■8" ' 
 
f ■■ ... 
 
 FERDINAND HERB, M. D. 
 
FEMALE DISEASES 
 
 THEIR 
 
 PREVENTION AND CURE. 
 
 A POPULAR-SCIENTIFIC TREATISE OF ALL DISEASES 
 
 PECULIAR TO WOMEN, WITH FULL DIRECTIONS 
 
 FOR SELF-TREATMENT. 
 
 BY . , \ ll\l{ l % 
 
 V 
 
 DR. FERDINAND HERB, 
 
 SPECIALIST IN FEMALE AND CHILDREN DISEASES. 
 WEST SUPERIOR, WIS. 
 
 $£r* Q£?* $£& 
 
 1896 
 
 HERB-MUSSGANG PUBLISHING CO., 
 SUPERIOR, WISCONSIN. 
 
Entered According to Act of Congress, in the Year 1896. by Ferdinand Herb, M. Er- 
 in the Office of the Librarian of Congress, at Washington. 
 
 t^agr^ ppau-uug co., msi suplr\or, \n\s. 
 pa\mtRs. 
 
Preface. 
 
 During my practice of many years as assistant physician at 
 clinical hospitals for women in Grermany, I was asked innumer- 
 able times whether there was no book that described in a pop- 
 ular style the nature and the treatment of the diseases of woman. 
 Although there are some works of a similar character, yet there 
 was none among them which I could have recommended as ful- 
 filling this purpose. They were either written in a style entire- 
 ly too scientific, and consequently unintelligible, or, trying to be 
 popular, entirely too superficial, and consequently devoid of real 
 contents. All these publications were, therefore, of as little 
 practical value as encyclopedias consulted for advice, their pur- 
 pose being merely to offer general information. 
 
 Induced by the universal and justified desire, I resolved to 
 supply this long felt want by the publication of this volume. 
 
 In order to offer a work from which real advantage and last- 
 ing benefits may be derived certain prerequisites have to be ful- 
 filled. Above all it is necessary to offer information, based upon 
 the facts of science, about the construction of the different fe- 
 male sexual organs and their surroundings. Only by such knowl- 
 edge, ladies not familiar with these may learn to understand the 
 various kinds of diseases. 
 
 For this purpose the first chapter has been written. It is 
 less practical, but nevertheless indispensible since it lays the 
 foundation for discerning defective conditions. 
 
 Furthermore, the physiology, i. e. the normal functions of 
 the organs has to be thoroughly described. This is always done 
 in the first part of the chapter in which the various diseases of 
 the respective organs are spoken of. 
 
Special attention is devoted to the discussion of preventing 
 female diseases. All sources causing these troubles are named 
 and described accurately. Particular advices for conduct during 
 the dangerous periods of a woman's life— as during the menses, 
 pregnancy, encouchment, etc. — have been inserted in their proper 
 places. 
 
 A special trait of this book, found throughout its pages, is 
 that all prescriptions for the various diseases are given in the 
 appendix, and in such a form that any druggist can fill them. 
 
 Many physicians distribute their own remedies, be it in or- 
 der not to be controlled in what they prescribe, or be it to compel 
 their patients to come again — to their advantage and the people's 
 disadvantage. In direct contrast to this custom it is the purpose 
 of this book to offer, after a thorough explanation of the symp- 
 toms, to the great number of ladies the means of helping them- 
 selves in case of sickness. 
 
 In this way not only great expense may be avoided in many 
 cases, but especially also to ladies who are too timid to consult 
 a physician, or who are too far from the cities to do so, the op- 
 portunity is offered to counteract beginning diseases instead of 
 rendering cure impossible by delay. 
 
 The description of operations has been omitted, their prin- 
 ciples, however, and the question of whether or not an operation 
 is necessary has been thoroughly explained so as to enable 
 every woman to form an opinion about her own case in every in- 
 stance. 
 
 A great number of illustrations have been added to the text 
 for the sake of explanation and in order to facilitate the under- 
 standing. If in spite of these there should still be any doubt 
 regarding the explanation of symptoms and troubles, a commun- 
 ication by letter will cheerfully receive attention. Succeeding 
 editions will profit by such correspondence. 
 
 West Superior, Wis. Dr. Ferdinand Herb. 
 
Anatomical Introduction. 
 
 In order to thoroughly understand the following treatise, it 
 will be necessary to learn to know the anatomical conditions, i. e. 
 the construction, situation and relation of the sexual organs as 
 created by nature and found in every adult healthy woman. 
 
 The arrangement of the different parts, though seemingly 
 complex and hidden from view, may easily be understood even 
 by a person unacquainted with the medical profession. But it 
 is necessary to get a clear conception of the essential organs and 
 their location, because only based upon such knowledge it will 
 be possible to distinguish between healthy and diseased condi- 
 tions, and to profit by the advices for the maintenance of and 
 care for health and for the understanding and self -treatment of 
 existing diseases. 
 
 With this end in view the following lines will give, in the 
 most condensed form possible, all the information as far as ab- 
 solutely necessary. 
 
 The female sexual apparatus, taken in a general way, con- 
 sists of the external organs of generation, forming the vulva, and 
 the internal organs, composed of the vagina, the uterus (womb) 
 and its appendages, comprising the oviducts, also called Fallop- 
 ian tubes, ovaries, ligaments and peritoneum. 
 
 All these organs, excepting the vulva, are located in the low- 
 er part of the abdomen, the so-called pelvis. They are invisible 
 to the eye, except in applying medical instruments, and can only 
 be reached by the examining fingers. 
 
 The pelvis (figure 1), being composed of several bones, has 
 the shape of a ring which contains and supports the intestines, 
 
the urinary and the genital organs, and at the same time serves 
 
 as a fixed point for the eolation of the thigh bones. (Figure IE.) 
 
 It is divided by a prominent line (figure 1, limit between 
 
 the false and true pelvis) into a false and a true pelvis. The 
 
 Figure 1 — Pelvis Bones. 
 
 A — Hip Bone. 
 
 B — Brim of the Hip Bone. 
 
 C — Sacrum. 
 
 D — Coccyx. 
 
 E — Thigh Bone. 
 
 F — Line between FF is the interspinal 
 
 line. 
 MM— Lower Brim of the True Pelvis. 
 
 (The same as MM in figure 3.) 
 
 upper part, the false pelvis, which is incomplete in front, is 
 bounded on each side by a large, wide bone, well-known by the 
 name of hip-bone (figure 1 A, figure 2 a). Its brim (figure IB) 
 can be traced to a great extent through the external skin. 
 
 The lower part, the true pelvis, is smaller than the upper 
 part, but its walls are more perfect. It has an inlet, the superior 
 circumference (figure 2 bb) ; an outlet, the lower circumference 
 (figure 2 cc) ; and a cavity, the space between the inlet and outlet. 
 
The walls of the cavity are formed in front by the pupe- 
 bone which is felt above the urethra, behind by the lowest end 
 of the vertebral column, i. e. the sacrum (figure 1 C) and the coc- 
 cyx (figure ID). This latter and the bones bounding the sides 
 of the pelvis, on account of their occult position, can only be 
 traced exactly by introducing the finger into the vagina. But 
 doing so, we are able to determine all details in a living person 
 with such accuracy as is essential for the discerning of female 
 diseases. 
 
 The outlet of the true pelvis is closed by the pelvis bottom, 
 ( figure 3 HH ; figure 4, dotted line between L and E ) a flat 
 spread muscle consisting of several layers interwoven with sin- 
 
 c c 
 
 Figure 2 — Shape of the Pelvis. . 
 
 aa — The Hip Bones bb — The Inlet of the True Pelvis, 
 
 cc — The Outlet of the True Pelvis. 
 
 ews and leaving openings only for the rectum, vagina and ur- 
 ethra. (Figures 3 and 4.) 
 
 The effective work of this pelvis bottom is plainly perceived 
 in efforts trying to hold back a moving of the bowels.. Thereby 
 all three passages are closed up more tightly, as will be especial- 
 ly noticed when introducing the finger into the vagina. In a 
 later chapter, when discussing the ruptures of the perineum and 
 the prolapsus of the uterus, we shall have more to say about the 
 functions and the importance of this conclusion of the pelvis. 
 
 Of great value to determine the location of the womb is an 
 imaginary line, the so-called interspinal line. It is drawn be- 
 tween the projecting points FF in figure 1, which can, be plainly 
 traced on a living woman. 
 
 The vagina and the bowels, running close together above the 
 pelvis bottom, are diverging toward the lower end and separated 
 at their outlet by a large skin-covered space, called the perineum 
 
(figure 4 K) . This part of the body is of importance in the scope 
 of this book because it happens very frequently in confinement 
 
 Figure 3 — Showing the Muscles of the Pelvis Bottom Made 
 Visible By Taking off the Skin and the Fat Under it. 
 
 A — Cut through the skin and the 
 
 fat lying under it. 
 B — End of the coccyx (figure 4 L.) 
 C — Opening'of the rectum. 
 D— Opening of the vagina. 
 
 E — Opening of the urethra. 
 F — Constrictor of the rectum. 
 G — Constrictor of the vagina. 
 HH — Muscles layers of the pelvis bot- 
 tom — dotted line in figure 4. 
 
 cases that it is torn and the results are often very serious for the 
 future. 
 
Toward thefront the perineum connects with the projecting 
 parts of the external organs of generation. The large lips (figure 
 4 C) which will be seen at first, two thick, fat duplications of 
 the external surface covered on the outside with common skin 
 and hair, are on the inside soft, smooth and shining. With 
 children and girls they are closed tightly, so that it is imposs- 
 ible to notice the smaller lips (figure 4 D) located toward the in- 
 terior. With married women, especially such as have given 
 birth to children, they may be seen without touching, if the legs 
 are put apart. These small lips, varying in size considerably, ex- 
 tend from the perineum to the clitoris, a small, very sensitive and 
 irritable organ in the upper part of the vulva, and encircle a smooth 
 cavity, the vestibule (figure 4X), which leads to two passages: 
 the urethra above and the vagina below. By reason of being so 
 
 Figure 5 — Regular Shape of the" Hymen. 
 
 a— The hymen. b — Opening of the hymen. 
 
 close together, and on account of both running into the same 
 space usually closed, it is easily explained why the one part is 
 also quickly affected if the other one is suffering from inflamma- 
 tion. 
 
