” had on the injured person was not due to any virtue of this ointment, because it was never applied to the wound, but to the weapon or implement which caused the wound. Its operations were entirely mental or psychical. It pacified the excited and anxious mind into the faith or belief that the best possible thing to do was being done, and nature went on triumphantly and effected the cure, for which, of course, she never got any credit. When a doctor or healer enters the chamber of the sick, putting on a wise air, or indulges in affectation, and when he succeeds in making a good impression, that alone assuages the pain. But if, on the other hand, he impresses his patients unfavorably, the sooner he gets out of their sight, the better they feel, because his presence has inspired neither confidence nor hope.

Hysteria constitutes a peculiar group of diseases which belong to that class of nervous ailments that are included among functional affections; they are oftener amenable to faith or mind cures than to drugs. A great number of diseases of women belong to this class and these poor deluded creatures never had anything real or serious the matter with them, until they went to some doctor who began to apply irritating drugs to their delicate organs, which made them ever afterwards habitues of doctors’ offices.

Functional diseases have a wide range. As their name implies, they are characterized by a disturbance of the function of an organ or system, without any visible alteration of its tissue or texture; there are no pathological or histological changes, which the most careful microscopic examination can detect. They constitute a scapegoat for our ignorance; it appears to be in the majority of instances a disturbance between the psychic or spiritual forces as they operate on the tissues. The normal and harmonious relations between the mind and the body or any particular organ are disarranged. Such are the hysterical convulsions or spasms which we see in women who have suffered great mental strain, especially grief, and often it is due to pure “cussedness,” or unbridled passion. In men there is also a hysteria; it was formerly believed that this peculiar nervous derangement was confined to women only, hence the name, but this was an error. I was once called to attend a physician of more than average ability, who located in this city for the purpose of enlarging his field of labor and usefulness; from where he came he had been very successful. His reputation as a surgeon was enviable and deservedly so, but here, in this city, among strangers and strange customs, he was a failure. This preyed on his mind so that he became despondent and gloomy. He failed in flesh and strength. I found him in his room convulsively sobbing, which shortly turned into a paroxysm of laughter. I prevailed upon him to return to his former residence among his friends and admirers, which he did, and he told me afterwards that from the moment he struck his “old stamping-ground” he felt stronger and better, and shortly recovered his former mirth and healthfulness.

Girls show this abnormal nervous function in different ways. I have known a case where a sensitive girl accidentally saw another girl in an epileptic fit; the contortions became so real and fixed in her mind, or imagination, that they were transmuted into motions or epileptic fits. I tried remedies but without any beneficial results. The parents afterwards went the rounds of the “fits doctors,” but with the same negative results. A Christian scientist or faith healer cured her, by cultivating or strengthening her will power.

There is a class of these faith healers, composed of silly, loquacious women and men, who know nothing at all of the principle governing their cures, and they glibly tell their patients, “You must say or think there is no disease, or I have no pain, or there is no body; all is well; all is good,” and a great deal of similar nonsense. All is not good, and all is not well by any means. I would say, Indeed there is pain, disease, and a body, but by striving to live a healthful moral life, and thinking healthful thoughts, of the good, the pure, and the beautiful, the curative energy of nature will become stimulated to repair the defects, to harmonize the functions and dissipate disease.

A person who is troubled with dyspepsia cannot get well if he thinks of nothing but an acid or sour stomach, or feels the food disagreeing with him before he has it in his mouth. He must have thoughts quite remote from these, and the chances are nine out of ten he will not feel what he eats. There is the same state of mind about “catching cold.” Some persons are forever on the alert to catch a cold, and why should they not, when they are always watching out for it? If you dress so that you do not sweat, and do not use too thick bedcovering, and are not constantly on the catch or lookout, I assure you you will not catch cold, nor will it catch you.

Terror or fright causes or cures diseases. Dr. Toad reports the case of a boy, in Tuke’s work, nine years of age, who was frightened into chorea, or St. Vitus’ dance, by his sister, who had covered herself with a white sheet and appeared before him unexpectedly, while he was in bed. I know, also, a case of functional bladder weakness of a child who wet his bed at night during sleep. There appeared no signs of any local disease, nor was any remedy which I employed of the slightest advantage. The father of the child, becoming exasperated, gave the child a severe thrashing one morning. The mother remonstrated at what she considered cruel and useless chastisement. But, strange yet true, that child never wet the bed after that; it was entirely cured by fright.

Sympathy will often make persons sick; of this I had in my own experience an opportunity for a very interesting observation. It was the husband of a woman who had been retching and vomiting incident to the early months of her pregnancy. So great was the sympathy of her husband that he retched and vomited exactly like his wife, not only when in her presence, but when separated from her, the impressions or thought exciting the excito-motor nerves of the stomach. This sympathetic sickness lasted as long as that of his wife.

Dr. H. C. Sawyer, author of “Nerve Waste,” has kindly shown the writer another form of functional or hysterical disorder, which was, or is even yet, considered by many general practitioners a scrofulous enlargement of the joints; but the doctor discovered the peculiarity of metastasis, which means a sudden or complete removal of a disease from one part to another. This gave the disease what he termed a hysterical or functional character. It would be the swelling of the elbow of one arm and the knee of the opposite side at one time; and in the course of a few weeks or months these would feel and appear entirely well, while the disease had located itself in other joints. This case the doctor considered could be only reached through the mind, or some faith cure. He further believed that many of these enlarged and swollen joints among the wealthier classes were due to a nervous trouble. Indeed, it would be an easy matter to cite case after case, from my own experience, or quote cases from the highest medical authorities, illustrating in every conceivable manner how the mind, the imagination, the emotions, or the different passions, are continually causing disease and suffering.

It must naturally follow that what is potent to induce diseases will, under different conditions, be a means of curing them.

A serious question now arises with reference to the selection of cases suitable to mind-cure treatment. Bigoted fanaticism is quite incompetent, so are the great majority of spiritual healers, owing to their absolute ignorance of the scientific aspects of disease. The first prerequisite for intelligent and proper treatment is to establish the precise nature of the disease under consideration. It must be distinctly grouped or classed, whether it be a functional or hysterical disease, or a zymotic or contagious affection.

In diphtheria or typhoid fever mind cure subserves no purpose; the treatment must be avowedly antiseptic and stimulating.

If it be a physical injury, say a fractured bone, it must be treated on mechanical principles.

A woman suffering in the pangs of labor, which is being delayed from some abnormal position or some other physical obstruction, can only be delivered through mechanical methods; and here the enthusiastic mind healer may commit serious errors, sacrificing limb and life by unnecessary delay. So I would lay down this broad maxim, that the mind healer must either be a competent, educated physician, or a physician should be a competent metaphysician.

Note.—In the year 1887 Mrs. A. C. Hurrell was a healthy, middle-aged woman and the mother of two children. When the youngest was ten months old she contracted a severe cold. The coughing spells “took her breath,” and from these exaggerated expiratory paroxysms she drifted into spasmodic asthma, at least that was the diagnosis of prominent medical men of Sacramento and of this city. Change of climate was advised and tried, so were also the different drugs which experience had taught to be useful, even operations were performed on her nasal passages by enterprising specialists, but all to no purpose. Morphine was prescribed by the first medical attendant, and when her suffering became unbearable she had to fall back on this drug for relief. In May, 1890, I was consulted, but a most careful examination revealed nothing which I could assign as a cause and upon which to base a hopeful treatment.

In October, 1891, she was persuaded to take treatment from a lady who claimed to cure through Christian Science (a mind healer). The treatment commenced on a Thursday afternoon. The lady impressed on her that the morphine, of which she now consumed, hypodermically, the enormous quantity of ninety grains a week, was injurious, and that if she made up her mind that there was no disease the asthma would leave her. Friday night the patient was in great agony, both from the withdrawal of the drug and the asthmatic attack, and this double pressure weakened the faith of both patient and healer, but the husband stood firm and insisted that she have no morphine. The struggle for breath and the narcotic continued until four o’clock Sunday morning, when she began to get easier; the improvement continued, and in ten days she had “outgrown” both. I saw her two months later, entirely recovered, and the most brilliant specimen of the efficiency of mind cure that one could wish to see.

CHAPTER IV.

GENERAL CAUSES OF UTERINE AND PELVIC DISEASES OF WOMEN.

Why are womb diseases so prevalent? is a question which we are not infrequently called upon to answer. At first sight this would strike one as a casual or commonplace remark, but a moment’s reflection makes it one of vital interest, for a truthful and intelligent reply lays bare the causes which undermine the health, strength and character of the mothers of our citizens, and when a disease of this sort becomes common, it threatens the morality, health and life of our nation.

The causes which operate in producing these diseases of the female differ widely in their origin; some are due to ordinary imprudence, while others are deeply rooted in moral depravity and marital abuses and for this reason I consider it convenient to arrange them into three distinct classes or groups.

The first class is characterized by comprising those causes which are for the most part accidental. They are peculiar to confinement and motherhood, and may be in a great degree controlled or averted by the skillful and competent accoucheur. They have principally a scientific interest, and do not fall within the scope of the non-professional reader.

The second class is entirely beyond anyone’s control. The causes belonging to this category are innate to the human organism; they induce those numerous afflictions which here and there sprout up in previously healthy persons, and are, in all probability, due to some specific hereditary taint. They are to be attributed to the natural imperfections of humanity, and are a constant reminder that the body is simply the transient abode of the soul, or spiritual man, and as such only perfect in its imperfections. Like the causes of the first class, these, too, have principally a scientific interest.

The third class of causes of uterine diseases constitutes a very large group, and has a popular or general interest. For this reason it should be freely discussed, because the causes of this class are avoidable.

They are entirely within the control of the average sensible person, and for that reason should be known and understood by everyone. These causes superinduce inflammatory diseases, which are not confined to the womb alone but take in the entire pelvic appendages, the Fallopian tubes and ovaries. They are the greatest source of revenue to the doctors, and vary in symptoms in different persons, from a slight casual reminder of something wrong to harassing pains and physical suffering; and that these all are brought about through ignorance, wanton carelessness, or sinful disrespect of nature’s or God’s law, is the characteristic feature of the causes under investigation.

Exercise in the open air is so essential in strengthening the nervous and muscular systems that where this is neglected it predisposes to womb disease. I consider the differently-devised indoor or room calisthenics or exercises as totally inadequate and no substitute whatever for healthful outdoor movement, and for the following reason: that while it irritates the muscular and nerve fibers, it lacks the stimulating and tonic influence of pure oxygen-laden air, so that the blood becomes still more deteriorated and overloaded by excessive waste material, which is not thrown off. If a person exercise at all with a view of deriving physical benefits, let it always be in the open air. Like walking, riding, rowing, to which bicycling should be added as one of the very best of outdoor exercises, the mind can then be engaged at the same time, though it must not be overstrained. The great obstacle nowadays arises from a fashionable and morbid desire to cultivate an appearance of delicacy; if, instead, recreations which required muscular exertions were more fashionable, the results in developing strong and hardy women would be astonishing.

No exercise can be profitable which is not interesting to the person who practices it.

It is not the bodily exertion alone which can profit a person, but the happy associations, the abandonment of self thought, the mental relaxation, and the pleasure which accompanies it. With one or two companions we can have a jolly time, while taking a swimming bath or floundering in the surf, but alone it soon becomes tiresome. If we take a stroll with an agreeable companion, we can walk a distance which, when undertaken alone, would fatigue and tire us completely out, while, when with an associate or friend, we cover the same distance refreshed and invigorated, because the mind is entertained while the body is exercised. This must have been the experience of everyone, and if it teaches anything worth remembering, it teaches that monotonous exercises should be avoided and entertaining ones sought and practiced. Walks over hills in small, friendly groups is one of the best modes of exercise I know of. And then there remain the many outdoor games. The pernicious systems of training which are observed in some female seminaries often plant the seeds for future disease. All the school hours are employed in reading, drawing, music, and other brain work, while the evenings are devoted to preparing lessons for the following day. This is very injurious, and should never be permitted.

After school hours the mind should have complete respite from study, so that the forces can recuperate themselves for the next day.

Nervousness or neurasthenia is often a result of this excessive mental application. Where the mind is constantly engaged in intellectual pursuits, the result often is a too rapid development of the brain and nervous system.

When the thoughts and memory of girls of tender age are too long and too laboriously engaged, there will be an abnormal development of the nervous centers; they will grow or develop beyond the muscular or physical strength, and a morbid impressibility, great feebleness of the muscular system, and a marked tendency to disease of the pelvic organs, is established. Parents may refer with pride to the precocious talents, the refined and cultivated tastes, of their daughters, as qualities to be admired and appreciated, but without a physical substratum it is a dreamy delusion. It would be much better for the children if their parents took more pride in rotund figures and robust constitutions, for these would ever be a source of joy, while the cultivated talents, especially at the expense of their health, will not only be of little practical value to them in after years, but often incapacitate them for wives and mothers, by making them restless, discontented, and physically unfit for maternal functions.

There is entirely too much scholastic education imparted to our girls, and not enough domestic education. I believe that the most favored should not have too much of one and not enough of the other, because if parents do not prepare girls for household duties in early life, they run desperate chances of laying the foundation for a failure in the remote future.

Children must be constantly reminded that they are in this world to serve a useful purpose, and that co-equal with every accomplishment is a utilitarian training.

We take a pride if our boys trade pocketknives, especially when our own gets the better one of the two, because we appreciate the natural business trait. He will be no less a good candidate for some of the learned professions, and, indeed, it has come to this, that material success in the professions depends as much on shrewd business tact as it does upon proficiency in professional attainments.

The knowledge or even wisdom of a person is of no earthly use to himself or the world if he or she do not possess the faculty of letting the people know of this superior wisdom; and that is why some persons often become more celebrated and even renowned than others, who are intellectually their superiors, because the former possess the faculty and cunning to make people believe in their superiority. By this I simply desire to impress upon parents not to be over-anxious about their daughters standing first in their class room, but, rather, to be very anxious that they attain a healthy and vigorous growth, and that sufficient practical knowledge of domestic affairs be imparted to them so that they can creditably fill their mother’s places some day. This I consider the best legacy.

The time to commence to train mothers is from the moment they are born. The minds of parents should be disabused of the false delicacy about this aspect of a girl, and while no one expects daily lectures to be given to children or young girls upon the responsibilities which await them, such information should not be studiously avoided. I insist that this important fact should not be lost sight of, motherhood is the ultimatum of feminine existence.

Mistaken conceptions of woman’s education, in pinning girls to a life of close mental application, is often productive of uterine disease, by lowering the tone of the nervous system; while others who are ambitious to acquire a professional education in later life, fall by the wayside as hopeless invalids.

I do not disparage her capacity to study with equal proficiency the arts and sciences, often with more ardor and closer application, than her male colleagues, but she is simply striving to accomplish that which the men can and do willingly accomplish for her, while at the same time she is neglecting the education of those qualities which are the sole inheritance of her sex, and which man could not usurp if he would.

This class of uterine diseases develops in a few years into melancholy, which closes the windows of the soul to the sunlight of hope, and gradually drags the sufferer into a decline, that nothing but an entire change in the habits and thoughts of the patient will ameliorate or cure.

I would have our girls as independent of our boys as the latter are of our girls. I would have it understood that each, in their specialty for which God and nature has ordained them, is as honorable and important in the social and industrial conditions of mankind as the other. I would give woman the right, and deem it her privilege, to frankly and unrestrainedly profess her fondness or desire to marry the man who she believes would make her a desirable husband, because woman’s intuition transcends man’s reason.

A reform in this direction would, indeed, elevate the woman to man’s estate, where she belongs. A little less sentiment and more sense is a wholesome panacea for some of the abuses of the marital contract.

I fully subscribe to the view that a woman shall at all times receive the same wages for her mental and physical labor that men receive for the same work, but I am entirely opposed to that modern tendency and false social philosophy which is constantly striving to make a man out of a woman. There is something so grossly absurd and unnatural in this artificial readjustment of the natural duties of the sexes, in their industrial and social relations, that it has degenerated in many instances into fanaticism.

Women are organizing everywhere for the purpose of increasing the facilities of their sisters in the studies of science and philosophy. Large sums are offered to the faculties of universities to gain admission to female students on an equal footing with the male students, for the purpose of studying some of the already overcrowded professions. In the main, all this abnormal rivalry does not contribute a single advantage to either sex.

There was a time in the history of civilized nations, and that time is not more than twenty or twenty-five years ago, when an academical education gave an immense advantage to its possessor over his less-informed contemporary, but this is not true in our time, because there is now an overproduction of college-bred men. The man who can decline a Greek noun or conjugate a Latin verb is no longer a rarity, because the sons of European tradesmen and American farmers have deserted the pursuits of their progenitors—which, in the case of the American farmers, is to be deplored—and obtained a collegiate education, that is no longer the inheritance of the privileged few, so that in our time and day an academical education has run to seed among the men. And now the attempt is being made, under the guise of social progress, to burden our girls with the same wisdom that has incapacitated many of our boys from making an honest and independent living. It would be much better for the State if two-thirds of our universities or high schools were changed into manual training schools or polytechnical colleges, where the foundations for the industrial pursuits may be laid, so that labor will be made not only respectable but intelligent.

We would then hear of educated mechanics or artisans, and scientific farmers, which, to my mind, requires the same order of intelligence to excel, that it does in the professions generally qualified as “learned.”

Why crowd our girls, then, into the professions for which they are not only unsuited by nature, but which are already demoralized by the keen competition within their ranks? It is, certainly, an open secret, in the profession to which I have now devoted the best years of my life, that the methods in vogue to get business have descended to the level of the “confidence trickster,” and that, no matter what ability or merit a person may possess, without the natural instincts and elements of the quack and charlatan he can gain neither a livelihood nor fame. This theatrical demeanor of the profession, this aping the gaudy display of European aristocrats by riding in closed coaches, driven by liveried coachmen, is but the outward symptom of the internal disease of contention for notoriety and success.

If, instead of all this false and demoralizing philosophy, termed “woman’s rights”—which is more appropriately designated “woman’s wrongs”—we turn the thoughts and ambitions of women towards domestic economy and domestic virtue, which alone should be and ever will be the ideal of noble womanhood, there will be, then, much less disease, more happiness, and less discontent. There is enough on God’s earth for all of his children to eat, wear, and work, if the labor and the subsistence are fairly and wisely apportioned.

The growing sentiment, which is as vicious as it is absurd, is that a girl, to be educated or accomplished, must be either a teacher, lawyer, or doctor, or anything else except an accomplished housekeeper, just as though it required less talent or ability to raise a child, cook a wholesome or digestible meal, and cut or sew a garment.

Why, there is much more thought and judgment required in making an angel mother than in administering or prescribing a dose of medicine and filing a legal brief, and there is not a lawyer or doctor who has given sufficient thought to the duties and requirements of maternity who disputes it for a moment. If our strong-minded women would preach this doctrine, which would tend to make household duties respectable, they would be benefactors instead of mischief makers, and then our comely girls would prefer to cultivate habits of domesticity, which should and would become as honorable an occupation as that of a doctoress or lawyeress.

Improprieties of dress are to be found in excessive or deficient clothing, in an improper adjustment, and in an inherent defect of the undergarments. I will reserve some of my views on these questions, for the chapter that is devoted to hygienic measures. In the main, the custom or manner of dressing women in Christian countries does not deserve that sweeping denunciation that some radical dress reformers make. I would not, if I could, change the very becoming and graceful modern female dress, for it possesses the merit of displaying the beauties of the figure in a modestly delicate manner, and it hides its defects from the vulgar gaze.

As a rule, there is too much pressure on the abdomen, from the weight of heavy skirts that are suspended from the hips, and not sufficient room for the chest to expand, so as to accommodate the respirating movements of the lungs. In the absence of shoulder bands, to which the skirts should all be fastened, the much-decried corset has its redeeming qualities, for it serves the purpose of a yoke or support for the different undergarments, and when not tightly laced is rather a benefit than an injury, and if the corset had a shoulder strap fastened to it over both shoulders so as to keep the garments from dragging on the hips, there could then be no objection to it whatever. The corset must always be so loosely worn as to permit the wearer’s hands to be easily passed between it and the waist. It then becomes a useful brace to a weakly woman and entirely harmless to a strong or healthy one. We can imagine how a tightly-fitting corset will cause mischief by compressing the ribs and abdominal walls, and that this absurd fettering will prevent the lateral expansion of the chest, and also injuriously press upon the internal organs, but this is not due to an inherent property of the corset itself, but to an abuse of it. One might as well advocate a return to the Roman sandal, on the ground that some persons are foolish and vain enough to wear shoes altogether too small for their feet, thereby causing deformities and corns. For my part, I admire a nice, well-shaped, healthy foot, incased in a low, broad-heeled, comfortable shoe, even if its size were one or two numbers larger than a pinched-up, deformed one. But no one would be enthusiastic enough on the question of healthy feet to have us all wear sandals again.

Warmth of the lower extremities is a very important point in a female’s apparel, and of more importance than all the other questions raised on this subject. The exposures endured by women, from ignorance or indifference to this fact, is, in my experience, a fruitful source of disease. The chilling blast which sweeps under the skirts must be mitigated and the moist vapor arising from a damp and cold earth neutralized. If the limbs are only protected by thin cotton fabrics, they are insufficiently clad to avoid the evils above mentioned. It is of the greatest importance that the limbs of women should be incased in flannel drawers, and these can be worn underneath the white muslin or linen ones, and the hose, especially in cold or damp weather, should be made of woolen material; the soles of the shoes should be sufficiently heavy so as not to be permeable by the moisture from the ground, and in wet or rainy weather rubber overshoes are always a necessity. When the feet and lower limbs are kept warm, the whole body is more or less protected against cold.

Superfluous or too warm garments are the cause of an endless variety of diseases. The rule is this, that any garment which by its weight or thickness excites perspiration when the wearer sits quietly or exercises moderately, is either superfluous or too thick or heavy, and, as perspiration relaxes and softens the skin, it makes one susceptible to take cold. It is reported on good authority that sealskin wraps cause more deaths among those who wear them than typhoid fever and for the reason above mentioned. Loosely-woven woolen goods make the best wraps and the best underwear. If we were called upon to state a single proposition which we considered of the greatest importance in preventing disease, we would frankly say that, next to an irregular and unwholesome diet, excessive clothing is the most mischievous factor in causing or predisposing to disease.

The same rule applies to bedcovering; if it be so heavy as to make the sleeper sweat during the night, he is almost sure to take cold from the sudden change, from a warm, moist bed to the cool room or comparatively chilled clothing.

Imprudence during menstruation. A heedless disregard, ignorance, or carelessness of the precautions above referred to is, during the catamenial days, quite sure to lay the foundation for disease. Every practitioner has met with a great number of cases where the disease originated during menstruation from some indiscretion, and it ran on for years, until a condition of affairs was developed which was well-nigh incurable.

The female organism is particularly sensitive about this time and much easier affected than at any other.

During this period the ovaries and uterus are intensely congested, and the Fallopian tubes which connect the former with the latter share this condition, and if a cold should suddenly check or interfere with the natural functions of these organs, it might result in inflammation of the ovaries or in a catarrh of the tubes and womb. Any one of these conditions is painful and often troublesome to cure, but when all these organs are complicated in the diseased process, which we frequently find to be the case, it may entail serious consequences.

Dysmenorrhea, or painful menstruation, will be a prominent symptom, if any of the above organs have suffered from imprudence, during this period, and I have known of cases which gave me no end of trouble before they were restored to health.

Measurements of the healthy uterus. In a grown person the average length is three inches, two inches in breadth and an inch in thickness. It weighs from an ounce to an ounce and a half. The size of the uterus is an important guide to the physician in establishing the presence or absence of certain diseases.

In the child-bearing period measurements and weight change, because the organ grows correspondingly large to accommodate the growth of the child.

Growth of the uterus from the moment of conception is one of the most interesting physiological studies. All its tissues, muscles, nerves, vessels, and lymphatics are increased in bulk and multiplied in number. The human ovum is an extremely minute microscopic cell, from one two-hundred-and-fortieth to one one-hundred-and-twentieth of an inch in diameter. This grows so rapidly that at the end of nine months we often have the average nine-pound baby. The growth of the muscular fibers of the womb is truly remarkable. They grow eleven times longer and twice to four times thicker, so that the growth of the womb keeps pace with that of the child.

Changes immediately after confinement. Women as a rule, and their husbands also, are wofully ignorant of the condition of the womb just after confinement, and at this point it will be opportune to impart the necessary information illustrating that it is one of the most critical periods of the entire process, because the pelvic organs are again very sensitive, somewhat akin to the menstrual condition, namely, one of engorgement, or congestion.

After the child is in the world, the uterus usually contracts to about the size of a cocoanut; its measurements and weight as compared with what it was before pregnancy have materially increased.

The diameter is now about four inches, and its weight a little over two pounds. If we now stop to reflect that its weight was formerly an ounce to an ounce and a half, to which size and weight it must again return, we can readily appreciate the important changes that must take place to accomplish this object. The scientific world has only learned how this is effected within the last thirty years. It was a very important discovery. The superfluous or excessive tissues are converted into fat—the process is called fatty degeneration—and as fat the tissues are absorbed into the blood and disposed of, and thus gradually is the superabundant substance removed, until its measurements are as they were formerly and its weight as it was before.

Involution is the name given to this process by medical writers. It signifies a rolling back of the size and substance of the womb to where it was before pregnancy. It is the physiological activity in the tissues of the organ to restore it to its former size and healthfulness. The time usually required for nature to accomplish this remodeling varies in different individuals from six weeks to three months.

Subinvolution is a term employed to designate a partial or complete cessation of this restorative action. The prefix sub means always under; in this case the same thing is meant, under-involution or incomplete involution.

When, in six weeks to three months after confinement, the womb has not returned to its previous healthy size, weight and state, or if the enlargement of the womb incident to pregnancy lasts longer than already specified, we have the disease termed subinvolution. It generally becomes complicated with inflammation of either the cavity of the womb or of its entire substance, and often the inflammation extends to all the other organs and tissues in the pelvis.

Indiscretion in getting up too soon may cause this state of affairs. Taking cold and excessive exertion should be guarded against.

A mother who has just been delivered must gradually feel her way as to how much and what she may or can do without jeopardizing her recovery. Pains in the pelvis, back, and thighs, or a heavy, dragging sensation after getting up, indicate a subinvolution. These symptoms should be attended to, because the longer they last the more obstinate the disease becomes.

Lying on the back after confinement for ten or twelve days is not only injurious but an unnecessary hardship for every mother. It is one of the most fruitful causes of an abnormal position or falling back of the womb, and very often this excites diseases which greatly complicate the improper location of the organ.

Retroversion and retroflexion of the womb will be considered more minutely later on. It is generally caused by this common error of nurses and physicians, who allow the delivered woman to lie and often insist on her lying on the back. Thus the womb gradually sinks backwards, instead of falling forwards, where it belongs: see Plate IV.

Women will not generally feel that anything is wrong until some time after they are up and around. The first few weeks or months after confinement, persons are inclined to attribute their weakness, pains in the back or thighs, and other disagreeable sensations, to the natural consequences of what they have gone through. But after weeks roll into months, and their former strength and health do not return, then they seek the advice of a doctor, who will disclose to them the cause of their suffering. This can be avoided every time by changing the positions of lying, from one side to the other, and from the back to the stomach for a change; then naturally the womb will gradually resume its normal position, which is inclined forward and rests with its body over and on the bladder. All of these displacements should receive early and prompt attention.

Antiseptic precautions. Only a few years ago this phrase was entirely unknown. It originated with the modern antiseptic treatment of wounds, and from the domain of surgery it has been transplanted into the department of obstetrics, in which the application of antiseptic principles has achieved the most brilliant triumphs. From this conception has sprung the germ theory of disease, which is now, beyond doubt, an established fact.

I never can forget my first case of childbed fever. It is only fourteen years ago, and then there was as yet no one who could give a scientifically truthful interpretation of the disease. My patient was a young mother, who was being rapidly consumed by a fever, but beyond that science had not unlocked the causes lurking in the organism, which had doomed the young woman, on the threshold of motherhood, to a premature grave.

Thousands of lives were yearly destroyed by puerperal fever. Volumes of literature had been written on the subject, but as yet no one had deciphered its origin.

Now the whole scene has shifted; we know that the fever is essentially a blood poison, a septic infection of the patient, precisely similar to a wound infection anywhere else on the body. The act of parturition causes wounds or abrasions; these, then, place the woman in imminent danger of infection of every sort, and it is this infection which it is now possible to avoid. There is the greatest precaution necessary on her part and on the part of her attendants, that she be not contaminated by suspicious-looking finger nails, or dirty hands, or soiled linen, or unhealthy and unclean surroundings.

The German Government has a compulsory law for a system of antiseptic precautions, which is incumbent upon all who attend lying-in women. The importance of a rule to guide midwives and others in carrying out strictly antiseptic measures was recognized in that country some ten years ago, and the statistics show a remarkable diminution of diseases peculiar to the childbed period. The sources of these infectious micro-organisms are very different. They may be derived from the body of another person, sick or having died from an infectious disease, from suppurating wounds and even from the secretions of healthy lying-in patients. The patient or person herself may have improperly bathed or neglected cleanliness and ablutions, but the greatest danger arises from the neglected and unclean hands and sleeves of the midwives and physicians, and from the instruments usually employed under these circumstances, like forceps, catheters, or the nozzle of a syringe. The law above referred to requires all these instruments to be thoroughly scalded, washed, and brushed every time they have been used, and by such a complete system of disinfection, the chances of infection are reduced to the minimum. I hope some day our legislators will be wise enough to give us similar laws.

CHAPTER V.

UNCLEANLINESS AS A CAUSE OF DISEASES IN WOMEN.

The custom of washing and bathing has existed from the earliest times. Among the Egyptians it was a part of their religious worship. Among the Jews it formed part of the ceremony of purification prescribed by Moses. The Greeks considered it a sanitary expedient, and among the Romans it was instituted for similar purposes. All virtues when carried to extremes degenerate into folly or vice, so bathing in the days of the Roman Empire, became immoderate and degenerated into enervating luxury and unbridled debauchery, in which indiscriminate bathing of both sexes was one of the demoralizing features.

The bath was usually taken after exercise and before the principal meal, which rule holds good to-day, as the very best and proper time. The gorgeous splendor of the Thermæ, which was a palatial edifice constructed by Agrippa, was adorned with beautiful statues and fine paintings, while luxuriant green foliage of great variety formed enchanting bowers of fairy splendor. This was thronged by the Roman citizens for the pleasures of gymnastic exercises and bathing.

In those countries which have adopted the religion of the Arabian prophet, Mohammed, people bathe as a part of their devotions, and a religion which has for a part of its ritual the washing of the body, goes a great way towards cleansing the spirit.

Among the Northern nations the introduction of the bath dates back to the period of the Crusaders, although Tacitus speaks of the river bathing of the Germans, which was one of the strengthening methods employed by the early Saxons. That filth and dirt generate crime and moral depravity seems to be apparent, where squalid misery has dulled the sensitiveness to unwholesome surroundings.

