Chapter XLVI: Introduction (16)

TREATING THE WRONG DISEASE. Our improved and perfected system of diagnosing, or determining, the _exact_ nature and extent of chronic affections, which, in most cases, we are able to do at a distance, and without a personal examination of the patient, as will be more particularly explained in the appendix, or latter part of this little book, has enabled us to avoid the blunders so often committed by the general practitioner, who not infrequently treats those afflicted with chronic ailments peculiar to women, for long weeks, and perhaps months, without ever discovering their real and true disease, or condition. Thus, invalid women are often uselessly subjected to treatment for dyspepsia, heart disease, liver or kidney affections, sick headaches, and various aches and pains, as if they were _primary_ diseases, when in reality, they are only so many local manifestations, or _symptoms_, of some overlooked derangement, or disease, of the womb. For, as we have already intimated, every organ of the system is in _intimate_ sympathy with the uterus, or womb. Any disease, either functional or organic, of this organ, is at once manifest through several, if not all, the sympathizing organs of the system. When we receive a sharp blow upon the elbow, the pain is felt most keenly in our little finger. Just so in diseases of the womb; often the most distress is felt in organs or parts of the system quite distant from the real seat of disease. On this account, thoughtless, easy-going and ignorant physicians are misled, and very commonly mistake the invalid's disease for some affection of the stomach, heart, liver, kidneys, or other organ, when really it is located in the uterus. Cure the disease of the womb, and all these disagreeable manifestations, or symptoms, vanish. Their cause being removed, the various dependent derangements, and disagreeable nervous sensations and sufferings rapidly give way, and vigorous health is firmly re-established.

TIME AND PERSEVERANCE IN TREATMENT REQUIRED TO CURE. Most chronic diseases of women are slow in their inception, or development, and their removal or cure must necessarily be gradual. Disease that has been progressing and becoming more firmly established for months, or perhaps years, cannot, except in rare cases, be hastily dislodged, and the system restored to perfect health. The process of cure, like the development and progress of the disease, must be a gradual one, accomplished step by step. Often, too, the use of medicines that, if _persisted_ in, will prove beneficial and curative, will, for a considerable time, arouse in the system very disagreeable sensations, and many times this leads unthinking persons to become frightened or discouraged, and to quit the treatment best adapted to their cases if only faithfully carried out. In many forms of womb disease, their are organic lesions or changes, that can be repaired only by a gradual process, just as an external wound would heal,--not suddenly, but by a constant, slow filling in and building up, or by the gradual development or growth of one cell upon another. Just as a great breach in a wall would be repaired by filling in brick upon brick, until the defect is effaced, so must these lesion's be removed by gradual processes. When fully repaired, the dependent, sympathetic derangements, disagreeable sensations, and all the long train of consequential symptoms are, one by one, abolished.

NOT LIMITED IN OUR REMEDIAL RESOURCES. It should be borne in mind that, while we recommend, in this little volume, certain courses of treatment for ordinary cases, the remedies mentioned do not by any means embrace all our resources in the way of medicines and other curative agencies, especially for complicated, difficult, or very obstinate cases. In many of the latter class we can send medicines that are exactly adapted to the case, if the invalid will fill out one of our "Applications for Treatment," which may be found folded in the latter part of this book, or which will be sent to any address, on application, by mail. In most womb diseases, the chemical and microscopical examination of the urine also furnishes valuable aid in determining the exact condition of the patient, as well as the precise stage of the local organic disease. Full directions for putting up and sending such samples may be found in the "Appendix" of this little volume. Every case submitted to us, either by letter or in person, receives the careful and deliberate consideration of a full Council of specialists before a decision as to the nature of the malady, or the proper course of treatment to be employed, is determined upon. The great advantage of this system of practice must be obvious to every intelligent, thoughtful person. No experimenting is ever resorted to. The treatment is _specially_ and _exactly_ adapted to each individual case, which requires such judgment, skill, and nicety of discrimination, as has only been acquired by our specialists through long and diligent study, and an experience embracing the treatment annually of many thousands of cases of those chronic diseases which are peculiar to women.

WORLD'S DISPENSARY MEDICAL ASSOCIATION,
663 Main Street, Buffalo, N.Y.

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MENSTRUATION AND ITS DISORDERS.

The function of the ovaries is to furnish ova or germs, and the functions of the uterus or womb are to secrete mucus; to exude the menses; to secrete the decidua; to contain and nourish the foetus and to effect its expulsion.

Menstruation, or the menses, monthly visitation, catamenia, menstrual flow, courses, or periods, usually makes its appearance in the female between the twelfth and fifteenth years, at which time the reproductive system undergoes remarkable changes. A marked characteristic of menstruation is its regular return about every twenty-eight days. The menstrual flow usually continues from three to six days, and the discharge seems to be ordinary blood, which, during its vaginal passage, becomes mixed with mucus, and is thereby deprived of the power of coagulation. The quantity exuded varies from two to eight ounces, but the amount consistent with the health of one person, may be excessive and weakening in another. This function is regarded as "being regular when its effect upon the system is favorable, for whatever organic process directly contributes to the health should be considered as normal. It occurs at regular intervals for about thirty years, when menstruation and the aptitude for conception simultaneously cease.

The departures from healthy menstruation are numerous. The most important of these are _amenorrhea, dysmenorrhea_, and _menorrhagia_.

AMENORRHEA.

The term _amenorrhea_ signifies the absence of menstruation when it should occur. It may be considered under two general heads: when it fails to be established at the proper age, and when, after having made its appearance, it ceases to return at the usual periods. The term _retention_ has been applied to the first, and that of _suppression_ to the latter. Menstruation may fail to be established in consequence of organic defects, or from some abnormal condition of the blood and nervous system.