 The part separating the vestibule from the vagina is formed 
 in virginity by the hymen (figure 5), a semi-lunar fold of mem- 
 brane, soft and tender with young, harder and more resistant 
 with older woman; it is usually torn at the first intercourse. Its 
 opening intended as a passage-way for mucus and blood is gen- 
 erally in the upper part, near the urethra. However, the shape 
 of the hymen is not always the same and very great differences, 
 even its absence, has been observed. 
 
 The vagina (figure 4 G), located behind the hymen, is a cyl- 
 indrical hollow organ, from five to six inches in length, extend- 
 ing from the external parts to the womb, and bordering in the 
 front on the urethra and bladder, in the rear on the rectum, the 
 lower part of the intestines. It is flattened from the front back- 
 
8 
 
 ward and its walls are ordinarily in contact with each other. (In 
 order that the drawing may be better understood the walls are 
 represented independently and apart from each other.) The an- 
 
 Figure 4 — Vertical Section of a Woman Demonstrating the 
 Situation and Relation of the Uterus, Bladdr and 
 Rectum. 
 
 M— Bladder. 
 
 N— Urethra. 
 
 O — Fundus. 
 
 P — Neck or cervyx of the womb. 
 
 Q — Body of the uterus. 
 
 RR— Douglas' folds. 
 
 S — Douglas' space. 
 
 V — Scrum and coccyx. 
 
 W — Canal of the spinal cord 
 
 X— Vestibule. 
 
 A— Buttock. 
 
 B — Hair of the pudenda. 
 C — Large lip. 
 D — Small lip. 
 E — Pupe-bone. 
 F — Rectum. 
 G — Vagina. 
 H — Rear vault. 
 I — Front vault. 
 K — Perineum. 
 L — End of the coccyx. 
 
 The lower doted line between L and E shows the pelvis bottom 
 the extent of the peritoneum. 
 
 the upper 
 
 terior is about four, the posterior five or six inches long. It is 
 constricted at its commencement by a strong and significantly 
 
working muscle, annulary surrounding the outlet, and called 
 'constrictor of the vagina' (figure 3Gr), a part of that muscle 
 layer which forms the pelvis bottom. On the upper end it em- 
 braces the lowest part of the womb, running into the vagina and 
 creating a duplication of what is called the vagina vault. 
 
 This vault is divided into two parts, the front vault (figure 
 4 i) in front, and the rear vault (figure 4 H) in the rear of the 
 womb. In the middle of the inner surface of the anterior and 
 posterior walls is a longitudinal raphe, the colum of the vagina, 
 which most distinct in the orifice, grows thinner the farther 
 up it goes, and ends before reaching the womb. It may be seen 
 
 Figure 6 — The External Skin Seen Under the Microscope. 
 
 a — The lower layers. b — The upper layers horny in texture. 
 
 best in women who have given birth to children, when the 
 external parts are opened. 
 
 It may here be stated that the vagina is very little inclined 
 to disease itself, and for obvious reasons. Like a tree that 
 has a rough and resistant bark to protect the tender, inner parts 
 from the inclement influences of the outside, so each human be- 
 ing has in a similar manner the so-called "epithel," which not 
 only covers the outer surface of the body, but all the inner 
 parts also. This epithel, however, composed of the small- 
 est corpuscles, visible only with the microscope, is varying 
 greatly in the different parts of the body, and is arranged 
 sometimes in thicker, sometimes in thinner layers, just as the 
 conditions demand it. The greater the necessity for protection 
 the more numerous are these layers and even on the general en- 
 velope, the skin, we find those utmost turning into a homy tex- 
 ture, which assumes in places exposed to constant pressure, as 
 the palms of the hands and the soles, a greater thickness, called 
 callosity. This principle of protection is applied by nature also 
 in the interior of the body. All those organs which are more 
 liable to be hurt have, therefore, a thicker covering of epithel- 
 
10 
 
 ium. For instance the stomach is the place where digestion and 
 absorbtion begins, while it is only the business of the month to 
 simply prepare the food, and that of the oesophagus to transmit 
 this prepared food to the place of digestion. These two, the mouth 
 and the oesophagus, being transmitters, have a similar office as 
 the vagina, as will be shown later, and have, therefore, the same 
 resistant epitheliate cover of several layers as we have seen on 
 the external surface, but without the horny texture. In the 
 
 Figure 7 — Showing the Uterus and its Eelation to Tubes 
 
 and Ovaries. 
 
 A — Fundus. 
 
 B— Body. 
 
 C — Neck or cervix. 
 
 D — Conus or vaginal portion. 
 
 E — Outer mouth. 
 
 F — Inner mouth. 
 
 G — Neck channel. 
 H — Cavity proper. 
 I — Tubes or oviducts. 
 K — Opening of the tubes into the per- 
 itoneum. 
 M — Ovaries. 
 
 stomach and the womb, however, both of which have to perform 
 certain distinct functions, several layers of cells would be a hind- 
 rance to the fulfillment of the duties of these organs. For this 
 reason these accumulated layers are here substituted by one, 
 which has its peculiarities in the respective organs. The discus- 
 sion of this, however, is beyond the scope of this book. The 
 protection thus afforded and the smooth surface from which the 
 sebaceous and sweat glands are absent, while muciparous glands 
 are rarely found, prevent the independent sickness of the vagina. 
 But this should not be understood as though the vagina were 
 
11 
 
 not often affected more or less by the inflammation of the vulva 
 or especially of the womb. 
 
 The womb, also called uterus, which, as stated above, pro- 
 jects with its lower part into the upper end of the vagina, is in 
 an adult a small pear-shaped body, about two inches long, one 
 and'one-half inches wide and one inch thick in its thickest place. 
 The upper and wider end, the bottom of the womb, is called the 
 fundus (figure 7 A), the narrower part more toward the center is 
 the body (figure 7 B) and the lowest and smallest the cervix or 
 neck (figure 7 C). The body and neck are distinguished from 
 each other by a very slight contraction. The lowest part of the 
 neck projecting into the vagina is the conus (figure 7 D). 
 
 On this is found the mouth or external orifice (figure 7 E), 
 
 Figure 8 — Glands. 
 
 A— Fundus. B— Neck C— Mouth 
 
 an outlet leading into the cavity. This small opening is round 
 in virginity and oval after parturition. By the inner mouth of 
 the womb (figure 7 F) is meant a very narrow part of the 
 cavity situated at the point where the body of the womb joins the 
 neck, and which divides the whole cavity into the neck channel 
 (figure 7 Gr) and the cavity proper (figure 7 H). This division 
 is of great importance not only from an anatomical but also from 
 a practical point of view, as will be seen in that part of the book 
 whicn treats of the diseases of the mucous membrane of the 
 womb. On the right and the left upper comers of the cavity of 
 the womb (figure 7) are located the entrances of the tubes which 
 appear as two very small openings. 
 
 The walls of the womb consist of three strong layers of 
 muscles which contract involuntarily, i. e. independent of the 
 will, upon certain irritations, and is not noticed in a normal 
 condition. On the outside the walls are to a large extent 
 
12 
 
 covered by the peritoneum, and on the inside by a mucous mem- 
 brane which gives a smooth surface to the whole cavity. 
 
 This mucous membrane of the cavity is very different from 
 that of the vagina, as described before, and is more subject to 
 diseases. For while the vagina has a comparatively smooth sur- 
 face and a resistable epithelium of numerous layers and few or no 
 glands at all, the epithelium of the mucous membrane of the 
 womb consists of only one layer of cells, is very tender, easily 
 destroyed and not resistible. At the same time this epithelium 
 rests upon a loose basis, rich in fluid and juice, and riven by 
 glands (see foot note) which in their many branches and exten- 
 sions furnish the best means for the settlement and develop- 
 ment of all sorts of microbes. These microbes cause in case of 
 sickness the glands to secrete that great quantity of slimy and 
 
 Figuee 9 — Ciliar Epithelium. 
 
 purulent matter, which while running out frequently undergoes 
 decomposition and adopts a corrosive character. 
 
 The epithelium of the womb as well as that of the tubes, 
 however, has other functions to perform besides the duty of af- 
 fording protection, which is comparatively limited, >as may be 
 seen from the fact that each cell has an instrument in the shape 
 of a small and slender hair-like organ, called the "cilium." This 
 epithelium is, therefore, named "ciliary epithelium." These cilia 
 are during the whole life in continuous motion, not moving in 
 all directions without purpose or aim, but all beating toward the 
 outer mouth of the womb in about the same way as the wheat in 
 the field waves in a light breeze. 
 
 Foot Note — By the term glands we do not understand the knot-like 
 formations as they appear on the neck and other parts of the body, for in- 
 stance glands in the region of the groin (inguinal glands) which can be noticed 
 through the skin and in case of inflammation show a swelling, but excavations 
 in the surface which branch out similiar to the tree through the mucous mem- 
 brane into layers of the muscles. The cells lining the inner ursface of the 
 cavitiy have the faculty of secreting mucus. (See figure 8.) 
 
13 
 
 In this way the motionless ovulum is carried from the ovar- 
 ies into the cavity of the womb, and mucus, matter and every- 
 thing not belonging there is thrown out. 
 
 The womb is located in such a position that, though also 
 between bladder and bowels, it does not run in the same direc- 
 tions with the vagina, but forms with the latter a right angle. 
 For this reason and on account of a slight inclination of the 
 front wall, the bottom of the womb rests upon the top of the 
 bladder while the outer mouth of the womb is directed toward 
 the chine-bone. Figure 4 shows plainer than words can tell the 
 positions of womb, bladder and bowels, and their relations to 
 each other. 
 
 In this position the womb is held by its suspensory ligam- 
 ents. These are in the first place the large ligaments which ex- 
 tend from the womb to both sides of the walls of the pelvis- 
 bone. They contain all the nerves and vessels conducting blood 
 to the uterus, and resemble a thick layer of tissues between 
 bladder and bowels, in which the womb apparently forms a con- 
 densation of muscles. Of less importance are the so-called 
 "Douglas folds." These are two strings containing muscle fibres, 
 which start from that point where the neck of the womb con- 
 nects with its body, and extends to the chine-bone. It is their 
 duty to hold the womb to the rear. At the same time they en- 
 circle the bowels in such a way as to make it appear as though 
 the bowels were passing through a door. (Figure 4 RR.) 
 
 Of the other means of holding the womb in its position, 
 which are not as important as those treated above we will only 
 describe the peritoneum. It has been mentioned several times 
 and as we shall have to refer to it frequently, an explanation of 
 this subject is desirable. 
 