Sanitary science has also demonstrated that filth is the most fruitful source of diseases that are called infectious, because their origin is due to germs of the lowest forms of vegetable life. The brightest page in the medical history of the nineteenth century is that which records the discovery of these micro-organisms as the cause of such diseases as septicæmia or blood poisoning, pyæmia, diphtheria, tuberculosis or consumption and others. All forms of fermentation and putrefaction are due to the presence of some germs, and upon this fact antiseptic surgery bases its scientific premises.

The germ theory of disease, like every new discovery, which supplants the accustomed and deeply-rooted theories of the speculative philosophers, met with opposition, criticism, ridicule and misconstruction, but the brilliant achievements of Lister and Koch have established its founders upon a pinnacle of fame, which promises to be an immortal monument to their genius, and not only in surgery has its beneficial influence been exerted, but the entire field of medicine has been enriched by the germ theory, which plays so formidable a part in the causation of many diseases.

The great boon that medical science will confer upon humanity, in the future, will not be so much in improved methods of treatment, as in the means and methods which medical science will devise for preventing disease. One ounce of prevention will always be worth a pound of cure. When we look back fifteen or twenty years, we must even now acknowledge that preventive medicine has accomplished greater results than curative measures, because the former can be made in the very nature of things absolute, while curative agents are only relative. Puerperal, or childbed fever, which is an infectious disease, was at times a pestilence, which destroyed women by the score, in maternity hospitals, or in certain neighborhoods, by the infection being carried by midwives or accoucheurs from house to house, yet no one had the least suspicion that it was possible to carry the germs of this disease under the fingernails of the attendant, or on the clothing or a syringe, or on some other little instrument, from one patient to another, and, indeed, there are a great many to-day who are practicing midwifery who are still ignorant of the importance of refined cleanliness.

But for this ignorance, there is no longer an excuse, because the infectiousness of this and other diseases is so positively established, and even the physical characteristics of the micro-organisms have become familiar to the microscopists. This knowledge of the causation of puerperal fever has been applied to the employment of preventive measures, so that this dreadful malady is becoming a rarity, particularly in countries where scrupulous care and cleanliness are enforced by governmental rules and regulations. I refer to this particular fever, because it is, to my mind, one of the most brilliant illustrations of the efficacy of preventive or antiseptic medicine.

There is a gynecological hygiene with which women should become familiar; it is based on the principle of antiseptic precautions applied to the daily lives of their sex. The object of this is to keep the body and reproductive organs that are exposed to contamination or infection from the outer world in the most refined and scrupulous cleanliness. The vaginal douche or syringe is as important an auxiliary to a refined woman’s toilet case as her tooth brush, because the cleanliness of the genitals is as essential to the preservation of health and comfort, as the possession of a sweet breath and the preservation of the teeth. I am therefore convinced of the hygienic value of familiarizing little children with washing or sponging their external genitals; in a few years this will have become second nature, and they are thus protected for all future time from contracting diseases which have their origin in personal uncleanness. It behooves mothers to avoid all delicacy on this subject, so that their little ones may grow up with the sentiment that to the pure in heart all things are pure. It is false modesty and ignorance which degenerate into vice and excesses; the scientific truth is always pure and holy, because it is based on reason, while abnormal delicacy is only emotional, and is quite likely to shoot into the other extreme, namely, licentiousness.

As the world grows wiser, the physiology of the reproductive organs should form a part of its wisdom, and in proportion to this knowledge, will their functions become questions of sense, instead of sentiment and nonsense.

The vagina is a membranous canal. It is situated in the cavity of the pelvis, below and behind the bladder, and in front and above the rectum. Its direction is curved from before backwards and a little upwards; its walls are flattened and ordinarily in contact with each other. Its length is about four inches along its anterior wall, and an inch or two longer along its posterior wall. In introducing a nozzle of a syringe it must always be remembered, that the tube is to be introduced directly backward on a horizontal plane with the body in the erect posture; by attempting to introduce it directly upwards, you meet with resistance from the anterior wall of the vagina.

In this cavity the secretion is susceptible of decomposition, owing to the accessibility of air laden with germs, which excite fermentation. A day or two after the cessation of the menstrual flow, there still lingers a little blood in the cavity of the vagina; this becoming infected with the germs in the vagina, a decomposition is the result, which is recognized by an offensive smell. The naturally soothing and harmless secretion is now changed into an acrid, irritating fluid, which not only may cause an inflammation of the membrane of the vagina, but also excoriate the skin at the orifice of the canal.

Leucorrhœa, or what is commonly called whites, is the most distressing symptom of this condition. In the course of months or in some instances a few years, the inflammation spreads from the vagina to the mouth and lining membrane of the uterus. Inflammation of the endometrium or lining of the womb will excite another complication, the so-called ulceration, but more correctly termed erosion. Who will deny the usefulness of any advice that will teach girls or women to avoid all these diseases? It is all contained in the simple phrase, Keep clean. Young girls must be taught by their mothers or guardians, not only the necessity of keeping the external genitals clean by daily ablutions, but a few days after menstruation, upon the slightest indication of offensiveness, she must resort to the employment of the vaginal douche or syringe, so as to wash out the seeds of disease, that are rapidly multiplying themselves, and if allowed to remain will entail the consequences to which I have already referred.

As an antiseptic wash, there is nothing so simple, efficacious and healing, as a solution of borax in previously boiled water, that has been allowed to cool to the proper temperature, which is between 103 and 106 degrees Fahr., one teaspoonful of the powdered article to the half gallon of water, to be used as a rinsing for each time.

Directions for administering vaginal douches will be given elsewhere. The proper time of the day for the employment of the wash is always at bedtime; and once or twice a week is quite often enough in the majority of instances.

Married women are more exposed to infectious contamination than single ones, because they are constantly liable to have infectious microbes introduced into the vagina during the ordinary course of marital relations. Men, as a rule, are neither cleanly nor careful in their habits, and approach their wives without any thought of serious consequences in their sexual relations. I had a married woman under treatment for an offensive discharge from her vagina which I traced to her husband, thence to a suppurating wound on his horse, which the husband had under his treatment. This can happen, of course, only through carelessness. By getting some of the matter or pus on the fingers, which incidentally contaminates his person, or not washing and brushing the finger nails, the husband may directly convey the infection to his wife, and thus inaugurate, unconsciously, an inflammation of the vagina, which becomes complicated, as the primary disease is neglected, leading to inflammation of the womb and ovaries, and often to abscesses, that compromise not only the health but the life of the sufferer.

To preclude the possibility of innocent infection, between husband and wife, there is only one means of prevention, and that is a careful toilet, which thoroughly cleanses the bodies in general and the genitals in particular.

Another fruitful source of disease of women, in this country and to an alarming extent in Europe, to which the elder Martin of Berlin called the attention of the profession over thirty years ago, is the specific or gonorrhœal infection of wives by their unfaithful husbands. The number of poor women whose health has been irretrievably ruined, by their husbands having had illicit relations with lewd, diseased women, is only known to those who have made this class of diseases a special object of inquiry. I have nothing to do with the moral aspect of this question, but only with the physical suffering that such men inflict upon their innocent wives and the mothers of their children, for the brief indulgence of libidinous pleasure. To think that any man would take the chances of making his wife a suffering and perhaps incurable invalid, just for the purpose of gratifying temporary animal passions, is to place him beneath the brute creation, which has not the intelligence to reason on the fearful consequences. No man who has been guilty of illicit relations should return to his wife until seven days have elapsed, and even not then until he has repeatedly washed himself by means of a syringe with some cleansing or disinfecting fluid, like borax water, or, what is preferable, a weak solution of the bichloride of mercury.

The wife and mother who entertains the slightest suspicion, must insist upon these precautions, and then not neglect to thoroughly wash and cleanse herself in the manner previously referred to. It is the height of hypocrisy to be mealy mouthed on this subject; the wives and mothers who are fortunate to have husbands beyond suspicion, should learn that some of their sisters have dangers to encounter and heartaches to suffer, with which their own lives are not marred, but perhaps the lives of their daughters may be; for the unhappy woman who becomes the wife of the blear-eyed sensualist, there is only one relief, and that is education in these subjects.

I know of no disease in which a correct and early diagnosis or recognition is of greater importance to avoid the frightful consequence and serious complications, than this one. It begins with a mild vaginal catarrh, which, when it is as yet locally confined to the vagina, can be easily cured. In course of time it spreads itself along the vaginal tract to the cavity of the womb. When it gets there, the treatment becomes more complicated, and for this reason; in order to reach the disease now, the cavity of the womb must be dilated, and this is an operation which the average physician can only accomplish in a bungling and imperfect manner. But even in this stage of the disease, in the hands of a skillful physician, the course of the disease can be checked and the patient readily cured. When the disease gets beyond the womb, when it invades the Fallopian tubes and the ovaries, the picture has entirely changed.

The organs affected are then inaccessible to local treatment, so that the disease invariably continues until the organs are more or less destroyed by inflammation, which results in the tissues breaking down into an abscess. In this stage of the disease it has become quite the fashion to operate in this class of cases, offering as an excuse a sure and speedy cure. Here I would interpose a word of warning to sufferers belonging to this class, not to be too willing to comply with surgical methods, because I know from careful observations, that promises of this nature end often in disappointment and death, while an intelligent conservative treatment can only disappoint but never kill, and with patience and perseverance in the application of electricity and hygienic rules of health, a cure is almost certain. The sick in body and mind are often beguiled into operations of a very serious nature, which are entirely unnecessary, because better results can be accomplished by other methods of cure, in which the possibility of a fatal termination is excluded.

Some women feel tired and languid from morning until night; they feel as tired in the morning when they get up as they were in the evening when they retired. If we tell them that it is entirely due to negligence of their own persons in not using vaginal washings regularly, they will undoubtedly feel surprised. In the great majority of these cases, this is owing to putrefactive changes going on in the cavity of the vagina. In the process of fermentative decomposition, the so-called ptomaines are developed; these are chemical poisons, which are absorbed into the blood, and by their depressing influences on the nervous system are the cause of the weakness and tired feeling. There are no remedies which, when taken into the stomach, will do the slightest good for this condition, and it is a waste of both time and money to expect relief from drugs.

This can easily be remedied by cleanliness, so that the secretions are not long enough retained in the vagina, to decompose and develop these ptomaine poisons.

During and after confinement is another important time for the employment of vaginal washes. The lochial discharge, which is one of the ordinary accompaniments of the newly-delivered woman, is a discharge from the uterus, which continues for several days, growing less and less, for a few weeks, when, in a normally healthy state of affairs, it should cease entirely. The lochia is the oozing from the mouths of the blood-vessels of the womb where the placenta or afterbirth was attached, together with the passing off of the old lining membrane of the womb, while the organ is returning to its original condition. At first the discharge is bloody, and it may retain this character for two or more days after delivery; then the color is changed, partaking more or less of a watery nature and presenting a yellowish hue; it then becomes whitish and ultimately ceases altogether. After the first four or five days the lochial discharge often becomes very offensive; this is a sign of putrescence or decomposition, and the only remedy in this, as in all other similar instances, is to wash the vagina thoroughly with borax water, or with a preparation for which a prescription will be given further on.

In every case of delivery, the mouth of the womb is more or less torn or lacerated; this is unavoidable, and it is generally harmless. One of the surgical humbugs is to sew or stitch, or attempt to stitch, these little harmless tears together, not of course for the good it will do the patient, because she is more likely to be injured by this meddlesome surgery, but to make a business and a fee. The common practice of these and kindred surgical expedients is one of the crying evils of an overcrowded profession which is trying to keep itself employed at all hazards.

The vagina also receives more or less injury during an ordinary confinement; if the midwife or the doctor is too meddlesome or in too big a hurry to get through, he will use the forceps, which simply means, to pull the child out and through the vagina, before nature has had time to dilate or stretch the parts sufficiently, to allow the child to pass through the maternal organs without injuring them. As a result of this brutal haste, frightful lacerations are incurred, which require immediate attention, but small lacerations heal without any further treatment than to keep clean.

After every confinement there is considerable sore or raw surface, with which the offensive discharge comes in contact, to become readily absorbed or taken up into the system, giving rise to fevers or inflammations of the womb and other pelvic organs. If one has a wound on any part of the body, the first thought would, or rather should, be to keep it clean; exactly the same treatment is required for wounds of the womb and vagina.

When the discharge becomes offensive, it also becomes dangerous and poisonous, and the only and proper thing to do is to thoroughly wash out the entire vaginal cavity until all offensive smell has disappeared. The only sure sign that anyone can have of the completeness and thoroughness of the vaginal washings, is that there is no longer any fetid or offensive smell perceptible.

It requires no particularly trained nurse or expert to administer a cleansing vaginal injection, yet it is more likely to be done in a bungling, inefficient manner than in a proper workmanlike manner; for this reason, it would be well to remember a few of the necessary details of carrying out the douching. In the first place, the room in which the vaginal douche is administered must be comfortably warm, so as to preclude the possibility of chilling the patient; the windows or any other opening liable to cause draft must be closed. The nozzle of the syringe, whether it be a fountain or a family syringe, must have been thoroughly brushed and cleansed with soap water, before and after each use; if the instrument is old, or has been used for questionable purposes, or, perchance, made the rounds of the neighborhood, it had better be thrown into the ash barrel, and an entirely new syringe, the “Alpha,” be employed, which, by its sure and continuous stream, I consider the most suitable female syringe. The bulb of a syringe must be compressed in the palm of the hand slowly and deliberately.

The position of the patient is of considerable importance; a vessel is placed under her, which is carefully adjusted, so as not to tip too far backwards, otherwise it will overflow and drench the bed or the patient’s clothing. Beneath the small of her back a few extra pillows are placed, and thus she comfortably reclines on her back, while the attendant manages the disinfecting wash and syringe, placed in a basin between her thighs. Half a gallon of the fluid is usually sufficient. The temperature of the wash is very important and may range between 103 and 106 degrees Fahrenheit.

The recumbent position is only intended for women who are confined to their beds; others, who are around and about on their feet, can sit comfortably over a chamber, on the edge of a low chair, having the vessel underneath them, and the wash of course in a separate basin. In the course of my experience I have been called to mothers, five to eight days after delivery, who were in a raging fever, presumably from the ptomaines which had developed in the vagina and poisoned the blood. After a few vaginal injections, sometimes after the first, the fever subsided entirely. These remarkable results we owe to the antiseptic treatment of disease, and when it once becomes generally known that this is only another word for cleanliness, infectious diseases will grow correspondingly less, and the cure for those that exist will be less experimental and more reliable.

CHAPTER VI.

MARITAL EXCESSES AND PREVENTION OF CONCEPTION.

In a previous chapter, the physiology of conception was explained, and it was shown to be an organic function, independent of and remote from the sexual act, and over which the parties to the act have no control. From this scientific statement of the actual fact, it becomes at once apparent that conception or pregnancy may result without natural sexual congress, by simply injecting the sperm of the male, by means of a uterine syringe, into the womb of the female, while she is in a state of unconsciousness. It is also quite probable that a criminal conspiracy of this nature could be carried out, without any violation to the delicate anatomy that is involved in the natural process; a detailed account of all the probabilities which the ingenuity of a scientifically-trained mind could devise, belongs more properly to the department of medical jurisprudence. It is, however, of sufficient general importance that the reader should have at least an idea of the door that has been unlocked through physiological researches.

What we are at present endeavoring to make clear is, the great distinction and difference between coition and fecundation or conception; while one is but the result of the natural instinct aroused by the senses, the other reaches out into the realm of the Creator. When man undertakes to destroy the product of conception, he has interfered with the prerogative of God and is guilty of murder.

The question may now naturally arise in the minds of pure and morally-disposed persons, whether there is any time, without doing violence to God’s law, that the children of men have the moral right to control, or regulate, the procreation of the human race? If I answer the question in the affirmative, I will then proceed to inquire into the ways and means to that end, and also into the pernicious methods that are employed, to accomplish this result.

It is true, that the Divine command was to be fruitful and multiply, but before this command was given, man was a free agent and a reasoning being, which implies that he is after all to be the judge as to the degree in which this command is to be carried out. That is, that there are mitigating and qualifying circumstances, which man has not only a right to consider, but which he is expected to take into account in propagating the species, by virtue of his reasoning faculties.

If this command were absolute and universal, chaste celibacy would be a cardinal sin, yet it has always been held by the canons of spiritual growth and morality, to be a Divine virtue, and even the loving Jesus knew not woman, because the forces that are thus expended will exert their power in other directions and towards developing powers of a higher order.

I believe that a moral code, which is too exacting to be observed by the average person, fails to accomplish the restraint or reform that is desired, so that, after all, it becomes essential to lay down such rules as the average men or women can follow as guides for their actions. A reformer, who starts out with the broad declaration that it is immoral to take human life, and a murderous act to destroy a half-formed human being in its mother’s womb, and that it is equally murderous to prevent the recent products of the sexual act from becoming a viable being, fails to make the impression he desires. The first half of the proposition neutralizes the second of its sacred essence, in placing on the same level the organic function of conception and the animal function of the sexual act.

This view is so manifestly absurd to the person of even ordinary perception, that I feel assured, that it would neither lessen feticide nor sexual excess.

Spermatozoa on the one hand, and the ova of the female on the other, are, even in the natural and uninterrupted course of nature, destined for destruction, for whenever the female menstruates, these ova are discharged, and whenever the male copulates, hundreds of spermatozoa are found swimming in the spermatic fluid, which in case there be no ripened ovum are nothing more than so much waste secretion. Both are a means to an end, and that end is the reproduction of the species. It appears to me a flight of fancy, from the sublime to the ridiculous, to assign to the sexual act the same importance as to the passive function of conception, and I believe that doctrines of this nature lack not only the least scientific support, but weaken any argument in favor of the moral or spiritual aspect, which alone raises the question of feticide from a social evil to a mortal sin.

Man is prompted by a powerful instinctive desire for the use of the sexual organs, that draws him involuntarily to the opposite sex, not for the continuance of the race, because the passion arises much oftener without the remotest thoughts of any fruitful results. I have the greatest regard for the life of the unborn child, yet I am far from agreeing with those who would stamp as libidinous every thought of the sexual instinct, that has not as its stimulus the procreation of the species. While the average man is in the flesh, he is an animal man, and there is no use of trying to make a spiritual saint out of flesh and blood, and when we do find that, we have a very exceptional and remarkable person. But what, as reasonable beings, we should do, is to bridle the animal passions with moral reins, so that we can stand up, in full-statured manhood, with the respectful approval of our own conscience, able to rise above the mere animal appetites, to the dignity of reasonable beings. This instinct, like other propensities, is excited by sensations, and these may originate either in the sexual organs themselves, or may be excited through the organs of special sense. In man the passion is most powerfully aroused by impressions conveyed through the sight or the touch. It often happens that localized sensations will excite the sexual desire of either sex, so that many cases of excessive sexual desire can be traced to some local disease of the genital apparatus: chief among the numerous causes that may be cited, is pruritus or local itch, erythema and active congestion of the womb and ovaries.

“This tendency cannot be regarded,” says Dr. Carpenter, “as a simple passion or emotion, since it is the result of the combined operations of the reason, the imagination, and the moral feelings: it is in this engraftment of the physical or spiritual attachment upon the more corporeal instinct, that a difference exists between the sexual relations of man and those of the lower animals. In proportion as the human being makes the temporary gratification of the mere sexual appetites his chief object, and overlooks the happiness arising from spiritual communion, which is not only purer but more permanent, and of which a renewal may be anticipated in another world,—does he degrade himself to a level with the brutes that perish. Yet how lamentably frequent is this degradation.” This quotation gives the entire physical and spiritual aspect of the question, by one of the most eminent physiologists of our time, so that in the natural course of our investigation we are led to inquire into the currents of thought, which would tend towards developing moral restraint.

Moral restraint means the restraint of the animal man by his spiritual or higher self; the will must possess its due predominance to exercise its determining power in curbing the passions of the one, and directing the course of the thought in the other.

The cold, calculating materialist, whose ideal is circumscribed by the laws that have been deduced from the phenomena of the material world, can scarcely appreciate the higher sentiments that are involved in this investigation, unless he becomes changed in thought and feeling to the things that are about him. To accomplish this result is hardly within the scope of this work. With the average man as we find him, my observation has taught me that it makes, after all, little difference, whether he believes in a spiritual nature or is avowedly materialistic. The great majority of men and women live, so to say, in the turbulent waters of their own passions, wafted hither and thither by the impulses of emotional excitement and instinctive desires. There is little or no hope for reform, if they have not sufficient force of character to cry halt, and stop to think a little upon questions which are to them of the greatest importance.

Marital excesses are the mainspring of so much disease, that ordinarily is attributed to quite different causes, that this chapter would be very deficient were I to omit to call the attention of my readers to this fact. The men on the whole are oftener the victims of the ill effects of unbridled lust than the women, which shows itself by violent and uncontrollable temper, in the one case, and stupid docility in the other: by a lean, hungry, nervous appearance, or a brutish, sanguineous obesity; extremes of the different temperaments and habits are but the natural outgrowth of the constitution inherent in each individual case.

Women, as a rule, are more passive, less amorous and more chaste in thought and feeling than men, and if we define emotion as an idea associated with pleasurable or painful feelings, women are, as far as appertains to their sexual nature, contrary to the generally-accepted opinion, much less emotional than men. Continence, among the unmarried women, is the rule, while among the men it is the rare exception; this is because her will is by nature stronger, while her reason is weaker, she intuitively arrives at conclusions that are her guide and saviour.

It is a prevalent idea among men that the marriage ceremony removes all restraint from the exercise of the sexual function; this not only neutralizes and destroys all sentiment of true love, which seeks for the happiness of the object it loves, but breeds hatred and contempt. To be permanently happy and mutually respectful, there must be love beyond the pleasure of gratifying the mere sexual instinct, there must be love in the realm of thought and a spiritual communion above the instincts of the flesh.

“Any warning against sexual dangers,” says Dr. Acton, “would be very incomplete if it did not extend to the excesses so often committed by married persons in ignorance of their ill effects. Too frequent emissions of the seminal fluid, and too frequent excitement of the nervous system, are in themselves most destructive. The result is the same within the marriage bond as without it. The married man and woman who think that because they are married, they can commit no excesses, however often the act of sexual congress is repeated, will suffer as certainly and as seriously as the unmarried debauchee, who acts on the same principle in his indulgences—perhaps more certainly, from their very ignorance, and from their not taking those precautions and following those rules which a career of vice is apt to teach the sensualist. Many a man has, until his marriage, lived a most continent life; so has his wife. As soon as they are wedded, intercourse is indulged in night after night, neither party having an idea that these repeated sexual acts are excesses which the system of neither can bear, and which to the man, at least, is absolute ruin and to the woman a source of disease. The practice is continued till health is impaired, sometimes permanently, and when a patient is at last obliged to seek medical advice, he is thunderstruck at learning that his sufferings arise from excesses unwittingly committed. Married people appear to think that connection may be repeated as regularly and almost as often as their meals. Till they are told of their danger, the idea never enters their heads that they are guilty of great and almost criminal excess; nor is this to be wondered at, since the possibility of such a cause of disease is seldom hinted at by the medical man they consult. Some go so far as to believe that indulgence may increase these powers, just as gymnastic exercises augment the force of the muscles. This is a popular error, and requires correction. Such patients should be told that the shock to the system, each time connection is indulged in, is very powerful, and that the expenditure of seminal fluid must be particularly injurious to organs previously debilitated. It is by this and similar excesses that premature old age and complaints of the generative organs are brought on.”

Wives of men of great vital force are not long before they become delicate, sickly and nervous, and, entirely ignorant of the real cause Of their feebleness, seek relief by taking “a good iron tonic,” which does them about as much good as if they had left it alone, the tonic effect of iron being entirely overestimated, but the delusion is created by associating the word iron with the idea strength. After the different tonics have been tried, the patient consults a physician, who, on general principles and after a hasty examination, informs her that she has “womb disease.” These two words for the time being settle the question; she now begins “to doctor,” and from the general or family doctor she finds her way to the female specialists, who, as a rule, belong to the recognized magnifiers and humbugs of the day. Here she becomes one of the regular habitues of the specialist’s waiting room, disappointed and not a little discouraged. She makes the rounds of the most prominent of them, until she has been doctored out of her dear patience and her still dearer money. Hope is often a forlorn consolation, and if by chance she now takes a trip to the country or undertakes a long visit at some distance, to her folks, which gives the poor woman respite from the “marital rights” of her Lord and Master, she recovers her former health, strength and buoyancy. Of course everybody congratulates her upon the wonderful effect of the climate, when the climate had no more to do with her recovery than the moon. The remarkable change was owing to having been let alone by husband and doctor.

That the attempt to call attention to these flagrant abuses of the dishonesty and ignorance of the one and the blind animal instinct of the other will be decried and stigmatized as “cranky,” I know beforehand, but I know also, that those who criticise these sentiments are fully convinced of the truth of the statement. The diseases that belong to this class are, like most uterine diseases, of an inflammatory nature, and for that reason rest is one of the most essential features in the treatment. But as this class belongs to the avoidable causes, prevention is much better than cure. I therefore advise, as of first importance, to abandon the American custom of man and wife occupying the same bed, which is only customary among the poorer classes of Europe, who cannot afford to have separate beds or chambers. The advantage of the European custom in segregating one’s self on retirement, to avoid the sexual instincts being unduly excited, can be borne out by remembering the physiology of the instinct, which we were told is excited by sight and feeling. Besides these, there is the possible undue familiarity, which the joint occupancy of the chamber or bed of man and wife may engender, and that, too, is likely to lead to excessive relations.

All efforts to exercise voluntary control, by prolonging the sexual act or extending the venereal orgasm, are fraught with the most pernicious results to the nerves, terminating in a partial or complete paralysis of the different organs of the body, or a low grade of inflammation is excited, which offers a fruitful soil for the development of various diseases.

A man who has become the husband of a woman should never cease to be a gentleman on that account, nor should he become lost to a consideration of those delicacies of refinement, which smooth the common relations in the exercise of daily duties.

Continence is the complete restraint from sexual indulgence, which in its fullest sense does not apply to the married state, but it comes within the scope of every married life to cultivate and practice it as one of its virtues. Every married couple should be continent for days and weeks at a time, and when one or the other is not feeling well, abstinence should be practiced, as the rule, not only to avoid a nervous shock, which may have serious results, but because conception in an abnormal physical condition, will perpetuate itself in the child, which is quite likely to inherit a nervous or sickly constitution. When pregnancy supervenes, undue sexual excitement of the mother often has the most serious consequences to the fetus, and may result in its death, or induce abortion.

Diet is to be regulated, to assist a firm determination to lead a chaste and purer life. Stimulating and highly-seasoned food, and alcoholic beverages, are not to be used, because they increase the circulation of the blood and stimulate the nerves to inflammatory activity. Meat should be eaten only once a day, and the supper should be bland and light.

Nature has set a time during which continence should be practiced for the purpose of preserving the health and controlling the reproductive function, that is, the menstrual period. Menstruation in women corresponds to the ripening and discharge of the human ovule. The aptitude for impregnation is a day or two before and six to eight days after the courses cease. This is a rule which applies to the great majority of women, and if the sexual relations are suspended from a few days before the onset of the menses until six or eight days after the flow has ceased, the chances for pregnancy are reduced to the minimum. This physiological relation of the organic function of conception to the sexual act is to be recommended as the most wholesome check to reproduction in early married life, although I believe that there is no time better calculated to raise a family than while you are young and hopeful.

Children are common objects of love and hope for both parents. Life and health are ever changing the relations of our surroundings, and when newly-married people put off to the dim future the hopes of rearing a family, they are often doomed to everlasting disappointment. Nature is capricious and jealous of her prerogatives, and those who trifle with her functions must expect to be frustrated in the end, and have no one but themselves to blame if she fails to respond to their capricious wishes. Children make trouble of course, so were we as troublesome in our time, but there is also a great deal of pleasure in watching them grow from day to day in bodily strength and mental perception, which no amount of selfish enjoyment can compensate.

The diseases that are brought upon women by the different practices and mechanical devices to prevent conception are too numerous to mention in a work of this character. Some of the methods are absolutely loathesome to all sense of decency and reduce sexual intercourse much below the instinctive indulgence of the brute; these debauches of the conjugal bed not only sap the vitality of the participants, but must lower or destroy all mutual respect, and ultimate in dissension and strife, which the divorce court will finally assuage.

Referring to the practice of conjugal onanism or interrupted or incomplete coitus, Dr. Franklin Devay says: “However, it is not difficult to conceive the degree of perturbation that a like practice should exert upon the genital system of woman by provoking desires which are not gratified; a profound stimulation is felt through the entire apparatus; the uterus, Fallopian tubes and ovaries enter into a state of orgasm, a storm which is not appeased by the natural crisis; a nervous super-excitation persists. There occurs, then, what would take place if, presenting food to a famished man, one should snatch it from his mouth after having thus violently excited his appetite. The sensibilities of the womb and the entire reproductive system are teased for no purpose. It is to this cause, too often repeated, that we should attribute the multiple neuroses, those strange affections which originate in the genital system of women. Our conviction respecting them is based upon a great number of observations. Furthermore, the normal relations existing between the married couple undergo unfortunate changes; this affection, formed upon reciprocal esteem, is little by little effaced by the repetition of an act which pollutes the marriage bed; from thence proceed certain hard feelings, certain deep impressions, which, gradually growing, eventuate in the scandalous ruptures of which the community rarely know the real motive.” This is in every respect as hurtful as the vicious practice of solitary vice, although that is comparatively less common among young virgins than among those of the opposite sex. Nevertheless, this is a frequent cause of hysterical symptoms and uterine disease. Stop it at once; there is no burden that a large family of children can impose upon you, be it even poverty and want, as great as the inevitable results of these unnatural habits.

The use of caps or tissue coverings, made of thin rubber or gold-beater’s skin, are not only suggestive of the licentiousness of the brothel but their employment causes physical lesions from their irritating friction to the walls of the vagina. I have had under my treatment obstinate ulcerations of the vagina which were due to their use, and in one instance it degenerated into cancer. The use of the “womb veil,” which originated in France, has been denounced as a fruitful source of ulceration of the womb, by modern French writers, who are more familiar with their indiscriminate employment than Americans. There has been also a plug or stem pessary employed for the purpose “of sealing up the womb,” which is partly introduced into the mouth and cervical canal of the organ; this obviously adds insult to injury, by also irritating the cavity of the womb and exciting inflammation of its lining membrane. There are other devices for a similar purpose, that have the same tendency of irritating and wounding the genitals of the female.

There is nothing that could be said, to intimidate some women, by forewarning them of the danger of their preventive measures; they will continue to make business for the specialists, and drain the purses of their husbands, but there is a great majority of good, noble, matronly women who are pure in heart and mind, that appreciate the value of the information that I impart. What I desire to further suggest, is a preventive measure that is entirely harmless and consistent with chastity and cleanliness, for I believe that within certain bounds, a woman has a moral right to limit or control the conception of her womb. But right here the option ceases. If she pushes her measures beyond the portals of the womb, if she employs medicines or mechanical devices to bring around her courses, when she suspects pregnancy or conception, she becomes a murderess in the eyes of the Creator. The bowl of tanzy tea, or any of the many quack nostrums, advertised in the public prints, are as much an instrument of murder as the probe of the abortionist. It would be the height of sophistry to make a distinction between the embryo of an hour or a day old, and that of any future period. The potentiality of a human being is established at the moment of conception, and the destruction of this, at any period, is homicide. No one can deny less importance to the cause, which is conception, than to the effect, which is the human embryo, for without the one, the other is impossible.

