Part 59

I have given a lengthy description of these organs; I think it will repay a careful reading. To understand a disease one should understand the organs that are subject to the disease.

CAUSES OF DISEASES OF WOMEN.

Dr. Child says among primitive people, woman is notoriously free from many of the diseases to which her sister in our present-day civilization is especially prone. As we ascend the scale of civilization, departing from a natural and adopting an artificial mode of life we find nature enacts due penalties for the transgression of her laws. The female among savage tribes has every advantage and opportunity to develop physical perfection, and her endurance suffers little, if any, by comparison with the male. How different is our modern system when the young girls are sent early to school and subjected daily to long hours of study, often in badly ventilated class-rooms, for nine months in the year, and this at the time of puberty, one of the most important periods of their life when they need plenty of out-door exercise. Surely, as Goodell says, "If woman is to be thus stunted and deformed to meet the ambitious intellectual demands of the day, if her health must be sacrificed upon the altar of her education, the time may come when to renew the worn out stock of the Republic it will be necessary for our young men to make matrimonial excursions into lands where educational theories are unknown."

[494 MOTHERS' REMEDIES]

Menstruation.--Many of the disorders of menstruation are due to carelessness and neglect of this function. There should be rest of both body and mind at this time, and especially at puberty. Rest is seldom allowed, but the daily routine is gone through, regardless of what may happen.

Dress.--The way the abdomen is now constricted, and this is now a prominent feature of women's mode of dress, is without doubt an important predisposing cause in female diseases. This contraction of the normal size of the cavity of the abdomen, with the subsequent compression and displacement of its organs, must of necessity produce dynamic (powerful) changes in the pelvis that cannot be otherwise than injurious to the pelvic organs. Tight lacing or any lacing, aside from the remote effects so unnatural a practice must produce, causes marked atrophy (dwindling) of the abdominal muscles. These are often so weakened that during labor they cannot properly assist the uterus (womb) in effecting delivery, and as a result instrumental interference, with its attendant dangers becomes necessary.

Prevention of Conception.--This is a very common practice among civilized women, and it has a most destructive effect upon the pelvic organs, as well as upon the general system.

Criminal abortion.--The chief danger from the criminal interruption of pregnancy is sepsis (absorption of poisons) into the system. This may be acute in character and have a fatal termination, or chronic in nature, leading to permanent injury of the womb and fallopian tubes, sterility and chronic invalidism.

Child birth.--Pelvic diseases frequently come from injuries received during labor.

Venereal diseases.--Dr. Child says, "Syphilis exerts its usual baneful influence, but gonorrhoea is responsible for more pathological (diseased) lesions (conditions) in the female pelvis than any other one factor. Its attack, if not resulting in ultimate loss of life, always leaves the tissue in an impaired condition, from which resolution (returning to natural condition) is rare. It is doubtful if a woman once infected with gonorrhoea ever recovers from its ravages. As a cause of sterility its power is beyond estimation."

INFLAMMATION OF THE VULVA.--(Vulvitis).--An acute or chronic inflammation of the vulva (external genitals) either from a specific, like gonorrhoea, or non-specific cause.

Causes.--Veit says, "Seventy-five per cent of the cases are caused by gonorrhoea."

Other Causes.--Accumulation and decomposition of discharges from the womb and vagina, inflammation of the inner lining of the womb and of the vagina. Foul, putrid discharges from neglected supports (pessaries) and tampons in the vagina; sloughings from cancer may act as exciting causes. Contact with ammoniacal and sugar urines has a similar effect.

[WOMAN'S DEPARTMENT 495]

In Infants.--It is usually due to want of cleanliness in failing to remove decomposing urine and feces. Mothers often allow soiled, foul smelling diapers to remain for a long time on the baby.

Symptoms and Condition of the Parts.--In the acute stage the mucous membrane around the opening of the vagina is red, swollen, painful and bathed in pus. The glands in the groin and glands of Bartholin are usually enlarged and tender. The glands of Bartholin and those around the urethra may become infected and fill with pus. The fatty glands of the labia majora are also sometimes affected and then appears the disease called Follicular Vulvitis (in the chronic stage secretion is abundant). The parts feel hot and there is more or less burning and itching. Walking makes the trouble worse, due to rubbing of the parts. Passing of urine increases the distress.