 The different organs in the cavity of the abdomen are sub- 
 ject to changes in position and extension as caused by the dif- 
 ferent postures of the body, for instance in lying, sitting, stand- 
 ing, walking, breathing, coughing, sneezing, etc. and by the fill- 
 ing up of the bowels, the bladder and the womb during the time 
 of pregnancy. In order that these organs may accommodate 
 themselves to the position the occasion demands, they have a 
 slippery covering, which extends not only over the bowels, stom- 
 ach, liver, etc, but covers also the walls of the abdomen. This 
 
14 
 
 is the peritoneum. In the pelvis of the woman it runs from the 
 front walls of the abdomen across the bladder, leaving a smaller 
 depression between bladder and womb and a larger one at the 
 rear part of the large ligaments. The covering of this bag, which 
 extends downwards between the rear, large ligaments to the end 
 of the cone of the womb, the so-called "Douglas space," belongs 
 to the peritoneum and is of great importance in many cases of 
 female diseases. (Figure 4 S.) 
 
 On the upper edge of the large ligaments, likewise covered 
 by the peritoneum, are the tubes, connecting the womb and the 
 ovaries. (Figure 7 e.) It is their function to transmit the ovul- 
 um from the ovaries to the womb, and their shape and construc- 
 tion is in accordance with this duty. Their small channel which 
 ends in a very minute opening in the upper corner of the cavity 
 of the womb, gradually grows larger towards the ovaries and fin- 
 ally opens into the peritoneum taking there the shape of a fun- 
 nel. At the brim of this funnel there are numerous fringes.- 
 One of these is in direct communication with the ovary and is 
 of special importance for the transmission of the ovulum. 
 
 The mucous membrane lining the oviducts is the same as 
 that in the womb, and has also the same ciliary epithelium al- 
 ready described. The layers of muscles surrounding this mem- 
 brane are not as strong as those of the womb and yet sufficiently 
 strong to expell diseased contents, which occurs with colic-like 
 pains. 
 
 Very close to the opening of the trumpet-shaped oviducts, 
 bedded in a fold of the rear surface of the large ligaments are 
 the germ glands of the female sex, the ovaries. They are small 
 and hard, about the size of a peach-stone, and are destined to 
 furnish the ovulum — that part of the germ contributed by wo- 
 man which will be developed into a human being. Just how 
 this is done and under which conditions, will be discussed in the 
 chapter on diseases of the ovaries. 
 
Diseases of the External Parts. 
 
 The deformities of the external female organs, among which 
 must be classed most especially that state known as hermaphrod- 
 ism, that is, the presence of both sexes, more or less distinctly dev- 
 eloped in one individual, are very rare and of little practical inter- 
 est. It is, therefore, not necessary to discuss them in detail. They 
 may, however, become of legal importance, in as much as such 
 deformities prevent or annul in certain cases a marriage, which 
 may have been contracted. An acquaintance with the normal 
 condition, allows one to readily detect any deviation therefrom. 
 
 On the contrary the inflammatory and ulcerous processes of 
 the external parts, the pudenda, are very frequent, as there are 
 numerous causes for their origin, both in children and adults. 
 
 In children we find, besides the light diseases originating 
 from uncleanliness, especially two forms causing more or less 
 trouble. One is brought about by the same germ which prod- 
 uces gonorrhoea with adults and is carried to older children by 
 sleeping with affected adults, or it is transmitted by sponges, 
 towels, clothing, etc., thus causing more or less suppuration of 
 the child's external genitals, at the same time affecting urethra 
 and vagina. 
 
 The other inflammations, occurring during dyphtheria, scar- 
 let fever and measles, are less frequent than the trouble above 
 referred to, but as they have a tendency to destroy the tissue, 
 they may do more harm to the affected parts. 
 
 The sudden appearance of diseases of the private parts in 
 adults, almost always is a proof of previous sexual intercourse, 
 except, of course, when they are known to be caused by opera- 
 
16 
 
 tions or injuries. They are the result of direct infection, and 
 are divided into two main classes — a purulent, catarrhal disease, 
 called gonorrhoea, and an ulcerous one, called chancre. The 
 first mentioned, which almost invariable affects the glands of the 
 vestibule, the vagina, the womb and often the urethra, will be 
 more definitely described in a later chapter. It is here only 
 mentioned in as much as it affects the external parts, the pud- 
 enda. 
 
 Symptoms — A few days after the infection, these parts be- 
 come red and begin to itch. An increasing feeling of discomfort 
 prevails. The itching and burning sensation, at first slight, grows 
 to pain, which increases with every movement and friction. The 
 parts become more and more sensitive, the slightest touch being 
 aggravating. The redness rises to inflammation, and swelling sets 
 in. A profuse mattery substance covers the lips of the pudenda. 
 The secretion is very offensive, and soils the clothing with ugly 
 greenish stains. Fever appears and the inguinal glands swell. 
 Urination is rendered difficult and is accompanied by severe 
 pains and a burning sensation. According to the strength of the 
 poison infected, the inflammation may be much less apparent. 
 The external parts are perhaps only slightly affected, the dis- 
 ease being confined to the other organs. 
 
 Not nearly so severe are the symptoms of the ulcerous form, 
 the chancre disease. The inconveniences thereby caused are 
 mostly so slight that generally no attention is paid to the "little 
 soreness" until its obstinacy and long duration demands it. Only 
 then it is found that the sores are not of an ordinary nature, but 
 that they are wounds, which spread and grow deeper. They are 
 distinctly rimmed ulcers, covered with matter, mainly found at 
 the entrance of the vagina, at the small and large lips, and oc- 
 casionally at the mouth of the womb. In the latter instance 
 they may only be detected by their evil consequences. 
 
 The surrounding of these ulcers is seldom highly inflamed 
 or much swollen. This is the case mainly in the malignant, or 
 "hard" form of the chancre, that state which is the first stage of 
 that terrible disease, syphillis, which poisons the entire body. 
 
 By examination it is found that this last mentioned form 
 differs from the mild form, by being hard and gristly to the 
 touch, a peculiarity from which it has taken its name. Both 
 
17 
 
 'forms are most infectious, but the mild form will leave no evil 
 consequences, if maturation of the glands of the groin, which 
 often sets in, can be avoided. The treatment of the mild form 
 is simple and a perfect cure not difficult to attain. 
 
 If the inflammation of the pudenda proceeds slowly the 
 cause must be sought in a weaker, but continuous irritation. 
 Next to uncleanliness, the chief cause may be found in all dis- 
 eases affecting the neighboring parts. Excepting the rare cases, 
 in which thighs and buttocks prove to be the seat of the trouble, 
 the vagina must be taken as the first and most frequent source. 
 Naturally, the discharges from the vagina, in themselves eaus- 
 tical, are rendered more so by coming in contact with the air, 
 and often also with the secretions of bladder and rectum. The 
 very faintest irritations are thus increased to high inflammation, 
 and according to the length of time the trouble has been in 
 existence, are found in all stages, from simple irritation and red- 
 ness to burning, swelling and pain. In spite of the most scrup- 
 ulous cleanliness and attentive care of the patient, such condi- 
 tions can only be improved by removing the first cause thereof, 
 and stopping the discharges. 
 
 The itching sensation which is characteristic to different 
 diseases of the external parts, and is generally caused by inflam- 
 mation and irritation, may be a trouble in itself, independent of 
 any other cause. It is very aggravating and the itching may 
 extend in every direction, affecting abdomen, buttocks and 
 thighs. At first no abnormal changes are noticeable in such 
 cases, except, perhaps, very small, almost imperceptible little 
 lumps, which appear on the lips of the pudenda, so that the ex- 
 ternal parts appear to bs in a perfectly healthy condition. Later 
 however, very disagreeable sores and ulcers are caused by scratch- 
 ing, which only increase the itching. At this stage of the dis- 
 ease it is often difficult to decide what may have caused the 
 trouble. 
 
 It seems that with an exertion of will power the scratch- 
 ing could be avoided, thus lessening the irritation, but such is 
 not the case. The desire to scratch may become so overpower- 
 ing that persons thus suffering are rendered unfit for society. 
 Nothing, not even the most powerful determination, can prevent 
 them from scratching. The causes of this unfortunate condi- 
 
18 
 
 tion, which is most often found in women just past the change ■ 
 of life, or later, less often at an earlier age, are not yet definitely 
 determined. It may be due to other troubles, viz: diseases of 
 the womb, pregnancy, or it may b3 merely a nervous symptom. 
 
 This disease must not be confounded with the one which is 
 caused by pinworms, often found in great numbers in the stools 
 of children. The presence of thssa worms creates a severe itch- 
 ing, which by ssra^ching causes inflammation. It is generally 
 known that thes?, minute worms, which often appear in vast 
 numbers in boarding schools and similar institutions, leave the 
 rectum at night when equally warm temperature surrounds the 
 child, and creep into the vagina creating there an irresistible 
 itch. The children are only too much inclined to scratch, es- 
 pecially at night when in bed, and inflammation soon follows. 
 It is very important that the cause should be speedily removed, 
 as otherwise even the youngest children become easily victims 
 to self -pollution, that unfortunate error which has destroyed so 
 many young lives. 
 
 Prevention— It being much simpler to avoid a disease by 
 using proper precaution, than to cure one already developed, I 
 wish to call the attention of my readers more especially to the 
 prophylax, i. e. the proper avoidance of the causes described in 
 the preceding lines. This is placed entirely into the hand of 
 the woman, the mother, while the healing of diseases is, in many 
 cases, the part of an experienced physician. 
 
 The care of the external parts should, in connection with 
 the general care of the body, begin in earliest infancy. The 
 custom of frequent bathing little children, has already provided 
 for this, if the utensils of the bath, such as sponges, towels; etc., 
 are kept exclusively for this infant. As the girl grows up and the 
 care of her person is entrusted to herself, it is, for obvious rea- 
 sons, necessary to attend properly to the care and cleanliness of 
 the external parts, which is often entirely neglected. Yet, the 
 diseases caused by this negligence are proportionately rare, and 
 easily done away with. It is much more serious if the maiden 
 reaching the age of puberty, from false modesty, or even the 
 the wife and mother on account of ease, neglects to practice that 
 cleanliness, which is so absolutely necessary. Nothing affords; 
 germs of diseases, everywhere present, a better ground to collect 
 
19 
 
 and unfold their destructive power, than the external parts and 
 the particles of blood and mucus clinging to the covering hair. 
 Luke-warm hip-baths, taken in the morning or evening in a 
 temperate room are always advisable. Additions of medicaments 
 are superfluous in health; the only thing necessary is to careful- 
 ly dry with an absorbent towel. And how easily is such a bath 
 prepared! A large basin and plenty of clean warm and cold 
 water is all that is required. A simple wash has not nearly the 
 beneficial effects, as the water then does not reach all parts, and 
 the advantages of molification are lost. 
 