Hence, not to bear a child implies not to conceive a child, for if once conceived, it must be born.

The reasons that may exist for limiting the progeny of each particular pair cannot be formulated into a code, for these are questions of conscience, between the individuals and their Creator, on the one hand, and on the other, they should be influenced by economic conditions and physical or constitutional taints of the progenitors. I do not believe in the truth of the law of Malthus, that there is a tendency for population to increase faster than the means of subsistence, but I am inclined to the view held by John Stuart Mill, that “no one has a right to bring children into life to be supported by other people.” But when the same eminent authority designates the procreative act as brute instinct, I think he is in great error, for that is not so. Conjugal affection and the sentiment of love spring from the reproductive systems, through the reflex action of the brain, and these have their moral significance, and should not be branded as brutal, for upon their normal functions depends the perpetuation of the race, and as it was so ordained by the Creator, it cannot be an unholy passion.

To be physically strong and well are the prerequisites for happiness, and if we cannot transmit to our offspring this essential quality, it would be much better for society if we were not instrumental in bringing defective children into the world. The competitive struggle for existence is hard enough for the vigorous and robust; how much greater must it be for the constitutionally infirm? When these conditions of infirmity exist, they should influence our course as progenitors; this appears to me self-evident, and I trust in the wisdom that is innate to the human soul, that only the best ends will be subserved.

An expedient that is to accomplish the object in view, must be in the nature of a wholesome sanitary measure, that violates no law of nature. The inordinate use of any preventive, coupled with excessive indulgence, cannot be without ill effects. Excesses must be studiously avoided, so as not to incur the diseases of which mention has already been made. The employment of a vaginal douche of the proper temperature, medicated with a little pure alcohol, is not injurious and is the most reliable of all preventives, provided it is intelligently used and without delay. The quantity of fluid to be used is a quart of warm water, of 103 to 105 degrees Fahr., to which two tablespoonfuls of alcohol is added; of this, three-fourths or all is to be douched through the vagina.

The vaginal irrigation is to be undertaken immediately after the act; if sufficient time is allowed to pass, the spermatozoa will have entered the mouth of the womb; then they are clearly beyond the reach of the wash. The warm water and the necessary paraphernalia are to be held in readiness so as to lose no time in making the toilet, nor should there be unnecessary exposure to the danger of catching cold. The nozzle of the syringe should always be of hard rubber, because that is not likely to rust or corrode. The syringe is to be kept scrupulously clean by means of occasional brushings in soapy water. Vaginal injections should never be taken in the morning, if the person is required to exercise on her feet, and for the same reason, should any husband have marital relations with his wife before rising in the morning, the wife is likely to suffer all day, either by soreness or pain or by a dragging sensation of the womb and vagina.

The same rule is to be followed in vaginal irrigation as for other purposes, the main point being to throw the fluid well up into the vagina, and that can only be done if the nozzle is carried directly backward and not upwards. No violence or force is to be used, under any circumstance.

CHAPTER VII.

CRIMINAL ABORTION OR FETICIDE.

I have so far endeavored to give a cursory description of avoidable causes, which were inadvertantly or thoughtlessly encouraged, and it is to be hoped that my friendly reproof and counsel will incite my readers to modify their pernicious habits and direct the currents of their thoughts into channels more or less in harmony with the hygiene that I have been at liberty to suggest.

There are few persons, if any, who would voluntarily act and think in a manner that would be prejudicial to their physical or moral welfare, if they were educated to a standard of knowledge that gave them an insight into the evil consequences. The law of self-preservation is innate in our natures, so that we are ready to cultivate the good and useful and shun that which may do harm.

Among the avoidable causes there is none so prolific of disease as that which is traced to the premature expulsion of the ovum or fetus from the mother’s womb.

This appears self-evident, when we stop to consider that the function of reproduction is at once by far the most complicated of the physiological processes of the female economy, so that its sudden interruption will naturally induce any one or all of the physical or pelvic ailments which we are called upon to discuss.

For our purpose it will not be sufficient to consider the subject from a medical standpoint alone, because the thoughts drift involuntarily, as it were, from the physical into the metaphysical, from the material into the spiritual part of our nature.

It is not within the scope of this work to enter upon an inquiry into the scientific evidence of the existence of the soul or advance any argument whatever in support of that doctrine, but I assume the existence of an immortal soul to be a fact.

What I will endeavor to explain is when and where this mystic union of the soul with the body takes place? Here the speculations of the medical philosophers have been contradictory, on account of attributing to the fetus different kinds of life, that is, an organic or vegetating existence attached to the mother’s womb, and as such not possessed of sentient principle, until the real or spiritual life imbues the fetus, when it becomes a living soul.

Hippocrates, the most famous physician of antiquity, who, even in the light of the nineteenth century, looms up as one of the most brilliant intellects that the world ever had, lent the weight of his judgment to this very unreasonable doctrine.

He supposed that animation occurred from thirty to forty-two days after conception.

The Stoics went still further and maintained that there was no vitality until after birth and the establishment of respiration.

The Academicians were of the opinion, that life was imparted to the fetus during the period in which the mother carried it in the womb, but they could not agree on the time when it began. Even the Roman Church, which, in the main, is right on this question, speaks of animate and inanimate fetuses. When it is remembered that there was no scientific physiology upon which the ancients based their opinions, it is not at all surprising that, in the light of modern research, they are shown to be all wrong.

There is no time during the child’s sojourn in the mother’s womb that life is less active than at another, and any opinion to the contrary is manifestly absurd and unscientific.

I appreciate the distinction between physical life, or vital activity, and spiritual life, but the one must necessarily be in the other.

A central fountain of physical force is consistent with scientific deductions, and physicists are inclined to admit such a source. Many of the phenomena of the material world are explained upon this hypothesis. The sun is supposed to be that central fountain of physical force which inspires activity in matter on this planet. Matter in itself is inert and motionless; the globe we inhabit has no energy in itself which could keep it in motion, but the forces playing on and around it impart to it its motive power.

The life of any complex organism, such as that of man, is in fact the aggregate of the vital activity of all its component parts, and each elementary part of the fabric has its own independent power of growth and development. If we contemplate the history of the life of a plant, we perceive that it grows from a germ or seed to a fabric, sometimes of gigantic size,—it multiplies its species, by the production of germs similar to that from which it originated. This it performs without feeling or thinking or any effort of its own. All the functions of which its life is composed are grouped together under the general designation of organic functions, or vegetative life.

In the building up of the animal structure we have precisely the same operations taking place, one minute cell added to the other, like the stone mason running up a brick wall, each brick representing a cell, until the structure is completed.

The question that we are particularly interested in is whether this “animal life” which stimulates the growth of the fetus from its first inception, can be any the less sacred at one time than at another?

There is a general impression among a large portion of the community that the fetus first becomes endowed with life at the period of quickening, which is between the fourth and fifth month of pregnancy. The time when the mother first feels the motion is considered the period when the child becomes animated, that is, when it receives its spiritual nature into union with its human nature.

The English law recognized the truth of this infamous doctrine, in varying the punishment of an attempt to procure abortion according to whether the woman be “quick with child or not,” and in delaying execution when a woman can be proved to be so, though the execution is made to proceed, if she be not “quick,” even if she be unquestionably pregnant. This was a most barbarous penal provision and hardly excusable in a savage nation, much less among a Christian people, because it is contrary to all fact, to all analogy, to reason, and at variance with biological science.

If the embryo or fetus is simply an animal growing in the mother’s womb, until the period of quickening or birth, it would not be a crime to procure an abortion, at any time, before these events take place. No sacrifice of a human life would be involved, so that the act would be simply a “misdemeanor” regulated by the degree of injury which the mother sustained as a result of the operation. This was the prevailing opinion for many centuries, until, in the year 692, the Roman Empire so amended its law that the procuring of an abortion at any time during the period of gestation was homicide, murder, to be punished with death.

France patterned after the Roman law for a time and made criminal abortion punishable by inflicting the death penalty; during the French revolution this law was amended by imprisonment for life; and later, under Napoleon, in 1810, the law was again changed, and the punishment lessened.

In England there has been a gradually growing moral sentiment to protect the defenseless child in its mother’s womb, so that to-day England has so amended her law that the fetus has the same protection in the uterus before as after quickening, so that a conviction for the procurement of criminal abortion at any time during gestation from conception until birth is felony and punished by imprisonment or transportation.

In Germany the law makes abortion a State prison offense, and public opinion is in such a healthy state there that anyone justly accused of this crime is quite sure to meet with a punishment.

In America legislation on this subject differs widely in the different States. In Massachusetts the barbarous distinction, “before quickening and after,” was still recognized a few years ago, so that the crime of abortion before quickening was not an indictable offense. In some of the States the laws are stringent and conform with the physiological facts of fetal life, but, like most of our “good laws,” they are. observed only in the breach.

The essential peculiarity in the process of reproduction is the absorption of a small cell of the male, the spermatozoon, by another small cell of the female, the ovum. This coalescence of the two, male and female cells, is the fertilization of the ovum, and constitutes conception.

The spermatic fluid of the male holds in suspension a large number of very small bodies, or cells, which, from their usually remaining in active motion for some time after they have quitted the human body, have been erroneously considered animalcules. A more thorough familiarity with these bodies, and careful microscopic examinations, can distinguish nothing in the nature of structure within them. They are simply little oval, flattened, transparent cells between the one-six-hundredth and one-eight-hundredth of an inch in length, having a little thread-like “tail,” gradually tapering to a fine point.

These measurements make the spermatozoa considerably larger than the average red blood-corpuscle, which is one-thirty-two-hundredths of an inch in diameter.

The spermatic fluid of a single emission of a healthy male contains thousands of these little ciliated cells, the cilia or tails of which are seen in an active vibratile undulatory motion, in the field of the microscope, wriggling hither and thither, like a school of frightened fishes. This lashing motion is continued for hours, and under favorable circumstances for days. In the cases of microscopical examinations of vaginal secretions of married women, for causes of sterility, I was able to establish their activity thirty-six hours after marital relations.

Through this peculiar lashing motion the ciliated cells are propelled onward and upward, through the mouth and cervix of the womb, thence along its body to the openings of the Fallopian tubes, along which they migrate to the ovaries of the female. In a healthy condition of the female generative organs, hundreds of spermatozoa arrive at the ovaries about the same time, a few hours or days after copulation, but as the ova ripen and are discharged only at regular intervals, the hundreds of ciliated bodies that travel thither are doomed to disappointment, and gradually lose their vitality, and perhaps are removed by absorption.

Of all these hundreds of germs it requires only a single one to combine with an ovum, or a similar little cell of the female, to constitute conception. When this combination has been accomplished, a new being is inaugurated, another human soul is started out, by the magic wand of nature, to go through the different spheres of evolution, of whose ultimatum we can have no clear conception, but this is perfectly clear, that after this coalescence of the two germs, the die is cast and the female becomes then only the vehicle in which the creative forces are effecting their elaboration.

Coition and conception are widely different processes, and require to be separately analyzed to be understood.

Coition is always a physical act, a gratification of the senses, and, like many other human passions, is often abused by excessive indulgence, degenerating into lust.

Conception, on the other hand, is purely passive, an organic function, without consciousness on the part of the female.

Thus far there is a similarity in the organic processes of conception in all mammalia, so that their embryos cannot be classified and assigned to their respective species in the early stages of their development. Physiologists are unable to say whether the one belongs to and will ultimately develop into a brute animal or a human being, yet one has the attributes of mental force, the elements of a soul, while the other is to follow a blind instinct, without the possibility of spiritual perception. Conception, in the one case, is simply a vegetative or organic function, while in the other there is, in addition, a spiritual effort to individualize a human soul.

The creative energy of nature is separate and independent of the sexual act, for it does not take place during copulation of the sexes, nor immediately after it, but hours or days after the act is accomplished.

I am often called upon to say when and where the human soul becomes associated with the human body?

There is a divine life, or spiritual energy, that animates the soul from the spiritual realm. It is the correspondency of the physical force that animates the physical body.

The term or phrase which I employ to designate this force is of less importance than the definition which is given to it, and upon this, of course, we must agree. I recognize in such an energy or power, the primal cause or force, behind and beyond the phenomena of nature. This force must be universal and omnipresent, hence spiritual; it must be the central source of supply for all spiritual things, so that the doctrine of Paul is scientifically in harmony with a rationalistic view of the subject, when he says “in Him we live and move and have our being.”

The science of the conservation of forces teaches, that forces are never lost, that they are indestructible and eternal. We derive our spiritual existence from this central spiritual sun and inherit the quality of eternity with it. Mind is spirit and the soul is mind; this is the view of Spinoza, who, in the second part of his work “Ethics,” employs the terms synonymously throughout the chapter “Of the Nature and Origin of the Mind or Soul.” Mind differentiates man from the inferior animal creations, and can make him what he will.

Professor Carpenter in his “Principles of Human Physiology,” tells us, that when we first discern the primordial cell, which is to evolve itself into the human organism, we can trace nothing that essentially distinguishes it from that which might give origin to any other form of organic structure. The earliest stages of its development consist in simple multiplication of cells by “duplicative subdivision,” so that a mass of cells comes to be produced, amidst the several components, of which no difference can be traced; and this also finds its parallel among the simpler organisms of both kingdoms. There is nothing at this period to distinguish the germs of man from that of any other vertebrated animal, yet in the course of nine short months a human being is developed possessing all the faculties of its progenitor, and how could all this come to pass, if not instituted at the moment of conception?

It is at this time and moment, that an atom of the universal spirit becomes separated and individualized, and the germ of a human soul is implanted, deep in the dark recesses of nature’s laboratory. The ovum of the female and the germ of the male coalesce, imbued by the incarnation of the immortal spirit, and no time can be more opportune for that union than at the very inception of our being, because the soul and the body must interact, one on the other.

In the reproduction of man, there is a higher purpose than simply to multiply the species. The Creator can only manifest Himself, if he has intelligent souls or spirits as his creatures, and the reproduction of the human species is the natural means of bringing this about.

The mystic union is accomplished at the time and moment of conception, when a unit of the universal spirit becomes individualized into a human soul. In the dark recesses of the mother’s womb the ovum of the female and the germ of the male, imbued by the immortal spirit, begin their growth and development together, this constitutes the triune of nature, from which the evolutions of body and soul take their beginning.

Sexual instinct is not an unholy and depraved action of the human mind, but the necessary means to an end, a finite instrumentality of the Divine mind to procreate the body, as an abode for the human soul. One of the attributes of the Creator is, in the very nature of things, to create, and he has thus endowed us, His creatures, for the manifestation of His creative power. He perpetually and eternally creates, and this has no reference to time, place or space: just as in the beginning, God created all things, so we recognize the supreme hand, now, to-day, and forever, ever active in His natural element.

The operation of nature’s law may be contravened by the selfish, sordid, criminal acts of the human heart, but it cannot be frustrated. No one can console himself, that the invincible law of evolution is at the capricious behest of finite man, and can be neutralized and obstructed at will; that would place a limitation on the Creator; it would contradict the omnipotence of the Divine mind; it would place every life or soul at the mercy of the sordid conscienceless abortionist, and it would reduce the Divine origin of man and the soul’s immortality to an absurdity.

After the fetus is murdered, its soul continues to grow in the spiritual realm, an undying witness of the criminal infamy which deprived it of that earthly experience which nature intended for the children of men. It is the greatest crime against nature to kill off a human fetus, and prematurely hurl into eternity a human soul, which has the same right to human experience as those already born, and, in the eyes of God, it is no less a crime than the murder of an adult.

“Dust thou art, to dust returnest,
Was not spoken of the soul.”

The meaning of the term abortion is etymologically not to be born or not to be carried out, or, in other words, the premature expulsion of the fetus from its mother’s womb, which is any time before it is capable of independent existence. This is according to the construction of the law of France, which means any time previous to the termination of the sixth month of pregnancy. Abortion may be accidental, that is, it may be due to a casualty which was entirely beyond the control of the person suffering or going through an abortion, or it may be due to disease affecting either the embryo or the mother.

The word “miscarriage” is generally preferred to that of “abortion” under the misconception that only the latter implies criminal culpability; this, of course, is an error, because each word means exactly the same thing, with this difference, that one is of Latin origin, while the other is a plain Anglo-Saxon term. An abortion that is brought about, from other than natural causes, for the deliberate and avowed purpose of escaping from the inconvenience, privation, and cares of maternity, is always qualified by the adjective criminal.

In the early months of pregnancy, it very seldom, though it occasionally does happen, that complications arise which place the life of the mother in imminent danger; that the embryo shares this danger in a corresponding degree is self-evident, because the fetus is unable to live independently of the mother any time before the expiration of the sixth month of gestation, so that the death of the mother means death to the fetus also.

Through a fall, heavy lifting, or a sudden jar, a partial detachment is liable to occur between the placenta of the fetus and the wall of the mother’s womb, that being the place where the blood of the one is exchanged into the blood of the other; from this, a hemorrhage may result, which will not yield to rest nor to other means which experience has taught to be useful. This loss of blood may be so great that, if it continues, the life of both will be sacrificed.

In some women pregnancy may become complicated with convulsions; these may be so violent, and recur so often, as to threaten life, and they are obstinate to all medicinal resources.

Contingencies of the above nature evoked the scientific inquiry, whether abortions are ever justifiable. The answer must invariably be, that when it is clearly seen that the mother will surely die, and her fetus with her, an induced abortion becomes a justifiable obstetric resource, and under these circumstances it is not a crime nor even a sacrifice of the embryo, which would have perished with the mother.

This rule of practice has been endorsed by the very highest authority in obstetric science, and the competent conscientious physician will readily draw the line between cases where so radical a measure becomes necessary, and where milder conservative measures will save the life of both mother and child.

This cannot be a license for crime, except that the sordidly depraved time server may often try to stretch the threatening danger, but when this is done it is no less a crime of murder in the eyes of God, than if he had premeditatedly and willfully slain a fellow-being.

Such persons would not shrink from the perpetration of any crime, be it ever so heinous and black. These wretches are too cowardly to thrust a poniard into their victims on the highway, but ever ready to operate in secrecy in the abortion chamber, which is hidden from the eyes of man. I have known abortions being sought and abortions being committed, upon the flimsy pretext of being too weak, or too sick at the stomach. These are shallow subterfuges, that should not be countenanced by any conscientious practitioner.

Many reasons are either imaginary or pretended, and I have often proved the fallacy of pretensions of an inability to carry a child, after women had gone through the abortion mills, by persuading them to become reconciled, for the time being, and that I would see them through to a happy end, and in no case were their fears justified by subsequent developments. There is a great deal in controlling the minds of these women, and directing them into wholesome channels of thought, and after that they become much happier and contented than ever before in their married lives.

If the proposition is generally accepted, that abortions are justifiable as a therapeutical expedient, you open the door to the criminally inclined. Wily women will impose upon inexperienced practitioners by feigning physical suffering as a result of pregnancy, for the purpose of getting rid of their fetuses. There is a certain amount of hardship and discomfort associated with the average pregnancy for a part of the period at least, but this should be suffered with a mother’s fortitude.

The testimony of the early canons of the Catholic Church is very decisive on the crime of abortion, namely, “that the destruction of the fetus in the womb of its parent, at any period from the first moment of conception, is a crime equal in turpitude to murder.”

In Protestant countries abortions are on the increase, and in America it is one of the crying crimes of society, which has so thoroughly tainted and defiled the moral sense of American communities, that it has become next to impossible to get a jury of twelve men who will agree on a verdict to punish this dastardly foul crime of murder, and the abortionist is thus encouraged in his iniquitous vocation.

Professor J. Taber Johnson, of Maryland, stated in his annual oration before the State Medical Society: “The difficulty of conviction for producing abortion is shown in the statement of the Attorney-General of Massachusetts, that of thirty-two arrests and trials of abortionists in that State, in a period of eight years, not a single conviction resulted; and this fact is equally true of other States.” This is indeed a sad commentary on the jury system, which often degenerates into a farce or travesty on justice.

The practice of abortion is on the increase. This is not due to a single cause, but to a number, operating separately or co-operating jointly to the same end. Boarding-house or hotel life exercises a pernicious influence on the habits and morals of women. They sit all day in their apartments with indifferent occupations, or walk the streets between meal hours, without the inspiring thoughts which a cozy home alone can inspire. The maternal instinct languishes or dies completely out, and if women become pregnant while transiently domiciled, they scruple not against committing this great crime, because their surroundings and accommodations may not be suitable for the changed relations which motherhood brings about. If these people had their own little homes, were they ever so humble, their minds would run in different grooves, their lives would be much happier and offspring longingly desired, to fill the nooks in the little household.

Want of domestic training in childhood lays the foundation for this crime. The American girl is trained with a view to display so-called refined accomplishments. This is done by totally ignoring domestic duties; these are to be shunned as menial and degrading; and when girls grow into womanhood and are married, they naturally look upon the ordinary household duties as drudgery, and quite unbecoming a woman of their attainments. There is nothing in their bosoms to arouse a pride in their homes; quite the reverse; that principle has never been inculcated in their youth, so that it is quite natural, that they hie to a boarding-house; here they patronize the abortionist, or acquire proficiency in that art themselves, from lack of nobler occupation.

Changed relations of the sexes destroy the maternal instinct. A man in a man’s place, and a woman in the sphere for which God and nature intended her, is for the best interests of society. There is useful and profitable work for everyone, but each should labor in his or her respective field of natural adaptability, in which there is plenty to do. There is, in the very nature of things, never anything gained by a woman doing a man’s work, because there are always plenty of men around to do that, but while a woman is doing a man’s work, she is necessarily neglecting a woman’s, which it is physically impossible for any man to do for her. There is, consequently, an irretrievable loss to society from misapplied labor. When the great Napoleon was asked by Madam de Stael whom he considered the greatest woman in France, his curt reply was, “She who bore the largest number of children.” This is a tribute to motherhood, which no one can ridicule, for whom should we honor and respect more than the faithful, loving mother, who makes her life subservient to that of her children? There is no comparison between the self-denial of parental devotion and the devotee to amusements and fashion, or the slothful wife, who imposes sterility upon herself for the sake of pandering to depraved appetites and frivolous pleasures.

Depraved associates pave the way to feticide. Some married women are so brazen and callous, that they have no delicacy in narrating their exploits of child murder with a triumphant air, whenever their acquaintances are patient and foolish enough to listen to them. These gadding persons often contaminate the minds of newly-married women, who had never for a moment entertained the thought of such an awful crime, and who would have made happy and contented mothers, were it not for the seeds of discontent and crime which were sown in their early matrimonial career. I have known mothers who had lost the delicate maternal instincts, without which a mother becomes a monster, advise their daughters and encourage them in the perpetration of this crime.

Women of this type should be avoided like the dreaded mancanilla tree, for they poison the body and soul of pure, virtuous women, with whom they come in close contact; they should be shunned by the young housewife like a pestilence, because their hands are scarlet with the blood of their own children.

Unprincipled physicians are too often instrumental in abetting criminal abortions, and this for two reasons, namely, for the immediate lucre which is to them in hand paid, and also for ingratiating themselves into the confidence of their patrons, so that they may become their physician in other ailments. These are the pariahs of the profession, but, viewed from a business standpoint, they are very successful. It is through the looseness with which medical colleges are conducted in this country, many of them not deserving the name of college, but more properly denominated a rendezvous of self-constituted professors and ingenious advertising sharps, that the ranks of the profession are overcrowded, because there is no scrutiny of moral character or professional attainments. These once labeled M. D.’s are determined to make a professional living, and nothing deters them from becoming particeps criminis, but owing to the corrupt and depraved jury system such a thing as punishing a physician for feticide is hardly ever heard of. I would advise my readers to shun each and every one of these criminal monsters as they would a pestilence. In general, “female specialist” is but another name for abortionist, for the great majority of these self-constituted specialists do not know the rudiments of the science of gynecology; and women should exercise great precaution in whose hands they place themselves, or, rather, their lives. I know of no calling that is capable of rendering more good to humanity than the profession which I have made my own.

The honorable physician occupies a position where he can do a great deal to improve the tone and morality of the community. He can do more than the pulpit in preventing feticide, because he can depict the physical dangers and the moral turpitude, for it is to him that the deluded woman first goes for advice. It is with him to become an oracle of heaven; in the great majority of instances he can be instrumental in saving human life and prevent the mother from murdering her own child.

Maternity is the function of Divinity in human nature. Who can look upon a newly-born babe without seeing something truly Divine, a manifestation of the Divine mind to create in his image, through the instrumentality of man, an innocent human flower, planted upon this earth to enjoy the fullness thereof, and what miscreant shall deny it its inheritance?

That husbands are often the instigators of this crime is a fact well known to every physician of experience. I have known of a number of cases where wives came to my office with a woeful tale of discontent on the part of their husbands, who did not want an “increase.” Such men are not worthy the name of father or husband. They should have been emasculated before they ever approached the marriage altar, for they are below the brute creation and have no claim on human affections. The luxuries of life should not be considered as weighing against the birth of children, nor the expense of maintaining a large family considered as an excuse for feticide; expenses had better be reduced and economized in other directions, so as to meet the little extra increase, which the little stranger may cause. It is a fact, that among thrifty people, large families are no barrier to material success, for the blessedness of heaven rests upon them.

I invariably solicit an interview with the recalcitrant spouse, and take the opportunity to tell him of the responsibilities which married life imposes upon married couples; that the simple gratification of the carnal senses is lust, which can and should be controlled by every person, and more in particular by married men. Matrimonial relations based only on libidinous pleasure are transient and evanescent; incompatabilities arise, which cause conflict and dissension, ultimating in estrangement and divorces, but when soul is wedded to soul, then they are in harmony with the music of the spheres, and children constitute the cement of an eternal wedlock which no man can rend asunder.

Abrupt termination of pregnancy constitutes in itself a diseased process in the tissues of the womb. We have already learned of the gradual growth of the body of the womb to accommodate the growth of the child; when abortion takes place there is a sudden check to this growth in the tissues of the womb, and a low grade of inflammation invades the entire structure. This inflammatory process fixes or hardens the womb so that this acquired enlargement often becomes permanent. The result is, that women can often trace the beginning of a long series of complaints and a shattered constitution to a so-called miscarriage. For this reason, the after-treatment of an abortion is of much greater importance, than after a regular normal delivery.

After the close of a natural gestation, the child is born, and nature immediately sets to work to restore the womb to its healthy normal size. No violence having been done to the organ, there is no extra effort necessary on the part of nature to restore it. In a premature expulsion of the fetus, it is altogether different, the cell growth and the necessary physiological action to build up the womb, to house the rapidly-developing fetus, was suddenly interfered with, and the shock which the vital activity sustains, diverts their energies into a diseased process. Inflammation is to be guarded against, for it constitutes the root of all pathological conditions; chief among them is its prevention of fatty degeneration and absorption of the superfluous tissues of the organ, so that the womb remains heavy and enlarged. This entails a series of consequences; its size and weight may force it to occupy an unnatural and painful position, such as a falling of the womb or procidentia, or it may turn or even bend on itself into abnormal positions, called versions and flexions; these become obstinate to treatment in proportion to the time which elapses from the occurrence of the disease to the time when they fall under proper treatment.

Inflammations are limited sometimes to only portions of the organ; this may be to the lining mucous membrane of either the body or neck. It may also invade the entire organ and even extend to the neighboring tissues and ligaments. From the uterus along the Fallopian tubes to the ovaries inflammation may spread itself, causing abscesses in its wake and other complications which may require surgical skill of a special nature to give permanent relief.

Sterility is often the result of disease caused by abortion, and this should be another warning to thoughtless, giddy women, who desire no children in their early married life, because it would interfere with their regular pleasure rounds, and so resort to abortions, which will, in all probability, make them entirely unfit to ever become pregnant or bear children. I have made an attempt to impress on the reader two things; one of these is the flagrant violation of ordinary and simple rules of health, the other the enormity of the crime of induced abortions, and to accomplish this I have avoided screening the subject by employing ambiguous or finely-selected phrases, but have used plain terms which will not shock the pure or noble in heart and mind, but may the hypocritical, under the gauze of a false modesty.

The Bony Pelvis in its relation to the entire body.

From the author’s original drawing.

CHAPTER VIII.

ANATOMY OF THE FEMALE ORGANS.

The bony part of the skeleton which is of particular interest to women, is the pelvis, so called, because it forms a basin or cavity which contains the most important female organs of generation.

All the organs that are liable to the diseases of women, bear certain anatomical relations to the pelvis, so that the phrase, pelvic diseases of women, is often employed instead of the phrase, diseases of women, and pelvic surgery means also, surgical procedures, that may be employed for the relief or cure of these diseases.

In confinement, the pelvis again comes into more or less prominence, for when the diameters of the pelvic canal have not their normal measurements, there is likely to be an obstruction to the passage of the child into the world, so that mechanical means must be employed to overcome the obstacle. A broad pelvis in a woman is always a guarantee that there will be no insurmountable difficulty in the parturient act.

Plate I shows the shape and locality of the bone in the human body, and gives also an approximate idea of the relation of the pelvis to the rest of the body.

While the pelvis was referred to above as a basin or cavity, this is only partly true, for it is also a canal or passageway, through which the child is born. The pelvis is divided by a prominent line into the false and true pelvis.

The False Pelvis is all that expanded portion of the pelvic cavity which is above the rim or line that forms a circular ridge, which marks the beginning of the bony canal to which the term true pelvis is applied.

The True Pelvis constitutes the lower subdivision of the pelvic cavity. The circular ridge, which marks the division, constitutes also the inlet of the true pelvis, which is much smaller than the upper or false pelvis. Its walls are more perfect and their lower circumference is very irregular and forms what is called the outlet. Between the inlet and the outlet we have what is called the true pelvic cavity, in which the internal female generative organs are contained.

These organs are located in the following order from before backwards: first, behind the pubis there is the bladder, and behind this is the uterus, and thirdly and a little to the left is the rectum.

On each side of the womb, but also in the small or true pelvis, are the Fallopian tubes and ovaries.

In this order the anatomical relations are easily remembered, and I believe that every woman should make it an object to learn at least as much of her own anatomy as I have laid down; because there is just little enough, so as not to make it tiresome, and quite enough to insure intelligent reading in the subsequent chapters.

The points of differences between the male and female pelvis are entirely on the principle of adaptation to natural functions. The female pelvis has a broadness or greater prominence of the hips and a correspondingly greater pelvic cavity, while that of the male is altogether more massive.

Its cavity is deeper and narrower, and the muscular eminences and impressions on the surfaces of the bones are much stronger marked.

Plate II. This illustrates a cut or section, through the middle of the pelvis, from before backwards, so as to give a side view of the capacity of the true pelvis and of the organs that it contains. A careful study of this plate will permanently fix the anatomy in the reader’s mind.

A Median Section of the female Pelvis and of the Organs that are centrally located.

This plate is anatomically correct; the uterus resting normally on and being elevated by the distended bladder.

The lines a and b show the planes of the inlet and outlet of the true pelvis, and it will be seen that within these lines the most important organs of the female are located.

THE BLADDER.