When the disease is caused by gonorrhoea it is more extensive and involves the vagina, urethra, the glands around the urethra and glands of Bartholin. This gland infection frequently results in an abscess.

Treatment.--In the acute form the patient should go to bed and remain there for some time. The parts should be kept constantly moist with a wet antiseptic dressing, listerine, hot water, etc., applied to the vulva and kept there.

1. If there is much pain the following solution may be used:

Acetate of lead 1 dram Laudanum 1/2 ounce

Water enough for six ounces.

Mix and apply constantly with sterile cloths.

2. For chronic form Dr. Child says, "The vulva should be shaved, thoroughly cleansed and a mild ointment applied daily thereafter," such as:

Salicylic acid 20 grains Oxide of zinc 2 drams Petrolatum enough for 1 ounce

Mix and make an ointment and apply daily.

If it is due to irritating discharges that cannot be checked, cleanse the parts thoroughly and use the Zinc ointment to protect.

ITCHING OF THE VULVA.--Vulvae or Pruritus.--This intense itching is the characteristic symptom. With the itching there is more or less swelling of the parts and extreme nervous irritability.

Causes.--This is doubtful; some think it is a purely nervous condition.

Parts irritable.--The upper angle of the labia majora and the mons veneris are the usual locations. The skin is inflamed thickened, raw, from the continual scratching."

Symptoms.--The itching and burning are almost unbearable at times, beginning most often around the clitoris, coming in paroxysms and made worse by warmth and motion.

In chronic cases the skin is a little thickened and looks dull and dry and is covered with small cracks and scratches, the result of the patient's efforts to stop the itching.

[496 MOTHERS' REMEDIES]

Treatment.--Systematic, general tonic treatment. Diabetes, gout, irritating discharges from the vagina and rectum should be removed. Pin worms and highly acid urine sometimes cause it in children. Internally the bromides to quiet the nerves and arsenic to build up the system should be given.

Local.--Strong solutions of corrosive sublimate (1 to 1000), nitrate of silver, tincture of iodine, and cocaine ointment give temporary relief.

Sometimes an operation is necessary.

CYSTS OF THE VULVA.--A cyst is a cavity containing fluid and surrounded by a covering (capsule). The duct (canal) of the gland of Bartholin, situated in the labia majora, sometimes closes and the secretions of the gland are not cast out, thus forming the cyst.

Cause.--The closing is nearly always the result of gonorrhea.

Condition.--The cyst is formed in the duct, the gland itself being affected rarely. It contains a thin sticky mucus. If the cyst arises in the gland, the swelling is more deeply situated. These cysts may be attacked with an acute inflammation and finally pus is formed in them, and a very painful abscess is the result,

Symptoms.--There are no symptoms except from the size of the swelling unless an abscess occurs. Then there is an acute local pain, quite tender on pressure, and often high fever.

Treatment.--If the cyst is large it should be removed, especially if it causes annoyance. If it becomes inflamed, rest in bed and cold applications are indicated. If it goes on to an abscess, a free cut should be made, the abscess scraped and good drainage given. Sometimes it is best to use pure carbolic acid in the walls of the cyst.

INFLAMMATION OF THE VAGINA, (Vaginitis).--Vaginitis is an inflammation of the mucous membrane of the vagina.

Varieties.--l. Catarrhal or simple 2. granular; 3. gonorrheal; 4. diphtheritic, and 5. senile.

1. Catarrhal or simple form.--This is the most usual form. There is a general redness of the membrane with swelling and increased secretion.

2. Granular.--This is an advanced stage of the simple type, and is due to long continued or repeated attacks.

3. Gonorrheal form.--Is due to infection by the gonococcus of Neisser (due to gonorrhea). This form is hardest to cure and may continue for years or life, The infection may extend to the womb, fallopian tubes and peritoneal cavity and produce inflammation of the womb (endometritis) pus in the tubes, (pyosalpinx) and peritoneal cavity. This is more common than even some physicians realize.