 Yet even cleanliness alone does not suffice, it should also be 
 exercised with the proper care and delicacy. For instance, it is 
 absolutely improper to use bathing utensils in common. The 
 daughter often uses, without compunction, sponges and towels 
 used by her mother, the servant those belonging to the children, 
 taking it as a matter of course that these things are to be used 
 in common, either not being aware of the malignant discharges 
 of the other, or not understanding the contagious power of their 
 own. The carelessness prevailing in this matter is proven by 
 the frequent use in common of a syringe. Not enough can be 
 said in protest against this evil custom, as even otherwise sen- 
 sible people are extremely careless in this respect. If it is de- 
 cided to do something to benefit your health, the small expense 
 arising from the purchase of the necessary articles should not 
 be considered; it is of so little account that even those of small 
 means can easily afford it. It certainly is far preferable to bor- 
 rowing an instrument from a friend and thereby endangering 
 your own good health. 
 
 Treatment — When once the disease has developed, clean- 
 liness alone will rarely suffice to dispel it. At any rate the cure 
 would be unnecessarily delayed with only this resource. If 
 causes of disease, such as cauterizing discharges, worms, etc., 
 exist, these must before all be removed. All irritation of the in- 
 flamed parts must be carefully avoided and for this very reason 
 medicines acting too strongly should not be used. If the local 
 trouble is accompanied by fever and severe pain it is always ad- 
 visable to remain in bed. Thus all friction and irritation is 
 avoided, the care made more convenient and the action of the 
 medicaments increased. Where high inflammation exists the 
 
20 
 
 remedies are best applied in shape of compresses. Boracic acid 
 (prescription 1), dissolved in boiling water and cooled again, or 
 lead water (prescription 2) in the usual form are very beneficial 
 Whether these remedies are to be used warm or cold depends 
 upon the feeling of the patient. Other remedies such as cor- 
 rosive sublimate (prescriptions), carbolic acid (prescription 4) 
 Creolin (prescription 5), Vaginol (prescription 6) are stronger 
 and must be used with care. The first two of these substances 
 are poisonous, but not the latter two. Cooling hip-baths 
 with middlings, oakbark boiled and strained are also beneficial. 
 Indigestible food is to be avoided and the bowels kept loose. 
 
 After the worst symptoms have disappeared or in chronic 
 cases, i. e. cases less severe but of long standing which do not 
 require the patient to remain in bed, the application of salves, 
 such as lead (prescription 7), zinc (prescription 8) iodoform 
 (prescription 9) and sublimate salves, or the dry treatment are 
 to be used in place of compresses. 
 
 By dry treatment, I mean the total avoidance of dampness, 
 in such cases in which cauterizing discharges cause the inflam- 
 mation, as is often the case in discharges from the vagina. This 
 is accomplished by carefully drying the parts after each cleans- 
 ing with soft linen or absorbent cotton, and then powdering 
 with starch, or better with lycopodium, borated talcum powder, 
 etc. 
 
 During the salve as well, as during the dry treatment it 
 may be recommended to stop all friction, which is almost in- 
 avoidable in walking, by inserting pieces of cotton between the 
 lips of the pudenda, and fastening them by a bandage, as des- 
 cribed later on. The cotton, which should be frequently renew- 
 ed, among other advantages absorbs all moisture caused either 
 by perspiration or by discharges, making them harmless as well 
 as odorless. 
 
 In cases in which involuntary urination exists this remedy 
 is insufficient. A timely operation and medical aid are here 
 necessary, as only they can successfully cure these unfortunate 
 diseases. 
 
 If the trouble, whose chief symptom is the severe itching, 
 is caused by diseases of the womb, diabetes, etc., it is necessary 
 that these be first cured, yet in this case as well as in such of 
 
21 
 
 mere nervousness local application may afford much relief. A 
 washing with a solution of 5 per cent, carbolic acid (prescrip- 
 tion. 10), a brushing with a solution of 10 per cent, cocaine 
 (prescription 11), embrocation with 5 to 8 per cent, carbolic 
 salve, etc. (prescription 12). or 10 per cent, cocaine salve (pres- 
 cription 13) have a very soothing effect, and rarely fail entirely. 
 Also lukewarm hip-baths with an addition of middlings often 
 give relief, but it is necessary to remain in the bath longer than 
 ordinarily. Above all, however, the scratching must be stopped 
 as much as possible, otherwise the inflammation cannot be al- 
 layed. If bad comes to worst the physician must give rest by 
 administering bromides, morphium, or other narcotics. 
 
 Entirely different measures must be applied against the 
 itching in children caused by pinworms. If the presence of 
 these worms has been discovered, their creeping from the rectum 
 to the genitals may be prevented by applying in the evening 
 mercurial ointment on the surrounding parts, the perineum and 
 the inner surface of the buttocks, since these little worms do not 
 creep over such spaces. Besides it is advisable to put a little of 
 the ointment, about as much as the size of a pea, into the rect- 
 um. This is, however, only a temporary remedy, and can only 
 be regarded as such, while it must ever be the principal aim to 
 extirpate these disagreeable parasites, which may be very difficult 
 in many cases. Different medicines have been used with various 
 results. Even persons claiming to possess never failing private 
 preparations have not been able to attain satisfactory results. 
 
 An old, popular remedy prepared out of garlic boiled in 
 milk and used as an injection seems to prove, after all, more sat- 
 isfactory in extirpating these pinworms than all kinds of worm 
 lozenges generally used. (Prescription 14.) In preparing this 
 take a moderate sized clean garlic bulb, cut it in small pieces, 
 boil it about a quarter of an hour in a pint of milk, strain through 
 linen in order to remove all thick and hard particles, allow it to 
 cool down to moderate temperature, and it is ready for use. 
 
 If one injection has not the desired effect it may be repeat- 
 ed once or twice during the succeeding days. 
 
 The pinworms live in the rectum, hardly ever in the upper 
 intestines. It is therefore evident why such injections have the 
 desired effect since they reach that place where these worms stay, 
 
22 
 
 We will now speak of such diseases of the external parts as 
 are not caused by inflammation, viz: tumors, ruptures and la- 
 cerations of the perineum, and their consequences and troubles. 
 
 Among the tumors occurring most we class the pointed and 
 the broad condyloma (wart-like excrescences) frequently pro- 
 duced by the contagious diseases described above. 
 
 The former are small, gristly formations, standing some- 
 times numerously side by side, having a ragged surface, similar 
 to a cock's comb. They are the result of existing gonorrhoea. 
 
 These pointed condylomas must be trimmed down and caut- 
 erized to the root. 
 
 The latter are indications of existing syphilis, and may oc- 
 cur on all parts of the body where two moist surfaces of skin 
 touch each other. They are broad, round or oval elevations of 
 the skin. On the surface they secrete an abundant, exceedingly 
 infective juice, and cause a sore feeling, however without great 
 pains. They are not trimmed down, but disappear during the 
 treatment of syphilis, if their surface is washed with brine and 
 powdered in with calomel. (Prescription 15.) 
 
 Large and small tumors of malignant character, which are 
 rarely found, must be removed immediately and their reappear- 
 ance must be prevented in the proper manner. 
 
 Ruptures sometimes cause a considerable swelling of the 
 large lips of the pudenda if intestines slide into them. They 
 are, however, rarely mistaken for tumors of the vulva on account 
 of their peculiar origin and condition. If they can be brought 
 back into the abdomen, medical care will not be required, 
 since any able bandagemaker can offer the necessary assistance 
 by a fitting, convenient truss, which will, assisted by regular 
 habits, remove the trouble permanently. 
 
 With laceration of the perineum, however, it is different. 
 Here only the skillful hand of the physician can afford the nec- 
 essary help, and remove the annoyances, which are frequently 
 ascribed by women, not familiar with their origin, to anything 
 but the lacerations of the perineum itself. 
 
 In order to understand the consequences of these injuries it 
 is indispensible to become familiar with the different degrees of 
 the ruptures of the perineum, which occur almost exclusively 
 during delivery, either on account of the disproportion of the 
 
23 
 
 head of the child and the maternal parts, or on account of an 
 unfortunate occurrence. If the perineum is more or less lacer- 
 ated without injuring the constrictor of the rectum (see anatomy, 
 figure 3) it is called an incomplete rupture; if the laceration, 
 however, extends into the rectum it is called a complete rupture 
 of the perineum. Occasionally the tear extents so far upwards 
 that the vagina and the rectum empty into the same cavity. 
 
 The annoyances caused by the rupture of the perineum do 
 not always correspond to the seriousness of the case. If the 
 laceration is not very large it may remain without any conse- 
 quences whatever. Generally the front wall of the vagina, be- 
 ing deprived of its support, sinks and projects more or less -be- 
 tween the external parts of the pudenda, and a feeling of being 
 continually wet, a. bearing down and a pressure upon the bladder 
 causing frequent urination will be noticed. If the rupture is of 
 great extent, the front wall of the vagina may lean further out- 
 ward, and drawing down the uterus, cause a prolapsus. This, 
 however, can only take place under other distinct circumstances, 
 for not seldom extended lacerations of the perineum are found 
 without any descent of the womb whatever. 
 
 The most evil consequences are found when the rectum is 
 also torn to a large extent. Winds and liquid excrements escap- 
 ing involuntarily, and continuous catarrh of the large intestines 
 and the vagina render life miserable, which is the more lament- 
 able since women just in the bloom of life are most frequently 
 affected with this trouble. 
 
 It is common to all ruptures of the perineum, since the 
 vagina does not close tightly as in the normal state, that germs 
 of diseases may easily find their way to the inner organs, as the 
 vagina, uterus and oviducts, and may cause chronic catarrh, not 
 taking into consideration that sexual intercourse is impaired 
 thereby, thus becoming frequently a source of dissatisfaction 
 for both husband and wife. 
 