MALFORMATION OF THE VAGINA. Retention of the menses may result from malformation of the vaginal canal, which sometimes terminates before it reaches the womb, being simply a short, closed sac. If the uterus and ovaries are perfect, all the feminine characteristics are manifest, and a vaginal exploration discloses the nature of the difficulty. If, however, the sides of this passage adhere in consequence of previous inflammation, they may be carefully separated by a surgical operation, and this function restored.

ABSENCE OR MALFORMATION OF THE WOMB. The uterus may be deformed or entirely absent, and yet there be an inclination, or symptoms indicative of an effort, to establish this function. The individual may be delicate in organization, graceful in bearing, refined and attractive in all feminine ways, and yet this organ may be so defective as to preclude the establishment of the menstrual function. Sometimes there is merely an occlusion of the _mouth_ of the uterus, the perforation of which removes all difficulty. In others, the _neck_ of the womb is filled with a morbid growth, or the walls of its canal are adherent, as the result of inflammation, and may be separated by a small silver or ivory probe, and the menses be thus liberated.

IMPERFORATE HYMEN. The hymen is a circular, or semilunar membrane, which imperfectly closes the outer orifice of the vagina in the virgin. When of a semilunar shape, it usually occupies the lower or posterior portion of the canal, leaving an opening in the upper or anterior portion, varying from the size of a quill to that of a thimble, through which the menstrual fluid exudes. This membrane is usually ruptured and destroyed by the first sexual intercourse, and, hence, its presence has been considered evidence of virginity. Its absence, however, must not be considered a conclusive evidence of sexual intercourse, for, as Dr. Dunglison says, "many circumstances of an innocent character may occasion a rupture or destruction of this membrane. It is often absent in children soon after birth; while it may remain entire after copulation. Hence, the presence of the hymen does not _absolutely_ prove virginity; nor does its absence prove incontinence, although its presence would be _prima facie_ evidence of continence."

Sometimes this membrane, when not imperforate, is so thick and strong as to render sexual intercourse impossible, and requires a cutting operation to open the vagina. Several such cases have been operated upon at the Invalids' Hotel and Surgical Institute.

It occasionally happens that the hymen is entire, or imperforate, at birth. This may not be discovered before puberty. But when this period arrives and the menstrual discharge takes place into the vagina, the female will suffer from the retention and accumulation of this secretion, and ultimately a tumor or a protrusion of the membrane which closes the vagina will occur, giving rise to severe pain and other serious symptoms. The retained menstrual fluid, increasing in quantity at every monthly period, dilates the womb as well as the vagina, and even the Fallopian tubes become distended, presenting at length an urgent necessity for relief.

TREATMENT. This condition admits of relief only by operative surgery. The operation consists in dividing the hymen by a crucial incision, thus allowing the accumulated fluid to be discharged, after which the vagina is cleansed by syringing it with warm water.

ABSENCE OF THE OVARIES. Let us suppose the case of a young woman who has fully reached the period of puberty without having menstruated. All the organs which we have described, are manifestly developed, she is healthy, vigorous, robust, and able to exercise freely or to engage in laborious occupations. But we notice that her voice is not sweetly feminine, nor is her presence timid, tender, and winning; there is wanting that diffident sexual consciousness, which gently woos, and, at the same time, modestly repels, and tends to awaken interest, curiosity, and desire. Considering also that she has never manifested any inclination to menstruate, we are irresistibly led to the conclusion that the ovaries are wanting; the delicate mustache upon the upper lip, the undeveloped breasts, the coarse features, and her taste for masculine pursuits, all concur in this diagnosis. Thus we account for the harshness of the voice, fitted for command rather than to express the mellow, persuasive cadences of love. Such a malformation cannot be remedied.

RETENTION AND SUPPRESSION FROM MORBID CONDITIONS OF THE BLOOD. Non-appearance, as well as suppression of the menses, may result from an abnormal state of the blood. The first condition which demands our attention under this head is _plethora_. In robust, plethoric females the menses are sometimes very tardy in their appearance, and every month the attempt to establish this function is attended with pain in the head, loins, and back, chilliness, nausea, and bloating of the abdomen. Sometimes there is intolerance of light or sound, and cerebral congestion, amounting almost to apoplectic symptoms. The pulse is full and strong, the blood abundant and surcharged with red corpuscles. Such persons may be accustomed to luxurious living, and there is evidently a predisposition to abnormal activity of the alimentary functions.

TREATMENT. We may briefly suggest that such subjects should engage in laborious physical exercise in order to expend the surplus of vitality, and should lessen the daily amount of food taken, and use that which is light and unstimulating. We should also prevent the determination of blood to the head, by keeping it cool and the feet warm, and by increasing the flow of blood to the extremities. The volume of the circulation may be diminished by acting upon the natural outlets, such as the skin, kidneys, and bowels. The proper means and appliances for quickening the circulation of the blood are indicated, and friction upon the surface, bathing, the daily use of such cathartics as Dr. Pierce's Pleasant Pellets, and, finally, the use of some general uterine stimulant, such as Dr. Pierce's Favorite Prescription, will generally prove successful in cases of amenorrhea resulting from plethora.

RETENTION AND SUPPRESSION FROM ANÆMIA. To describe the condition of the patient whose blood is low and deprived of the richness, warmth, and bloom, it once possessed when it kindled admiration and enthusiasm in others, is but to give a picture of a numerous class of female invalids. It is sad to see beauty fading, vigor waning, and Bright's disease or consumption slowly wasting the blood and consuming the vital cells, until the spirit can no longer dwell in its earthly abode and death claims the skeleton for dust.