The bladder is situated at the anterior part of the pelvis. It is in relation, in front with the symphysis pubis, behind with the womb, some convolutions of the small intestines being interposed; its base lies in contact with the neck of the uterus and with the anterior wall of the vagina. The bladder is said to be larger in the female than in the male, and is very broad in its transverse diameter.

THE URETHRA.

The urethra is a narrow membranous canal, about an inch and a half in length, extending from the neck of the bladder to the external orifice. It is placed beneath the symphysis pubis, embedded in the anterior wall of the vagina, and its direction is obliquely downwards and forwards. Its diameter, when undilated, is about a quarter of an inch; behind the bladder and urethra, there is in regular order the uterus and vagina, and behind both of these, the rectum.

THE PERINEUM.

The Perineum is the muscular triangular body between the vagina and rectum; it constitutes a segment of the female pelvic floor; it is the prop for all the pelvic organs, and for that reason every woman should know precisely what it is, and study the plate carefully until she understands it. The skin covering it is of a dark color, thin and freely movable over the underlying parts. There is no part of the pelvic anatomy so vulnerable, because in confinement during the passage of the child’s head into the world, the perineum is put on a great stretch, and if the delivery progresses too quickly or is hurried, then the tissues have no time to stretch themselves so as to accommodate the child’s head, and they must naturally tear.

The awkward and officious use of instruments will do the same thing. I have seen the perineum torn asunder from this cause, from the vagina and back into the rectum.

Plate III is one of the most instructive drawings that I could devise. It gives the reader a practical illustration of the internal generative organs and their anatomical relations to each other. This was a drawing from my own dissection, and the clearness and artistic reproduction is due to the skill of the engraver, Mr. H. X. Van de Casteele, of this city.

THE VAGINA.

The vagina is a membranous canal, extending from the vulva or introitus to the uterus. It is situated in the cavity of the pelvis, between the bladder in front and the rectum behind; its direction is not in a straight line, but curved from below backwards and upwards. When distended it is cylindrical in shape, but naturally it is flattened from before backwards, so that its walls are ordinarily in contact with each other. In length it averages about four inches in its anterior wall, while its posterior wall describes a segment of a larger circle, that makes it between one and two inches longer. At its commencement it is constricted, and at its upper extremity, where it is attached to the womb, it is dilated, so as to surround the vaginal portion of the neck of the womb (see Plate III, c) this is a short distance above the mouth of the womb. The attachment extends higher up on the posterior than on the anterior wall of the womb, which makes the posterior lip of the womb longer than the anterior.

The mucous membrane is continuous above with that covering the vaginal portion of the uterus; below it begins at the vulva. Running longitudinally along the anterior and posterior walls are distinct ridges or raphe; these are the columns of the vagina.

The relations of the vagina to the neighboring organs can be studied to better advantage by referring to Plate I.

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:—

Its anterior surface is concave, and is in relation with the base of the bladder and with the urethra. Its posterior surface is convex and connected to the anterior wall of the rectum for the lower three-fourths of its extent, the upper fourth being separated from the tube by a fold of the peritoneum, the recto-uterine fold, which forms a cul-de-sac between the vagina and rectum. Its sides give attachment superiorily to the broad ligaments, and inferiorily to the Levatores Ani muscles and recto-vesical fascia.

THE UTERUS OR WOMB.

The uterus is the organ of gestation, receiving the fecundated ovum in its cavity, retaining and supporting it during the development of the fetus, and becoming the principal agent in its expulsion at the time of parturition. In the virgin state it is pear-shaped, flattened from before backwards, and situated in the cavity of the pelvis, between the bladder and the rectum. It is retained in its position by the round and broad ligaments (Plate III, ii and kk) on each side, but also by virtue of its anteverted position, and by the vagina and perineum. Its upper end or base (a) is directed upwards and forwards; its lower end, or apex, is directed downwards and backwards in the line of the axes of the inlet of the pelvis. It therefore forms an angle with the vagina. The uterus measures about three inches in length, two in breadth at its upper part, and an inch in thickness, and it weighs from an ounce to one and a half ounces in its healthy condition.

The fundus or base is the upper broad extremity of the organ (a); it is convex, covered by peritoneum, and placed on a line below the level of the brim of the pelvis.

The body (b) gradually narrows from the fundus to the neck. Its anterior surface is flattened, covered by peritoneum in the upper three-fourths of its extent, and separated from the bladder by some coils of the small intestines; the lower fourth is connected with the bladder.

The posterior surface of the body is convex, covered by peritoneum throughout, and separated from the rectum by some convolutions of the intestines.

Its lateral margins are concave and give attachment to the Fallopian tubes (n), above.

The round ligaments (i) are attached below and in front of these, while the ligaments of the ovaries (o) are attached behind and below these structures.

The cervix or neck of the womb (c d e) is the lower rounded and constricted portion of the uterus; around its circumference is attached the upper end of the vagina, which extends upwards a greater distance behind than in front.

At the vaginal extremity of the uterus is, in the virgin womb, a round, but after childbirth a transverse aperture, the os uteri or mouth of the womb, bounded by two lips, the anterior of which is thick, the posterior narrow and long.

THE FALLOPIAN TUBES.

The Fallopian tubes, or oviducts (n) convey the ova from the ovaries to the cavity of the uterus. They are two in number, one on each side, situated in the free margin of the broad ligament, extending from each superior angle of the uterus to the ovaries. Each tube is about four inches in length; its canal is exceedingly minute, and commences at the superior angle of the womb by a minute orifice, the ostium internum, or internal mouth, which will hardly admit a fine bristle; it continues narrow along the inner half of the tube, and then gradually widens into a trumpet-shaped extremity, which becomes contracted at its termination. This opening is called the ostium abdominale, or abdominal mouth, because it communicates freely with the abdominal cavity. The margins of this extremity are surrounded by a series of fringe-like processes, termed fimbriæ, and one of these processes is connected with the outer end of the ovary. This part of the Fallopian tube is called the fimbriated or fringed extremity (m).

THE OVARIES.

The ovaries are analogous to the testes in the male. They are two oblong flattened and oval bodies, situated one on each side of the uterus, in the posterior part of the broad ligament behind and below the Fallopian tubes. Each ovary is connected, by its anterior margin, to the broad ligament, by its inner extremity to the uterus by a proper ligament of the ovary, and by its outer end to the fimbriated extremity of the Fallopian tube by a short ligamentous cord. The ovaries are of a whitish color, and present either a smooth or a puckered uneven surface. They are each about an inch and a half in length, three-quarters of an inch in width, and about a third of an inch thick, and weigh from one to two drams.

CHAPTER IX.

MENSTRUATION AND MENSTRUAL DISORDERS.

The first appearance of the menses marks an epoch in the life of the girl which ushers in womanhood. It is the harbinger of the fruitfulness of the maiden, whose limbs now become rounder, and her hips widen out, while the breasts increase in size and the entire aspect undergoes peculiar changes, which all point to the approaching condition of maturity.

The term is derived from the Latin plural menses, meaning month, from moon, and it is an actual fact that the lunar forces seem to influence this physiological function, inasmuch as it recurs every four weeks; most women menstruate during the first quarter, and only a very few during the new or full moon.

During infancy and childhood, the sexual system of the female is inactive. The menstruation begins, in a temperate climate, about the fourteenth or fifteenth year of life, and ceases at the age of forty-five or a little later.

The climate exerts a marked influence in determinating the first appearance of menstruation, which is further influenced by the conditions of life and society in which the child is brought up.

The diversity in the ages at which children menstruate in different countries cannot be laid to any constitutional peculiarities of the races. Observation has established that, when children of the same race and family are brought from a hot to a colder climate, the advent of the first menstruation changes. These girls menstruate not so young as their older sisters, but begin about at the same age as those who are born in the colder climate.

In hot countries, for instance in Africa, the negroes and girls in East India begin to have their periods at the age of ten to twelve years. In Sweden and Norway the average age for the first menstruation is sixteen, while further north, in Lapland, the ages vary from eighteen to twenty years. Next in order of importance, influencing the menstrual epoch, are the surroundings and food.

In the same climate there are differences in the ages of children that are entirely due to these causes. Children who are pampered and who are nurtured in ease and luxury menstruate earlier than those of the poor or even of the middle class, who are brought up in habits of industry.

We observe again a difference in the ages between those who are reared in the country or rural districts and the dwellers in the cities, whether it be in luxurious apartments or in tenement houses. The former grow older and stronger than the latter before the show begins.

The temperament also greatly influences the development of the function; children who are nervous, irritable, and of a sanguineous temperament, menstruate earlier than those of sedate habits.

The color of the hair and complexion are also indices of the respective appearance of the menses in the brunette and blonde. It has been observed that the dark-complexioned girls menstruate sooner under similar conditions than the blondes. Weakly children, who are delicate from some constitutional habit, or whose organism has suffered from disturbances of indigestion or suffered severely from teething in early childhood, menstruate earlier than their stronger and robust sisters.

The quantity of the natural menstrual discharge, as well as the time or duration, varies greatly in health with different individuals. We first notice a slimy discharge, which soon becomes tinged with blood, and after one or two days it is almost of pure blood. The flow generally lasts three or four days, very seldom only one day, and sometimes a week to ten days.

The monthly recurrence of the menstrual periods averages thirty years; in temperate climates it may overreach this figure a little, while in hot climates it comes much below this average.

It does not follow as a rule that because a woman began to menstruate quite young, the change of life will take place earlier. This also depends much upon temperament, habit and mode of life.

Physiologists have established, by carefully-prepared statistics, that the average period of menstruation for women who began to menstruate early is thirty-three years, while those who commenced late have an average of only twenty-seven years.

When a woman is forty-five years of age, we may, however, as a rule, look for the change of life to set in; if she goes beyond this age, she may be taken as the exception.

The cavity of the womb is the principal source from which the blood comes; while the ovaries and tubes are also greatly congested with blood, the amount that comes from them must be very small.

The blood that comes from the womb is not different from blood coming from any other source; the changes and peculiarity of the menstrual show are due to its passage through the vagina, where it becomes contaminated with vaginal secretions.

It is supplied from the blood-vessels of the womb, oozing through the mucous membrane of that organ, just as in a case of nosebleed. The entire womb is more or less swollen, and more especially the mucous lining, so that it corresponds, in many instances, to an inflammatory process, and for that very reason, a sudden check of the menstrual flow will often result in a regular subacute or acute inflammation of the womb. If the discharge of blood from the uterus is in small quantities and a gradual, steady flow, it becomes so altered by the secretions in its passage through the vagina that it does not coagulate, but when it is poured out more rapidly or in larger quantities, the menstrual blood coagulates or congeals in the same manner as if it were derived from other sources.

If a woman becomes pregnant, the menses as a rule are suspended during the child-bearing period, and usually remain absent after the child is born so long as the woman nurses the child. I have known one woman who menstruated during her entire pregnancy, and another who had had eight children and never menstruated in her life, yet she was, and always had been, in perfectly good health: thus we see, that there is no rule without exceptions.

An essential part of the menstrual function is that in which the ova or female germ cells ripen and are expelled from the ovary. The menstruation is only a reflex or side issue, to a more important part that is going on in the female generative system; this is termed ovulation, or the ripening and expulsion of the human egg from the tissues of the ovaries. In the physiological process that operates in the economy of nature for reproduction, the ovaries are the principal organs. The other organs are simply accessory, and indeed many of the lower animals have no other organs than the ovaries for the perpetuation of their species.

In the human female, the ovaries consist of a tough fibrous tissue, between whose meshes are little cysts, which are called Graafian vesicles, and these little vesicles serve as the nests in which the ova or little germ cells mature.

These ova which are imbedded in the Graafian vesicles are so small that they can only be seen by a high magnifying power.

The activity of the ovaries begins at puberty, and ceases with the change of life, or menopause.

The approach of the menses is signalized by a certain group of symptoms, which clearly indicate a congestion of the pelvic organs.

There is generally a drawing sensation in the back and thighs, and a sensitiveness upon pressure in the regions of the ovaries and the womb. There is a feeling of lassitude and weakness of the limbs, sometimes hot flushes changing off with chills, and often a feverish condition, which will last until the flow is fully established.

Professor Dalton says: “In many birds, for example, the plumage assumes at this period more varied and brilliant colors; and in the common fowl the comb or ‘crest’ enlarges, and becomes red vascular. In the American deer, the coat which, during the first year is mottled with white, becomes in the second year of a uniform tawny or reddish tinge. In nearly all species, the limbs become more compact and the body more rounded; and the whole external appearance is so altered, as to indicate, that the animal has arrived at the period of puberty, and is capable for reproduction.”

In the human subject, the child now becomes conscious of the sexual instinct, however chaste or virtuous her mind, for we must not dull our intelligence with the idea that the sexual function is unholy; it is no more so than to say our prayers; so that an additional duty is now incumbent upon mother or guardian.

The child must be made to know that she must be more reserved and guarded in her relations with the male sex; that she no longer can romp or play on the knees of male friends or visitors, and that it is dangerous and unbecoming to be left alone with them. A little later on, she must be apprised that she too may become a mother, and that that would be a great disgrace for one so young and not married. The child thus learns to protect herself against the insidious smiles and snares of the seducer, for he is ever abroad, and often family friend and trusted adviser.

There are beings who are men in form only, but at heart are black villains, and selfish brutes. When the mischief is done, then it is too late to repent of a mother’s negligence, or to bewail a child’s disgrace and man’s perfidy; the three combined make one of the most distressing scenes that it has ever been my misfortune to behold.

Successive crops of eggs ripen, and are discharged by the adult female at each menstrual period.

I have already said that the ovum is contained in the Graafian vesicle, in which it grows and matures, as the fruit ripens on a tree, so the Graafian vesicle gradually ripens for the expulsion of the ovum, which gradually makes its way to the surface of the ovary. Within the Graafian vesicle the serous fluid accumulates, so that it ruptures and discharges its little ovum, which is taken up by the fringed extremity of the Fallopian tube, and carried along the oviduct into the womb, from which it escapes into the vagina, and is lost, provided conception has not taken place.

Investigations have been made as to the number of ova certain mammalia discharge, and it has been found to correspond with the number of young that the animal produces at birth. Where a litter consists of from three to twenty, as in the bitch and the sow, a similar number of eggs ripen, and are discharged at the period of œstruation.

In the cow or mare, and in the human female, as a rule, only one egg is discharged at each period of ovulation.

The discharge of ripened ova does, however, occur in exceptional cases without any sign of the menstrual show, and the person may be susceptible to conception, so that we may reasonably infer, that ovulation constitutes the most important function of the menstrual period.

MENSTRUAL DISORDERS.

These are designated by different terms, not because each name signifies a particular disease, but simply an indefinite symptom of a diseased condition. In other cases menstrual disorder may produce symptoms that are common to widely different diseases. In other words, the phrase menstrual disorder, without being qualified as to its particular cause, means, from a practical standpoint nothing upon which a treatment can be intelligently based. Not any more than a cough which is simply an irritation of the bronchial nerves, and may be due to a bronchitis or pneumonia, or it may not be due to any pulmonary affection at all, as, for instance, in the case where an aneurismal tumor presses on the bronchial nerves, and excites severe paroxysms of coughing. A great many menstrual disorders are due, not to any disease of the generative organs, but to an affection of the nervous system.

Menstruation may be precocious in some girls, and if the discharge is not accompanied with the usual symptoms of backache and some of the other symptoms that characterize the normal appearance of the menses, or if the girl is otherwise not fully developed, and has in this climate not reached her twelfth or fourteenth year, it constitutes a sign of a disease. If, however, the show recurs at certain intervals, it is not to be considered with the same degree of apprehension that it would be if it recurred at irregular intervals.

The sanguineous discharge which shows itself at the genitals during an acute attack of an infectious disease, has no relation whatever with the menstrual function; this may take place in children at any early age.

We often see girls who are not yet thirteen, who still wear short clothes and go to school, that menstruate regularly, but with this precocious menstruation there is also a corresponding development of the body which gives them a womanly appearance. Such girls should not be permitted to expose themselves to the inclemency of the weather, because they are much more liable to take cold, which may result in inflammations, than girls in whom the menses have not appeared.

Girls of a scrofulous taint or other hereditary habits of constitution, often begin to menstruate prematurely; outdoor exercise and cod liver oil with cold sponging on retiring at night are the proper resources for building them up.

AMENORRHŒA.

This term is employed for the purpose of designating an absence of the menstrual flow in persons who are old enough to menstruate, and in whom there is no physiological reason for its suppression, such as being too young, after the change of life, or during pregnancy and while nursing the child on the breasts.

We find this disorder of the natural function of menstruation more among the women of the rich and affluent whose lives are spent in indolence and luxury; this is to be ascribed to lack of sufficient exercise to stimulate the nervous and sanguineous systems to the performance of their healthy functions.

The amenorrhœa, or a retarded menstruation in young girls, is oftener the result of a general debility than of a disease of either the womb or ovaries. We have here again about the same causes playing their pernicious role as in precocious menstruation in weakly children; that is, that the same causes produce directly opposite results. The scrofulous and hereditary taints always interfere with the proper and healthy development of the system; in amenorrhœa they appear to be a hindrance to the formation and growth of the red blood corpuscles. In some girls the suppression of the courses appears to be a wise conservative provision of nature, because the girls are already so weak and bloodless that even the loss of a very small amount would only increase the anæmia, so that in these cases it is not so much a question of “bringing on the courses” as of building up the constitution, and enriching the blood in order to bring about the desired result.

Chlorosis, or the green sickness, is not simply an anæmia or a bloodlessness, but a physiological incapacity of the system to prepare the required blood cells for the sanguineous fluid, and this is, indeed, the most frequent cause of the disorder under consideration. Chlorosis is a disease that is peculiar to the female sex, beginning as a rule at the age of approaching puberty, between the fourteenth and twentieth year, so that there appears to be a physiological relation between the blood genesis on the one hand, and the development of womanhood on the other.

In some cases we can trace the impoverished condition of the blood to unhealthy dwellings, impure air, want of exercise, improper diet, nervousness, the reading of exciting, amorous novels, and the practice of masturbation or self-abuse. On the contrary, the disease is often developed under the most moral and exacting discipline and hygienic surroundings.

I have known girls who lived in the country, enjoyed horseback riding, ate nutritious and wholesome food, and whose solitary moments were beyond suspicion, yet at the age of puberty they commenced to fade in color, and fail in strength, gradually growing paler and weaker, until they became chlorotic and bloodless. This can only be explained on the theory that the period in which nature was preparing the system for the purposes she had in view, caused a shock to the nervous system, which so disarranged the functions that the sanguineous system did not respond to the growth of the generative system.

Then there is another class of cases, where girls menstruate before they are old enough, and without their bodies showing any visible evidence of developed womanhood, who belong to the most obstinate cases for successful treatment.

The relative diminution of the red blood cells to the healthy standard is in some cases truly alarming. In the average healthy blood, there are, in one thousand parts of blood, one hundred and thirty parts of red blood cells; this falls to sixty, and even forty parts in the thousand in the chlorotic patient.

It is one of the peculiarities of this disease, that while the muscular tissue wastes away, the fatty tissue is not only preserved, but it sometime increases, so that in a family of several girls, the chlorotic girl is considered the ‘most fleshy,’ but as fat is not flesh, the appearance is deceptive.

When we stop to think a moment, that the red blood corpuscles are the messengers which absorb the oxygen in the lungs during the respiratory movements, and carry it to the different organs and tissues of the body, without which all tissue change would cease. And that the same red blood cells must return again to the lungs for exhaling the carbonic acid, one of the waste products of tissue growth, then the diminution of the red blood cells in the proportion above given, must affect the entire system very injuriously.

This is indeed the case; the natural respiratory movements are insufficient on the slightest exertion, so that patients tell us that when they walk a little fast, go up the stairs, or even sweep the room, they feel a shortness of breath.

There are other symptoms that point to carbonic acid poisoning, which it will be interesting to review. A great majority of these symptoms are to be found in every case of chlorosis. The muscles become weak at first, because their nutrition is interfered with, and they waste away, and secondly they become irritable from the poisonous presence of the carbonic acid, and so are often very painful. The patients are easily tired out; some, indeed, feel tired all the time, getting up in the morning as worn out as when they retired at night.

The nervous system suffers as much, because the principal nerve food is oxygen, and if there is no blood, there can be no oxygen; a starved nerve is a painful nerve. We find neuralgias, affecting the different parts of the body, the rule; when these are located in the external muscles, they are easily recognized, but when located in the deep organs, as the ovaries or the womb, they are generally mistaken for something else. The nerves of these individuals being in such an irritable state, it is natural to infer, that hysteria is often to be found as one of the complications, so that habitual sadness, and abnormal longings after chalk, lead pencils, and other indigestible articles are prominent symptoms.

The circulatory system suffers derangements that are characteristic of chlorosis. Palpitation of the heart is a prominent symptom; this is partly due to the irritation of the carbonic acid on the cardiac nerves, and partly to sensitiveness of the patient, owing to a morbidly-increased sensibility of the whole body. Chlorotic patients blush up at times, only to be followed by a green paleness that is peculiar to the disease. Pain in the region of the heart, and disturbances of the digestion, are sometimes prominent symptoms. There is no feeling of hunger; eating is not so much from hunger, but more from a sense of duty to keep up the strength. A heavy or full feeling is often experienced after a meal, and a sourish eructation will give relief to the oppression, because the walls of the stomach are relaxed and in sympathy with the general debility.

But in all cases of chlorosis the sexual functions are the seat of the greatest disturbance; amenorrhœa or the suppression of the menses is the most prominent symptom. The ovaries no longer seem to expel ripened ova, for there are no indications that point to their activity, because there is not only an absence of the show, but also an absence of the other signs that were noted when we considered menstruation and ovulation.

There are a great many other diseases of which amenorrhœa is a prominent symptom; these will be referred to when separate diseases become the subject of special inquiry.

The treatment of amenorrhœa is, indeed, in the great majority of cases, the treatment of chlorosis, and that should be conducted on common-sense principles. If the child has vicious practices, they must be corrected, and everything else that has been mentioned as a cause must be abandoned. Children who were once robust and strong require electrical treatment, while those who were naturally weak require nourishing food and tonics. If there is in the entire pharmacopœa a remedy that deserves the name of a specific, it is to that one which I suggest in amenorrhœa due to chlorosis or anæmia. Iron preparations are very numerous; every physician has his favorite prescription; some are to be praised more for their elegance and flavor than for any virtue that they possess. If in these cases any positive and decided result is to follow the administration of iron, it must be given in such a mild form that it can be taken in great quantities without irritating the stomach or interfering with digestion. If the contents of the whole alimentary canal are saturated or impregnated with the ferruginous medicine, there will be astonishing curative effects.

I have often observed chlorotic cases who have made the rounds of the different iron springs, and who have taken the numerous and various fancy elixirs, without the slightest perceptible effect, bloom up, after being fed, so to speak, on some harmless iron preparation, which was astonishing to themselves and surprising to their friends. The following is my favorite prescription for chlorosis or anæmia:

NO. I.

Mix with sufficient water to make into a hard mass and divide into one hundred and fifty pills, and roll in powdered cinnamon.

Take three pills three times a day and after three days increase to four pills at one dose three times a day, then after another three days increase to five pills as many times a day as before; if these doses are not at first borne, begin with less, and if there is no costiveness or tendency thereto, omit the aloes.

If there is reason to believe that the impoverishment of the blood is partly or wholly due to scorfulous taints, then it is advisable to take fresh, pure cod liver oil in conjunction with the iron pills; three boxes of pills are, as a rule, necessary to effect a cure.

It happens quite often in chlorosis or anæmia that there is a distressing dyspepsia or indigestion with loss of appetite. In these cases I would first advise to put the stomach in order; this is done by first avoiding all indigestible food, such as cakes, pies, and puddings, and taking the following medicine:

NO. II.

Take a tablespoonful three times a day, and if the bowels move freely take less.

Hygiene in the treatment of every disease is to be an important factor; all vicious habits must be abandoned.

DYSMENORRHŒA.

Difficult or painful menstruation is the definition of the above word; all painful menstrual disorders that take place either before or during the menstrual flow come under this designation.

The seat of the pain, when of a colicky nature, is in the uterus; when a continuously dull ache is in the small of the back, it is located in the nervous plexus in the small of the back. The pain is very often in the ovaries and in that portion of the peritoneal membrane which folds over all the pelvic organs and extends on the sides of the womb, constituting the broad ligaments; when the pain is confined to these structures, it is principally felt below the stomach and over the lower part of the bowels.

Painful menstruation is a prominent symptom of a great many diseases, and it often strains the ingenuity of the most clever specialist to trace the symptoms to their real cause.

Obstructive dysmenorrhœa, as its name implies, is due to some hindrance or obstacle to the escape of blood from the cavity of the womb. The obstruction may exist in the neck of the womb, at its mouth, or in the vagina. When the obstruction is in the neck of the womb, it may be congenital or date from birth. The constriction or narrowness may be due to an acquired inflammation of the lining membrane of the neck of the womb. Every inflammation causes a swelling of the tissues, and if the inflammation continues, the swelling becomes permanent and a stricture is the result.

Such strictures are often the result of the applications of strong caustics and meddlesome tampering by the ignorant specialist and abortionist. The application of the electrical current by means of the uterine electrode is the most modern and effectual method of treating these cases successfully.

Flexion of the womb is understood to be a condition in which the uterus is flexed or bent upon itself at a sharp angle, just as a rubber hose that is bent sharply on itself becomes compressed at the kink so as to shut off the flow, in this manner the flow of blood from the cavity of the womb is partly shut off, and the obstruction is the cause of the painful menstruation.

In some women who have flexion or a bent womb there is no obstruction, because the probe passes the canal freely; in these cases dysmenorrhœa must be traced to some other cause. If it is clearly established that flexion is the cause of the obstruction, the most successful treatment is the electrical current. I have often had cases where little mucous growths no larger than a small marble, grew in the canal and obstructed the free escape of blood; after these were removed, the dysmenorrhœa ceased at once.

Other obstructions may be due to a stricture of the vagina or some deformity of the hymen; a very slight surgical operation will permanently relieve both of these hindrances.

There is a much larger proportion of cases that suffer from painful menstruation in whom the uterine organs are perfectly healthy, but who are systematically injured by dishonest or hungry specialists, by being subjected to local treatments. I have had cases of this nature fall into my hands very often. They had made the rounds of the specialists and had been made the innocent prey of avaricious professional competition, so that it is of the greatest importance to distinguish this class of cases from those in which the pelvic organs are the seat of the difficulty.

Nervous and congestive dysmenorrhœas are particularly adapted for the hygiene of home treatment. Nervous or neuralgic dysmenorrhœa is very often overlooked, and treated as a local lesion of the womb.

The psychical exaggeration which many women experience at the approach of the menses is abnormally heightened in dysmenorrhœa. The pains in the back, in the hips, and in the lower part of the abdomen disturb the normal operations of the mind. The irritation of the nerves of the womb is often reflected to distant organs, and pain is felt in remote regions. Some women suffer only just a day or two preceding the flow, while others suffer severely during the entire period, so that they are forced to keep to their bed the greater part of the time.

Professor William Goodell, one of the most profound and original female specialists in America, has this to say in a recent publication: “I have learned to unlearn the idea— and that was the hardest task of all—that uterine symptoms are not always present in cases of uterine disease; or that, when present, they necessarily come from uterine disease. The nerves are mighty mimers, the greatest of mimics, and they cheat us by their realistic personations of organic disease and especially of uterine disease. Hence it is that even seemingly urgent uterine symptoms may be merely nerve counterfeits of uterine disease. I have, therefore, long since given up the belief, which, with many, amounts to a creed, that the womb is at the bottom of every female ailment.

“Nerve strain, or nerve exhaustion, comes largely from the frets, the griefs, the worries, the carks and cares of life. Yet although the imagination undoubtedly affects it, it is not a mere whim or imaginary disease, as all healthy women and physicians think; but it is the veriest of realities. When some flippant talker or some slipshod thinker scoffs at nervousness as a sham disorder, I say to him: ‘Can the bribe of a principality keep you from blushing when you are ashamed, or from blanching when you are afraid?’ Under the flitting sense of shame or of fear these vasomotor disturbances are momentarily beyond your control; and so they are in the nervous woman, whose vital organs are, as it were—not transiently but—perpetually blushing and blanching under deficient brain-control over the lower nerve centers.

“Strangely enough, the most common symptoms of nerve disorder in women are the very ones which tradition and dogmatic empiricism attribute to womb disease.

“They are, in the order of their frequency, great weariness and more or less of wakefulness and inability to walk any distance, a bearing-down feeling, headache, nape-ache and backache, scant, or painful, or delayed, or suppressed menstruation, cold feet, and irritable bladder, general spinal and pelvic soreness, and pain in one ovary, usually the left, or in both ovaries. The sense of exhaustion is a remarkable one; the woman is always tired, she passes the day tired, and she goes to bed tired, and she wakes up tired, often, indeed, more tired than when she fell asleep. She sighs a great deal, she has low spirits, and her arms and legs become numb so frequently that she fears palsy or paralysis.

“There are many other symptoms of nerve strain, but since they are not so distinctly uterine, and, therefore, not so misleading, I shall not enumerate them. Now, let a nervous woman with some of the foregoing group of symptoms recount them to a female friend, and she will be told that she has womb disease. Let her consult a physician and ten to one he will think the same thing and diligently hunt for some uterine lesion. If one be found, no matter how trifling, he will attach to it undue importance, and treat it heroically as the offending organ. If no visible disease of the external organs be discoverable, he will lay the blame to the invisible endometrium, or on the unseeable ovaries, and continue the local treatment. In any event, whatever the inlook or the outlook, a local treatment is bound to be the issue.”

The nervous variety of painful menstruation is frequently due to impoverishment of the blood, which, as we have learned, is often the direct cause of irritable nerves. The same treatment as for chlorosis will give the desired relief: the treatment with iron pills. If the stomach is deranged from dyspeptic disorders, then my dyspeptic mixture, No. II, is to be given. But there are cases that are purely neuralgic without any apparently serious lesion of the blood; cases in which the neuralgia of the womb or ovaries is probably due to exposure to cold or some other indiscretion; here the following recipe will effect a cure in the course of several months:

NO. III.

Mix. Take a teaspoonful in a tumblerful of milk three times a day, between meals.

Congestive dysmenorrhœa is oftener in the nature of an acute or sudden attack, except when it is due to a chronic inflammation of the lining membrane of the womb. It is often brought on by a sudden or inadvertent exposure, just at the time when the menses should make their regular appearance.

Persons of a plethoric habit and those who have been the subjects of inflammations either of the womb or in the tissues surrounding the womb, are more liable to this form of dysmenorrhœa than others. It will often be ushered in with a chill, followed soon with fever. There is headache, the skin becomes dry and hot, and often there is considerable irritability of the bladder, straining of the rectum and diarrhœa. Unless the pain is due to an obstinate displacement, it yields to proper treatment. For the straining and irritable bladder a hot sitz-bath should be employed for ten to fifteen minutes. In the absence of a suitable vessel for a sitz-bath an ordinary bathtub can be used by filling it six or eight inches with water, at a temperature of 104°F., and while sitting in the bath allow the boiling water to run slowly into it, so as to keep the temperature up. These sitz-baths should be taken several times a day, and after each bath the patient should rub herself thoroughly dry and wear flannel next to the skin. The extremities and feet should also be kept warm by wearing woolen hose.