[WOMAN'S DEPARTMENT 497]

4. Diphtheritic--Due to diphtheria, not frequent.

5. Senile type.--This comes only after the change of life.

Symptoms.--There is pain in the lower abdomen. Passing of urine is frequent and is attended with smarting and burning pain. There is a feeling of heat and burning in the vagina, and a copious discharge of mucus and pus. In the gonorrheal variety the urinary disturbances are most marked.

In gonorrheal variety the symptoms date from a distinct onset, last longer, do not yield so rapidly to treatment, and complications, such as enlarged glands in the groin and in the vulva and vagina, inflammation of the lining of the womb and fallopian tubes, inflammation of the bladder, often make their appearance early.

Treatment (in acute cases).--Rest in bed and prolonged vaginal injections of a solution of corrosive sublimate (1 to 4000 strength) three times a day. If the gonorrheal poison is present in the pus, the walls of the vagina, cervix and cervical canal should be dried and thoroughly painted with a twenty per cent solution of nitrate of silver. The patient should be in the knee-chest position for this treatment.

In chronic cases the gonorrhea poison (gonococcus) is found most frequently just behind the posterior lip of the cervix and here the silver solution should be applied very thoroughly.

VAGINISMUS.--This is a painful reflex muscular contraction of the vaginal orifice, and is most often observed in patients of a nervous and sensitive temperament. Treatment.--Any local cause of irritation should be removed. If there is no local irritation, the opening should be dilated under an anesthetic. Tonics, exercise, and a complete change of scene are beneficial.

DISEASES OF THE CERVIX.

TEAR OF THE CERVIX (Laceration).--This is a tear in the lower part of the cervix. There may be one or more. The left one-sided tear is the usual form. Next comes the tear on both sides (bilateral). Tears on front and behind are not frequent. Tears are found in about thirty per cent of women who have had children.

Causes.--The majority of cases are caused by labor, and is due to a cervix that is not perfectly dilated. Very hurried, quick labors cause it sometimes, but the greatest injuries are due to the various operations for delivering the child through a cervix that is not fully dilated.

Symptoms. Immediate and remote.--On the immediate, when the tear is severe, there is bleeding; later, sub-involution, that is, the womb does not return to its normal size and weight.

Remote symptoms.--Leucorrhea, thick and mucus in character; profuse menstruation and inability to become pregnant. When the tear has extended through the internal opening the woman win not be able to carry the child to full term, even if she becomes pregnant.

[498 MOTHERS' REMEDIES]

Treatment.--Tampons of ichthyol (ten per cent), mixed with glycerin, introduced twice a week against the cervix and permitted to remain forty-eight hours will often afford relief.

The tear should be repaired after child-birth, if possible. If not then, and if it does not heal, it should be repaired later when the tear extends through the internal (opening) or in case of extensive raw surface on the cervix.

INFLAMMATION OF THE CERVIX.--This is an inflammation of the mucous membrane lining the canal of the cervix (cervical canal), known as Endocervicitis; it may be acute or chronic. The acute form is seen most often as a part of a general infection involving both womb and cervix, and will be described later. The chronic form is a very common condition and it is difficult to treat.

Cause.--Injury and tear of the cervix.

Symptoms.--Leucorrhea, profuse and frequent menstruation, pain in the back and loins. On examination a string of thick mucus is seen at the external opening (os) of the cervix; and of women who have borne children there are usually signs of tear and rawness of the cervix present; (Endometritis usually produces a thin watery discharge, while gonorrhea produces a thick, pus-like discharge).

Treatment.--Hot vaginal douches, containing one dram of sulphate of zinc to one pint of water, used every night for ten minutes. Hot water with witch-hazel, about four drams to the pint, is also good. Tincture of iodine applied locally twice each month. White oakbark tea used as an injection once a day for this trouble; also good for vaginitis.

INFLAMMATION OF THE LINING OF THE WOMB. Endometritis.--Endometritis is an inflammation of the lining membrane of the womb, with a tendency to extend to the lining membrane of the fallopian tubes and to the peritoneum. These are the acute and chronic varieties.

Causes.--It may occur during an acute skin disease eruption, like that of scarlet fever, and occasionally upon exposure to cold during menstruation. The most frequent exciting causes are the microorganisms, like the gonorrhea poison, etc.