CHRONIC DECLINE, with its attendant anæmia, may be induced by bad habits, destitution, or constitutional depravity. Sickly forms, wrecks of health, address our senses on every side. All these subjects evidently once had a capital in life, sufficient, if properly and carefully husbanded, to comfortably afford them vital stamina and length of days. Alas! they have squandered their estate, perchance in idleness and luxurious living, or have wasted it in vanities or misdirected ambition. Having become bankrupts in health, there is necessarily a failure of the menstrual function, and then follows a _panic_. All the blame of the insolvency and general derangement, is unjustly attributed to the non-performance of the duties of the uterus. Thus, this organ is altogether _dependent_ Upon the general health for its functional ability, yet frequently treatment is instituted to compel menstruation, regardless of the condition of the system. Thus the enfeebled uterus is wrongfully held responsible for general disorder, because it ceases to act, when _by acting_ it would further deplete the blood and thus materially contribute to the already existing chronic decline.

No matter what are the causes of this decline, whether they are the follies of fashion, the effect of indolence, debility in consequence of insufficient food, perversion of nutrition by irregular habits, lack of exercise, or the taking of drastic medicines, the result is anæmia and amenorrhea.

TREATMENT. We would suggest in such cases a nutritious diet, increased exercise, cleanliness, regular habits, hard beds, and useful employment. The diet may be improved by animal broths, roasted meats, fresh beef, mutton, chicken, or eggs, and the dress should be comfortable, warm, and permit freedom of motion. The patient should indulge in amusing exercises, walking, swinging, riding, games of croquet, traveling, singing, percussing the expanded chest, or engage in healthful calisthenic exercises. The hygienic treatment of this form of amenorrhea, then, consists in physical culture, regular bathing, and the regulation of the bowels, if constipated, as suggested in this volume under the head of constipation.

The _medical treatment_ should be directed to enriching the blood, improving nutrition, toning up the generative organs, and the health of the whole system. This requires the employment of uterine and general tonics, and Dr. Pierce's Favorite Prescription, which is sold by druggists, happily combines the properties required. It improves digestion, enriches the blood, exercises a tonic and gently stimulating effect upon the uterus and ovaries, and thus promotes the function of menstruation. It is not a strong emmenagogue, but operates slowly, yet surely, and in accordance with physiological laws, being eminently congenial in its effects upon the female system, and, hence, not liable to do harm. There is danger in employing active driving medicines, besides, no emmenagogue, however powerful, can establish the menstrual function so long as the system is in a debilitated condition and the blood reduced. The restorative effects of the "Favorite Prescription" should be secured by administering it regularly, in from one to two teaspoonful doses, three or four times a day, for several weeks, and as the system is built up and those symptoms appear which indicate a return of the menses, their visitation may be encouraged by the use of hot foot and sitz-baths, and free doses of Dr. Pierce's Compound Extract of Smart-weed. But the latter should only be used when symptoms of approaching menstruation are manifested. By following out this course of treatment, a soft flush will gradually take the place of the pallor of the cheeks, the appetite will return and the health will be restored.

ACUTE SUPPRESSION OF THE MENSES may be caused by _strong emotions,_ as excessive joy, or by violent _excitement_ of the _propensities_, as intense anger, sudden fright, fear, or anxiety. Suppression may result from sudden exposure to cold, immersion of the hands or feet in cold water, drinking cold water when the body is heated, sitting on the cold ground or damp grass, or from a burn or wound. It is not uncommon for women to labor in the heated wash-room, pounding, rubbing, and wringing soiled linen, thereby overtaxing the delicate physical system. While feeling tired and jaded, all reeking in perspiration, they rinse and wring the clothes out of cold water and hang them upon the line with arms bare, when the atmosphere is so freezing that the garments stiffen before they finish this part of the task. Is it any wonder that acute suppressions occur or that inflammations set in?

The symptoms which naturally follow are a quick pulse, hot skin, thirst, fever, headache, and dizziness, and the inflammation may locate in the ovaries, uterus, lungs, bowels, brain, or other parts. No matter what organs are attacked the menses are suppressed. The suppression can generally be attributed to an adequate cause, resulting in constitutional disturbance. The severity and duration of the attack and the power of the constitution to resist it, must determine the gravity of the consequences.

TREATMENT. As acute suppression of the menses is due to derangement of the circulation of the blood, caused by taking cold, by violent excitement of the propensities or excessively strong emotional experience, the prominent indication is to secure its speedy equalization. Give a hot foot, a warm sitz, or the spirit vapor-bath and administer full doses of Dr. Pierce's Compound Extract of Smart-weed, to produce free perspiration. Dr. Eberle, a very celebrated medical author, says that he used the Extract of Smart-weed in twenty cases of amenorrhea, and affirms, "with no other remedy or mode of treatment have I been so successful as with this." Our experience in the use of the Extract has been equally satisfactory. Should this treatment not establish the function, Dr. Pierce's Favorite Prescription should be given three times a day until the system is invigorated, say for twenty-eight days, when the above course may be repeated, and generally with success. Should the case be complicated with inflammation of the lungs, brain, or other vital organs, manifesting alarming symptoms, the family physician should be called. The treatment should be active and suited to the indications of each particular case. When the disease becomes chronic, the active stage of symptoms having passed, and it continues to linger without making the desired improvement, all the means suggested for the treatment of suppression from anæmia should be employed. Their use will be followed by the most gratifying results. It should be borne in mind, however, that when we have suggested any treatment in this volume, it is generally such as the family may institute and apply, and does not, by any means, represent the variety or extent of the remedial resources which we employ when consulted in person or by letter. We refer our readers to only a few of the safe and reliable remedies which we have prepared and placed within their reach, and give them just such hygienic advice as we think will best serve their interests.