Towels wrung out of hot water should be carefully folded and applied to the lower region of the abdomen and then covered over with a thickly folded flannel cloth so as to retain the heat and moisture; when the towel has cooled off repeat the dipping in hot water.

The Femina vaginal capsules are of inestimable value in this class of diseases. They relieve congestion of the womb by allaying the irritation. The best time to use one is just before retiring, and after taking a sitz-bath, or a vaginal injection of hot water, or both. Persons who are of a costive habit should pay particular attention that, about the time their monthlies come around, their bowels act freely, and to accomplish this purpose the Femina laxative tablets should be taken, one each night for several nights before the courses are expected.

MENORRHAGIA AND METRORRHAGIA.

By menorrhagia is meant, as the composition of the term implies, an excessive flow of blood at the regular monthly period; by metrorrhagia, a flow of blood from the womb at any time irrespective of the regular menstrual periods. Neither of these forms can be called a disease, as they are solely the symptoms of several kinds of uterine affections. In the course of our investigations, we will find that one of the most prominent and common symptoms of different womb diseases is hemorrhage of the womb.

If the hemorrhage is the result of general debility from protracted nursing, the child must be weaned, and recipe No. I, with a nourishing diet, will effect a cure.

Hemorrhage may be due to the presence of a fungoid inflammation, tumors, or affections of the mouth or neck of the womb, or congestion of the ovaries.

It is very often due to a “bad getting up” from confinement, where the womb has never returned to its original size. Sometimes it is due to a portion of the afterbirth that was retained in the cavity of the womb. It is also a symptom of cancer. As I have already said, it may be the symptom of so many different diseases that the proper course to pursue is to find an honest and competent physician to make a thorough examination, for the purpose of deciphering the real cause, and when that is discovered, it is as a rule, an easy matter to remove it and thus afford the patient permanent relief.

There is no remedy which on the whole is so effectual in controlling hemorrhage, no matter from what cause, as:

NO. IV.

Dose: a teaspoonful in a little water every four hours until the flow ceases, or until a physician is consulted to diagnose the case. In pregnancy, the administration of ergot is not admissible; cold water compresses are also useful in checking uterine hemorrhage, and the utmost quietude should be observed.

Nervous exhaustion from protracted confinement, or mental worry from the loss of a child or the death of a friend, may also cause uterine hemorrhage. The ergot is useful in these cases, with a change of air and scenery.

CHAPTER X.

HISTOLOGY OF INFLAMMATION.

Inflammations of the various tissues assume different forms as far as the gross appearances are concerned, but the underlying condition is precisely the same. The various types of inflammations that are produced by one and the same process are of considerable scientific interest, but to the practical and inquiring reader, whose principal object is to obtain sufficient information to be able to cure herself, it would be confusing were I to attempt a description of their differences.

There is no word that is so often employed as inflammation, as a designation of disease, and when we learn that there is only one kind of inflammatory process, whether of the brain, the lungs, liver, kidneys or bowels, the entire subject of inflammatory diseases at once becomes greatly simplified, because if you understand one you must understand all.

I will in the subsequent chapters speak only, or principally, of inflammatory affections of the different organs that come within the province of this specialty, and I am convinced that if the reader will bear with me, so that I may take sufficient time and space to explain the most advanced scientific views of inflammatory processes, she will be more than compensated, by a clearer understanding of what will be said in succeeding pages.

Inflammation comprises a series of phenomena, which partly take place in the vascular apparatus or blood vessels and partly in the tissues comprising the structure of the organ. Inasmuch as inflammation is not a single process, a definition of a few words is insufficient to convey to the mind its real meaning. If I were simply to describe the peculiarities of the circulation, that characterize the inflammatory process, we should only have an incomplete idea of the changes that were taking place.

Since the time of Galen, who lived two hundred years after Christ, inflammation was recognized by four cardinal symptoms, namely redness (Ruber), swelling (Tumor), pain (Dolor) and the increased temperature (Calor). To these modern pathologists have added a fifth symptom, which is lessened or diminished function (Functio Læsa).

The above five cardinal symptoms can be established in the majority of the acute stages of inflammation: in the chronic or subacute variety, one or the other symptom may be absent, or so obscured as to escape notice.

The nature and structure of the tissue materially modify some symptoms and exclude others, so that redness, pain and even perceptible swelling may be absent. Galen already in his time attributed the redness to an increased blood supply and the swelling to an exudation of lymph or serum, through the walls of the blood vessels: this was as near the truth as scientists arrived, until within our own time. The discoveries in this field of science have been greatly enriched in the last twenty years through the researches of the German school. Various theories have been advanced from time to time, as to the probable causes or processes that are going on in the tissues while inflammation is active. One observer believed that he had found the solution of the inquiry in a supposed spasmodic contraction of the capillary blood vessels, another in their paralysis, while still another adhered to the belief of a neurotic affection. Professor Virchow, the father of the modern school of pathological science, ascribed the conditions of the tissues to an irritable state of the inflammatory process, inducing an exaggerated cell growth; while his former pupil, Cohnheim, through an extended series of newly-devised experiments, has conclusively proved that none of the theories advanced are supported by demonstrable facts.

Our present thorough knowledge of the combined disturbances and phenomena, that play their part in the vessels and tissues, of the body during the inflammatory action in living tissue is due to the unremitting toil of Professor Cohnheim. He was the first to speak from facts, as they presented themselves to his eye under the microscope. It was he who had the genius that suggested the examination of the whole process of inflammation, in the living tissues under the microscope. This he accomplished by narcotizing a frog, and while alive, but insensible to pain, a portion of the peritoneum or mesentery, which is almost transparent, so that the circulation may be plainly seen, was fastened with pins upon an ingeniously-devised rack or stage. The inflammation is now excited by etching the membrane with a little acid and a sharp needle, and then the object is placed under the microscope. If the operator is careful, so as not to tear or crush the vessels or tissues, and preserves the moisture, by spraying with warm water from time to time, the circulation and the abnormal processes of inflammation that are going on, may be observed and studied with great exactness for several hours. I will now describe what may be seen in the field of the microscope.

The first change to be observed is in the vascular system and within the vessels themselves; this begins with a widening of the small arteries, then of the smaller capillaries and veins. This increases the current of blood with greater velocity through the widened vessels. Sooner or later this rapidity of the current lessens; there is a marked slowness to be observed in the stream. The single or separate blood cells, which in the beginning of the observation could not be distinguished, can now be distinctly seen, especially in the veins and small capillaries, in which, from the slowness of the current, the blood accumulates. In the veins there now appears at the periphery of the current a pellucid plasmatic layer, in which there are white blood cells, that have separated themselves from the main current; the white cells either float slowly along or adhere to the walls of the vessels. This phenomenon the Germans term “Randstellung der Farblosen Blut Körperchen,” which means, bordering of white blood corpuscles. Not long after the “bordering” of white cells, a change takes place in the cells themselves, that is very interesting. The white cells become elongated and spear-shaped at one extremity, which pierces the wall of the vessel, and after a little while the sharp extremities will appear on the outer surface of the wall of the vessel, and a little later on, indeed, the entire protoplasmic cell will have emigrated into the tissue, outside of the vessel. Or, in other words, the colorless blood cells will have passed through the walls of the vein or capillary, and this constitutes an extravasation.

The first extravasated cells will soon be followed by others in great quantity, so that in six to eight hours veins and capillaries are surrounded with white corpuscles. In their normal destination these become organized into fibrous or granulation tissue; and for this reason, an organ that is the seat of chronic inflammation becomes immensely enlarged from this inflammatory accretion. We can now readily appreciate why the womb, liver or kidneys become augmented in size from inflammatory processes. Indeed, this applies to all growths and even to bone, and if a part is injured by a cut, accident or disease of some sort, precisely the same processes are at work to repair the lost tissue. It cannot fail to become apparent at once, that to understand the phenomena of inflammation is to possess the key that opens to our understanding the operations not only of most diseases, but of the healing processes of wounds and injuries. In the course of the experiment we see also red blood corpuscles transude, which are always accompanied with more or less fluid or plasma.

The above detailed account seems to explain in a clear manner the different cardinal symptoms that have become recognized features of inflammation since the time of Galen. The great vascular activity explains the redness, swelling and increased temperature. The pain can be traced to the pressure from the exudation, to which the delicate nerve filaments were exposed, while lessened function would be the natural result of nerves or tissues so compromised.

I made an attempt to initiate the reader into the science of inflammatory processes and if I have succeeded in making myself understood, then I am satisfied with having imparted a most useful lesson, because there is no process in the entire field of disease that is so general; it is almost safe to say that with the exception of functional diseases, there is perhaps no class of diseases with which an inflammatory process is not more or less associated. This is true of consumption, which is an inflammatory process excited by and around the bacilli or micro-organisms, and these inflammatory nodules are called tubercles. The growth of a cancerous tumor is associated with an inflammation. The development of a common boil is an illustration of an inflammation, breaking down or destroying part of the tissue which is inflamed. It is the same in inflammation of the lungs or pneumonia as it is in ordinary catarrh; the differences that are presented to the eye are only modifications of degree and peculiarities that are due to the difference of the tissues of which the organ or membrane is composed.

CHAPTER XI.

URETHRITIS AND NEURALGIA OF THE URETHRA.

Inflammation of the canal by which the urine is conducted and discharged from the bladder is termed urethritis.

There is no organ of the female anatomy that is oftener the seat of local inflammation.

The acute and chronic inflammations that affect the male urethra, also affect that of the female, only perhaps to a more limited extent, owing to the comparative smaller mucous surface of the tube, it being only from an inch to an inch and a half in length.

Inflammation is oftener confined to this portion of the urinary apparatus than is generally supposed, because any derangements of these parts is at once attributed to the bladder, and it is an actual fact that many women have doctored uselessly for years, for the one, when it was the other that was diseased. Symptoms of urethral inflammations are so very similar to inflammations of the bladder that the points of distinction are easily overlooked.

The trouble begins with frequent desire to void urine and a continual bearing down or straining sensation, which may be accompanied with a sense of heat suggesting to the minds of the most chaste and pure women, sexual desire, which the gratification of that indulgence does not relieve nor satiate, but, on the contrary, the sexual passion becomes only exaggerated. It is only the strongest force of character and Christian fortitude that keep some of these unfortunate women in the path of rectitude and virtue, and it is only the scientific specialist who can appreciate the real cause. In many instances women, truly noble in character, have fallen from their high estate, because uncontrollable impulses swept them into the maelstrom of licentiousness, which might have been averted, if they had known of whom to seek proper advice.

This irritation is often innocently and ignorantly acquired in early girlhood by fingering the parts, or practicing masturbation, which sets up an inflammatory condition of the urethra that becomes chronic, and in time may entail the terrible consequences to which I have already alluded. For that reason mothers should not be over-delicate; they should not only keep a watchful eye on their children when in seclusion, but should make it their holy duty to gradually initiate their children into a knowledge of physiology and of the diseases that may result from any violation of youthful virtue.

Why is it that many children who have been reared in an atmosphere of sanctity, children who have enjoyed from their earliest recollection moral and spiritual administration, have fallen into vice and depravity? The reader should stop to answer this question for herself, while I too will answer it for her.

It is because moral teachers overlook the fact that human beings are dual; that we are all animal, however spiritual, and that the functions of the animal nature must be understood in order that the spiritual nature can control them.

A false delicacy has entirely neglected this part of the education of our children, which I stamp as the height of stupidity and hypocrisy.

Among other causes of this malady is hot and acrid urine, or gravelly discharges from the bladder, cutting and irritating the mucous membrane in its passage; abrasions of this nature often lay the foundation for ulcers. When the urine is in that condition, it is probably due to a complication of diseases of the bladder, the kidneys and the liver. A chemical and microscopical examination of the urine will be the only means of settling these questions.

The urethra often takes on the inflammations of the neighboring tissue or organs; disease of the vulva or of the vagina will spread itself to the urinary canal. I have seen cases in which the whole trouble was traceable to a catarrh of the neck of the womb.

Gonorrhœal infection of the vagina will in the great majority of cases extend itself to the urethra as well as to the cavity of the womb and neighboring organs.

If treatment in these complicated cases is to be successful, it must be directed to the disease in all of its strongholds; this, of course, can only be done under the direction of a skillful specialist.

There is a predisposition on the part of the mucous surfaces to become infected by eruptions of the eruptive fevers, and the urethra is particularly liable to this invasion. Children who have had the measles and scarlet fever will often be troubled with frequent and smarting micturition and after convalescence from all the other symptoms of the respective fevers, they are still more or less annoyed for weeks or months with a urethritis. I have had cases of this nature that dated back years. If the early treatment is neglected and the case becomes chronic, it generally spreads to the bladder, which also becomes similarly affected.

Smallpox pustules are apt to break out in the urethra during the acute stage of the disease, and excite a very itching and painful urethritis. Dysentery in children may give rise to the disease. In adults I have noticed the affection in connection with typhoid fever, but this generally passes off with convalescence. Hemorrhoids or piles give rise to urethral inflammation which does not yield to treatment, but subsides at once after the removal of the piles. The application of a Spanish-fly blister to any part of the body may also cause a stranguary or a urethritis.

Mothers may become uneasy, as to the cause of the muco-purulent discharge from the urethra of their little girls. I have known them to entertain suspicion of some specific infection being introduced into the genitals, in some mysterious manner; a little inquiry into the history of every case, dispels these absurd delusions, and it will be found that pinworms have caused the inflammation. In adults, however, the subject should be made the object of particular inquiry. During delivery, the passage of the child’s head exerts great pressure on the urethra, so that it may be crushed or torn across. Women may be troubled with derangement from this cause for a long time, or for their whole lives, if the real cause of their ailment is not recognized. Displacements of the womb in different directions, principally when it is tipped backwards so that its neck impinges on the urethra or neck of the bladder, compresses the canal, so that its caliber is diminished, and a painful obstruction and retention of urine ensue.

Papillated growths and mucous polypoids that were so small that they were hidden from external sight, but readily detected by scientific methods of examination of the urethra, by means of the urethral specula, were the exciting causes of some cases that came under my treatment. The unfortunate victims were under the impression that their kidneys or their bladders were diseased. The numerous quack medicines advertised for the cure of these maladies were copiously consumed, doing, of course, more mischief than good. The removal of the growths in each instance at once put a stop to any further inconvenience.

In pregnancy, after the third month, the womb rises out of the pelvis, so as to accommodate its increasing size. This naturally drags the bladder upwards, and so stretches the urethra that it becomes sore and extremely irritable. To relieve this distress until the parts have accommodated themselves to their new relations, the Femina vaginal capsules are of the greatest value, and without the slightest ill effect arising from their use. Vaginal irrigations of hot water are also of decided benefit, especially before using a capsule.

Mix. A teaspoonful to be given to an adult every four hours till relieved.

The symptoms of inflammation of the urethra are always very pronounced, because the mucous membrane of the urethra is the most sensitive part of the bladder. In the healthy state the coloring of the lining membrane is of a pale red; when inflamed or catarrhal, it assumes a dark red, or a cherry color. The membrane is also considerably swelled and puffed, and feels hot to the touch, and imparts a burning sensation to the patient. The muco-purulent secretion excoriates or chafes the skin, so that the parts look angry and red in the neighborhood; this is oftener observed in children. The characteristic symptom of frequently urinating is never absent, while very little is passed at a time, yet the straining to pass water continues, after the last drop is voided.

The treatment is cleanliness to begin with. In grown people, the entire vulva and vagina must be rinsed out with a warm borax solution, in the proportion of one teaspoonful of the powdered borax dissolved in a quart of water. In little children the same object, that of cleanliness, is to be accomplished with a small ear syringe.

After the external parts and the vagina are thoroughly cleansed, then, by means of a hard rubber syringe, No. 1, three or four syringefuls of clean borax water are injected into the urethra for the purpose of cleaning that too. To relieve the straining and frequent desire to micturate, which is accompanied with more or less pain, I give:—

NO. V.

Mix. A teaspoonful in a wineglassful of water three or four times a day for an adult; children in proportion.

The patient must confine herself to a bland liquid diet, principally of milk, raw eggs beaten up in bouillon or broth. Vegetables may be eaten, but they are not to be seasoned with anything but salt; and alcoholic liquors, wine or beer must also be suspended for the time being.

NEURALGIA OF THE URETHRA.

The female urethra is sometimes the seat of simple neuralgia, by which is meant a painful condition in which there is no apparent disease or inflammation of the tissues.

This pain assumes often a spasmodic character; that there is a cause for this is certain, but it is as a rule remote from the sensation which attracts attention. It is often found to be the symptom of some of the diseases to which I have already referred. These are ulcerations, displacements, or inflammation and congestion of the neighboring organs. Abnormal growths or tissues will often be painfully reflected on the nerves of the urethra. I remember a case of internal hemorrhoids, which was never suspected by the patient because there were no painful symptoms pointing to the rectum, but in which the urethra was very painful in its entire extent. The suffering from this urethral neuralgia had lasted for years, but disappeared at once, on the removal of the piles. I have called attention to a catarrhal inflammation of the urethra, from stretching occasioned by the ascending womb after the third month of pregnancy; there is a similar pathological process after the seventh month of gestation, when the pregnant womb begins to descend again into the pelvic cavity, and this is particularly marked in the pregnancy with the first child, when the pain is often very severe.

If in a first pregnancy there is no abnormal disproportion between the dimensions of the child’s head and the maternal pelvis, or if there be no abnormal position of the child, then there is an obstetric rule that the womb, or rather the child’s head, begins to descend into the pelvis after the seventh month of gestation, so that it can accommodate or conform itself to the maternal parts. This occasions a drag on the urethra downwards and backwards, which is painfully annoying, and there is a constant inclination to pass water.

There are two mechanical methods of relieving this distressing symptom; one is to obtain as much rest as possible in the recumbent position, and the other is to wear an abdominal supporter or bandage around the lower abdominal region, so as to take the weight off the urethra. The internal medication consists of an occasional dose of a mild laxative medicine.

In the newly married, the urethra becomes sometimes the seat of a painful spasmodic contraction; this is due to a tense hymen, which should be slightly nicked with a pair of scissors. Exposures to colds will also cause neuralgia. Fresh beer and sour wine make the urine irritating, and also occasion painful symptoms.

A thorough examination of the mucous membrane of the urethra which does not reveal any inflammatory condition or abnormal growth, establishes its neuralgic character. The next step will naturally be to make such a careful examination of all the surrounding tissues and organs, for the purpose of ferreting out the real cause. When the cause is removed or cured, it will also relieve the urethral pain. In the absence of a clear comprehension of the true nature of the malady, the treatment must be palliative. The sitz-bath is always one of the most palliative measures for all sorts of pelvic pains and aches. Vaginal injections of hot water, not too hot, from 105 degrees to 108 degrees, are another sort of general panacea,—the quantity of fluid should be large, from half to one gallon, in which a teaspoonful of pulverized borax has been dissolved. If the pain is very severe, then a Femina vaginal capsule should be used every night before retiring, and immediately after having used the vaginal irrigation. The bed should always be previously warmed with a hot bottle, unless it is very warm weather.

If the urine is irritating, a cupful of buchu tea three or four times a day, or German chamomile tea, should be drunk between meals. If these measures do not give relief, then consult an honest, competent physician, in whose integrity you can rely.

CHAPTER XII.

INFLAMMATION, CATARRH, AND OTHER DISORDERS OF THE BLADDER.

The female bladder is easier approached than that of the male. This is clearly illustrated in the anatomical Plate II, which should be thoroughly studied before this chapter is read.

The bladder lies directly behind the symphysis pubis, above or in front of the vagina. On account of the comparative shortness of the female urethra, to that of the male, the cavity of the bladder is also much more accessible through this channel, and if access through this communication does not suffice, then the interior of the female bladder may be exposed by an incision through the anterior wall of the vagina, but this resource becomes rarely necessary. Formerly we had to content ourselves with external appearances, that were confined to the external anatomy of the urinary canal on the anterior vaginal wall, aided only by a delicate sense of touch. Valuable as these means of examination sometimes were, they were far from satisfactory to either physician or patient. Now we are able to examine with the finger, aided with the eyes, almost the entire lining of the bladder.

Professor Simon, of Heidelberg, was the inventive genius of this improved method of examination, by means of a series of graded specula or hard rubber bougies, which are known by his name. The specula are simply small, smooth, pin-shaped, hard rubber bougies, about three inches in length, beginning with a size that is three-tenths of an inch in diameter, to the largest, which is eight-tenths of an inch in thickness. These are carefully introduced into the urethra, commencing with the smallest size, which is retained for a few minutes and then withdrawn, and the next size inserted, and this continued until the largest one has been inserted, or the required dilatation accomplished, either for the purpose of introducing the finger into the bladder, or exposing its lining membrane for inspection. While this procedure does not fall into the sphere of home treatment, it is of sufficient interest to women in general that they should know what can actually be accomplished by the expert specialist. Were I to review the malformations, or dislocations, of the bladder, or the history of stones in the bladder, or other foreign bodies, that the female specialist is very seldom called upon to treat, I should only worry the patience of the reader with things that she would not readily understand. The same is true of growths and tumors of the bladder, which have principally a scientific interest for the practitioner of medicine, but for the casual reader they are too profound in their details for a clear understanding.

INFLAMMATION.

Inflammation of the bladder is in medical language termed cystitis. It presents itself under two varieties or subdivisions, acute and chronic, depending on the duration, whether recent or protracted.

The disease begins in the mucous membrane, and the acute inflammation comes on suddenly. It rarely occupies the entire mucous surface of the bladder, but usually occurs in irregular spots. Some spots are as large as the palm of the hand, while others are only the size of a ten-cent piece. The parts that are most frequently affected, are the neck of the bladder and its posterior wall, although no portion of its lining membrane is exempt from inflammation.

It rarely happens that the inflammation spreads over the entire extent of the bladder, or that it invades the muscular tissue; if it should complicate the latter, it would involve the peritoneum; this would add a very serious complication, namely, a peritonitis. Cystitis may be due to an extension of gonorrhœal infection from the vagina and urethra, or from other purulent affections. Women who are unable to pass water after confinement, may be liable to the disease from retained urine, decomposing in the bladder and causing inflammation. On the other hand, a filthy catheter used by a midwife or doctor who is careless or ignorant of the necessary antiseptic precautions, and who fails to brush and boil out the catheters, and uses one catheter on different patients, without the precaution of even thoroughly rinsing it, may give rise to dangerous cystitis. The most serious case that I ever have seen was directly traceable to this cause. If impure air gets into the bladder this will also excite cystitis; to prevent that, is to close with the finger the outlet of the catheter that is used for drawing off the urine, when withdrawing the instrument, a precaution seldom observed.

Newly-brewed malt liquors, alcoholic stimulants taken in excess, diuretics of spirits of turpentine and cantharis, or highly-seasoned and rich food, are among the exciting causes; irritating injections into the bladder or vagina, and even cold-water injections into the vagina, must be added as exciting causes of this painful affection. Venereal excesses operate in exciting visceral inflammation, and when the slightest symptoms are felt, prudence and good common sense dictate continence. The first feeling that manifests itself is a dull, heavy, aching sensation, immediately after urinating, and an involuntary inclination to further relieve or empty the bladder by pressing or bearing down. Soon after the first indication to void urine, there is another desire to empty the bladder, and the same symptoms repeat themselves, only in a more aggravated form. The distress of micturition gradually becomes continuous so that during the short intervals between the times that urine is voided, and as the disease progresses, the pain becomes sharper. This is accompanied by a kind of gnawing uneasiness in the region of the whole bladder, which has intermissions, but is greatly increased when the desire to make water is felt. If the disease progresses, the pain is now felt in the neighboring organs and a general constitutional disturbance manifests itself. The patient will now generally have a severe chill; this is followed with heat and thirst and an increase in the pulse. The desire to void urine at shorter intervals becomes more prominent and only drop by drop, accompanied with distressing spasm and a burning sensation along the urinary canal.

The region of the bladder becomes in the advanced stages of inflammation extremely sensitive and tender, and if the peritoneum is involved, even the weight of the bedclothes becomes intolerable. The limbs are drawn up and the body is inclined forward to relieve the tension of the abdominal muscles and their pressure on the bladder.

The neighboring organs begin to sympathize with the advanced state of the inflammation at this stage; cutting pains are felt in the rectum, while darts of pain shoot from the bladder towards the groins and ovaries.

Owing to the spasmodic action of the urethra, the bladder is never completely emptied so that the urine gradually accumulates in abnormal proportions; the retained urea rapidly decomposes into ammonia and the urine becomes very hot and irritating, thus greatly augmenting the suffering. Under these circumstances, the bladder may become greatly distended and feel as a sensitive globular tumor above the pubis. The retention of the urine may be complete, owing to a partial paralysis of the bladder and now complicated with spasmodic stricture. Nausea and vomiting are rarely absent in this stage, the tongue becomes coated and dry, while the expression is anxious and the fever very high.

In the commencement of the disease there is some difference in the symptoms of inflammation of the bladder which arises from the nature and seat of the inflammatory process.

If the neck of the bladder is mainly affected, the spasmodic desire to urinate is more pronounced, and the pain is felt low down in the vagina and anus, while the symptoms are higher up in the rectum, with constant inclination to go to stool, if the base or posterior wall of the organ is principally involved.

Acute cystitis runs its course in six or eight days; under favorable circumstances and appropriate treatment all painful symptoms will in that time have subsided, and the patient will have entered upon a course of permanent recovery.

If through a constitutional habit, or through neglect or improper treatment, the disease is not curbed, the result will be quite different; the inflammation may pass into a suppurative stage or assume the chronic form.

The treatment in the acute stage will resolve itself into two different measures of relief; these are first to subdue the spasmodic pain and nervous excitement, and secondly, to quiet the local irritation. The pain is best controlled by morphine powders, one-fourth of a grain each, given every four hours. Warm teas of German chamomile or flaxseed, so as to dilute the urine, may be freely given. Hot vaginal injections of borax water have a remarkably soothing influence; the hot sitz-bath is another useful adjuvant. It has been customary in this country and England, to apply hot water compresses or hot poultices over the hypogastrium, which is that part of the lower abdomen corresponding to the region of a distended bladder.

After eight years of extended experience in this country, and a thorough trial of hot fomentations for inflammatory affections of the abdomen, I became convinced that the German method of cold-water compresses gives more relief and is more in the nature of an abortive, hence curative.

I recommend to my patients, instead of the hot-water applications, a rubber bag, filled with broken pieces of ice, and applied over the region of the bladder.

The bowels should be freely moved with castor oil or a dose of salts and senna, or by an enema of warm soapsuds.

The food should be bland and of a fluid nature as nearly as possible, broths with an egg, milk gruels or bread and milk.

CHRONIC CYSTITIS.

If the acute attack of cystitis in the course of eight or ten days becomes modified, but convalescence is not established, then it is quite probable that the disease is drifting into a chronic stage.

The mucus or slime that formerly accompanied the urinary discharge is now assuming the character of matter or has become muco-purulent. While this is a very rare symptom of the acute variety of cystitis and usually of brief duration, in chronic inflammation it is one of the characteristics of the malady, and often lasts for a long time; the muco-purulent fluid is occasionally remarkably profuse.

The pus is not always furnished by the free surface of the mucous membrane, but may be traced to small abscesses, situated in the tissue between the mucous membrane and the muscular wall of the bladder. The locality for the formation of these abscesses is principally at the neck of the organ, although there is no part of the organ that is entirely exempt from them. Fortunately, the abscesses generally point inwards or towards the cavity of the bladder, but it not infrequently happens that they break through and empty into the vagina or even into the adjacent bowel or abdominal cavity.

The occurrence of pus or suppuration is by itself so grave a process that it is always accompanied with certain well marked and stereotyped symptoms, which are cold chills, alternating with flushes of heat, increase of heat or fever, anxiety and restlessness. The pain now becomes dull and throbbing in character, and the burning or stinging is only felt when the patient urinates. When there are abscesses, the nervous derangement may be so great as to cause the mind to wander in delirium. Before the appearence of pus in the urine, nothing but a skillful examination can establish the existence of an abscess.

The treatment for suppuration of the bladder, when limited to the surface of the mucous membrane, is always curable with intelligently-directed treatment, which is the same as that for chronic catarrh of the bladder, to be detailed further on.

ULCERATION OF THE BLADDER.

This is perhaps seldom a condition by itself, but rather a complication of the preceding disease. The ulcers occupy the place of what were formerly little abscesses, that have broken into the cavity of the organ. Foreign bodies in the bladder by their direct pressure on the delicate tissues of the membrane have been the cause of ulcerations, that gave rise to dangerous hemorrhage. Earthy concretions or stones will naturally form in the bladder, and the end of a gum catheter has also been found in the bladder broken off in the bungling act of drawing off the urine, or, what is more likely, by boring and poking within the cavity of the bladder, with a catheter or bougie, by persons ignorant of pelvic anatomy or in the belief that the bougie was in the cavity of the womb, for the purpose of inducing an abortion.

Ulcerations will always be accompanied with more or less inflammation or visceral catarrh, so that the symptoms will fall under that head which has already been considered.

CATARRH OR SUBACUTE INFLAMMATION.

The mucous membrane of the bladder, like that of the nose, mouth or bronchial tubes, has its natural secretion of healthy mucous. When any of these membranes become irritated or congested from any cause, this natural secretion becomes so increased as to make a perceptible flow of the secretion of mucus, and this is what the term catarrh signifies. Catarrhs always presuppose the existence of inflammation, which in its nature is subdued or mild, so that it has been qualified as subacute, which is intended to convey the idea that the tissue need not be red nor hot and swollen as is always the case in the acute form of inflammation.

Chronic catarrh of the bladder is traceable to any or all the causes that have been enumerated in the acute processes, because every acute inflammation of the bladder may terminate in a chronic form. It occurs at any period of life, but it is most common in elderly subjects; it is always an attendant of ulceration of the bladder or some abnormal growth in the bladder. If the disease is once established and is due to a complication, it is liable to become aggravated or re-established after a brief subsidence by exposure to cold, excesses in diet and drink, or diseases of the vagina, uterus or rectum.

The secretion of catarrh is white and glairy and resembles the discharge of leucorrhœa or whites. When disassociated with acute inflammation of the bladder, it comes on gradually, or in a slow, insidious manner; for this reason the term subacute inflammation is sometimes employed by authors, because there are no fiery symptoms at the onset of the affection.

The urine is always more or less altered in character, because the inflamed mucous membrane predisposes the urine to speedy decomposition. There is frequent and difficult micturition, and the entire region, but in particular the affected organ, is more or less sensitive and sore.

The quantity of mucus which passes off with the urine varies greatly at different periods and in different cases. In the early stages it may entirely escape notice, being so small that if the urine is not saved in a vessel and accumulated for the twenty-four hours the mucus can hardly be detected; thus, the entire quantity of the above period may often not exceed two teaspoonfuls. When the disease becomes more advanced, the quantity of mucus may be equal to the quantity of urine that passes. The secretion is very thick and sticky, and settles to the bottom of the vessel or adheres to its surface. If there is pus mixed with the mucous secretion, it becomes a more serious question, and it may then be inferred that other organs are involved, the conductors of urine from the kidneys to the bladder, for instance, or the kidneys themselves. If the disease is confined to the bladder, the prospects for a cure are very favorable; only when diseases of other organs in the neighborhood are the exciting causes of the malady are the chances for a cure correspondingly limited.