 Happily these conditions may be amended at once, as long- 
 as no infections of the upper organs have set in, by a perfectly 
 harmless operation, in which the perineum is restituted to its 
 normal shape, and the conclusion of the vagina restored. 
 
Diseases of the Hymen 
 
 The hymen, this little veil which separates the vagina from 
 the external sexual organs, has more of a social than of a fun- 
 tionary importance. It is the only organ we know of that must 
 be destroyed to fulfill the purpose nature designed woman for. 
 To think, however, that the presence or absence of the hymen 
 is a positive proof whether or not sexual intercourse has taken 
 place, is a great mistake. As well as the absence of the hymen 
 does not indicate that sexual intercourse did take place, its pres- 
 ence is not a sign to the contrary. We sometimes find that from 
 the very birth no hymen exists, or only in an incomplete form. 
 In other cases it is already torn in youth in consequence of in- 
 juries, or what happens oftener, it was damaged by masturba- 
 tion. On the other hand we know of quite a few cases where 
 the hymen was only destroyed at the time of the first parturition 
 and even prostitutes have been found whose hymen was entirely 
 intact. 
 
 These exceptions are not so very rare, and it is necessary to 
 know of their occurrence, as only so sometimes great injustice 
 may be prevented. 
 
 It is true, we do not live in the age when witches were 
 burnt, nor do we practise the old Hebrew custom when every 
 young woman was stoned, whose bed did not show spots of 
 blood after the night of the wedding, but there still exists today 
 the prejudice that, as a proof of virginity, the bed of the bride 
 must appear in the above mentioned condition the next day. 
 Generally it is so, but it would be cruel and wrong to accuse 
 every woman of infidelity who cannot show these bloody marks.. 
 
25 
 
 Many suspicions, rendering a happy family life for years imposs- 
 ible would not have arisen if those facts were better known, and 
 their knowledge will restore confidence where an imperfection 
 of nature and not a fault of the woman is the cause of suspicion. 
 
 Of much greater importance to the physician than the ab- 
 sence of the hymen, is the excessive bleeding in the bridal bed, 
 which happens, when in breaking the hymen, a larger blood- 
 vessel is torn or when the break penetrates farther into the 
 tissues than usual. By pressing a clean cloth firmly against the 
 place the bleeding is mostly stopped, otherwise a physician must 
 tie the vessel, because hemorrhage might set in and cause death. 
 
 The little hole found in every hymen in normal condition, 
 designed for the passage of blood and mucus, is sometimes miss- 
 ing on account of mal-formation, or is clogged up in consequence 
 of ulcerous processes, so that the vagina is completely closed. 
 
 This abnormal condition generally remains unobserved un- 
 til the time of the first menstruation. The little secretions of 
 mucus, which are produced in a virginal healthy condition, will 
 never cause a high state of disorders. However, the menstrual 
 blood being secreted in much larger quantities than the latter, 
 accumulates more and more each month and although partly 
 concentrated in the meantime by the absorbtion of water, it 
 produces, by forcible extension of the organs located higher in 
 the pelvis, very painful colics and other disorders in the abdomen. 
 
 The symptoms are characteristic, since the pains of colic are 
 not continuous but only felt at certain intervals, i. e. just at the 
 time when the menses should occur. These pains and cramps, 
 returning at certain intervals, then diminishing gradually and 
 reappearing again, when found with otherwise healthy non- 
 chlorotic girls, who are of such an age in which the menses 
 ought to have set in, and the bulging out of the vagina should 
 lead every woman to the correct conclusion. Yet the grossest 
 negligence caused by ignorance or a wrong sense of shame, is 
 found many a time in a condition which might have been easily 
 removed in the beginning with the least danger, but endangers at 
 a later time even life. 
 
 It is not necessary to speak here of the inflammation of the 
 hymen caused by the diseases of the pudenda, in which it natur- 
 ally participates, but it may be well to mention another condi- 
 
2() 
 
 tion deserving notice, called in medical language "vaginism."' 
 By this term we understand a very violent and painful cramp of 
 all the muscles of the pelvis bottom (see page 5) caused by an 
 abnormal sensitiveness of the parts of the entrance of the vagina, 
 during copulation which makes it even impossible to introduce 
 the tip of a finger into the vagina. 
 
 The hymen is almost exclusively the cause of this disease, 
 only occasionally it is the result of little painful ulcuscules or 
 tumors in that vicinity. It being incidental to newly married, 
 and rarely to older ladies, indicates the source of this abnormity. 
 Either the hymen is too tenacious or, and this is probably more 
 frequently the case, the strength of the husband is insufficient 
 to break the closure of the vagina. At the vain efforts to force 
 an intercourse small cracks of this veil are caused which will in- 
 flame at repeated trials. The pains increase and though at first 
 love of spouse and sentiment of duty prevail over them, finally 
 this is impossible and they become so intolerable that the wife 
 trembles at the approach of the husband and the thought of 
 copulation throws her into convulsions. 
 
 In serious cases of this disease, even when the patient is 
 under chloroform, a vehement shock goes through the whole 
 body as soon as the hand of the operating physician touches the 
 sensitive place. 
 
 The treatment is different in accordance with the causes; 
 generally, however, permanent cure is effected by removing the 
 entire diseased conclusion of the vagina. 
 
Diseases of the Vagina. 
 
 The vagina is that cylindrical tube which connects the outer 
 parts with the womb and serves for the reception of the male 
 organ at the time of copulation The length varies considerably 
 in the different instances — from one -third of an inch in cases of 
 ■deformity, to three or four inches in normal conditions. It is 
 likewise impossible to give certain dimensions as to width, but 
 it may be stated that in women, who have given birth to child- 
 ren, the vagina is much larger than in those who did not pass 
 through pregnancy or premature birth. 
 
 Instances in which the vagina is duplicated or altogether 
 absent, in which case there is very little or nothing of womb or 
 ovaries to be found, and also such in which the bowels empty 
 into the vagina and the excrements and the blood of the monthly 
 course leave the same outlet, are of great scientific interest, but 
 of very little practical value, since they are so rare that only oc- 
 casionally a case comes under observation, even in the largest 
 clinics. Nevertheless it is advisable to look for abnormities in 
 every newly born child in order to be able to take at once the 
 necessary steps for remedy. 
 
 Inflammation of the vagina, occurring in comparison with 
 deformities of the vagina very numerously, furnishes next to the 
 diseases of the outer pudenda a wide field for self -treatment, be- 
 cause the place of the disease can yet be* reached by the use of 
 the syringe or irrigator. Later, when the disease has reached 
 the womb, this is impossible. Discharges of various kinds from 
 the vagina are so numerous that women often pay very little at- 
 tention to them. So many of their lady friends and acquaint- 
 ances are suffering from them, so they do not seem to be any- 
 
28 
 
 thing abnormal and do not seem to amount to much. And yet 
 they are diseases. The healthy walls of the vagina are compar- 
 atively dry having only such a small quantity of mucus as is 
 necessary to keep them lubricous. Although resembling the 
 epidermis they will never be as dry as this, because it would be 
 contrary to the function of the vagina. The insufficient evap- 
 oration on the one hand and the continuous supply of mucus 
 from the womb on the other, are the cause of this lubricity. 
 
 It may, therefore, appear to be an absurdity to claim that 
 in spite of the many discharges the diseases of the vagina itself 
 are not of frequent occurrence. And yet this is so. We have to 
 figure here with a fact that is so very often misunderstood. In 
 the majority of cases it is not the apparently diseased vagina, 
 but the actually diseased womb from which these discharges 
 originate, and usually from its lowest part — the neck. It is 
 quite natural that in cases where these discharges have existed 
 for a long time, the vagina will finally suffer also, since these 
 morbid secretions must pass through it on their way outward, so 
 that, especially when remaining in the vagina for any length of 
 time, they have sufficient occasion to develop their injurious 
 work. 
 
 Inflammation, originating in the vagina itself, is mostly 
 caused by sexual intercourse. It is a sad but nevertheless in- 
 disputable fact, that the majority of all men, in the upper as well 
 as the lower classes, have suffered once during their lives from 
 the so-called gonorrhoea. This disease is an inflammation of the 
 urethra, contracted by contagion and for that reason contagious 
 in its nature. Very little attention is often paid to it, and its 
 importance is sadly underestimated. Before the last traces of 
 this disease, which in some cases may remain for years, have 
 disappeared the person not fully cured will marry, and many a 
 young husband will behold in his young continually suffering 
 wife a victim of his dissippation. In a masterly and powerful 
 manner the great specialist, Professor Dr. Schroeder, of Berlin, 
 in his book on female diseases expresses himself thus: "There is 
 hardly anything more pitiable than the fate of the young wife 
 infected by gonorrhoea in the night of her marriage. She has 
 entered into married life as a blooming girl and with the sweet- 
 est hopes, but after the first intercourse an inflammation of the 
 
29 
 
 sexual organs sets in which makes further intercourse extremely 
 painful, often impossible. Frequently during the wedding-trip 
 the pains in the region of the pelvis commence, and in some 
 -cases the young wife has to take to her bed for weeks, suffering 
 from an "inflammation of the abdomen," and a broken wife will 
 leave the bed again, sick for the balance of her life, or at least as 
 long as the menses have not ceased. The only hope that will 
 uphold her, the hope to become mother, is destroyed by the fact 
 that the tubes have been infected by the disease. This is an- 
 nually the fate of thousands of women. It is not the much 
 abused wedding-trip which ruins so many a young wife, but gon- 
 orrhoea, which the husband has been suffering from at the time 
 of marriage. As far as the women are concerned it is safe to 
 say that gonorrhoea does more harm amongst them than syphilis." 
 
 After Professor Neisser, of Breslau, had discovered and 
 proved that the genitor of this disease was a so-called gonococ- 
 cus, a very minute microbe, which can only be seen with a 
 strong microscope, it was the merit of Dr. Nceggerath, of New 
 York, to show the amazing frequency of the disease and to de- 
 monstrate its malicious effects upon women. In its general 
 traits the dark picture drawn by him is true, for sneaking treach- 
 erously from organ to organ, this j)oison will slowly but surely 
 ruin the affected person, and after having once gained a hold it 
 is very difficult to drive it from its hiding places. 
 