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DYSMENORRHEA.

(PAINFUL MENSTRUATION.)

_Dysmenorrhea_, from its Greek derivation, signifies a _difficult monthly flow,_ and is applied to menstruation when that function becomes painful and difficult. Menstruation, like other healthy operations of the body, should be painless, but too frequently it is the case, that discomfort and distress commence twenty-four hours before the flow appears, and continue with increasing pain, sickness at the stomach, and vomiting, until the patient has to take to the bed. When the discharge does occur, speedy relief is sometimes obtained, and the patient suffers no more during that menstrual period. With others, the commencement of the function is painless, but from six to twenty-four hours after, the flow is arrested and the patient then experiences acute suffering. Pain may be felt in the back, loins, and down the thighs. Sometimes it is of a lancinating, neuralgic kind, at others, it is more like colic. Frequently the distress causes lassitude, fever, general uneasiness, and a sense of lethargy. There are those who suffer more or less during the entire period of the flow, while the distress of others terminates at the time when a membranous cast is expelled. For convenience of description, dysmenorrhea has been divided into the following varieties: _neuralgic, congestive, inflammatory, membranous_, and _obstructive_.

_The neuralgic variety_ of dysmenorrhea, sometimes called _spasmodic_ or _idiopathic_, occurs when there is excessive sensibility of the ovaries and uterine nerves, which sympathetically _respond_, especially to cutaneous, biliary, and sexual irritation, and when ovarian or uterine irritation is communicated to distant nerve-centres. In the first class, usually comprising lean persons of an encephalic temperament, whatever disorders the functions of the general system, instantaneously reflects upon the ovaries and uterine nerves, and the menstrual function Is correspondingly disturbed, and, instead of being painless, the flow becomes spasmodic, with paroxysms of distress. In the second class, which includes those persons who are plethoric, the ovarian and uterine nerves seem to be the origin and centre of irritation, which is sometimes so severe as to cause indescribable pain. We have known women who affirmed that the severity of labor pains was not so great as that from this cause. In one instance, the subject suffered thus for eleven years, and then became a mother, and has ever asserted that her periodic suffering was far more intense than the pain experienced during her confinement. These neuralgic pains fly along the tracks of nerves to different organs, and capriciously dart from point to point with marvelous celerity, producing nausea, headache, and sometimes delirium.

IN THE CONGESTIVE VARIETY of dysmenorrhea, the menstrual period may be ushered in without pain; after a few hours, the pulse becomes stronger and more rapid, the skin grows hot and dry, the menses stop, there is uneasiness, restlessness, and severe pelvic pains. Evidently, the mucous membranes of the Fallopian tubes and uterus have become congested, and the pain results from the arrest of the functional process, the exudation of blood.

THE CAUSES are plethora, exposure to cold, excitement of the emotions or passions, and a morbid condition of the blood. Sometimes congestion arises in consequence of a displacement of the uterus.

IN THE INFLAMMATORY VARIETY, the mucous membrane of the uterus is the seat of irritation. The blood flows into the capillary vessels in greater abundance than is natural, and those vessels become over-dilated and enfeebled and so altered in their sensibility as to produce local excitement and pain. It may be associated with inflammation of the ovaries, peritoneum, or bladder. Upon the return of the menses, there is a dull, heavy, fixed pain in the pelvis, which continues until the period is completed. There is generally tenderness of the uterus, and also leucorrhea during the intervals between each monthly flow.

IN THE MEMBRANOUS VARIETY of dysmenorrhea, the entire mucous membrane which lines the cavity of the uterus, in consequence of some morbid process, is gradually detached and expelled at the menstrual period.

SYMPTOMS. There are steady pains at the commencement of the menstrual flow, and they increase in violence and become decidedly expulsive. The mouth of the uterus gradually dilates, and finally, the membrane is forced out of the uterus, attended with a slight flow of blood and an entire subsidence of the pain.

THE TREATMENT, in all the preceding varieties of dysmenorrhea, should consist of measures to determine the circulation of the blood to the surface, and increase the perspiratory functions. Congestion and inflammation of the internal organs are generally induced by exposure to cold or from insufficient clothing. Sometimes they follow from neglect of the skin, which is not kept clean and its excretory function encouraged by warm clothing. The domestic treatment at the monthly crisis should be commenced by the administration of hot foot, and sitz-baths, after which the patient should be warmly covered in bed, and bottles of hot water applied to the extremities, back, and thighs. Dr. Pierce's Compound Extract of Smart-weed should be given in full doses, frequently repeated, to secure its diaphoretic, emmenagogue, and anodyne effects, which, for this painful affection, is unsurpassed. For the radical cure of this disease, whether of a congestive, inflammatory, or neuralgic character, Dr. Pierce's Favorite Prescription, which is sold by druggists, is a pleasant and specific remedy, which will most speedily correct the abnormal condition that produces the trouble, and thereby obviate the necessity of passing this terrible ordeal at every monthly period. The patient should take two teaspoonfuls of the medicine three times a day, and keep up its use in these doses for weeks. Frequently, one month will suffice to cure, but in most cases, a longer season is required. In the end, the suffering patient will not be disappointed, but will become a new being, ready for the enjoyment and duties of life. The bowels should be kept regular throughout the treatment by the use of Dr. Pierce's Pleasant Pellets, if necessary. A hand or sponge-bath should be used daily to keep the skin active, and be followed by a brisk rubbing of the surface with a rough towel or flesh-brush. A wet sheet pack will cleanse the pores of the skin and invite the blood into the minute capillaries of the surface, and thus prove of great benefit. It should be repeated after an interval of seven days, but ought to be omitted if near the approach of a menstrual period. The clothing should be warm, to protect the system against changes of temperature; especially should every precaution be taken to keep the feet dry and warm. The patient should walk in the open air, and the distance should be regularly lengthened at each succeeding walk. If the course of treatment which we have suggested be faithfully pursued, a permanent cure will be effected.