The success of any treatment will depend in a great measure upon the nature of the exciting causes. These require to be removed, if within the possibility of medical skill, before the catarrh can be made to subside.

Should the mucous or muco-purulent secretion be very abundant, the bladder must be thoroughly rinsed out; first once every twenty-four hours, and afterwards every other day, so that the mucous membrane will be cleansed from all foreign irritating elements. I am employing for this purpose Thiersche’s Boro-Salicylic solution. This of course can only be carried out by a skillful physician.

When the disease is in its incipient stage it is amenable to intelligently-directed home treatment.

The most perfect rest of mind and body is one of the essentials to success, the entire suspension of stimulating drinks of an alcoholic nature, of which beer is the most irritating, and tea or coffee must be discarded. A milk and vegetable diet is the most beneficial to subsist on, and all condiments, even salt, must be dispensed with.

If the bowels are costive they must be regulated either by means of enemas of warm water, or what may prove of greater and more lasting benefit is the use of Femina laxative tablets. One tablet should be taken every night at bedtime, and if one operates too much, then one every other night may be all that is required.

Demulcent drinks of flaxseed tea, or slippery-elm water, should be drunk freely, and for the catarrh of the bladder there is no prescription that ever gave me the same satisfactory results as this one:——

NO. VI.

Mix, and take a tablespoonful or less three times a day.

Wear flannel drawers and woolen hose, so as to guard against sudden changes of the weather.

NEURALGIA AND NERVOUS IRRITABILITY.

The bladder is often the seat of functional derangements that are characterized by a morbid sensibility and pain.

The principal symptom of this disease is a frequent desire to urinate. A careful examination of the urine reveals nothing abnormal in the fluid that would point to the slightest affection of the bladder, nor are any of the symptoms that characterize inflammation present. There is no mucous sediment, but in a large proportion of cases there is an abnormal deposit of the phosphates that would point to nerve waste. There is often a similar irritability in the vaginal canal, in fact, there is such a mutual sympathy between the two, which can hardly be located in any one particular organ.

Hemorrhoids and constipation are sometimes found to be the cause.

In women of a nervous temperament the bladder often becomes the seat of a steady neuralgic pain. Sometimes this pain is periodical, recurring every day and about the same hour and lasting the same period. This pain is of a lancinating character, and radiates from the bladder to the neighboring organs. I have noticed these symptoms, particularly in women who had lived in malarial districts, and whose blood had become impoverished by malarial fevers, or from excessive hemorrhages due to some uterine trouble.

Sexual excesses and other abuses that lower the tone of the nervous system will also develop a neuralgic condition of these parts. Persons who seek relief from this distressing complaint must first abandon their vices before they can expect alleviation from any treatment. This affection is not in itself dangerous, but the frequent recurrence of paroxysms of pain render life miserable. If the general system requires toning up, I would recommend the iron pills after Formula I, with a good liberal diet of eggs and milk. For immediate relief of the painful spasms, the sitz-bath and hot vaginal injections are of great value. And for the irritable bladder I can recommend:——

NO. VII.

Mix, and take a tablespoonful three times a day.

The gouty and rheumatic bladder is so very rare that a detailed description is hardly necessary. But it might be well to remind the reader that if she is of a gouty or rheumatic disposition and has also bladder trouble, it may be due to the bladder being compromised or influenced by gout or rheumatism. In that case, appropriate treatment directed to the rheumatic diathesis will also cure the bladder.

PARALYSIS.

The female bladder becomes paralyzed from various causes; some of these are located in the organ itself, while others are due to disease of the brain or spinal cord. An obstruction to the flow of urine through the urethra causes the bladder to become overdistended with urine and induces paralysis. A prolonged pressure from the child’s head during delivery is oftener the cause of transient paralysis than any other. It happens that lying-in women cannot pass their urine for several days after confinement. Violence from without, as a blow or a kick, may have a similar effect. This results from the pressure to which the bladder was subjected. Operations on the rectum, vagina, or any of the pelvic organs, are frequently followed by a partial or complete paralysis. In all these cases, there is only one precaution to observe, and that is to draw off the urine at regular intervals so as to avoid an enormous accumulation of fluid.

The paralysis becomes dangerous and obstinate to treatment, in proportion as the bladder becomes abnormally distended, and the length of time that the muscular tissues are under the excessive strain.

In those cases where the paralysis is due to spinal or brain disease, there is little prospect of a cure. In other cases, as for instance after confinement or an operation on the rectum for piles or fistula, it generally passes off in a few days.

Great care and cleanliness must be exercised in using the catheter, so that the bladder is not infected from filth or virus from another patient. A catheter that has been employed on a patient who had her urine drawn off while she suffered from purulent catarrh or puerperal fever, will inoculate a healthy person with the same disease, and in this manner diseases are often communicated. The bladder is exceedingly liable to infection.

HEMORRHAGE.

A discharge of blood from the bladder is not of frequent occurrence, but it occurs often enough to make it noteworthy, and women should at least know that there is such a thing. It oftener takes place in men than in women, as a symptom of some grave or serious disease, or it may be only a trivial disorder. Hemorrhage of the mucous membrane takes place very readily, owing to the delicacy of the tissues and the great vascularity of the submucous layer, and there is a much greater tendency to hemorrhage in some persons than in others.

Persons who are weak and debilitated bleed much easier than strong, vigorous ones, because the blood may become so thin or poor in fibrin that it greatly loses its property of coagulating. Some diseases bring this particular diathesis about, such as scurvy, also measles, scarlatina or smallpox. Worms have been found to make their way from the rectum into the cavity of the bladder, and caused profuse and even fatal hemorrhage. A violent fall of the body, rupturing an artery in the bladder, severe horseback riding, and venereal excesses, have all caused almost fatal hemorrhages, to which must be added ulceration of the mucous membrane. The most profuse hemorrhage of the bladder that I was ever called upon to witness, followed drinking a strong decoction of wormwood; irritating diuretics, like spirits of turpentine or tincture of cantharides, are also liable to cause bleeding. Hemorrhage is always accompanied with frequent desire to pass urine and spasmodic pains at the neck of the bladder. The blood may also coagulate in the bladder, causing an obstruction. The treatment consists principally in keeping the patient very quiet, and a rubber ice bag should be applied over the region of the bladder; nothing but bland liquid food is advisable, but no hot drinks are permissible. If the urine does not pass, a soft rubber catheter should be employed for the purpose of drawing it off.

Hemorrhages of the mucous membrane, whether of the bladder, the bowels or lungs, generally yield to the following mixture:——

NO. VIII.

Mix, and give a teaspoonful in a little water every four hours; children in proportion.

URINARY FISTULA.

By this is meant a permanent unnatural opening into the bladder from without, through which urine escapes.

The situation of the female bladder, just in front and over the vagina, and also its attachment to a portion of the cervix or neck of the womb, exposes it to injuries, especially from pressure of the child’s head during delivery. By referring to Plate II, it will be seen at a glance how easily an accident can take place from this cause. It was at one time supposed that delivery by forceps was the most fruitful cause of this lesion. That this is likely to happen only where the instrument is in incompetent or bungling hands, there is no reasonable doubt. A thorough acquaintance with the entire subject has proved that there are other causes that are the mainspring of this, sometimes very serious accident.

Indeed, the opposite view is now entertained by the profession; that is, that prompt delivery by forceps will prevent the parts from being injured, when the soft parts, and particularly the bladder, is under severe and prolonged pressure by the child’s head. There is no question that there is greater peril to the mother and child, in undecisive delay, provided the attendant has the requisite judgment and experience to act intelligently.

The hypothesis upon which this is based is the restorative property that living tissue possesses, to regain its vitality, after it has been subjected to severe and inordinate pressure. This we may observe in our daily experience; when, for instance, we jamb or crush our finger, or a child has its fingers momentarily crushed between a closing door, the fingers are sometimes crushed flat, but upon being released, they rapidly regain their shape and vitality. If the pressure were continued for any length of time, the blood in the tissues would have become congealed, and the circulation permanently shut off, so that recuperation would have been impossible, and the tissues would have sloughed or mortified.

If the bladder, under the direct pressure of the child’s head against the pubic bone, be subjected too long, the same results would naturally follow: the tissues could not regain their vitality, and they would either tear or subsequently slough or mortify, which causes the fistula.

The vagina and bladder, like every other tissue of the body, except that of the brain or nerves, will suffer a great deal of contusion for a short time, but if protracted beyond a reasonable length of time, it will be permanently destroyed or injured.

A urinary fistula is always a serious malady, since it exercises a deleterious influence upon the patient’s health. If the opening is only small, a spontaneous cure may take place, but if it reaches considerable dimensions, it requires to be accurately adapted and stitched together. The best time for the repair of the injury, is six to eight weeks after the receipt of the injury.

Rupture of the female bladder is comparatively rare, for the reason that women are not exposed to the same serious accidents as men; but if women will persist in doing everything that men ought to do for them, the statistics may be reversed. When the bladder is distended and violence is brought to bear on the abdominal walls, corresponding to the region of the filled bladder, a rupture is likely to result. Surgical measures should at once be resorted to, so that the injury can be repaired before inflammation of the peritoneum sets in.

CHAPTER XIII.

ACUTE AND CHRONIC INFLAMMATION OF THE VAGINA.

When speaking of inflammation of the vagina, reference is had to its mucous lining alone. It undoubtedly happens that structures or tissues beneath the mucous covering become involved in the inflammatory action, but this occurs so seldom that it is not of sufficient moment to make it the subject of an inquiry in a practical work.

The mucous membrane of the vagina, like all other mucous surfaces, has its natural secretion for the purpose of lubricating and keeping its surface moist. In a perfectly healthy state, the color of the vaginal mucous membrane is a pale red, this becomes scarlet red upon irritation. In girls who are not irritated or women who have not been abused by sexual excesses nor infected by disease, the normal secretion is just sufficient to preserve the moisture of its surfaces, but not in such an excess as to be noticed as a secretion or discharge outside of the vaginal canal. There is a physiological exception to this normal rule, a few days before and after the menstrual period, when the mucous membrane of the vagina sympathizes with the general congestion of the pelvic organs. The mucous secretion becomes then greatly increased, amounting to a catarrh or flow, this, however, is only transient and subsides with the cessation of the menses. This might with propriety be termed a natural or physiological catarrh.

For convenience of description and corresponding with the anatomical changes and the sources of their origin, inflammation of the mucous membrane of the vagina may be acute or chronic, simple or specific.

Acute inflammation in this instance is no different in its characteristic symptoms from inflammations elsewhere; it develops suddenly, and there is congestive swelling and pain. There is considerable heat in the parts, increased redness, and the canal is very sensitive. In the beginning the mucous membrane is dry and contracted, but after a few hours or a day, relaxation and moisture supersede. The secretion is very scant at first, but becomes more abundant as the disease progresses, its character also changes from a white, glairy mucus to a creamy, muco-purulent or yellowish discharge. The urethra may also become involved, and then the symptoms that were detailed in connection with urethritis are also present.

Acute vaginitis may arise from a great variety of causes, but the worst case that ever came under my notice was the scalding effect of a hot-water injection, given under the advice of a physician who had ordered the patient to use the water “as hot as she could stand it,” and also told her “the hotter the better.” This profoundly wise suggestion was carried out by the patient with a vengeance, for she used nearly boiling hot water, which she had tested by putting in her finger and quickly withdrawing it. The steaming fluid so scalded the vagina that a most pronounced acute inflammation of the vagina was the immediate result. I have had other cases of the chronic form come under my notice that were aggravated by similar advice, so that a word of warning against the thoughtless and indiscriminate use of hot-water injections will not be without value.

The vaginal irrigations of hot water, as a general stimulant to the mucous surfaces, or as an alterative to stimulate the absorbents to increased activity in removing old pelvic exudations, deserve a recognized place as a useful therapeutic measure, often of the greatest value, but too hot or “as hot as the patient can bear it,” is superlative nonsense and absolutely injurious.

No water injections into the vagina that are kept up any length of time should be warmer than 110 degrees Fahr. and never should vaginal injections be employed without using a thermometer to gauge the heat. When the solution is medicated, 103 degrees should be the average temperature, but it should never exceed 107 degrees Fahr. Exposure to cold and moisture especially during the menses is prominent among the causes of acute vaginitis; injury from pessaries or coition, retained putrefying secretions in the vagina, or the application of chemical preparations, or injury during confinement, will all induce this disease. Prolonged nursing causes anæmia, which predisposes the system to catarrhs. During the child-bearing period catarrhs of the vagina are quite common, and excessive coition excites a very painful inflammation of the vaginal mucous membrane.

Gonorrhœal infection arising from a specific contagion gives rise to a very painful and dangerous vaginitis. The character and nature of the specific virus admits of no particular description, because its infectious quality of a specific nature does not at all depend upon the physical appearance of the infectious discharge from the male. Whether it is yellow or greenish, muco-purulent or a glairy mucous discharge, establishes no criterion, but the presence of microbes, the gonococcus of Neisser; this, of course, a careful microscopic examination can alone establish. This much is true, that careful researches in Europe, by competent and reliable authorities, have established the fact, from carefully-prepared statistics, that this is a far more fruitful source of uterine diseases than was formerly dreamed of.

A specific vaginitis has a greater tendency to spread itself along the mucous tract of the genital organs of the female than a simple non-specific catarrh. In the former the womb and Fallopian tubes become successively affected, as we shall learn more definitely when we have occasion to inquire into the diseases peculiar to these organs.

Acute inflammation of the vagina has pronounced symptoms, and when any one of them is felt by the patient, she should lose no time in resorting to treatment.

The first symptom that is generally perceived by the patient is a sense of heat and burning in the vaginal canal; this is also reflected in the neck of the bladder during micturition. As the disease develops, there is a constant desire to pass water frequently, and this becomes sometimes a prominent sign. A dull aching weight is felt between the vagina and rectum. After these have lasted for some days, an offensive discharge from the vagina ushers in the second stage, excoriating the skin around the vulva, and if the disease should spread itself to the neighboring organs, there is a violent throbbing pain in the whole pelvis.

Women who are suffering with acute painful vaginitis should take to bed; all pelvic diseases of any acuteness at all are treated at a great disadvantage when the patient is running around and on her feet. The disturbance in the circulation, the exposure to cold from cold floors or damp sidewalks, and the impossibility of preserving an equable temperature of the body, when out of bed, only aggravate the malady.

The vagina is to be douched several times a day with half gallon of warm water, in which a half teaspoonful or one tablet of Femina antiseptic uterine lotion has been dissolved, and when the canal is rinsed, a Femina vaginal capsule should be introduced, but only once a day, and that is preferable at bedtime. The feet and extremities should be kept warm, and in married women total continence should be observed while the slightest irritation and soreness exists. By the non-observance of this precaution, the best directed efforts will often be frustrated and many female diseases which are readily curable in the beginning become chronic, and a moment’s reflection ought to make this clear to any person of ordinary intelligence.

If there is the slightest suspicion that the disease is of a specific nature, the treatment must be antiseptic in its nature. Your physician should be reminded of the possible nature of the disease, for doctors as a rule are ignorant of the dangers that ordinarily accompany gonorrhœal infection.

Oppenheimer in Germany made experiments for testing the germicidal properties of various drugs on the specific germs of gonorrhœa, and he proved that a corrosive sublimate solution of 1 part to 20,000 will kill the gonococci. Corrosive sublimate is the corrosive chloride of mercury, one of the most powerful of the mineral poisons, and while it is perfectly safe in the dilutions that it is employed in, the greatest precaution must be constantly exercised to keep the drug isolated and out of the reach of children, especially the “antiseptic tablets,” of which mention will be made below, because little children and adults also might at first sight believe that they were candy.

I am accustomed to employ the corrosive sublimate much stronger than the Oppenheimer experiments demand, a practice which I base upon practical observations, while in the Berlin clinics, and that is in the proportion of 1 to 2,000. John Wyeth & Bro., of Philadelphia, and other manufacturing chemists, make compressed tablets or wafers, which are very convenient and easily handled by any person of average understanding. These are sold by the druggists in little wide-mouth bottles, properly labeled, so that the required strength, 1 to 2,000, is obtained by dissolving one or two according to their strength in a half gallon of warm water. Whenever gonorrhœa is suspected, the vagina should be thoroughly rinsed out several times a day with the corrosive solution. If the patient fears mercurial poisoning, the antiseptic irrigation can be followed by plain warm-water rinsings as a safe precaution against mercurial absorption.

CHRONIC CATARRH, LEUCORRHŒA OR WHITES.

An acute inflammation of the mucous membrane of any organ may drift into the chronic or subacute form, so that any of the causes which give rise to the acute variety are among those that are to be looked for in chronic catarrh. The general characteristics of catarrh are the same, whether acute or chronic or whether located in the nose, throat, bronchial tubes or vagina. This fact greatly simplifies the whole subject of catarrhal inflammations, so that the general reader will find no difficulty in acquiring the necessary information for successful home treatment of this very common class of diseases.

Chronic vaginal catarrh has been divided into two varieties, vaginal and uterine. The distinction depends upon its origin or complication. Vaginal catarrh has its origin in and is limited to the vaginal canal. I have already called attention to a purely physiological catarrh that accompanies the menstrual flow and which subsides with the cessation of the menses; in addition to this, there is probably no woman who goes through life without at some time during her natural existence having this disease or symptom. Often the discharge is so scant that it entirely escapes her notice, and not until it becomes annoying by its constancy and abundance do women seek assistance.

In ancient times and until quite recently, it was considered as a distinct disease, attributed to constitutional debility or an indication of impure blood; these theories are now entirely discarded. The modern school of Gynecology has given it quite a different interpretation, and considers leucorrhœa rather a symptom of some local disease than a disease itself. Experience, and careful research in, the sick chamber fully corroborate the correctness of this view, so that a simple local chronic catarrh is the exception to the rule. The exception applies oftener to children than to adults. We find it in young babies or little girls of all ages as a result of diarrhœal discharges which are acrid and filter themselves into the vagina and by their sharp, irritating action on the mucous membrane, excite at first an acute, and afterwards a chronic catarrh of these parts. Eruptive fevers have induced a similar effect upon the mucous membrane of the child’s vagina and also upon that of the bladder; obstinate catarrhs are frequently traced to these fevers. I have known pinworms to make their way from the rectum into the vagina and by their irritating presence excite in the little child a very distressing vaginal catarrh.

The irritation or itching which the inflammation and decomposed secretion cause, makes the child involuntarily dig or scratch her vulva, which of course only aggravates the disease, and which has already been mistaken for precocious masturbation, and will undoubtedly often be so considered again by superficial observers. In later years a subacute inflammation of these parts will undoubtedly develop this pernicious practice, and I have known several cases myself where young girls became physical wrecks from a combination of chronic vaginal catarrh and self-abuse, no one ever dreaming of the real morbid condition, but attributing their decline to everything else but the right cause.

There is another complication that may arise from catarrhal inflammation in little children, and that is an adhesive inflammation of the vaginal walls; that means that the sides of the vagina may partly or completely grow together, and thus change the normal diameter of the vaginal canal. In after years this may entail frightful suffering, either by mechanically obstructing the escape of the menstrual blood or otherwise interfering with the normal function of the canal. There are many diseases from which we suffer in adult life for which the foundation was laid when we were young, through the ignorance of our parents.

The stormy symptoms that usher in the acute form are absent in the development of the subacute or chronic variety. This disease begins sometimes so insidiously that the patient may not be aware of its existence for quite a while. The secretion may not be at first changed in its character, save that it is noticed in greater abundance. In the course of time, the nature of the secretion will be greatly changed, from a white glairy discharge into a grayish opaque secretion; this will be tinged greenish some days and be of a muco-purulent aspect. In the great majority of cases it is a whitish cheesy discharge from which the names leucorrhœa or whites have been derived.

The color of the vaginal mucous membrane in chronic catarrh is of a bluish red tint, and its surface presents in places granulated patches, that bleed easily when they are touched. The vaginal walls are relaxed, so that women often complain that they have a sensation of “feeling open;” this is indeed the real state of affairs; the walls of the vagina may become so relaxed as to constitute a prolapse of the anterior portion or wall of the vagina, dragging the bladder and womb down with it.

A great many of the so-called “falling of the womb cases” are no falling of the womb at all but simply a relaxed vagina, in which the wearing of pessaries or any other mechanical uterine supporter will actually do a great deal of harm.

The treatment of vaginal catarrh is principally local, when there are no constitutional complications. Of course there are rules of conduct that apply to all catarrhal patients, whether the catarrh is of the genitalia, of the nose or throat or of the bronchial tubes; these rules constitute the hygiene of catarrh, a subject which is discussed in a separate chapter in this work to which the intelligent reader is referred.

The main feature of the treatment consists in thorough cleanliness of the vaginal canal and in the use of a soothing lotion. This object is best accomplished by the use of the Femina antiseptic lotion and in the following manner: Dissolve one tablet or half a teaspoonful in a cupful of hot water and then add this to a half gallon of warm water of a temperature of 103° F., and by means of an elastic bulb syringe, use the entire quantity at one time. If the discharge is profuse, or if any offensive odor is perceptible, then the vaginal injection should be made several times a day.

In case there is soreness and pain in the pelvis, and there generally is, a Femina vaginal capsule should be introduced into the vagina, just before retiring.

When the patient feels a dragging sensation, or such symptoms as would indicate a prolapse (falling down) of the vaginal walls from weakness or relaxation of the columns and muscular tissue which give them support, then the Femina antiseptic uterine lotion should be used, as before described, with this difference, that double the quantity should be dissolved in the cupful of hot water, and then added to the half gallon of warm water of the same temperature and used in the same manner. When the Femina antiseptic uterine lotion is used in its double strength, the remedy loses nothing in its healing effect but becomes more astringent, strengthening, and disinfectant.

Be sure that the nozzle of the syringe sweeps the entire vaginal cavity, and if the above quantity of fluid should not be sufficient to thoroughly cleanse the vagina, then use double the quantity of fluid.

With this prescription I have cured cases of leucorrhœa of twenty years’ standing which had gone through the ordeal of all the different treatments that they were capable of undergoing.

I would recommend to those patients who feel their wombs dragged down, the knee-chest posture, that means, to kneel down on the floor with the hips elevated as high as possible and the chest close down to the floor. This position rolls the abdominal organs upwards and forwards, and thus naturally draws the womb and vagina into their normal positions, much better than any mechanical appliance or operator can possibly accomplish it. It simply allows the relaxed organs, through the natural law of gravitation, to gravitate where they belong. It is necessary to retain this kneeling position for only ten or fifteen minutes, repeated twice a day, say night and morning, and the curative effect is truly wonderful.

When I speak of the curative measures of displacements in general and of falling of the womb downwards and backwards in particular, I will give a detailed description of the knee-chest position.

There should be a choice in selecting a vaginal syringe or a syringe for vaginal bathing. The “fountain syringe” has several objections that are insurmountable. In the first place, the quantity of fluid that is to be used is limited by the capacity of the reservoir, or in order to replenish it, the even tenor of the rinsing is disturbed. Another objection is, that the convenient peg upon which to hang it is not always present, or a shelf upon which to rest it not high enough; then there is not the control over the stream that is desirable, so that considerable confusion arises at times from the fluid wetting things that had better be kept dry. For these reasons I prefer a bulb syringe.

CHAPTER XIV.

HYGIENIC MEASURES FOR CATARRHAL DISEASES OF THE FEMALE ORGANS.

No treatment for catarrhal inflammations in general and of the pelvic organs in particular is certain and complete without special attention being given to certain laws or rules that are laid down for the preservation and attainment of health, and these comprise one of the collateral departments of medical science which is termed hygiene.

What the skin or integument is to the exterior of the body, the mucous membrane which lines the respiratory passages and other organs is to the interior of the body.

The mucous membrane is only a modification of the skin, and while it differs in its glandular composition in the different organs that it lines, in the main, it retains the common characteristics of the skin or outer covering of the body.

The corium or fibrous layer of the mucous membrane is analogous to the derma of the skin; and it is in fact a continuation of it at the orifices of the body.

The corium of the mucous membrane supports an epithelial layer of cells that are of various forms, differing in the different organs that it lines.

Underneath the corium of the mucous membrane there is the fibrovascular layer, which contains the blood vessels, lymphatics and nerves and embedded in the epithelial cells supported by the corium are the numerous mucous glands or follicles. In some portions of the mucous tract and projecting out of it are little elevations called villi or papillæ, analogous to the papillæ of the skin.

These glands and papillæ exist only at certain parts and are modified according to the function that the organ performs. The mucous glands of the stomach differ from those of the intestines, and those of the mouth from those of the bronchial tubes. The mucous membrane of the womb differs from all the rest, by having no submucous or fibrovascular layer; the mucous glands of the womb are imbedded and extend directly into the muscular tissue of the organ. The secreting glands, which form a special feature of mucous membranes, are abundantly supplied by small capillary blood vessels and nerves, so that any disturbance of the general or systemic circulation or a derangement of the nervous system will at once greatly influence the healthy or normal secretion of the membrane, just exactly as the skin is affected by cold or fright.

In order to appreciate all the causes that operate for either good or evil, we must pause for a moment and consider the sympathy with and the close relation of the mucous membrane to the circulation of the blood and the nervous system. The mucous membrane of the different organs is often made the safety valve through which obnoxious materials or morbid conditions of the blood are eliminated from the system, and for that reason I have long ago discarded the usual harsh measures in the treatment of sudden or acute catarrhs. I have found that, by carefully watching and giving close attention to the details of certain rules of health, catarrhs speedily disappear of their own accord: on the other hand, if irritating local remedies are constantly used, catarrhs continue to grow worse.

This demonstrated fact so very often repeated, impressed upon my mind the importance of hygienic measures for the successful treatment of catarrhal inflammations, whether they are of the respiratory organs or of the female pelvic organs. The most prominent and efficacious measures are to be found in intelligent precautions for preventing colds and inuring the system to changes of temperature by appropriate outdoor exercise.

By far the greater proportion of female complaints are catarrhal inflammations, and these fasten themselves upon all the pelvic organs—on the bladder, vagina, womb and Fallopian tubes.

We generally know how we contract a bronchial catarrh or bronchitis, a nasal catarrh or sore throat; in precisely the same manner do women contract most of their pelvic catarrhs, that is, from a common cold or sudden chilling of the body or part of the body.

Dr. Thomas F. Rumbold, in his work on the “Hygiene and Treatment of Catarrh,” says: “The history of every case of chronic catarrh attests that the complaint commenced with colds in the head and that the disease grew upon the patient almost imperceptibly, the first colds being so trivial in character as to attract but little attention.”

This statement is as true of the great majority of cases of vaginal and uterine catarrh as it is of catarrhs of the air passages, and for this reason the measures and precautions for the prevention of colds must be one of the features in the successful treatment of female complaints.

The particulars of the causation of colds and the hygienic precautions for their prevention are hardly ever given the attention which their importance demands in the treatment for catarrhal complaints of women, so that a great deal of suffering is left unrelieved and a great deal of expensive and useless doctoring is endured. Altogether too much reliance is placed upon a wash or some local application made by the doctor to the affected parts, and, indeed, the mainspring of the catarrhal affection is entirely overlooked or neglected, which is, the susceptibility to the recurrence of fresh colds.

The injurious effects of taking cold or chilling the body or any part of it, have been the subject of special inquiry in Germany. The mucous membrane and the skin seem the most sensitive to sudden changes from a warm to a colder atmosphere, but observations have already proven that besides the usual catarrhal inflammations, there are other inflammatory conditions that are developed. The kidneys, lungs, and liver have been found to be the seat of inflammations in a series of experiments that were made with rabbits that were removed from a warm to a much colder apartment, and from this may be inferred that these conditions originate similarly in the human subject.

The logical conclusions of these researches have been, that the chilled or cooled blood becomes chemically altered and acts as a direct irritant in the small capillary vessels, and by that means all the phenomena of inflammation of the tissues are excited, and these of course develop wherever the cold may strike or locate.

When we speak of a slight or a bad cold, we cannot form the least idea of the remote effects that the cold may bring about. It may lay the foundation of a nephritis or Bright’s disease of the kidneys, or some other lesion, and that it often gives rise to vaginal and uterine catarrh is as certain as that it gives rise to nasal catarrh or a cold in the head.

An aptitude to take cold grows with each repetition of the attack and the prolonged duration of the acute catarrhal symptoms. And for that reason persons grow into the habit of taking cold upon the slightest exposure or change of temperature. At this stage of catarrh there is an abnormal sensitiveness of the mucous membrane and skin, in which the slightest draught of air or even passing from one room to another occasions an attack of sneezing or a chill and other symptoms that will indispose the patient for several days.

The great majority of individuals have a natural predisposition to certain diseases.

In anatomy the body has been divided into systems. A system is an assemblage of organs composed of the same tissues and intended for similar functions, as the circulatory system, the nervous system, the muscular system, the cutaneous system, etc.; these systems are all liable to particular diseases. In one person the mucous membrane of the respiratory system is the most sensitive part of the body, while in another, and especially in women, it is the mucous membrane of the genito-urinary system. In other words, one person will take a cold and it will settle in the head or on the bronchial tubes, while another from the same exposure will get a catarrhal inflammation of the bladder or womb; this is only explained on the theory of natural predispositions, and, perhaps, hereditary taints.

If a person once knows the weak or vulnerable points, he can outgrow them, by employing such rules of hygiene as experience has taught to be useful. There is much more benefit to be derived in an educational treatment directed to the prevention of disease, for this is also in the nature of a cure, than in a blind obedient faith in the treatment or remedy of a physician who may be ignorant, and generally is, of the laws of health or the science of hygiene.

To promote health and to antagonize disease is greatly within one’s own power, because there is no doubt that most diseases are the result of imprudence that cannot be attributed to ignorance, because persons commit these errors with a full knowledge of their evil effects.

A healthy habitation, that has all the advantages of pure air and sunshine, is an essential feature in regaining health and encouraging a cure. There are hundreds of persons who have been sick and miserable for years, and who have made the rounds of all the doctors they ever heard of, without the least benefit to themselves, because they were never told how to live, and their living rooms are dark and sunless and poorly ventilated.

The even and equable temperature of all the rooms of a house should be kept in constant view, so that sudden and extreme changes of temperature are avoided.

Warming a dwelling artificially should be one of the important features in the construction of a completely-furnished residence. This subject has been neglected, owing to the temperate climate of California, yet the moisture of the air, and the closeness with which dwellings are built in cities, exclude the rays of the sun and make houses too cold for health and comfort. In our climate we become more sensitive to the cold air than those who live in drier regions.

In shaded houses and rooms, especially in damp weather, we need artificial heating as much as they do in colder climates, so that architects should make it a study to introduce a system of heating that will insure an equable temperature throughout the entire building, at a minimum of expense.