 Symptoms — The symptoms of the disease in the vagina it- 
 self are very different, and may appear in a violent or in a mild 
 form — the usual form being the first mentioned; the latter is 
 less frequent. A few days after the contagion, a feeling of dis- 
 comfort, of heaviness and of burning is noticed in the abdomen, 
 and a thick, greenish -yellow, creamy matter runs from the vag- 
 ina, soiling the undercloth with stiff spots. Frequently fever 
 sets in during the first week and causes the person to take to the 
 bed. Generally a little later a burning pain is noticed when 
 urinating, a sure sign that now the urethra has been reached by 
 the poison. The affection of the bladder and bowels is followed 
 by a pressure of the urine on the one hand and a constipation 
 and a painful moving of the bowels on the other. If the inflam- 
 mation has fully developed, the vagina looks reddish, is swollen 
 and hot and the mucous surface, before smooth and even, is 
 
30 
 
 everywhere uneven and rough, especially in the region of the 
 vault of the vagina. An examination at this time is extremely 
 painful and after withdrawing the finger a stream of purulent 
 matter will flow out. Naturally the outer parts of the pudenda 
 cannot escape contagion, and the womb also will soon be affect- 
 ed, especially in cases of neglected and inadequate treatment. 
 Where skillful care is obtained., however, the disease will quick- 
 ly change its phases. The purulent matter grows less and thin- 
 ner and resembles rather skimmed milk; when urinating the 
 pains cease and a perfect cure is seemingly accomplished, but 
 seemingly only. For although the violent symptoms may have 
 disappeared, in some places, for instance in the neck of the 
 womb, or in the glands of the vestibule some remnant of the 
 microbe is left and will start the disease again at the first chance 
 possible, only in a milder form. And in this way a source of 
 pains has been created, which will make it impossible for many 
 women, who have to depend upon their labor for a living, to earn 
 anything and even those women, who are so situated that they 
 can afford to take better care of themselves will feel a perpetual 
 displeasure and their continuous illness prevents them from en- 
 joying life. 
 
 In all other cases, accompanied sometimes by still more 
 violent symptoms, such long and sneaking results are less to be 
 expected since with the healing of the process the cause is re- 
 moved also, and there is no danger of it spreading again. Yet 
 at the time of being taken ill these diseases are by far more 
 dangerous. Besides the scars that sometimes remain should not 
 be underestimated in their importance, since in causing stric- 
 tures of the vagina they may be the cause of unsurmountable 
 difficulties at the time of parturition or even copulation. 
 
 Fortunately these cases of the worst character in which 
 pieces of the vagina mortify and are thrown off under high and 
 exhausting fevers and a poor condition of health, are very sel- 
 dom, and practically only occur with children suffering from 
 scarlet fever, dyphtheria, measles, erysipelas or other contagious 
 diseases. With adult women the same effects may be caused in 
 cases of child-birth, or by being hurt with some unclean instru- 
 ment, or by foreign things of any shape in the vagina, if the 
 necessary attention and care is not taken. 
 
31 
 
 Among the latter are especially the so-called pessaries. It 
 is well known that these instruments are used very frequently in 
 cases of dislocation of the interior organs, especially of the womb, 
 and that they are often the only remedy of relieving suffering 
 woman from their pains. On account of their apparently easy 
 application and the frequency with which they are needed, the 
 pessaries are inserted by many an inexperienced person, although 
 devoid of all deeper knowledge of the conditions and relation of 
 the female sexual organs. The credulous patients have to suffer. 
 It is not sufficient to put in a pessary in cases where necessity 
 demands it and then dismiss a woman without giving her all the 
 necessary instructions. What does the patient know about the 
 dangers of using a pessary if nobody called her attention to 
 them? It is by no means a harmless affair if mucus, blood and 
 matter in state of decomposition accumulate in the vagina after 
 a pessary has been inserted. But even in observing strictest 
 cleanliness a soft rubber pessary will always cause effluxion after 
 it has been worn for some time, so that it is advisable to use in 
 chronic cases one of hard rubber. If, therefore, either through 
 carelessness or ignorance the necessary rinsing is neglected the 
 most disagreeable results will be observed. Aside from the fact 
 that in such cases the inflammation always extends upward into 
 the womb and tubes, the pressure caused by every not perfectly 
 fitting pessary will create ulcers, which being constantly irritat- 
 ed by the accumulated rotten fluid and continually tending to 
 heal will finally enclose the instrument so tightly that it actually 
 has to be cut out. And again since these ulcers spread more 
 and more and penetrate to the bladder and bowels, they create 
 abnormal combinations between the respective organs through 
 which urine and excrements will empty into the vagina, leaving 
 no other way for a cure than an operation. 
 
 The suppurating inflammation of the vagina or of the pud- 
 enda of little children directly after birth or a little later, corres- 
 ponding in its symptoms precisely to the infection by gonorrhoea 
 in adults is caused also by the same microbe, the gonococcus, 
 previously described, and the advice for its care as given before 
 ought to be carried out. 
 
 A peculiar form of inflammation worthy to be noticed, dev- 
 elops occasionally with elderly women, producing a gumming up 
 
32 
 
 and growing together, especially of the upper parts of the vag- 
 ina. At this age thin, pussy discharges occur which produce 
 small and minute ulouscules on the walls of the vagina; some of 
 these will simply heal, others, however, when meeting another 
 one directly opposite will grow together with it, forming bridges 
 of tissue in the interior of the canal. This texture being loose 
 in the beginning is easily torn when the tube of the syringe is 
 introduced and the insignificant bleeding may easily be mistaken 
 as caused by cancer of the womb. 
 
 Prevention — Before we discuss the prevention and treat- 
 ment of these diseases, I desire to describe an instrument that is 
 to be used by women in nearly all kinds of female troubles. By 
 simply washing we cannot always reach the seat of the disease, 
 and since it is very desirable to attack the evil at its root, num- 
 erous instruments have been constructed to accomplish this pur- 
 pose. Of all these none has proved so useful, however, as the 
 syringe. This apparatus consist of a smaller or larger rubber 
 bag, a long, flexible pipe and a non-flexible vaginal tube. The 
 bag filled with water is hung up above the patient, the fluid des- 
 cends by the action of the gravitation alone and gives a continu- 
 ous irrigation. Manual efforts are not required. The rapidity of 
 4 he flow is regulated by raising or lowering the bag or by simply 
 turning a stopper-cock placed just above the vaginal tube. 
 
 With this instrument the rinsing of the vagina, to which 
 we shall refer frequently in this book, is to be performed, ob- 
 serving, however, certain conditions. Above all the bag should 
 never be hung up too high, since the pressure of the water in- 
 creases the more the reservoir is raised, and a vehement injection 
 will never do any good but may eventually do harm. One and 
 one-half or two feet is sufficiently high to cause the water to run 
 out. This is all that is required. Before the tube is introduced 
 into the vagina it is advisable to allow some water to run through. 
 In this way the air is expelled and its noxious entering into the 
 vagina is prevented. Again, the position of the person during 
 the rinsing is of importance. When in a sitting position over a 
 vessel the water will flow out quickly and easily. But this is 
 not always desirable, and only answers the purpose when it is 
 intended for cleanliness. In all cases, however, in which it is 
 necessary that medicaments dissolved in water should act upon 
 
33 
 
 the membrane of the vagina or the mouth of the womb, or where t 
 as for instance in hot water injections, the higher temperature 
 must be made use of, this way of rinsing is insufficient. Then 
 it is necessary to lie down flat on the back, allowing the water 
 to run into a vessel placed below. Although the preparations for 
 rinsing in a lying position are more inconvenient, the fatigue and 
 exertion is not near as great as in the former. The principal ben- 
 efit of this position, however, is that the water does not run off 
 before the vagina is completely filled. Thus it is puffed up, the 
 folds are spread out and, while at a little pressure from the re- 
 servoir the water runs out slowly, the medicines dissolved in 
 the fluid can develop an extensive activity, especially because 
 the last remnants of the injected liquid stay in the vagina for a 
 long time if the person remains lying quietly. 
 
 An actual prevention of contagion by gonococcus is in most 
 cases difficult or impossible. Year after year many men, young 
 and old, rich and poor, are infected in the public houses, which 
 are so often — it is a sad fact — without any control in sanitary 
 respect. And how many are infected without ever being entire- 
 ly cured. Yet they intend to get married and do enter married 
 life, be it that they are ignorant of the germ of the disease hidden 
 in some remote place, or be it that they consider the occasional 
 discharges not dangerous at all or unworthy of attention, be- 
 ing confirmed in this opinion even by persons who ought to 
 know better. In such cases the maiden is left absolutely to the 
 integrity of her future husband and must take what fate has des- 
 tined for her. No wonder that Noeggerath, of New York, goes 
 so far as to say that many girls do not want to get married since 
 they have seen in the pitiable conditions of the companions of 
 their youth, their own fate, should they enter married life. And 
 not only the wife, but also the child she may give birth to, must 
 suffer from the sins of the father, since the same germ, the gon- 
 ococcus, contained in the discharges of the mother, threatens its 
 eyes with eternal darkness if it lodges there during parturition. 
 The dangerous character of the inflammation of the eye caused 
 in this way and appearing between the second and fifth days 
 after birth is unfortunately not enough known to the public and 
 is generally only recognized when it is too late and the eyes* 
 sight lost for ever. Every eye, not only that of a new-born 
 
34 
 
 child, but also that of an adult, is a place where the microbe of 
 the gonorrheal can easily grow, for the conditions for its devel- 
 opment are there very favorable. It can, therefore, not be too 
 strongly impressed upon the mind of every woman having vag- 
 inal discharges, to wash her hands carefully with soap after com- 
 ing in contact with the genitals bsfore touching her eyes or 
 those of her child. 
 
 While very little can be done in the way of prevention in 
 cases of the kind just described, other diseases of the vagina 
 may easily be avoided. Mere cleanliness, frequent hip-baths 
 and injections will do much to prevent disease and are, therefore, 
 recommendable to every woman, especially when married. But 
 when a pessary is worn more care must ba taken of the internal 
 genitals. Daily injections are then a necessity and can not be 
 recommended too urgently. Even if there are no discharges, 
 rinsings with clean boiled water to which a little, pure soda may 
 be added if the mucus is though and difficult to remove, are in- 
 dispensible. The water should be luke-warm and the amount of 
 soda eventually added to one quart of water not more than about 
 one-half or two-thirds of a tablespoonful, in order not to cause 
 irritation. The pessary should be taken out at intervals by an 
 experienced person, and thoroughly cleaned with brush, soap 
 and some disinfectant solution. Should the slightest inconven- 
 ience be caused which might be ascribed to the pessary, it is 
 necessary to remove it at once, replacing it by a better fitting 
 one. 
 