Acute Variety.--The whole mucous lining is inflamed. In severe cases the whole mucous lining is destroyed and the deeper muscular tissues of the womb are invaded.

Gonorrheal Variety. Symptoms.--There is general pain in the lower bowel region, in spells at first, later constant, with rapid rise of temperature and pulse. A purulent (pus) discharge appears early from the cervix, usually about the second day, and difficult and burning passing of urine are early symptoms. There is inflammation of the vagina accompanying it in about fifteen per cent of the cases, while inflammation of the fallopian tubes, pus in the tubes, and local peritonitis are common results.

[ WOMAN'S DEPARTMENT 499]

MOTHER'S REMEDY. Inflammation of the Womb. 1. A Good Tonic for.--"For inflammation of the uterus or ovaries try a hot sitz bath every day for a week, and then every other day. In case of hemorrhage this bath is invaluable, and will relieve when all other means have failed. It can be taken during the hemorrhage, or at frequent intervals between times. Remember, one should always lie down after a sitz bath. If desired you may give aconitum tincture. Dose:--Two drops in a half glass of water, tablespoonful doses every ten to thirty minutes according to the severity of the case." If a woman has taken a severe cold, then the aconite should be given, but under no other condition.

PHYSICIANS' TREATMENT.--Dr. Child advises that the cervix be dilated, and the interior of the womb, cervical canal and vagina swabbed out with a ten per cent silver nitrate solution. Subsequently vaginal douches (1 to 5000) corrosive sublimate solution followed by a salt solution, one dram of salt to a pint of water, should be given for at least one week. Keep the bowels open.

SEPTIC PUERPERAL ENDOMETRITIS.--This is an inflammation of the inner lining of the womb that occurs after child-birth during the first few weeks, and is due to a poison.

Symptoms.--The attack usually begins with a chill, preceded by a regular increase of the temperature and pulse. The face looks flushed at first, but it soon becomes pale and the patient has an anxious look, as the disease goes on. There is very little pain, if any. The discharge that always follows labor is diminished or stops and has no odor, if there is any discharge.

The death rate is from five to twenty-five per cent.

Treatment.--Never scrape out (curette) the womb for this disease. The womb should be washed out with a hot salt solution, one teaspoonful of salt to one pint of water, and then packed with ten per cent iodoform gauze. This solution should also be injected hot into the rectum and frequently. The bowels should move freely, and if necessary injections may be given for that purpose.

The strength must be kept up by a liquid diet. Milk, brandy and strychnine, if necessary; 1/100 of a grain of strychnine can be given every four hours. Milk should be given every half hour, about two ounces at one time: or more if it agrees well.

The gauze should be removed gradually, beginning on the third day and ending on the ninth day.

In this disease the interior of the womb is smooth and contains no broken down or foreign tissue. In the next disease, Putrid Endometritis, it is far different, for this is caused by the presence of dead material, such as parts of the after-birth, left in after labor, or sloughing tumors. This material becomes putrid (rotten), and thus causes the disease called "Putrid Endometritis."

[500 MOTHERS' REMEDIES]

PUTRID ENDOMETRITIS.--An inflammation of the inner lining of the womb caused by putrid (rotten), decaying material.

Symptoms.--A chill is sometimes present at the beginning. The fever is high, pulse bounds and feels hard and strong, the face is flushed but there is little or no pain. The discharge from the womb, unless it is blocked by a clot, is foul smelling. The flow after childbirth is scanty, sometimes suppressed. The womb and ovaries are not very tender.

Treatment.--The first thing to do, of course, is to get the dead material, such as parts of an after-birth, clots, shreds, etc., out of the womb, and then scrape the rough surfaces. This must be done carefully and with perfectly clean tools and liquids of every kind. Then wash the womb thoroughly with the hot salt solution. One teaspoonful of salt to one pint of boiled water. After this pack the womb with ten per cent iodoform gauze, which may be bought in this strength. Remove this from the womb about the third to the ninth day. The bowels should be kept open.

Diet.--Should be of milk or at least of liquids only. The patient can be given whisky or brandy and 1/60 grain of strychnine every four hours if needed.