The fireplace or open hearth, which has become so popular with us as the pleasantest and healthiest mode of heating and also insuring ventilation, should be discarded for something much better. The fact that the fire is directly beneath the chimney flue explains the fact that eighty-seven per cent of the total heat yielded by coal or coke and ninety-four per cent of that yielded by wood escapes through the chimney. This enormous loss of temperature arises from the current of air necessary for combustion, carrying with it a large quantity of the heat produced which is lost in the atmosphere. This of course is a means of ventilation, but a little reflection will convince almost anyone that it cannot be the most practical, and in this State where coal is very high it is equally expensive. The smoke, soot, and ashes that are inseparable from the open fireplace make it troublesome and dirty, not to say anything of the coal gas, which poisons the atmosphere of a room, and I have often noticed its noxious influence on infants.

There are objections against warming one or two rooms of a house and leaving the others cold. A warm sitting room, while the halls and bedrooms remain cold and chilly, is a very fruitful source of cold and catarrhs.

There is a vast difference between heating for health, and heating to have warm rooms; in the former, the warm rooms would be incidental to health and comfort, while in the latter you might sacrifice health for warm rooms.

Heating by hot air has serious objections that may be briefly stated as follows: Fresh air passing through or around red hot furnaces, becomes so rarefied that it no longer contains sufficient oxygen for healthful breathing purposes.

The expansion and contraction of the furnace allows the escape of the noxious gases of combustion which become unavoidably mixed with the hot air that is to heat the dwelling, and thus vitiate the air that is to be breathed, and should there be any malaria from defective sewerage in the basement that, too, would be circulated with the heated air.

It seems also to be impossible to distribute hot air equally to all the rooms of a house through long flues, for the hot air is choked off at the registers by the counter currents of cold air from the rooms on the side of the house exposed to the winds, while the protected side is always overheated.

I have practically demonstrated, in my own residence, that hot water is the most simple and efficient means of heating a dwelling for both health and comfort, and for several reasons: There is no danger of overheating, and there is no possibility of vitiating the air, because the temperature of the hot water is always lower than even the boiling point.

With a proper distribution of the heated water through pipes, and radiators of sufficient heating surface, all rooms can be warmed to an equal temperature. Another consideration is the economy in fuel when properly constructed heaters are used, for the water readily absorbs the heat and retains it for hours after the fire has ceased to burn. Unlike steam heating, a moderate fire will warm the house in moderate weather. Hot water heating does not exclude a practical scientific system of ventilation. There is no danger from explosion, nor from fire, the plant is absolutely odorless and noiseless, and requires neither mechanical skill nor close attention to run it. There is no doubt of the durability of a hot water system, for if properly constructed it should last as long as the building, and the cost is less than a number of mantels with the necessary flues.

The most comfortable average temperature for living rooms is from 65 to 70 degrees Fahr., for hospitals and sick rooms a higher temperature is generally required, say from 75 to 80 degrees Fahr.

Dr. Horace Dobell, of London, in his work entitled “Winter Cough,” makes some very practical and useful remarks, when he says: “But before leaving the subject of sudden changes of temperature, I must not forget to speak of sleeping rooms. It is quite astonishing what follies are committed with regard to the temperature of sleeping rooms. On what possible ground people justify the sudden transition from the hot sitting room to a wretched cold bedroom, which may not have had a fire in it for weeks or months, it is impossible to say, but it is quite certain that the absurd neglect of properly warming bedrooms, is a fruitful source of all forms of catarrh. We cannot too much impress this upon our patients.”

There is another source of danger in artificial heating, and that is, in having the air of the house always much warmer than the most favored temperature of the open air. This is a great mistake because it is under these circumstances almost impossible to go from an overheated house or apartment into the open fresh air without catching cold, and for this reason the thermometer should be found in every well-regulated household. Women who are under treatment for female disease should never get into a cold bed, even if there has been fire in the sleeping room during the day. In damp and cold weather there should be greater precaution in this respect. The best bed warmer is one or more earthenware jugs, like the German seltzer water jugs, filled with hot water. Earthenware radiates the heat better and retains the warmth longer than glass, while there is no danger of the heat cracking the jug, as it will glass bottles. One or two of these jugs filled with hot water and put into a bed an hour or so before retiring will bring the temperature up to an agreeable warmth.

Proper clothing is perhaps from a sanitary standpoint of equal importance with that of artificial heating and ventilation. With appropriate clothing, the body can be protected against the inclemency of the weather and the sudden changes of the atmosphere so that no ill effects are experienced from the great changes of temperature to which we are exposed. Women are dressed less warmly than men, although they do not possess the bodily strength to resist cold in the same degree as men. Their garments are not only made of lighter material, but the loose, fluttering manner in which they hang around the limbs does not protect their bodies in the same thorough manner that similar material made after the style of men’s clothing protects men.

This does not imply that women should don men’s clothing, because the present costume or outside apparel of women of civilized countries, is both graceful and modest. A reform, however, in her underclothing is not only desirable but in many cases absolutely necessary to insure permanent relief from catarrhal affections.

All women who are suffering from uterine or pelvic diseases, and who are still wedded to the injurious costume of open drawers and skirts, have an important lesson to learn.

A warm and complete covering for the lower extremities and pelvic organs is paramount to any medicine or treatment that can be given.

It is during the menstrual period that the pelvic organs are more susceptible to congestion and inflammation from exposures than at any other time, and from the manner in which women dress, it is surprising that there is not more sickness among them than there really is. Wide and open cotton drawers, and skirts hanging loosely around their limbs, with cotton hose, are no protection against drafts and sudden changes, so that it often happens that the extremities are chilled and cold, which is in itself sufficient to cause uterine diseases. When this exposure continues, with some already existing disease, it will neutralize the best-directed efforts to accomplish a cure.

It is said of the celebrated Boerhave, that among his effects there was a carefully-sealed prescription, which contained the secret for preserving health and vigor to a ripe old age. In his last will and testament it was provided that the prescription should be sold to the highest bidder at public auction. A physician who was anxious to procure the recipe of this renowned Dutch doctor, bought it for a very high price. On breaking the seal and anxiously unfolding the paper, he found these words: “Keep the head cool, the extremities warm, and the abdomen free.” The buyer was greatly chagrined at the simplicity of the supposed panacea, but, if the profession and the public only appreciated the real worth of the advice, there would be much less sickness.

This strikes at most of the evils in dress that pave the way for diseases of women. It comprises the evil effects of tight lacing and compressing the abdominal organs by improper support for the skirts. A corset should never be worn so tight that the hand cannot be passed through the waist line. In the absence of a waist or shoulder straps for the support of the skirts from the shoulders, shoulder straps should be fastened directly to the corset, so as to relieve the hips and abdomen from the weight of the clothing.

The corset waist is not only a perfect substitute for a corset, in supporting the bosom and preserving the form so as to give a handsome figure, but it supports the skirts without restricting the circulation and respiration, or compressing the abdominal organs. In buying or making a waist or bodice, particular attention must be paid to the shoulder bands, so that these bands are short enough to give the waist or bodice support from the shoulders. If, then, the skirts are buttoned to the waist, the weight is taken from the hips, where it injuriously depresses the abdominal organs, and falls on the shoulders, where it cannot do any harm. There is a good deal of humbuggery about these new devices, and those who make it a business to sell them, never take the pains, or are incompetent, to properly fit the waist. If one only bears in mind that, if the waist does not support the skirts from the shoulders, there is nothing gained over wearing an old-style corset, imposition is impossible.

The dressing for the feet should be warm and comfortable. Women who go to balls and parties should always wear overshoes in going to and coming from an entertainment. Thin and light shoes must be avoided in cold and damp weather; in fact, there is nothing that women should be more careful about than too light and low shoes which do not keep the feet warm. For comfort and keeping the feet warm, there is nothing like a loosely-fitting leather shoe, with wide and thick soles, and a low, flat, English heel. It is also the best “corn remedy” I know of.

When the weather is wet and cold, rubber overshoes should be worn, and these should be removed when entering the house. Women who have a tendency to cold feet, will find the cork or felt soles worn inside of the shoes, a great source of warmth and comfort. The coldest stratum of air is invariably on the floor of the room, and there is, perhaps, no easier or more unsuspected way to take a cold than to exchange a pair of high, warm shoes that fit closely around the ankles, for a pair of light, low slippers. If you desire to rest your feet in a pair of light slippers, then add a pair of heavy woolen socks over the stockings, this will greatly lessen the chances of taking cold.

Women who are suffering from pelvic or womb diseases, and who are anxious to get well, and those who are troubled with painful menstruation, and menstrual irregularities, should wear woolen hose. Thin cotton, silk-mixed, or silk hose are not sufficiently warm, nor do they retain the natural heat of the body like woolen stockings.

Those who have once accustomed themselves to woolen hose, should not discard them in the summer months for cotton, linen or silk goods, and this is to be particularly observed on this coast, but the hose should be exchanged for thinner and lighter goods of the same material, corresponding to the demands of the season. It would not be wise or prudent to wear the same quality and amount of clothing in warm weather as in cold; otherwise the excessive clothing in the summer months will induce perspiration on the slightest exertion, and thus the system becomes most susceptible to cold when the weather changes or becomes cooler.

Elastic garters to maintain the tops of the stockings in position should be avoided. Rubber bands make a continuous compression on the vessels and nerves, although almost every woman claims that she does not wear her garters tight, yet at night when she removes the elastics there are deep furrows marking the constriction of the garters. The spring-wire garters are just as injurious, for they also exert a continuous pressure.

The veins of the legs are, for the most part, superficial, and this steady and gradual compression is very injurious to the venous circulation, so that the blood is prevented from returning from the limbs as readily as it should; this induces cold feet, and when the circulation is already weak, it often imparts a feeling of heaviness to the limbs, for which women doctor but without getting any relief. The only proper support for the hose is elastic straps that are supported from the waist; they are now so well known and for sale in every dry goods store that a description of them is unnecessary.

To keep the legs and body warm is not a question of quality or quantity of skirts or wraps. If the limbs under them are not separately enveloped and are only covered with thin cotton or silk hose and open cotton drawers, women are continuously exposed to the cold, damp emanations from the ground and to the drafts caused by the motion of the skirts, and blasts of wind.

The most intelligent suggestions for Dress Reform are those that are directed towards reducing the weight or displacing the heavy, stiff, and unwieldy skirts and clothing the extremities of the female in divided garments, so that they are no longer exposed to the dangers of cold and drafts. The divided skirt is in the direct line of a modest and desirable improvement of woman’s dress, and it is growing in popularity among the most intelligent of reading and thinking women. If the specialists of female diseases were to study the interests of their patients with the same ardor that they study the methods how best to fill their offices with patients, on whom they perform useless and dangerous operations, they would be of some actual benefit to our wives, mothers, and sisters, and our women could be dressed as gracefully as at present with less than half the underclothes to pack around with them.

I am decidedly opposed to anything approaching in style or shape the bloomer costume; the present style of outside dress cannot possibly be improved for a comely garment, but it is underneath this that an entire change should be speedily effected. The divided skirt is cut like drawers that have a width of thirty to forty inches of goods in each leg. I believe that the width of each leg should not be more than twenty-five to thirty inches; this makes the skirt warmer and lighter. This is not attached to a band to fasten around the waist, but to a yoke, which should be buttoned to the bodice waist, suspending the skirt from the shoulders. The material will be a matter of individual taste; the two qualities that should be always looked for are softness and warmth, and for that reason Jersey flannel and ladies’ cloth are the most suitable material; in summer or warm climates, pongee or wash silks may be substituted.

The skirt is cut on the bias to fit the hips, where it is fulled in and attached to a yoke instead of a band and in the back it laps about two or three inches. The advantage of the divided skirt is that it protects the limbs and body against drafts and cold emanations, and takes the place of all underskirts and petticoats. This skirt alone, however, would be insufficient to accomplish all that is desired by way of guarding against exposures; for this reason there is also a so-called Union suit worn under the divided skirt to complete the covering of the limbs.

Union suits, as the name implies, unite a pair of closely-fitting drawers with an undershirt. There is no particular advantage in uniting the underdrawers with the undershirt, but there is certainly no disadvantage. The principal object that is to be attained is not in unionizing drawers and shirts, but wearing such closely fitting undergarments that the extremities are permanently protected, and in having them so lapped or closed that the abdomen and pelvic organs are securely protected against cold.

Equestrian tights are made on the same principle and for a similar purpose as union suits, namely, to properly and surely cover the limbs and in a measure displace the great load of petticoats that women usually wear. They come in drawers and also in combination suits with the undershirts; a choice may be left to individual taste. There are different brands of these goods on sale in all the dry goods stores of our large cities, the prices being regulated by material and quality of the goods from which they are made. The woolen goods are preferable for practical purposes.

Women who do not like the woven closely-fitting drawers can take their choice between the latter and home-made flannel drawers, the French flannel for the lighter and the English bully for heavier and warmer clothing will be found to be the most serviceable materials; patterns for making up closed or button drawers may be had at the leading pattern stores of any city.

Women who cannot grow up to an appreciation of the divided skirt should by all means wear equestrian tights or buttoned flannel drawers, under cotton or linen ones; this will enable them to throw off one or two petticoats or skirts because the drawers will safely substitute the skirts and be much lighter. Some women dread the absence of skirts on account of appearing too scant; a little extra fullness and drapery to the dress make the absence of skirts not noticeable. If this were not quite so, there appears no satisfactory reason why a woman should feel embarrassed to modestly display the contour of her form any less than a man.

CHAPTER XV.

METRITIS OR INFLAMMATION OF THE WOMB.

This is an inflammation of the entire substance of the womb, which, like all inflammatory processes, is acute or chronic.

Inflammation does not always affect the whole body of the womb, but it is quite oftener limited to one or the other layer or membrane that enters into its architectural whole. Then, again, there is the anatomical division of the organ into a body or corpus, and a neck or cervix; of these either one may be affected, without the other, so that inflammation of the cervix should be the subject of a separate inquiry.

Most of the diseases of the womb are due to inflammation. This was the opinion of J. H. Bennett, of London, as long ago as 1845, in which year the first edition of his work on “Inflammation of the Uterus” was published. Up to that time, the subject had never been practically pursued to the same logical conclusions, so that the opinions of the leading professional minds were far from unanimous on this question. But the vigor and energy with which the young author defended his views, forced attention and conviction upon the greater part of the profession, in this country and Europe.

He started out with a view to prove: “1. That inflammation is the primum mobile in uterine affections, and that from it follow, as results, displacements, ulcerations and affections of the appendages. 2. That menstrual troubles and leucorrhœa are merely symptoms of this morbid state. 3. That in the vast majority of cases, inflammatory action will be found to confine itself to the cervical canal and not to affect the cavity of the body.”

Since the appearance of the first edition of Dr. Bennett’s work, which is now forty-six years ago, there have been many careful and clever observers in this field of pathology, but there is yet to appear a successful contradiction of the truth of his inflammatory doctrine. Twenty-six years after Dr. Bennett wrote the above book, he read a paper before the British Medical Association on the same subject, in which there is no modification of his first conclusions on the importance of inflammatory lesions. He says: “1. Uterine displacements are by many too much studied per se (by themselves) independently of the inflammatory diseases that complicate and often occasion them. 2. That the examinations made to ascertain the existence of inflammatory complications are often not made with sufficient care and minuteness, as evidenced by the fact that I constantly see in practice cases in which inflammatory processes have been entirely neglected, and the secondary displacements alone treated. 3. That inflammatory lesions are often the principal cause of the uterine displacements through the enlargement and increased weight of the womb, or a portion of its tissues, which they occasion. 4. That when such inflammatory conditions exist, as a rule they should be treated and cured and then time given to nature to absorb morbid enlargements before mechanical and surgical measures are resorted to.”

If these propositions could be engrossed and a copy sent to every doctor in the land, as a safe and sure guide in his treatment of diseases of women, it would prove a great boon to the suffering women of this country. One of the notorious abuses of the profession, is the penchant for the employment of mechanical means, either by means of instruments or the surgeon’s knife. Women are wantonly subjected to painful and tedious treatments which in many cases only aggravate their original suffering, while a few simple rules of hygienic treatment would not only restore them to health and vigor, but would save them the privation of paying fees to incompetent, unscrupulous or avaricious doctors, who have only one ambition, that is, to get the patient’s money. I have known an instance where this barbarous course under the guise of scientific treatment, broke up the home of a once happy and prosperous couple, and finally when the resources were so low that the expense incident to housekeeping and a nurse could no longer be defrayed, the household effects were disposed of, and, as a last resort, the overdoctored woman was taken to a hospital, where her last hopes were lulled into an artificial sleep, while the surgeons performed an operation from which her depleted body and squandered vitality could never recover. She died.

I am convinced from observations in large female clinics in Berlin, and from my own studies in the pathological laboratory while a student abroad, that Dr. Bennett’s conclusions are corroborated by actual facts. The freedom with which dangerous operations are undertaken for comparatively trivial complaints is degenerating into a license that is criminal and which in some cases is nothing less than murder. In the absence of a high moral sentiment which should control the profession, but does not, the State must step in and say who shall practice medicine and surgery, and by limiting competition, the evil propensity to make the most of one’s opportunities will not be elevated into a fine art, and men, although unscrupulous, may be at least indifferent honest.

Acute metritis comes on suddenly, and this occurs quite often during the menstrual period. Women as a rule are altogether too careless during menstruation; they seem to forget that at this time the womb is congested and swollen, and that if the natural flow of the blood is interfered with, this congestion will turn into an inflammation. Exposure to cold, or getting the feet damp, or inordinate exercise that overheats the system, will bring this about. Sometimes there may be a tumor or swelling in the womb which occludes the cervical canal, so that the menstrual fluid cannot escape; this will also cause inflammation. A stricture of the cervical canal, occasioned by the womb being flexed, will interfere with the egress of the menstrual flow, and this also may give rise to inflammation. Vaginal injections either too hot or too cold, and particularly immediately after copulation, when the pelvic organs are still in a high state of congestion, is quite liable to excite metritis. Gonorrhœal infection is another source of inflammation, but this is invariably preceded by an endometritis, which I will consider separately.

Large, ill-fitting pessaries worn in the vagina for a supposed retroflected or prolapsed uterus, or a stem pessary, are fruitful causes of metritis.

Other causes are criminal abortion, complicated with blood poisoning from the unclean probes or instruments, that the abortionist has employed on previous operations without thoroughly cleansing and disinfecting them; the application of strong caustics to the cervix of the womb, as well as injections into the cavity of the uterus. Meddlesome doctoring by means of the unskillful and unnecessary use of instruments, like the probing of the womb without proper antiseptic precautions, or the scraping, stretching or operating on the womb without the essential antiseptic precautions which a scientific comprehension of the subject demands, has frequently caused this affection.

It occurs very often as a part of the general inflammation produced by the absorption of putrid or septic matter during the childbed period. This indicates a lack of cleanliness on the part of the attendants during confinement; inflammations of this nature constitute one of the types of puerperal or childbed fever.

The most prominent symptom is pain. This is greatly aggravated on the slightest pressure, or on moving or turning in bed. Upon a digital examination, the womb is found enlarged or swollen, and when the organ is tilted up on the examiner’s finger, there is a sharp lancinating pain radiating from it in all directions.

The first symptoms of pain are always accompanied with fever, and this may have been ushered in or alternated with a chill. The pain may be first felt rather deeply in the pelvis, and this is increased by a frequent desire to pass urine and a straining of the rectum. It may further become complicated with a looseness of the bowels, or an obstinate constipation. Nausea and vomiting is a frequent symptom during the course of the disease, and if the metritis is developed during menstruation, the flow may suddenly stop, but, on the other hand, the hemorrhage may become alarmingly profuse. Standing, walking, coughing and straining at stool excite the most excruciating pain, so that a recumbent quiet position is the only comfortable way for the patient to maintain herself, with the head as low as possible to insure the most easy recumbency.

The treatment for acute metritis depends somewhat on the cause in each individual case. There are, however, two indications that require to be met, and these are common to all inflammations, namely, to relieve the pain and check the inflammatory process.

The former is quickly relieved by introducing into the vagina a Femina vaginal capsule in the usual manner; repeating every six to eight hours, until the pain is sufficiently alleviated to occasion no suffering; then one capsule should be employed every night until cured or until restlessness requires that something must be done to calm the patient.

If the metritis is due to suppressed or checked menstruation from cold or exposure, then, and only then, are hot fomentations over the entire abdomen the most appropriate application, and if the patient is plethoric, I advise a half-dozen leeches to the inguinal region of one or both sides to be of unequaled value for checking the disease.

Until my experience and observation in German hospitals, I was in the habit of employing hot applications for all acute inflammations of the abdominal organs. These were either in the form of hot-water fomentations or flaxseed poultices. Hot applications undoubtedly give relief, but I doubt whether they ever cut short or abridge the inflammatory process in any case. I am inclined to believe that in a great many instances hot fomentations have the tendency to encourage suppuration, and that an abscess is often the result of their use. I have seen decidedly better results from cold applications, and the colder the better, so that I now employ them universally in all acute inflammations of the pelvic organs except in the noted exception in which the inflammation is due to a sudden check of the menses from exposure. As a preventive of inflammations, after delicate operations on the uterus, I apply the rubber ice bag with invariable success.

The most suitable rubber bag for this purpose is a size of six by twelve inches; it should be filled with broken pieces, and then securely tied. I prefer to envelop the bag in a thin layer of flannel, so as to take off the cold, clammy sensation which the rubber imparts to the skin. There should be two of these bags, in case of accidentally tearing one, and so that the reserved one may be in readiness when the other is removed. The cold does not only check and control the inflammation, but it also benumbs the nerves, so that it greatly relieves pain. I keep these ice bags applied over the region of the womb, until all the acute symptoms disappear. The vagina, however, should be irrigated with medium hot borax water, once a day, so as to remove any irritating discharge from the uterine cavity.

The digestive derangements that so often accompany acute metritis; the nausea and vomiting of this and kindred diseases, are alleviated by this formula:—

NO. IX.

Mix, and take a tablespoonful every one or two hours, until relieved; to allay the thirst and dryness, take small pieces of ice. Constipation of the bowels should be relieved by taking a Femina laxative tablet every six hours until the stools are freely moved; after that one should be taken every night or perhaps every other night, so as to keep the system regulated.

Some persons suffer from costiveness because they do not drink enough water, and when taking medicines to correct this disorder it is always well to drink a large tumblerful of water at the same time, and especially at bedtime, three or more hours after supper, and early in the morning is another good time for drinking water and taking a laxative.

CHAPTER XVI.

CHRONIC METRITIS OR CHRONIC INFLAMMATION OF THE WOMB.

When from neglected or improper treatment, the acute inflammation is not checked, so as to restore the organ to its normal condition, the inflammatory process assumes a chronic character. As inflammation is an abnormal vital activity, which results in the proliferation or building up of fibrous tissue, it must be naturally inferred that if the inflammatory process is active in an organ for a considerable length of time, the tissues of this organ must grow or increase, so as to augment its size and weight. This is indeed so, hence the other names that have been given to this disease to distinguish it from the acute or transient form, all imply tissue growth, as hypergenesis of the connective tissue, engorgement or inflammatory hypertrophy of the uterus.

The entire organ may be thus affected, or it may be limited to either one or the other anatomical divisions of the uterus, namely, the body or the neck.

Of all the different varieties of chronic inflammation of the womb, that of the neck or cervix is the most frequently met. This is due to the fact that in married women and those who have born children the cervix of the womb is exposed to mechanical injury from coition, friction against the vaginal walls in walking and from lacerations during delivery.

The body of the womb is further removed from all these mechanical agencies to which the cervix is exposed, for the body is within the abdomen of the female, and for that reason it is less liable to be injuriously affected by influences that cause inflammatory enlargement. But notwithstanding all this, it is a common disease.

A great many cases of womb complaint that do not yield to ordinary treatment are really of this nature, but owing to carelessness or incompetency are never recognized. The symptoms of this disease, which are obstinate leucorrhœa, falling of the womb or displacements, are mistaken and treated for the disease itself. Women who suffer with this complaint are extremely liable to go on for quite a while feeling comparatively well and in hopes that they are recovering, when some extra exertion or exposure to cold brings on a relapse, which lights up an acute inflammatory process. This passes into the old troublesome disease and this resumes its chronic form. After a repetition of the general routine treatment, the patient may again live under the delusion that she is going to get well only to have her hopes blasted by a sudden reappearance of the former painful symptoms, that are alike discouraging to herself and a puzzle to her friends.

The cause of inflammatory enlargement of the uterus is usually connected with parturition or abortion.

There never can be either the one or the other without more or less vascular activity, which is essential to the repair of the womb and its restoration to its physiological or healthy condition. All the uterine tissues are at this time in a high state of irritability, and if there is a natural predisposition to inflammatory diseases, then the slightest obstacle to an uninterrupted recovery will kindle an inflammatory action, that will fasten itself on the uterus. In the very nature of things this results in a deposition of inflammatory material, with a consequent increase of intermuscular fibrous tissue which increases the size and weight of the uterus.

What our mothers termed in former days “a bad getting up,” that is, when women get up from their confinement weakly and with more or less pain and dragging in the pelvis on walking or the slightest exertion, is generally owing to the above-described condition. This disease is now almost as common as ever. I can always trace these cases to a confinement or an abortion.

It is very rare that it is due to a depreciation of vital forces from improper food, over-exertion, a prolonged nervous depression or a constitutional tendency to tubercle, scrofula or some other hereditary diathesis, although these undoubtedly predispose the patient to the disease.

Abortions stand at the head of all the causes that excite this affection. When the uterus is pregnant and its natural growth is abruptly checked by the destruction of the embryo, then the organ becomes at once the seat of a congestion and great vascular activity, for the purpose of repairing the injury that the premature expulsion of the embryo or fetus inflicted.

If this congestion is delayed from improper care or treatment which fails to recognize the important fact that an abortion or interruption of pregnancy is a much greater shock to the system than a delivery at full term, it must result in arrested involution or permanent inflammatory enlargement. This most persons fail to appreciate, and, as a result, they do not take the same precautions that they would after the delivery of a living or fully-developed child.

I am well aware that criminal abortionists are in the habit of deceiving their patrons by assuring them that there is no danger or bad results to be feared from their criminal operations. This is a vicious falsehood, and, coupled with the statement that there is as yet no living being in the womb, the crime of manslaughter is added to that of malpractice. In every case of abortion, whether accidental or criminal, the same care and attention must be given to the woman as during any natural lying-in period.

There is a class of chronic inflammations that I have noticed in women who have always suffered from painful menstruations or from excessive or prolonged hemorrhage at the regular monthly period. This is complicated with some ovarian disease, which yields, however, to appropriate treatment.

There is quite a series of symptoms that denote the existence of chronic metritis; these are not all present in each particular case but quite enough of them to diagnose the disease. Some of these symptoms are in the nature of complications, which in themselves may be mistaken for an individual disease, but upon a careful inquiry they can be traced directly to a chronic metritis, which if removed disposes of all the lesser ailments.

The following are the most noted signs of this affection: painful copulation, and pain on defecation; a dull, heavy, dragging pain through the pelvis, much increased by walking; during menstruation the mammæ are sensitive or painful; several days before the approach of the menses there is a dull pain, which lasts during the menstrual flow; around the nipples, there is pigmentation or darkening; sometimes nausea and vomiting, and dyspepsia, headache, and languor; pressure on the rectum with tenesmus and hemorrhoids; leucorrhœa from catarrh of the womb; pressure on the bladder with tenesmus or straining.

This disease may continue for years uninterruptedly, and, if there is not a cure accomplished, or successful measures for its relief are not employed, it will continue until the menopause, or change of life, which may effect a spontaneous cure.

The enlargement is most noticeable in the cervix or neck. This is sometimes so great as to extend one or two inches into the vagina, and this condition is often mistaken for falling of the womb or prolapse, which is far from a correct diagnosis. A growing of the womb from chronic inflammation is the proper explanation.

The hygienic suggestions given in a former chapter, form an important auxiliary in the treatment of this complaint, and for that reason it should be carefully studied.

The treatment of chronic metritis has been, up to within a very recent period, anything but satisfactory in its results. This was owing to an inadequate knowledge of the real nature of the disease, which was marked by so many symptoms that were in themselves obscure and hard to separate as such, from the main affection.

This confusion of the true nature of the pathological process, resulted in a great many vague therapeutical resources, so that the treatment is even yet far from uniform and thorough. Many of the recognized resources laid down in the text-books, on diseases of women, are not only useless, but absolutely injurious, and, in order to save the reader time and money, I will make a brief mention of the most prominent of them.

Depletion, or the abstraction of blood in chronic metritis, effects no permanent benefit in the inflammatory process. I am convinced that, in the long run, the patients grow worse, because this treatment lowers the vitality and reduces the recuperative forces, which are so important, in the treatment of all chronic complaints.

Scarifications or puncturing the cervix with a sharp lance or pointed knife, will not sufficiently impress the morbid process, so as to stimulate it into a healthy action.

Some authors speak very highly of cauterizations and blisters upon the neck or lips of the womb; this I have repeatedly tried, and in not a single instance was it of the slightest use, but it aggravated the symptoms, and in one case it excited a severe, acute metritis that proved almost fatal.

Specialists, as a rule, fall into routine practice, and exercise neither originality or intelligence in practice, outside of the text-book on their shelf. They inject strong fluids or caustics into the cavity of the womb with a view of checking the inflammation in that manner. This treatment is dangerous and delusive. If the patient endures the treatment, she may be stimulated for a time with the idea that something very curative is being done, but my experience has been that the disease only becomes worse, because the womb is too delicate and sensitive an organ to improve under these repeated irritating assaults.

There is a home treatment for mild cases which I recommend to my patients, with satisfactory results. It consists principally of dissolving one teaspoonful of the Femina uterine lotion in a cupful of boiling hot water, after which this should be added to a gallon of warm water of a temperature of 105 degrees F.; these irrigations are to be taken every night, and if the water can be borne hotter the temperature may be gradually increased to 107 degrees F. A napkin should be worn and the bed warmed with a hot water bag before retiring. Ten to fifteen minutes later a Femina vaginal capsule is to be introduced high up into the vagina, by first quickly dipping the capsule into warm water.

In obstinate cases I have used electricity with the greatest success. This is administered by means of a broad dispersing electrode applied on the abdomen, and another electrode, covered with a sponge, is carried up the vagina, to the womb. In this manner I employ an intensity of sixty to one hundred and fifty milliampères, for ten to fifteen minutes. This is repeated several times a week, and from three to six weeks, and with other hygienic treatment the patient recovers.

When women are in moderate circumstances, and can spare neither time nor money to visit the office, for the length of time that is required for the electrical treatment, I follow the plan of the Berlin clinic, which originated in Vienna, with Prof. Carl Braun, and is strongly recommended and practiced by Dr. Martin, in Berlin. This consists in an amputation of the cervix, or, in other words, the abnormally elongated and enlarged uterus is trimmed down, and the diseased membrane is scraped out. While the cervix is recovering from the operation, there is also a diminution in the size of the body of the organ, and the chronic inflammation subsides with it. This operation is not dangerous to life, and in my experience I have as yet never had a bad symptom to interrupt the recovery. In obstinate cases, it is, perhaps, one of the most useful surgical measures that was ever devised, and we owe it to the genius of Professor Braun, that all obstinate cases of this nature are amenable to successful treatment.

CHAPTER XVII.

ENDOMETRITIS OR CATARRHAL INFLAMMATION OF THE WOMB.