IN THE OBSTRUCTIVE VARIETY of dysmenorrhea, some organic impediment hinders the exit of the menstrual blood from the uterus, which, consequently, becomes distended and painful. The pain may be constant, but is most acute when the uterus makes spasmodic efforts to discharge the menstrual blood. If these efforts prove successful, there is an interval of relief. Flexion or version of the womb may produce partial occlusion of the canal of the neck of the uterus, thus preventing the free flow of the menstrual fluid through it. Tumors located in the body or neck of the uterus often cause obstruction to the free discharge of the menses. Imperforate hymen and vaginal stricture also sometimes cause obstruction and give rise to painful menstruation. As these several abnormal conditions and diseases will be treated of elsewhere in this volume, we omit their further consideration here.

Partial adhesion of the walls of the neck of the womb may result from inflammation of the mucous lining, and prevent a free and easy exit of the menstrual fluid. In many cases, the contracted and narrowed condition of the canal of the cervix seems to be a congenital deformity, for we can trace it to no perceptible cause. It is also true that contraction and partial, or even complete, stricture of the cervix, or neck of the womb, often results from the improper application of strong caustics to this passage by incompetent and ignorant surgeons. Every person has observed the contraction of tissue caused by a severe burn, which often produces such a distortion of the injured part as to disfigure the body for life. A similar result is produced when the neck of the womb is burned with strong caustics. The tissues are destroyed, and, as the parts heal, the deeper-seated tissues firmly contract, forming a hard, unyielding cicatrix, thus constricting the neck of the womb, through which the menses pass into the vagina.

THE UTERINE DILATOR.

This instrument is introduced into the canal of the uterine neck with its blades closed. By means of the thumb-screw the blades are then separated as shown in this illustration, the cervical canal being thereby dilated to the required extent.]

TREATMENT. From the nature of this malady, it will readily be seen that no medical treatment can effect a radical cure. We must therefore resort to surgery. In a small proportion of cases, the stricture may be cured by repeated dilations of the constricted part of the cervical canal. This may be accomplished by using a very smooth probe which is fine at the point, but increases in size, so that its introduction will widen and expand the orifice and canal. The stricture may be overcome in many cases by using different sized probes. In some instances, we have employed the uterine dilator, represented by Fig. 3. We have also introduced sea-tangle and sponge tents into the neck of the womb, and allowed them to remain until they expanded by absorbing moisture from the surrounding tissues. The latter process is simple, and in many cases preferable. By means of a speculum (see Figs. 15 and 16), the mouth of the womb is brought into view, and the surgeon seizes a small tent with a pair of forceps and gently presses it into the neck of the womb, where it is left to expand and thus dilate the passage. If there seems to be a persistent disposition of the circular fibers of the cervix to contract, and thus close the canal, a surgical operation will be necessary to insure permanent relief. In performing this operation, we use a cutting instrument called the hysterotome (see Figs. 4 and 5). By the use of this instrument, the cervical canal is enlarged by an incision on either side. The operation is but slightly painful, and, in the hands of a competent surgeon, is perfectly safe. We have operated in a very large number of cases and have never known any alarming or dangerous symptoms to result. After the incision, a small roll of cotton, thoroughly saturated with glycerine, is applied to the incised parts, and a larger roll is introduced into the vagina. The second day after the operation, the cotton is removed, the edges of the wound separated by a uterine sound or probe, and a cotton tent introduced into the cervix, and allowed to remain, so that it will expand and thus open the wound to its full extent. This treatment must be thoroughly applied, and repeated every alternate day, until the incised parts are perfectly healed.

In operating, this instrument is introduced into the canal of the neck of the womb, when a thumb screw in the end of the handle is turned, by which a small blade is thrown out from each side, and as the instrument is withdrawn from the canal an incision is made on each side, thus enlarging the passage. The upper figure illustrates the instrument closed, ready for introduction; the lower one, with the blades projected for cutting.]

Many times patients cannot understand why it is that the operation of cutting the constricted cervix causes no pain; they often being entirely unconscious of the making of the incision. The explanation is easy. The cervix uteri, or neck of the womb, is supplied with but few nerves of sensation, and is almost as destitute of sensation as the finger or toe nails, the paring of which causes not the slightest pain. On this account we never find it necessary to administer chloroform or any other anæsthetic when undertaking this operation. If the patient be extremely sensitive the application to the cervix of a weak solution of cocaine is quite sufficient to completely benumb or anesthetize the parts so as to entirely avoid all pain from the operation.

STOHLMAN'S HYSTEROTOME.

This instrument has two cutting blades which shut past each other, as seen in the lower figure, so as not to cut when introduced into the canal of the uterine neck. After introduction, the cutting blades are separated, as shown in the upper figure, the extent of the incision being regulated by the thumb-screw attached to the handles, as represented in the lower figure.]

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MENORRHAGIA.

(PROFUSE MENSTRUATION.)