MALIGNANT DISEASES OF THE WOMB.--Cancer or carcinoma is a malignant disease of the neck (cervix) of the womb.

Causes.--The immediate cause is not yet known. Tears and erosions (scraping off and making raw) are supposed to act as direct causes.

Symptoms.--Bleeding is the early and very important symptom. After the change of life (menopause) is over if bleeding occurs and continues it is a very bad sign and the womb should be examined immediately. Later, a watery bloody discharge appears, with pain, loss of weight and general weakness. Pain is not an early symptom. It appears when the disease has spread to the nearby tissue.

Treatment.--The only thing to do is to operate and the earlier the better. The womb and all its belongings should be removed. If this is done early it is very successful. If the case is too far advanced, the only thing to do is to make the patient as comfortable as possible.

For the pain, morphine or opium should be given.

For the discharge, hot water and corrosive sublimate (1 to 2000) is the strength to be used. This should be used daily as an injection into the vagina.

Cancer of the Body of the Womb is found in only about two per cent of womb cancers.

Treatment.--An early operation is then necessary. The chances of obtaining a cure if operation is done is better even than in cancer of the neck of the womb. There is less chance for the adjoining structures to be affected so early and readily.

[ WOMAN'S DEPARTMENT 501]

FIBROID TUMORS OF THE WOMB or Fibromata, Frequency.--Some observers state that twenty to forty per cent of all women over thirty-five years have one or more of these tumors. They are not malignant. They are more common in women who are sterile, unable to become pregnant. They appear early in life and attack all classes. They appear oftener in the body of the womb than in the neck. When in the body of the womb the back wall is the common site. A covering of loose fibrous tissue surrounds the growth. Few blood vessels appear in the tumor, nourishment being received from the surrounding tissues. Their growth is slow, except during pregnancy, when they grow rapidly. There are three varieties named according to their location and the structure covering: or surrounding them. 1. Interstitial; 2. sub-mucus; 3. sub-peritoneal or sub-serous.

1. Interstitial.--They are in the substance of the womb wall. They are usually many and vary in size.

2. Sub-mucus (under the mucous membrane).--They project into the cavity of the womb, are covered by mucous membrane and are attached to the womb by a broad base or pedicle. This is sometimes cut off spontaneously, and then the tumor is expelled from the womb.

3. Sub-peritoneal.--They are under the peritoneum, which forms its outer cover.

Causes.--Are not known. They are more frequent between thirty and forty.

Symptoms.--Difficult monthly sickness, too much blood flowing from the womb, unable to become pregnant, sometimes, and abortion. Bleeding comes more from the sub-mucus variety generally. Pain is caused by the size and weight and by pressure upon the bladder, rectum and the nerves. Death rarely results except from the complications.

MOTHER'S REMEDY. 1. Ulcers of the Womb, Common Wood Cactus for.--"Common wood cactus tea. Take wineglassful three times a. day." Should remove all thorns, chop fine and boil in sufficient water; add gin to make dose more pleasant.

Treatment.--Operation is needed when the symptoms are pressing. The sub-mucus variety may make an early operation necessary on account of their location.

Symptoms Calling for an Operation.--Size of the tumor; from the pressure symptoms; persistent bleeding from the womb. Sometimes it is necessary to remove the entire womb, especially in the interstitial variety, for the walls of the womb may be filled with the tumors.

[502 MOTHERS' REMEDIES]

SUBINVOLUTION OF THE WOMB.--This simply means that the womb, after miscarriage or child-birth, fails to return to its normal size and weight.

Causes.--This is frequently due to getting up too soon after labor.

Symptoms.--Menstruation or too much flow of blood (menorrhagia), dull, heavy feeling in the pelvis, backache or leucorrhea.

Results.--The womb frequently becomes misplaced.

Treatment.--Proper supports should be put in after the womb has been placed in its proper position.

If seen early enough some cases can be cured by tampons of ichthyol used three times a week and prolonged hot water injections at bed time. Cotton soaked in ichthyol and glycerin are frequently of benefit three times a week used as a tampon. The patient should not be on her feet much, or be active. Witch-hazel water can be added to the hot water injection if so desired.