Endo means within, and metritis signifies womb and inflammation, and when all are combined, the compound term denotes inflammation of the lining membrane of the womb, which is the affection that I am now to consider.

It would be impossible to find a single person of middle age who has not experienced sometime during life the discomforts of a catarrh or cold of some part of the respiratory passages, whether in the head or bronchial tubes.

The mucous membranes are especially sensitive to noxious influences, and sound a timely note of warning by an acute catarrh, which, if heeded, will in many instances save the person from a dangerous, if not fatal sickness.

The adage, “Prevention is better than cure,” is one of the most truthful sayings in the English language, and, if persons would profit from the admonitions of a “slight cold,” many a fatal pneumonia or bronchitis could be averted.

What is true of the mucous membrane that is common to both sexes is true of that which is peculiar to the female organs alone.

There is no mucous membrane that is more liable to catarrhal inflammations than that lining the uterus. There never was a woman who was not some time in her life afflicted with a transient uterine catarrh. It may have been of so mild a form that the symptoms which it occasioned were hardly noticed, or, perhaps, ascribed to some other ailment.

There are several varieties of endometritis; some of these are based upon the length of time that the affection has lasted, while others owe their classification to the anatomical division of the uterus into body and cervix. Those that relate to the duration of the disease are either acute or chronic.

Acute endometritis is the most common form; it has also been described under the names of acute uterine leucorrhœa, acute uterine catarrh, and acute internal metritis. It usually runs a rapid course, ending in recovery or in the chronic form. It undoubtedly passes unrecognized in many instances, and in this way many cases of painful menstruation or suppressed menstruation are explainable.

It can be said that at each and every menstrual period there is a physiological catarrh, which belongs to the natural process of the menstrual function. During each menstruation there is a hyperæmia, or congestion of the mucous membrane, so that the turgent blood vessels rupture, and this constitutes the menstrual flow. Before this congestion reaches the point of bursting the capillaries, and about the time that the sanguineous flow ceases, there is an increased and altered mucous secretion of the mucous membrane. If this secretion is prolonged beyond the normal period that constitutes healthy menstruation, or if it continues to be present at any time between the menstrual periods, it constitutes a disease or a catarrh. Now when we consider the close relation that the normal functions of the womb have to those that are abnormal, and that the one may be the stepping-stone to the other, we need not be surprised that endometritis, or catarrh of the womb, is one of the most common affections to which women are liable.

Chronic endometritis is where the disease has lasted for a long time; some authorities consider it a rare affection, but this is a great error. Any disease so frequent as acute endometritis must, in the very nature of inflammatory processes, become chronic, in a large proportion of cases.

Endometritis of the body of the womb, in contra-distinction to a partial inflammation, located and confined to the mucous membrane of the neck or cervix of the womb, forms another or third variety of this affection. This disease has been described under the names of chronic corporeal endometritis, uterine catarrh, uterine leucorrhœa, and internal metritis, and the seat of it is confined to the lining membrane of the cavity of the womb, without complicating the cavity of the cervix; but there is no doubt that when either the one or the other is the seat of a stubborn catarrh, the remaining portion of the uterus must become sooner or later more or less compromised in the diseased process.

Chronic cervical endometritis is where the inflammation affects the membrane of the neck; this has been described under the names of cervical catarrh, cervical leucorrhœa, and endocervicitis. These terms are all derived in composition from the Latin word cervix, neck.

The uterus is really divided into two cavities that run into each other; one of these is the cavity of the body, while the other is the cavity of the cervix, a fusiform canal, measuring about one inch and a quarter in length. The cervix partly projects into the vagina, and, as a result, is liable to injury and irritation, to which the other portion of the organ is not exposed. Friction and other influences aggravate the inflammatory process, so that erosions, granular and cystic degenerations, follicular ulcers and chronic enlargements, become complications of the catarrhal inflammation of the cervix.

To return again to a consideration of the general aspect of catarrh of the womb, for it is one and the same pathological process that underlies the different forms. There is a simplicity in the relation of cause and effect, that will strike the casual student as one of the most instructive lessons that it is possible to learn, because it also suggests the simplicity of the measures of which persons can avail themselves for the prevention or cure of this affection.

From the physiological reasons that were mentioned as a cause of endometritis, it follows, as a natural consequence, that the predisposition to catarrh of the womb, varies greatly with the age of persons, so that before the age of puberty, at a time when there are no periodical congestions of the womb from the menses, it occurs very rarely, while from the period of pubescence, and during the functional activity of the pelvic organs, it is very prevalent, but at the approach of the menopause and sexual decadence the predisposition is again lost.

As far as the character and nature of uterine catarrh is concerned, that which in technical language is termed the pathological anatomy is no different from what it is in catarrhal inflammations in other organs, so that the remarks that were made on similar affections of other organs, apply with equal correctness to catarrh of the uterus.

There is, however, one exception of which I desire to remind the reader, and that is a hemorrhagic or granular variety of inflammation. In this form of the disease the mucous glands, and the blood vessels that are distributed between these glandular tubules, increase or multiply enormously, so that I have seen the mucous membrane in some places a quarter of an inch in thickness. This is the most obstinate variety to yield to ordinary remedies, and as it occasions excessive and at times dangerous hemorrhage from the womb, it should not be treated as conservatively as the other varieties of which I have spoken.

There is only one sure method of cure that proved in my hands a success, and that consists in the entire removal of the diseased mucous surface.

Dr. Düvelius of Berlin made the discovery and demonstrated the fact that the mucous glands of the uterus project into the muscular tissue of the organ, and that if the diseased mucous membrane is removed or scraped off, down to the muscular layer, a healthy membrane is regenerated from the terminal glandular ends that remain imbedded in the muscular tissue. This seems to have been proved by experience, for I have performed this operation in several obstinate cases of uterine catarrh, and in several instances the woman became subsequently pregnant, which proves at least that the regenerated mucous membrane is capable of performing its physiological function, as though it never had been interfered with. With proper antiseptic precautions and in skillful hands, there is absolutely no danger in this operation, but the technique should be thoroughly understood by the operator.

The etiology or causation of uterine catarrh resolves itself into predisposing and exciting causes. Predispositions are defined as that constitution or condition of the body which disposes it to the action of disease under the application of an exciting cause. Persons who possess a thoroughly healthy constitution may be exposed to exciting causes without the slightest danger of contracting diseases, to which others who are predisposed fall victims. The predisposing causes of endometritis are a naturally enfeebled constitution; the existence of a scrofulous or tuberculous habit; impoverishment of the blood from chlorosis; prolonged mental depression; improper and insufficient food; prolonged lactation; frequent parturition under unfavorable surroundings; any indiscretion after delivery which interferes with the regeneration of the womb; styles of dress that depress the uterus; want of fresh air and wholesome exercise.

Professor T. G. Thomas, in his work on Diseases of Women, asks the question why most of these influences should produce this affection more than others. His answer is that “they do not do so.” “Sometimes they cause chronic pneumonia; at other times granular lids, and again at other times chronic endometritis.”

The exciting causes laid down by the same eminent authority are “displacement of the womb; excessive or intemperate coition; the use of intra-uterine pessaries; puerperal endometritis; exposure or fatigue after confinement; efforts at production of abortion and prevention of conception; vaginitis either simple or due to gonorrhœal infection; painful obstructive menstruation; exposure during menstruation; sudden checking of the menstrual flow; and tumors in the uterine cavity or walls.” Some of the causes here enumerated are much more fruitful of the disease than others. A woman whose constitution has been weakened, and whose digestion is deranged, by habits of indolence and luxury, whose style of dress so depresses the abdominal viscera that her uterus is pressed down into the vagina, is particularly liable to develop a catarrhal inflammation from connubial approaches. When these are not without pain, then there is some predisposition that should be inquired into and righted.

Uncleanliness is not spoken of by authorities as among the causes of uterine catarrh, yet it is a very frequent one. I have succeeded in curing so many catarrhal affections of the vagina and uterus by simply advising the use of vaginal irrigations with borated warm water, that I am convinced that a lack of personal cleanliness is a very prolific cause of this affection. The accessible generative organs, both of the female and male, should be the object of thorough rinsings so as to reduce the possibility of infection to the least degree. All mucous membranes have their natural secretions, and these are on light provocations abnormally increased. The vagina is always the seat of more or less bacterial fermentation or decomposition, and if this is retained for any length of time, it becomes not only putrid and offensive, but also a direct source of infection to the mucous membrane of the womb. This is more so in a married woman, who is exposed to the carelessness of her male consort, who has not been apprised of the dangers of septic infection, that may be innocently communicated to the wife by negligence of his own person. The wife is exposed to all and every impurity that the male has on his person, and thus she is in constant danger of having her internal organs infected, from the outer organs of the male.

There is no doubt that many women become infected from this source, and that obscure and stubborn catarrhs of the vagina and womb are strictly traceable to personal uncleanliness of the male. From the researches of Dr. Noeggerath of New York, it would seem that in a great many cases of pelvic diseases in women, the affections can be traced to a latent gonorrhœa in the male. This phrase means a gonorrhœa in the male apparently cured, which even two years after the supposed cure infects a healthy vagina, causing a discharge and a complication of the uterine mucous membrane. I have seen some cases that fully corroborate the views of Noeggerath, so that before we put the blame of uterine disease solely on the shoulders of the wife, let us find out how much the husband is to blame.

Specialists in particular, but doctors in general, often forget that a woman has other organs besides a womb and ovaries; there is a relation of cause and effect between valvular lesions of the heart or diseases of the lungs, that obstruct the return of the venous systemic circulation to the right cavity of the heart, and catarrhal diseases of the pelvic organs.

Biliousness or an affection of the liver, that interferes with the portal circulation, or the pressure of tumors or swellings on the uterine veins, are also among the causes, while the accumulation of feces or habitual constipation is often overlooked as too trivial to deserve professional notice, and yet its removal is often the only successful means to cure the patient.

The various eruptive and infectious diseases, like smallpox, scarlatina, measles or typhoid fever, may excite in their course a uterine catarrh, that will remain behind as a chronic complaint, after the acute affection has subsided.

The acute variety of endometritis is much more prevalent as a disease than is commonly supposed, but, owing to an absence of specific or definite signs, pointing directly to the mucous membrane, which the woman herself can recognize, it is generally mistaken for something else.

The disease begins with signs of an active congestion in the pelvic organs; such as drawing pains in the small of the back and in the groins, and a feeling of fullness and weight at the bottom of the pelvic floor. The urine is voided with pain and there is a sensation of heat in some parts of the urethra. Pressure on the lower abdominal region is painful, and the sensitiveness diminishes from the middle towards one or the other side. In mild cases these symptoms are not accompanied with fever, headache or a disturbance of the nervous system; there may be diarrhœa due to reflex irritation of the rectum, and the stools are accompanied with bearing-down pain. After three or four days there is usually a discharge of a viscid liquid, which in eight or ten days becomes creamy, purulent and often tinged with blood. The fluids that are discharged from the vagina sometimes become so acrid and irritating that, when they come in contact with the skin of the vulva, abdomen or thighs, it becomes irritated and inflamed, which leads to excoriations and an itching, that may spread over the entire body. The reaction of this discharge is either acid or alkaline, depending upon whether the discharge of the uterus or that of the vagina predominates; as the discharge from the uterus is always alkaline and that from the vagina always acid, there is nothing of a practical diagnostic value in ascertaining the chemical reaction of the secretion. The vagina will generally be found to be hot and more or less swollen as in ordinary vaginitis. The womb itself, however, will be enlarged and sensitive, while the cervix is gaping or open. Through the speculum, it is seen to be red and congested, and from the gaping mouth there issues a clear, albuminous-looking fluid or a muco-pus.

In the subacute or chronic form the symptoms are by no means always so prominent as to indicate the existence of the affection, or they are so marked, by some of the numerous complications, which are in the nature of cause or effect, that its recognition will become extremely difficult. The effect which the disease has on the general organism varies greatly in different individuals. Some women of robust appearance have an aggravated form of uterine catarrh without any immediate ill effects on their nutrition or general health. Other women lose flesh early and become weak and worn; they become pale, and the face assumes a yellowish ashen hue with dark rings under the eyes. Through reflex irritation from the nerves of the uterus other nerve centers become involved, so that a general neurasthenia becomes developed with its characteristic concomitants of neuralgia, muscular spasms, uterine colic and hysteria.

With a third class the inflammation spreads from the lining membrane to the substance of the womb itself, causing an enlargement of the uterus, which induces displacements and a dragging sensation in walking, pain in coitus and painful defecation. The inflammation does not limit itself to the womb, but an ichorous discharge creates distressing symptoms of vaginitis, inflammation of the bladder, and pruritus vulvæ.

When the uterine cavity is the seat of an abnormal vascular activity, there often exist symptoms of pregnancy that may mislead the patient or physician. Nausea and vomiting are sometimes present, the darkening of the skin around the nipples, and an enlargement and sensitiveness of the breasts, meteorism, or a swelling of the abdomen, caused by the accumulation of air in the intestinal canal from reflex nervous irritation, and when this symptom is added to the irregularity of menstruation, it is easy to fall into the error of diagnosing pregnancy.

Sterility on the one hand, and habitual abortion on the other, should direct attention to the probable existence of endometritis. Very often barrenness has led to an investigation of the condition of the uterus which disclosed the existence of the disease. A woman who conceives, and then loses her child in the first months of pregnancy, is afflicted, in all probability, with a chronic endometritis. In these cases, where conception takes place, it is to be presumed that the sensitiveness and irritability of the inflamed mucous membrane is not suitable for the permanent fixation of the ovum, so that the slightest shock will open the flood gates of a congested uterus, and thus the embryo is separated from its attachment, and lost.

The cervix is sometimes the seat of a special feature of uterine catarrh, that is due to the chronic inflammation of the cervical mucous membrane, stimulating a growth or proliferation of its own tissue or structure. This growth causes an enlargement and elongation of the entire cervix, and a spreading of the lining membrane of the cervical canal to the vaginal surface of the cervix. This encroachment of the cervical lining on the vaginal lining is the displacement of the pavement epithelial cells of the vaginal portion by the cylindrical or columnar epithelial cells of the cervical canal, and this gives rise to erosions and follicular ulcers.

These erosions have a glandular arrangement, and are often mistaken for cancerous or malignant growths. There is no doubt in my mind, that most of the so-called successful cures of cancer were nothing but cures of erosions.

The microscopists, whose lively imaginations make them see things that do not exist, would make us believe that they can take a small section of the suspected growth, and establish the existence of cancer by microscopical examination; this is utterly impossible, because the cancer cell is no different from normal cells, and in erosions we often find the follicles so close to each other, and their cells so closely packed, one on the other, that no candid mind can say whether it is a malignant or an innocent growth.

The claim that “nests of epithelium cells,” as the stereotyped phrase goes, constitute scientific evidence of cancer, is utterly absurd. Such eminent authority as Professor Arnold, of Heidelberg, makes the assertion that positive diagnosis of cancer, from a small section or scraping, is impossible. I am myself fully convinced of the truth of this assertion, for while I was making microscopical studies in Germany, I had abundant evidence of the truth of this statement. It is indeed very unfortunate, both for science and suffering humanity, that as yet there is no absolute means of diagnosing cancer positively, and for that reason the quacks, and those who are not quacks, will continue to fleece their victims for supposed cancer.

I believe that the cause of cancer is either due to a ptomaine or organic poison that is generated in the body, or to a specific germ or bacillus. If it be due to the latter, and the germ theory of disease makes that highly probable, there is no doubt that a method of staining will soon be discovered, that will make the specific microbe recognizable in the field of the microscope, but as yet most cancer diagnoses by microscopy are only surmises.

TREATMENT.

Continence in sexual intercourse is one of the prerequisites to the successful treatment of all uterine diseases. This is so often overlooked by those giving advice in such matters, that their otherwise appropriate suggestions for treatment are frustrated. The women who are suffering, appreciate the value of this interdiction without further argument, but the average man does not appear to have the common sense to readily comprehend that the mechanical irritation incident to the sexual act, and the accompanying physiological congestion, will surely aggravate an inflammatory process, no matter of what nature. Men, whose animal instincts dominate their entire being, so that reason, if they ever had any, is dethroned, should stop to consider their immoderate conduct, which perpetuates the suffering of their wives from ailments which men themselves have often inflicted, and for which women are innocent martyrs.

The acute variety of uterine catarrh is to be treated like all other acute inflammatory diseases.

The patient should at once take to bed, so that she may keep herself warm and quiet.

If the inflammation is due to cold or exposure during menstruation, and the menstrual flow has been suddenly checked, then three or four leeches, applied to the inguinal regions on both sides, will be of decided advantage. Over the lower abdominal regions hot compresses should be applied; these are made by wringing cloths or a large folded towel out of hot water, over which a piece of oiled silk, rubber, or oilcloth is laid to retain the heat and moisture. At other times, that is, when the inflammation is not due to cold and a sudden stoppage of the menses, the application of ice bags is preferable to the hot compresses, in the manner elsewhere described.

The pains which are felt in different parts of the pelvis are relieved by using the Femina vaginal capsules; say one every six to eight hours, after a hot vaginal injection of plain water, or a hot sitz-bath. If there is nausea or vomiting that too is often relieved from the soothing influence of the capsule which allays the nervous irritability.

Should the stomach not be in a condition to take nourishment from biliousness or other causes, prescription No. II on page 138 should be taken in tablespoonful doses every four hours until the stomach is settled and the system regulated; if any food is taken it should be between times and of a liquid nature.

If there is straining or diarrhœa, I prefer to employ an enema of one pint of warm German chamomile tea, to which half a teaspoonful of McMunn’s elixir of opium or laudanum is added. If the pain and straining are very severe, one teaspoonful of either is not too much; by requesting the patient to retain the enema for ten or fifteen minutes, the medicine is directly absorbed, and the effect is both soothing and healing. This may be repeated several times a day, if the pain does not subside after the first injection.

The bowels are sometimes found to be in an opposite state, namely, constipated; this must be relieved at once. An enema of warm soapsuds answers the purpose, or a half-tablespoonful of warm water, in which a half-tablespoonful of glycerine is dissolved, makes an excellent injection for constipation.

Hot vaginal irrigations should be at once commenced, and repeated as often as twice or three times a day. I always dissolve a teaspoonful of powdered borax in the hot water, of which no less than half a gallon is used at one time; this is antiseptic and healing. After six or eight days, once a day will be sufficient.

Chronic uterine catarrh or uterine leucorrhœa does not require the active treatment which was recommended for the acute form. It depends quite often on causes, whose removal is absolutely necessary to the intelligent and successful treatment of the affection.

The causes that have been enumerated must be carefully and repeatedly reviewed, so that each individual case can be traced to its source. Those causes that are improbable must be eliminated from those that are probable, so that by a gradual process of exclusion we narrow the number down to those that actually exist. This simplifies the treatment to actual conditions that can be intelligently met.

Vaginal irrigations constitute in the chronic form of the disease an accepted and most useful therapeutic resource. There is nothing that will ever contraindicate a thorough cleansing of the vaginal canal, so that the organ may not be bathed in its own morbid and irritating secretion. It is a wholesome auxiliary to any course of treatment that may be adopted. It avoids self-infection and places the pelvic organs in the best possible condition for the healing powers of nature to work out a cure.

If the uterine catarrh is the result of a venous obstruction due to a congested liver and a general derangement of the digestive apparatus, then any local treatment will be of no avail without first removing the hepatic derangement.

Costiveness or constipation is a very common complaint with women and a very painful cause of womb disease, but it is so simple and ordinary in its nature that the wise will not deign stoop to notice such trifles, but if it required for its removal a surgical operation, for which a handsome fee is the inspiring motive, then we should hear of it as often as we do of lacerations or flexions of the cervix as a cause of uterine catarrh, and its removal would then indeed become absolutely necessary for effecting a permanent cure.

Why is it that the treatment of uterine disease has degenerated into “professional faking” that is alike disgraceful to the profession and a daylight robbery of the patient. A woman, for instance, is suffering from what she supposes to be womb disease. She consults a doctor, or what is still worse, a time-serving specialist, who examines her and sees at once signs of uterine catarrh.

He at once applies a little tincture of iodine or carbolic acid diluted with glycerine or a solution of nitrate of silver to the cervical canal. The woman is now informed that this application must be repeated two or three times a week, for which she must call at the office that number of times every week, for an indefinite period. At each visit she is subjected to the same routine humbuggery for local medication, but does she get any better? In my early professional experience I innocently and ignorantly tried these methods myself, and I say no! But, as a matter of fact, this constant irritation and poking around and into the womb will inflame any healthy uterus, and much more one that is already slightly irritated, so that patients lose their hope and become convinced themselves that they are no better, but feel worse than when they first commenced treatment.

This inefficient treatment, like the examination, is conjectural and mechanical and therefore incomplete and unscientific. The cause of her entire trouble is never approached. The woman suffers for years from constipation, which also inclines her to piles, because the pressure of the hardened feces on the hemorrhoidal veins obstructs the flow of venous blood and the same pressure on the uterine veins congests the mucous membrane of that organ and gives rise to the symptoms of endometritis. All these conditions should be inquired into, and many others, before local treatment is decided on; simply running to the doctor’s office and having these medical applications made to the cervix or canal of the womb amount to nothing; this, as a general rule, does only harm, and is as superfluous as if one were to take a nasal douche of salt water or some other catarrh remedy, whenever he feels a little cold in the head.

The proper course to pursue in this and similar cases is to prescribe an appropriate diet, and regulate the bowels. It is precisely in this way that women who have made the rounds of the doctors, happen to take some patent laxative or nostrum that relieves their constipation, and accomplishes the wonderful cures of which we often hear and that were no doubt Godsends to the sufferers that were cured, after all the first-class doctors failed. By far the greatest proportion of cases of uterine catarrh are of a simple and transient nature and are only intensified by probing and local treatment.

When I first began the practice of medicine, I made the same mistake in following the advice of books and those who should have known better, for they have had ample opportunity to be convinced of the fallacy of these local measures in the great majority of cases, but some minds are incompetent to learn from experience, for that requires close observation, and logical reasoning.

I soon discovered that the catarrhal inflammations got worse, in proportion to the trouble and pains I took to treat them locally, so that I became ashamed of my ill success and abandoned the local treatment entirely, and this I shortly discovered was the means of curing them. Instead, I simply directed patients to rinse themselves with quite warm salt water, that is, a tablespoonful of ordinary cooking salt dissolved in a gallon of water. Now I prefer Femina antiseptic lotion to the same quantity of water, which has greater healing properties than either pulverized borax or common salt. I particularly advised them to keep their feet and lower extremities warm, regulating their diet and keeping their bowels open. I noticed that the patients began to improve, and that the improvement continued until they were fully restored to health and vigor. This method of treatment would not keep an office overcrowded with deluded patients, but it proved far more satisfactory to all concerned than meddlesome measures, and illustrated one of the most common abuses to which suffering women are liable.

In taking a laxative patients must feel their way as to the proper dose to take in their own individual case; constitutions differ very much in this respect, so that it is impossible to lay down one and the same rule for different persons. It is not good practice to give medicines three or four times a day in cases of habitual constipation, for it is liable to derange the digestion and interfere with the appetite. The proper method is one dose at bedtime and this should be increased or diminished until the suitable dose of the remedy has been ascertained; when this is accomplished, the dose of the remedy should be gradually lessened, a few drops every day, till it can be entirely dispensed with. If the ordinary dose fails to relieve the bowels, an additional treatment of glycerine enema at or about the time that the stool is to take place is to be employed. One or two teaspoonfuls of glycerine should be diluted with an equal quantity of water, and by means of a hard rubber piston syringe thrown into the rectum. The stimulating effect of glycerine on the nerves and mucous membrane, materially assists in relieving the torpor of the rectum, which has become insensitive to the irritation of its natural contents.

Patients who are costive must get into regular habits of relieving themselves, that is, have a regular hour every day when to go to stool, then the medicine will in time cure the most obstinate cases of constipation, otherwise it is impossible to cure it. It takes a constant amount of effort to get well, so that those who are too indolent or think it too troublesome to exert themselves, cannot hope to recover.

If there is great debility and impoverishment of the blood, then I would advise prescription No. 1, which are the iron pills, of which three pills should be taken three times a day. The moderate use of wine, either claret or Riesling, with the food, instead of tea or coffee, is very beneficial, between meals a glass of Porter to relieve the gone-in feeling, until the system has recovered sufficient strength to do without it, that is when ordinary exertions are no longer a burden.

The small percentage of cases that do not yield to the above treatment, become legitimate subjects for an honest specialist, for there may be extensive lacerations of the cervix that require surgical treatment, or an elongated cervix that should be amputated, or a granulated hypertrophied membrane of the uterine cavity that should be scraped out; all these operations are without danger if the operator has thoroughly mastered the details of antiseptic surgery and has the manual skill to do the work properly.

CHAPTER XVIII.

THE NATURAL POSITION OF THE UTERUS AND HOW IT IS SUPPORTED.

The uterus is not a stationary fixture in the female pelvis, but enjoys a mobility within physiological bounds, which in itself explains the great diversity of opinions which may and do arise respecting the normal or abnormal position of the womb in any given case.

When the surrounding organs and tissues of the womb are in a healthy condition, and the abdominal walls are not compressed by the weight and pressure of skirts, nor the liver or diaphragm forced down towards the pelvis by a tight-fitting corset, the organ is movable in every direction, without the slightest pain or suffering.

The uterus is not tied down by any ligaments, as one might imagine from a description of the several ligaments that constitute only in a small degree its support, for it changes its position in retching, coughing, breathing, singing, walking and all other violent movements.

The question now naturally arises: What is the normal position of the uterus, and what constitutes its natural supports? To answer this interrogation is to controvert one of the most baneful fallacies in gynecological practice, for the amount of torturing and useless doctoring to which women are constantly subjected, owing to some fancied displacement of the womb, illustrates the force of precedent or of accepted opinions, that were fortified by years of erroneous teaching.

It was supposed until quite recently that when the body of the womb was inclined horizontally forwards, this was unnatural or a sign of disease, until Prof. B. S. Schultze, director of the gynecological clinic of Jana, successfully controverted this doctrine. In his work “Die Pathologie und Therapie der Lageverænderungen der Gebærmutter,” which is the most classical work extant on displacements of the uterus, says: “From the post-mortem findings it was inferred that the uterus occupied in the living woman the same position as in the cadaver; such an assumption did not take into account the actions of the muscles on the position of the uterus in the living subject nor the intra-abdominal pressure which is entirely absent after death, so that the dead organ naturally gravitated backward after the remains had lain for several days on the back.” Another observer, Dr. Hach, found in a number of cases that he had examined during life, the uteri bent forward or antiflexed; twenty-four hours after death he discovered the same uteri in an opposite direction or retroflexed.

This and similar subsequent researches have demonstrated the fact that when the body of the womb rests on the bladder it is not in an abnormal position as formerly supposed and called anteversion or anteflexion, but that it is natural for it to be so, and when the body is elevated and its axis forms an obtuse angle with the horizon, the inclination is a post-mortem condition.

With these precursory remarks I am now able to answer the first clause of our query, and would say that the uterus is in its normal position when its long axis is nearly parallel to the horizon or at right angles with the perpendicular or long axis of the body. The normal position of the uterus is modified when the bladder is full or distended, for this lifts the body of the uterus upwards, thus temporarily making an acute angle with the vertical axis of the body, which was formerly considered to be the permanent and natural pose of the organ.

In referring to the bony pelvis, Plate I, it will be observed that the same is in the nature of a canal, for the passage of the child into the world. At other times than during the child-bearing process, this canal must be effectually closed to perfectly retain its contents. To accomplish this purpose it is provided with a bottom or floor, which is to give this necessary support, not only to the organs that the pelvic cavity contains but also to the abdominal viscera that are superimposed upon them. In order to accomplish this, its outlet must be as effectually closed as the bottom of a box or barrel in which material things are stored for the purpose of carrying them from place to place. In the human subject this bottom is called the pelvic floor, because it serves the purpose of a bottom or floor to the pelvic canal.

The pelvic floor is not a simple structure but a complicated arrangement of organs and tissues. If we begin to examine it from below upwards, we first have its outer covering in the skin; then, the superficial and deep fascias, the triangular ligament of the bladder and a group of interlacing muscles. The organs that enter into the composition of the pelvic floor and interwoven with the preceding structures, are the bladder, the vaginal walls, the rectum and connective tissue. Examine Plate II.

Through this floor there are several openings, which are guarded by a special set of constrictor muscles that are termed sphincters. These are sufficiently strong in the bladder and rectum but in the vagina they would be entirely insufficient to close this canal effectually.

The vagina, or, for our purpose, it will be clearer if we say “vaginal canal,” divides the pelvic floor into an anterior and posterior segment, and it is by means of this division that the whole structure of the pelvic floor is weakened; this will be perceived at a moment’s reflection, when we compare it with the pelvic floor of the male, who has no vagina; and for this reason men are never troubled with the prolapses to which women are liable. Nature, however, has made an attempt to compensate this physical defect in a manner that reduces the weakness occasioned by the vaginal canal to its minimum. The vaginal canal does not enter the pelvic cavity in a directly upward or perpendicular course, but obliquely upwards and backwards, as may be seen by referring to Plate II. The result is that the intra-abdominal pressure falls on the vaginal walls from above, and thus compresses and approximates the anterior and posterior walls of the vagina to each other, so that it constitutes a self-closing valve, but, notwithstanding all these provisions, this slit or opening through the pelvic floor still remains the weakest point of the inclosure for the pelvic and abdominal viscera. When the causes are sought that underlie the various displacements of the uterus, they are generally to be found in an impairment of the pelvic floor, through some changes or accidents that are peculiar to pregnancy and delivery.

As we are also to inquire in the succeeding chapter into the displacements to which the womb is liable, it would greatly assist our understanding if we first got an idea of what constitutes the natural supports of the uterus? The word ligament is defined as anything that ties or unites one thing or part to another; a bandage; a bond. This is the idea in the popular mind, so that when the terms broad and round ligaments of the womb are employed it is supposed that they are for the same purpose for which ligaments are usually intended. This is, unfortunately for a clear understanding of the subject, a great mistake, because these ligaments are an exception to the generally accepted meaning of the term, for they neither tie nor support the uterus in its natural position. One may readily imagine that this erroneous conception would lead to a mistaken course in the treatment of most cases of displacements, because too much importance is bestowed upon structures that have no physiological bearing on the disease.

Drs. Hart and Barbour, of Edinburgh, in their “Manual of Gynecology,” which is the most scientific and practical work that has lately appeared in the English language, have this to say in speaking of the support of the uterus: “The question of the support of the uterus is still disputed. The broad and round ligaments have nothing to do with its support, they are only useful as giving fixed points for the contracting uterine muscles during parturition. The chief support is the compact unbroken pelvic floor, on which the uterus rests just as one sits on a chair. It is the whole pelvic floor that supports the uterus and viscera, not the perineum alone.” The perineum (see anatomical Plate II) is only a small though strong part of the pelvic floor. If the reader will now patiently review the organs that, together with the other tissues, constitute this floor, and this can be most profitably done by studying Plate II, there can be no confusion of ideas whatever. In the following pages I have occasion to refer to what is understood by the term pelvic floor.

CHAPTER XIX.

PROLAPSUS OR FALLING OF THE WOMB.