 Only when these precautions are observed, a pessary can be 
 worn without danger of evil results. 
 
 Although, as previously stated, the discharges are rarely 
 consequences of diseases of the vagina, since these secretions 
 originate mostly in the cavity of the womb, yet they should be 
 the signal for every woman to commence with the vaginal injec- 
 tions, if this has not been done before, to prevent the accumul- 
 ation of the noxious substances and their evil results. These 
 washings practiced in the above described way and with the 
 necessary cleanliness and care are not only of the greatest ad- 
 vantage for prevention, but many cases of diseases of the womb 
 can be cured by this procedure if the secretions are regularity 
 and thoroughly removed. 
 
35 
 
 Treatment — In cases of catarrh of the womb, however, as 
 well as in actual diseases of. the vagina, an addition of medicine 
 to the water is indispensible. Care must be taken to avoid the 
 use of too corrosive injections in the first stages of gonorrhoea, 
 for they might increase the inflammation. Corrosive sublimate 
 (prescription 18), chloride of zinc (prescription 19) maybe rec- 
 ommended as an addition to the water. Especially the latter 
 acts often remarkably quick. 
 
 In ordinary cases of discharges which originate from the 
 uterus desinfecting preparations are decidedly preferable. It 
 would lead too far to enumerate them all, since there is a great 
 variety of them and the results are not always the same. Sev- 
 eral of the most approved and best are mentioned. Vaginol is 
 the most preferable, because it is a very strong antiseptic but 
 not poisonous and cleanses thoroughly. Besides this I would rec- 
 ommend: Boracic acid powder, dissolved in hot water; salicylic 
 acid, carbolic acid, Creolin, etc. Permanganate of potash (see 
 foot note) is most effective, when it becomes necessary to de- 
 odorize the discharges. (Prescriptions 20 to 25.) 
 
 Should these preparations prove to be too strong and pain- 
 ful it is best to substitute injections of luke-warm clean boiled 
 water or slimy decoctions of bran, oats, barley, flax seed, etc. 
 
 In the later stages, after the virulent symptoms have ceased 
 and the disease takes more of a chronic character, the contract- 
 ing preparations are preferable. Decoctions of walnut leaves, 
 or oak bark, also solutions of alum, tannic acid, sulphate of zinc, 
 one-half to one teaspoonful for each quart of water, may be used. 
 (Prescriptions 26 to 28.) 
 
 After each injection,, which may be repeated two or three 
 times a day in acute cases, and once or twice a day in chronic 
 cases, the external genitals must be fully dried by tipping with 
 a soft towel or absorbing cotton, and protected from discharges 
 by inserting a piece of cotton between the lips of the pudenda. 
 
 It must be left to the physician to proceed more energetic- 
 ally by inserting small prepared balls of cotton, applying powder 
 
 Foot Note — The brown stains caused by the latter preparation can best 
 be removed from the clothes by holding them above burning sulphur after 
 they have been moistened, and washing them. 
 
36 
 
 or corrosives to the membrane of the vagina, in order to abbrev- 
 iate the course of the disease and prevent evil consequences. 
 
 Besides this local treatment healthy food and regular evacu- 
 ations of the bowels and bladder are essential. If after infection 
 with gonorrhoea the pains are too great while urinating it is ad- 
 visable to take milk frequently, pure or diluted with water, or 
 other non-alcoholic beverages, such as lemonade, light tea or 
 coffee, etc. 
 
 The urine being thus diluted, the irritation of the urethra 
 produced by the dissolved chemical substances will be diminish- 
 ed, and the pains cease. 
 
 By this treatment causing frequent urination, the bladder 
 is kept clean and not so easily attacked by catarrh. 
 
 It is self-evident that sexual intercourse must be stopped. 
 This will be easily observed as the pains are very severe during 
 copulation. 
 
 The diseases of the vagina caused by pessaries can be cured 
 rapidly and easily if not too far advanced, by injections, as soon 
 as the cause of the disease, the pessary, has been removed, which 
 may be very difficult in some cases. 
 
 The inflammation of the vagina of children produced by the 
 gonococcus should be treated with luke-warm cleansing hip- 
 baths, and iodoform bougies of the thickness of a lead pencil 
 must be applied. These introduced into the vagina after it has 
 been cleaned, will stop the mattery discharges in a short time. 
 
 The ulcers in the vagina of older women having a tendency 
 to intergrow and originating, as stated before, in a disease of the 
 interior of the womb, can only be removed by a cure of the lat- 
 ter disease. But as long as no more aggravating symptoms ap- 
 pear, injections with the above named preparations, especially 
 with Vaginol, will be sufficient to prevent these corrosive dis- 
 charges. 
 
 Finally a few words about the lacerations of the vagina and 
 the abnormal communications between the vagina, urethra and 
 bladder on the one hand, and the vagina and the bowels on the 
 other, which were merely mentioned above. These communica- 
 tions are called fistula?, and are divided according to their loca- 
 tion, into fistula? of the vagina and urethra, fistula? of the vag- 
 ina and bladder, fistula? of the vagina and bowels, and fistula? of 
 
37 
 
 the womb and bladder. Figure 10 a, b, o and d shows all four 
 forms. 
 
 The origin of these fistulas is caused like the rupture of the 
 perineum almost exclusively during parturition, and happens in 
 two different ways. Disproportions of the maternal parts and 
 the head of the child is always presupposed. Nature will quit 
 its work if in such a case all endeavors to throw out the ripe 
 fruit are in vain. The labors, at first powerful, sometimes even 
 
 Figure 10. 
 
 a — Fistula of vagina and urethra. 
 c — Fistula of vagina and bowels. 
 
 b — Fistula of vagina and bladder. 
 -Fistula of womb and bladder. 
 
 to powerful, diminish in force gradually and finally cease. The 
 process of birth stops. But as soon as the life of the child or 
 that of the mother is at stake, the physician is compelled to act. 
 At unlucky handling of the forceps, under especially difficult 
 conditions, or by the slipping of the instrument, it may happen 
 that its edges cut through the tissue like a knife. And then the 
 injury is done. Directly after the birth urine or excrements 
 pass involuntarily through the vagina and the young mother re- 
 
38 
 
 veals at onoe what has occurred. The passing of urine alone, 
 however, is no decisive proof of a fistula, for urine may escape 
 involuntarily through the urethra on account of an injury to the 
 closing muscle of the bladder without laceration of the tissue. 
 
 Fistulas caused in the other way are independent of the in- 
 terference of a physician. In those cases in which the delivery 
 is difficult and much retarded the soft maternal parts are pressed 
 with force against the bone walls of the pelvis, especially the 
 front wall, by the child's head and the injuries by contusion are 
 sometimes so great as to cause these parts to mortify. Between 
 the third and the fifth days after the birth the destroyed tissues 
 drop out and leave the passage open. The losses of substances 
 are here mostly of greater extent and more difficult to cure than 
 the others. 
 
 The sufferings caused by the last mentioned malady are in- 
 tense. The most aggravating catarrh of the vagina, and at a 
 later stage such of the womb are the results. A woman thus af- 
 flicted is unfit for society, even that of her own family. The 
 disagreeable odor, and the continual moistness of body and 
 clothes, caused by decaying substance, fill her with disgust for 
 her own person and this alone will induce her to summon the 
 aid of a physician at once. 
 
 The treatment can only be of a surgical character since cure 
 by self-treatment is impossible and simple vaginal injections 
 have hardly any effect. As long as the fistula is small, the phy- 
 sician may be able to close it by one operation, but if it is large, 
 several may be necessary to accomplish a perfect cure. 
 
Physiology of the Womb. 
 
 Before we proceed with the discussion of the diseases of the 
 most important female genital organ we will describe the physi- 
 ology, i. e. the normal, natural development and the functions of 
 it, in order to facilitate the understanding of its abnormities. 
 
 The anatomical description given in the first part of this 
 book defines the shape and the position of the womb in a middle- 
 aged woman and in a non-pregnant condition. Since the chan- 
 ges in the development, size and functions of the womb are not 
 inconsiderable at different periods, we may divide the life of a 
 woman, regarding her sexual activity, into three parts — the time 
 before the beginning of menstruation: childhood; the time of its 
 periodical appearance: maiden- and womanhood; and the time 
 after the cessation of the menstruation: matronhood. There is 
 not only a functional, but also a psychological basis for this dis- 
 tinction. 
 
 Innocent and ignorant of the position and the duties of the 
 woman, the child spends an unsuspecting childhood. The germ 
 of sexual desires is dormant to the same degree as the genitals 
 are unfinished and undeveloped. There are no especially strik- 
 ing marks to tell of the distinction between male and female. 
 Only the close observer will notice at an early age that the forms 
 of the girl are softer and rounder and the skin is more delicate 
 and tender. The intellectual development takes its peculiar 
 course and the indications of the female character are soon evid- 
 ent. The games of the boys do not attract the girl, and the 
 work of the mother within the house is of greater interest to her 
 than that of the father. She will conceive quicker than a boy 
 
40 
 
 of about the same age, but will be less persevering in her work 
 than the latter. The bust is as yet undeveloped. The womb, 
 at this time a comparatively very small orgari, consists mainly of 
 the neck while the body is merely layed out and awaits its dev- 
 elopment. The ovaries, likewise incomplete and small, do not 
 show maturing of an ovulum and are covered by a smooth per- 
 itoneum. 
 
 With the development of these latter the girl becomes a 
 maiden and a physical as well as a psychological change is not- 
 iced. The character of the woman is now more plainly marked. 
 Even those girls who have participated in the lively and noisy 
 games of the boys are looking more for companionship of their 
 like. The sense of shame appears to a greater extent. The 
 form becomes stronger and more developed; the hips get 
 wider: the breasts grow more prominent, sometimes in such a 
 measure that the tension causes pains, and that even the pressure 
 of tight-fitting dresses is very annoying; the hair of the pudenda 
 grows and the changes of the internal genitals are remarkable ; the 
 vagina becomes wider and more spacious; the womb, formerly 
 so small, grows considerably, especially in the upper part, i. e. in 
 its body. Its cavity, destined for the reception and keeping of 
 the impregnated ovulum takes its shape and the ovaries, develop- 
 ed to their full size, furnish impregnable ovula and begin to be 
 covered with scars at the place where the ovula have left them.. 
 