The word _Menorrhagia_, which is of Greek derivation, literally means _monthly breaking away_, and is employed to designate profuse menstruation. This disorder must not be confounded with those hemorrhages which are not periodical, and which are due to other causes. The term _menhorrhagia_ is restricted to an immoderate monthly flow. The menstrual flow may occur too often, continue too long, or be too profuse. It induces a feeble pulse, cold extremities, weak respiration, general debility, and may occur in opposite states of the system, _i.e._, in women who have a plethoric and robust habit, or in those of flaccid muscles and bloodless features. When the menstrual discharge is natural, it is so gradual that by mixing with the vaginal secretions it is prevented from coagulating, while in this disease, clots are often formed.

SYMPTOMS. In women of a _plethoric_ habit, it is ushered in by itching and heat in the vagina, pain and a feeling of weight in the loins and lower part of the abdomen, and, at times, the breasts become hot and painful. There is considerable thirst, headache, and giddiness. At last, the blood appears and flows profusely, and all the violent symptoms at once subside. The rest of the period is marked by an inordinate flow, leaving the system weak from the loss of blood. It oftener occurs, however, in persons who are naturally weak and delicate, in which case the periods are more frequent and continue longer, and after a time they are renewed by any bodily exertion or mental emotion, so that a constant drain exists. If the flow of blood is not continuous, leucorrhea intervenes. The patient gradually loses strength and becomes languid, her face is pale and usually bloated, livid circles appear around the eyes, the appetite is impaired, the bowels are constipated, and the feet and ankles swollen. Lack of blood in the brain is indicated by headache, ringing in the ears, and dizziness. The patient is nervous and irritable, being disturbed by the slightest noise, and the heart palpitates after the least exertion.

CAUSES. The _first_ form is caused by eating too much rich and highly-seasoned food, drinking wine, porter, ale, or beer, want of exercise, in brief, whatever induces plethora; the _second_ results from an insufficient or poor diet, leucorrhea, frequent abortions, want of ventilation, inherent feebleness, and whatever depresses the vital powers. Either form may be due to syphilitic taints, excessive sexual indulgence, accidents of pregnancy, or organic diseases of the womb. The morbid affections of the womb most likely to induce menorrhagia, are granular ulceration of its mouth and neck, fungous degeneration of its lining membrane, and tumors within that organ. As these subjects will be severally considered hereafter, we shall here dismiss them with this brief notice.

Profuse menstruation is very prone to occur in young women of a lymphatic temperament, whose organs are sleazy in texture.

TREATMENT. To control the excessive flow, the patient should remain in her bed, and assume the recumbent position until the period is passed. If circumstances prevent strict compliance with this rule, it should be observed as nearly as possible. Warmth should be applied to the feet, and cold cloths, which ought to be removed as soon as they become warm by the heat of the body, should be repeatedly placed upon the back and abdomen. A strong tea made from cinnamon bark, or witch-hazel leaves or bark, taken freely, will prove very efficacious in checking the flow. The fluid extract of ergot, in doses of from half a teaspoonful to a teaspoonful, in a little water or cinnamon tea, is one of the most effectual remedies in this affection. Another valuable remedy for arresting menorrhagia is an infusion of Canada fleabane; or the oil of this plant may be administered in doses of from five to ten drops on sugar. Gallic acid is also a good styptic to employ in these cases. If there is febrile excitement, a hard pulse, frequent and throbbing, and if there is headache, thirst, parched lips, hot and dry skin, as is sometimes the case, then menorrhagia is due to an augmented action of the heart and arteries, and the indication of treatment is to diminish vascular action. This may be temporarily accomplished by the use of veratrum viride, which should be continued until the flow is sufficiently diminished.

The means already suggested will generally prove effective in controlling the inordinate flow at the time. Treatment that will produce permanent relief should then be adopted. The condition of the skin, kidneys, and bowels, requires attention for noxious elements should not be retained in the system. To give tone to weakened pelvic organs we know of nothing more specific in its effects than Dr. Pierce's Favorite Prescription, which is sold by druggists. It should be taken continuously for weeks, in order to fully correct the extremely weakened condition of that organ. It also aids nutrition, and thus tones up the general system, so that in the form of profuse menstruation, resulting from debility, the patient is strengthened, her blood enriched, and her nervousness quieted, which constitutes the necessary treatment to make the cure permanent.

As women approach the critical age, and menstruation ceases, if they are anæmic, their condition is pitiable. This period is popularly denominated the _turn of life_. Under favorable circumstances, the vitality is decidedly enhanced, and the decline of this function is attended with a revival of the bodily powers. But when this crisis has been preceded by excessive labor, when intemperance or excesses of any kind have deranged the bodily functions and perverted nutrition, when the mind has been long and deeply depressed, or when the insidious progress of disease of the heart, liver, or other Important organs, occurs in consequence of irregularities of living, then there is danger of congestion of the uterus and a protracted and profuse menstrual flow, which favors a decline.

The treatment of this form of menorrhagia does not differ from that already suggested. The diet should be light and nourishing, and daily exercise, such as walking, riding, change of air and scenery, all will contribute to restoration. Especial attention should be directed to the condition of the bowels and liver. If the latter be deranged, Dr. Pierce's Golden Medical Discovery will be a most efficacious remedy. When there is a diminution of vital force, resulting in impaired nutrition and disorders of blood, an alterative is required which will insensibly and gradually restore activity by removing the causes of derangement. Impairment of nutrition is very frequently associated with functional or organic disease of the liver, and curative measures consist of the use of alteratives, friction baths, exercise, nutritive diet, and diversion of the mind. Whenever innutrition depends upon deprivation of the blood or torpor of any of the secretory organs, the "Golden Medical Discovery" will prove to be an invaluable remedial agent, for it is an alterative and at the same time a blood restorative. If the bowels be costive small laxative doses of Dr. Pierce's Pleasant Pellets should be employed. The "Favorite Prescription" regulates the menstrual function by toning up the tissues of the uterus and restraining the escape of the menses from the orifices of the blood-vessels. While the diet should be nourishing, consisting of wild game, mutton, chicken, and wine, the patient ought not to debilitate the stomach by the use of strong tea or coffee. The circulation of the blood should be quickened by riding, walking, exposure to sunlight, and fresh air. The patient ought to engage in some light occupation, in which the mind will be constantly as well as agreeably employed, but not overtaxed. By pursuing the course of treatment, invalids suffering from menorrhagia may be permanently restored to health.

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THE TURN OF LIFE.

(CESSATION OF THE MENSES.)

Menstruation commonly occurs at regular monthly intervals, during a period of about thirty years. The time for its cessation depends somewhat upon the date of its first appearance. In the temperate zones it commences at about the fifteenth year, and, consequently should terminate at the forty-fifth year. Instances are common, however, in which it has been prolonged until the fiftieth and even to the fifty-fifth year. In warm climates it commences and terminates at an earlier age.

As women approach the critical period of life, if the general health and habits be good, the discharge may gradually diminish, and, at length, totally disappear, without producing any particular inconvenience, but this seldom happens. More frequently, the discharge is entirely absent for six or seven weeks, and when it does return, it is more copious than usual. In some cases, the flow is not only too profuse, but too frequent. Many months may elapse before the menses return, and, even then, they are apt to be very pale and deficient in quantity.

The fluctuations of this function occasion irregularities and disturbances of the general health. When the flow of blood is diverted from the uterus, it is liable to be directed to the head or some other part of the body. In fact, there appears to be constitutional agitation, and disorders of all the organs. Perhaps one reason for calling this a critical period is, that if there is a morbid tendency in the system, a disposition to develop tumors of the breast or uterus, these are very liable to make rapid progress at this time, since they are not relieved by the customary, local exudation of blood. It is a time favorable to the awakening of latent disorder and morbid growths, for, at the decline of the menstrual function, the uterus is not so capable of resisting vitiating influences.

There is greater liability to irritation of the bladder and rectum, and the menstrual flow may be superseded by a white, acrid discharge, caused by an inflammation of the mucous membrane of the vagina. Even if the system be not enfeebled by excessive losses of blood, debility may result from a continued irritation of the uterine organs, and cause the morbid discharge. The nervous system sympathetically responds, becoming exceedingly irritable, and thus implicating in this derangement every bodily organ. In some constitutions, the change of any habit is almost impossible, particularly if it is improperly acquired, or detrimental to health; and so we have sometimes thought respecting this function, that the more it has been abused and perverted during the time of Its natural activity, the greater is the disturbance occasioned when it ceases.

TREATMENT. There should be regularity in all the habits of life. Women are too apt to approach this important period without due care and consideration. When the physical system is about to suspend a function, it is folly to endeavor to perform the labor or assume the responsibilities which were permissible when the constitution was more robust.

How the duties of each day and hour weigh upon the energies of the mother! What intense solicitude and yearning she experiences! How unselfish is that mother who each day works steadily and faithfully for others, and who is conscious of the hidden dangers that lurk around her pathway! With confiding faith and love, she commends the interests of her children to Him who doeth all things well. She anticipates the wants of her family and strives to supply the desired comforts, thus wasting her strength in the labors prompted by her loving nature. Would it not be a greater comfort to those children to have the counsel of their dear mother in later years, than to have the bitter reflection that she sacrificed her health and life for their gratification?

Unconsciously, perhaps, but none the less certainly, do women enter upon this period regardless of the care they ought to bestow upon themselves. Without sufficient forethought or an understanding of the functional changes taking place, they over-tax their strength, until, by continuous exertion, they break down under those labors which, to persons of their age, are excessive and injurious. Is it strange, when woman has thus exhausted her energies, when her body trembles with fatigue and her mind is agitated with responsibilities, that the menses capriciously return, or the uterus is unable to withstand congestion, and capillary hemorrhage becomes excessive? If the physical system had not been thus exhausted, it would have exercised its powers for the conservation of health and strength. It is better to be forewarned of the ills to which we are liable, and fortify ourselves against them, rather than squander the strength intended for personal preservation. Let every woman, and especially every _mother_, consider her situation and properly prepare for that grand climacteric, which so materially influences her future health and life.

The general health should be carefully preserved by those exercises which will equalize the circulation of the blood, and the regular action of the bowels should be promoted by the use of those articles of diet which contribute to this end. Relieve the mind of responsibility, keep the skin clean, and enrich the blood with tonics and alteratives. For the latter purpose, use Dr. Pierce's Favorite Prescription and "Golden Medical Discovery." If these remedies fail, seek professional advice. A careful regulation of the habits, strict attention to the requirements of the system, and the use of tonic medicines, will very frequently render the employment of a physician unnecessary

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LEUCORRHEA.

("WHITES.")

Leucorrhea is the symptomatic manifestation of some uterine or vaginal affection, vulgarly called "whites." We say _symptomatic_, for the white or yellowish discharge, which we term leucorrhea, is not a disease, but a symptom of some uterine or vaginal disorder. We call it a _white_ discharge to distinguish it from the menses and uterine hemorrhages. It varies, however, in color and consistency from a white, glairy mucus to a yellow or greenish, purulent, fetid matter. Sometimes it has a curdled appearance, at others, it is of the consistency of cream. Leucorrhea is the most common symptom of uterine derangement, and there are few females who are not affected by it at some period of life. It may originate either in the vagina or uterus, and it is accordingly termed either vaginal or uterine leucorrhea. The nature of leucorrhea is analogous to that of nasal catarrh. In a healthy state, the lining membrane of the genital organs secretes sufficient mucus to moisten them; but, if the mucous membrane is temporarily congested or inflamed, the secretion becomes profuse, irritating, and offensive. Vaginal and uterine leucorrhea are essentially different in character, the former being an acid, and the latter an alkaline secretion, and, while the first is a creamy, purulent fluid, the latter is thick and ropy, like the white of an egg. In fact, the latter discharge is rich in albuminous matter and blood-corpuscles, hence, its great debilitating effect upon the system, and, if not promptly arrested it is likely to produce _vaginitis, pruritus vulvce_, or _vulvitis_.

VAGINITIS is indicated by intense inflammation of the mucous membrane of the vagina. When this affection is present the patient experiences a sense of burning heat, aching and weight in the region of the vagina, violent and throbbing pains in the pelvis, and the discharge is profuse and very offensive. There is also a frequent desire to urinate, and the passage of the urine causes a sensation of scalding.

PRURITUS VULVAE. The discharge irritates the nerves of the external genital parts, thus producing an almost unendurable itching. Scratching or rubbing the parts only aggravates the affection. The patient is tormented night and day, is deprived of sleep, and naturally becomes despondent. Pruritus vulvae, in its severest forms, is often developed when the discharge is scarcely noticeable. It is the most common result or accompaniment of leucorrhea.

VULVITIS. This term indicates an inflammation of the lining membrane of the external genital parts. Sometimes the inflammation extends to the deeper tissues, causing great pain, and even suppuration, resulting in the formation of an abscess. The attack is indicated by redness, swelling, and a feverish state of the affected parts, which is quickly followed by a profuse flow of yellow pus, and, in some instances, small ulcers are formed on the affected parts.

SYMPTOMS. The sufferer from leucorrhea becomes pale and emaciated, the eyes dull and heavy, the functions of the skin, stomach and bowels become deranged, more or less pain in the head is experienced, sometimes accompanied with dizziness, palpitation is common, and, as the disease progresses, the blood becomes impoverished, the feet and ankles are swollen, the mind is apprehensive and melancholy, and very frequently the function of generation is injured, resulting in complete sterility. Exercise produces pain in the small of the back and the lower portion of the spine, and, owing to a relation of the vaginal walls, the womb falls far below its natural position, or turns in various directions, according to the manner in which the weight above rests upon it. Ulcers are apt to appear upon the mouth of the womb, the matter from which tinges the discharge and stains the linen. Hysteria is often an attendant of this disease.

CAUSES. The immediate cause of leucorrhea is either congestion, or inflammation of the mucous membrane of the vagina or womb, or both. The exciting causes are numerous. Among others, deranged menstruation, prolonged nursing of children, pregnancy, abortions, excessive indulgence in sexual intercourse, uncleanliness, piles, uterine ulcers, and displacement of the womb, are the most common. In brief, it usually accompanies every uterine disorder which vitiates and reduces the system. During childhood, particularly in scrofulous children, discharges from the vagina are not unfrequent, owing to worms or other intestinal irritation.

Among the organic causes of leucorrhea, are ulceration of the mouth or neck of the womb and tumors. These will be considered hereafter.

TREATMENT. We have dwelt upon leucorrhea because of its prevalence and in order to exhibit the various forms it may assume. These reasons long ago prompted us to investigate it; and, ascertaining the derangement to consist in a relaxation of the walls of the vagina, attendant upon depressed vitality, for many years we experimented with various medicines to find those that would exercise specific properties in restoring the tissues involved to a natural condition, thereby arresting the abnormal discharge. Our efforts in that direction have been very successful, and our expectations more than realized. The treatment which we shall recommend is rational, based upon the pathological conditions of the disease, and has been attended with the greatest success.

It embraces the use of those general restoratives and specific uterine tonics, so harmoniously combined in Dr. Pierce's Favorite Prescription, a remedy which has achieved unparalleled success in the cure of this affection and won the highest praise from thousands of grateful women. It many cases, it is well to accompany its use with alterative treatment, for which the "Golden Medical Discovery" will be found especially effective. It is an absurd practice to arrest the discharge with astringent injections _alone_. The weak and lax walls of the vagina, as well as the other tissues of the system, require strength, and this can be gained only by the use of general and special tonics. Appropriate injections as _auxiliary_ treatment will very much _assist_ in the cure. The "Favorite Prescription" is a special tonic for the affected parts, and the "Golden Medical Discovery" is the best general alterative of which we have any knowledge. They may be taken in alternate doses every day. If the patient is very pale and anæmic, one drachm of the carbonate, or two drachms of the citrate or pyrophosphate of iron, may be advantageously added to each bottle of the "Favorite Prescription." If the carbonate be employed, as it is insoluble, the bottle should be well shaken every time before using. The functions of the skin should be kept active by frequent baths, and the patient, if able, should walk or ride in the open air, and freely expose herself to the sunshine. If the invalid be too weak to exercise much, she should go out in warm weather and sit in the open air. Sunshine is no less important in maintaining animal, than in supporting vegetable growth and health. The human being, like the plant, sickens and grows pale, weak and tender, if secluded from the sunlight. The apartments occupied should be thoroughly ventilated. Many women are sickly and feeble because they live in badly ventilated rooms.