 But the most characteristic sign of attained puberty is 
 the regularly occurring monthly secretion of blood, called men- 
 struation. 
 
 The genitals remain in this state up to the forty-fifth or 
 fiftieth year with the variations caused by pregnancy. After this 
 age the third stage of life is attained: matronhood — menstru- 
 ation ceases. The genitals, having fulfilled their purpose — for 
 only in very rare exceptions impregnation is now possible — 
 commence to adopt the changes brought about by old age, and 
 lose considerable of their previous perfection. The sexual in- 
 stinct, generally less pronounced in women than in men, in most 
 cases ceases entirely or decreases at least considerably, not only 
 by loosing the desire, but also in consequence of the pains dur- 
 ing intercourse caused by the tension of the walls of the vagina. 
 For the vagina shrinks and becomes, especially in the upper 
 
41 
 
 part, so narrow that instead of growing wider as in former years, 
 it grows narrower towards the womb taking the shape of a fun- 
 nel. The womb also undergoes the same process of diminu- 
 tion; the shrinking of the conus (see figure 7) is frequently so ex- 
 tensive that the opening of the womb does not project into the 
 vagina anymore but may be found as a continuation of the lat- 
 ter at its upper narrowest part. The body of the womb, likewise 
 diminished by the shrinking of the muscle fibres, becomes small- 
 er and very mobile, as the ligaments relax and the fat in the 
 tissue of the pelvis disappears at an advanced age. The ovaries 
 start all these processes by their own diminution. Their trans- 
 formation into a small cluster of ragged and tough scars, hardly 
 perceptible to the examining finger, is the result of periodically 
 occurring expulsions of ovula during menstruation which has 
 continued for years, and which by the busting of ovisacs (see 
 diseases of the ovaries) always caused a new wound and after 
 healing a new scar. 
 
 Even before the complete cessation of menstruation the 
 development of impregnable ovula decreases, as may be seen 
 from the comparatively rare occurrence of pregnancy after the 
 fortieth year, and generally ceases entirely with the disappear- 
 ance of the menses. 
 
 The storms of sexual life alloted by nature have passed 
 away and the pleasures, as also many of the sufferings produced 
 by the surging of the blood to the abdomen during the time of 
 capability of procreation have disappeared. 
 
 Throughout the time of womanhood and puberty there are, 
 as previously stated, periodically returning sanguinous secre- 
 tions from the genitals named courses, menstruation, monthly 
 or menses. 
 
 Their first appearance is contemporaneous with the com- 
 plete development of the genitals, i. e. with the first maturing 
 of impregnable ovula in the ovaries. After a duration of about 
 thirty to thirty-five years they disappear. It would be incorrect 
 to suppose that the earlier their beginning has been the sooner 
 they would cease, or the later they have commenced the later 
 they would stop. On the contrary the opposite may be frequent- 
 ly observed: the earlier the beginning the later the cessation. 
 The average age of the beginning of menstruation varies not 
 
42 
 
 only in the different nations, but also in the different classes of 
 population of the same nation. It fluctuates in Germany be- 
 tween the ages of 12 and 20, the average being 15 or 16. The 
 difference between the inhabitants of city and country is very 
 distinct, since the manner of living of the women in the cities, 
 generally easier and more luxurious, hastens its appearance 
 while the hard work of the girls in the country tends to retard 
 it. Still greater is the influence of race. In the torrid zones 
 and with oriental nations, even with Jewesses living in temper- 
 ate zones, menstruation begins much earlier, in frigid zones, 
 however, later. 
 
 The beginning is generally painless and easy, excepting 
 the nervous excitement with which the commonly inexperienced 
 and ignorant girls are seized when after an indefinite uneasiness 
 of several days suddenly a bloody flow occurs from the genitals. 
 It is, therefore, advisable to acquaint children with this cir- 
 cumstance when its occurrence may be expected. 
 
 After the first appearance menstruation usually recurs reg- 
 ularly in a period of from three to five weeks. Twenty-eight 
 days is the average normal time. Only with chlorotic, hard 
 working or previously sickly girls it may be irregular from its 
 beginning or may stop again for an indefinite. time after its first 
 occurrence. Contrary to this the monthly bleeding reappears 
 usually so j3unctually that almost the hours of the commencing 
 of "being unwell" may be stated. Variations of a few days or 
 even of a week must not be considered alarming as long as there 
 are no greater troubles. Almost always certain disagreeable 
 sensations are connected with it, which is even indicated by the 
 very name "being unwell," yet they must not exceed a certain 
 limit. A feeling of general displeasure, ill humor, irritability 
 at trivial things, languidness, loss of appetite with a heavy feel- 
 ing in the abdomen, sometimes also a little headache and hemic- 
 rany may yet be numbered among normal symptoms. 
 
 Whatever is beyond these is abnormal. Pains in the back 
 of a higher degree, cramps 'resembling pains during child-birth, 
 pains in the region of the navel and stomach, or extending to the 
 legs and up the back as far as between the shoulder blades,* 
 pains at the movement of the bowels, at urinating, faintness 
 demanding to take to the bed, severe headache, pimples in the 
 
43 
 
 face and on the body, the hands and feet, all this points to ab- 
 normal conditions and we will show the reasons for this later. 
 
 The duration of menstruation may vary greatly in a healthy 
 as well as in a sick condition; but usually it is of equal length 
 in one and the same person. Three days is considered the aver- 
 age time, but there are numerous exceptions, and a menstruation 
 lasting one or two days only or even five or six days must be 
 considered normal as long as the sanitary conditions of the body 
 do not surfer thereby. Regular decreases or interruptions on 
 certain days during which time the blood will flow very scarcely 
 or not at all, and then appear again for a short time, are no rare 
 occurrences. 
 
 The quantity of the blood lost, which is moreover difficult 
 to estimate, likewise varies greatly, one-quarter of a pound may 
 be considered the average. It does not by any means always 
 correspond to the duration of menstruation. Whether too much 
 or too little is secreted can only be decided by the general health, 
 It is a known fact that stout, corpulent, sanguineness persons 
 overcome a certain loss of blood, normal for them, with the great- 
 est facility, while a delicate person, having insufficient blood, 
 loosing the same amount will bs greatly weakened thereby. This 
 indicates the necessity of considering also the accessory circum- 
 stances. The popular opinion that a person, who loses during 
 her menstruation only a few drops of blood, even if affected by 
 no other ailment, must be a sick one is, therefor, not at all cor- 
 rect, if there are no troubles in consequence of this. If there 
 are none and if there is neither consumption nor any other gen- 
 eral disease to be taken as its cause, such a condition must be 
 considered normal and medical assistance is not necessary. If 
 the loss of blood is a great one it is only then necessary to inter- 
 fere when the organism is weakened too much thereby. 
 
 The blood discharged during the monthly purification is of 
 dark color and liquid. All coagulation in the womb, which 
 causes the lumps to be expelled with cramp-like painful contrac- 
 tions of the muscular walls must be considered a disease. 
 
 As previously stated the monthly courses exist for a period 
 of about thirty to thirty-five years and their cessation occurs be- 
 tween the forty-fifth and fiftieth year of age, generally about the 
 forty-eighth. Irrespective of little variations, the exceptions to 
 
4 4 
 
 this rule, in which for instanoe women oeass to menstruate at 
 an age of thirty or even before this, are comparatively rare and 
 generally caused by defective processes in the ovaries. But even 
 without these, under normal circumstances, the cessation of the 
 menses, the "change of life," creates a critical time, for generally 
 they do not end as they began, suddenly and without troubles. 
 It is true there are women with whom menstruation ceases for 
 ever without any foreboding, but these are exceptional cases. 
 More frequently we find a gradual decrease, the courses growing 
 weaker and weaker and occurring at longer and longer intervals. 
 
 In most cases, however, the approaching change of life is 
 indicated by the irregular appearance of the menses and their 
 great variations in time and vehemence. The time of their oc- 
 currence can not be predicted any longer, the menstruation last- 
 ing otherwise three or four days extends over one or two weeks; 
 the flow of blood grows stronger and is sometimes so profuse that 
 local treatment becomes a necessity. There are greater and 
 greater intervals until finally the longed for rest is at hand. But 
 even after a long pause menstruation may reappear. This fact 
 almost invariable creates suspicion of a forming of malignant 
 tumors, especially if the loss of blood is a heavy one, and med- 
 ical aid should be promptly sought in such cases. 
 
 A slight annoyance, yet one worthy of mention, often ap- 
 pearing during this period of life, is the increasing corpulency, 
 a disagreeable formation of fat; but other, more serious trouble, 
 almost always attack women, in the "change of life," caused 
 by derangements in nutrition and such of the nervous sys- 
 tem; great languor, nausea, loss of appetite, frequent vomit- 
 ing, constipation or diarrhoea, a feeling of bloatedness, a rushing 
 of the blood to the head with headache and dizziness, palpita- 
 tion of the heart, insomnia, etc. Serious sickness with fatal re- 
 sult can only be ascribed indirectly to the change of life. 
 
 Various conjectures regarding the monthly recurring dis- 
 charges of blood, which naturally attracted attention even in 
 antiquity, have been made, which were the more absurd the 
 greater the ignorance was of the functions of the female 
 sexual organs. One of the most popular views in this regard, 
 which has come down to us from our ancestors circulates gen- 
 erally even today among all classes of people and finds its echo 
 
45 
 
 in the expression "monthly purification." Poisonous substances 
 in the blood are supposed to be periodically expelled in this 
 way. What was more natural than to guard against these sec- 
 reted substances? History tells us that the old inhabitants of 
 India considered the women unclean during menstruation and 
 forced her by their customs and rites to cleanse herself by bath- 
 ing in the holy river. Priestesses were not allowed to bring 
 their offerings and sacrifices to the gods during this time ; Greek 
 and Roman woman of rank retired to their appartements. The 
 woman of the present day disregards this restraint, and it will 
 be impossible to notice the days of menstruation in a refined 
 and healthy person, especially since it is a matter of etiquette to 
 fulfill the duties of society also during this period often to the 
 harm of the respective person. For sanitary reasons only it is 
 advisable to take precautions, but menstruation is not a purific- 
 ation. If by this act poisonous and noxious substances were re- 
 moved from the blood why should nature have withheld such a 
 dismission of poison from man? No, the flow of blood has an- 
 other reason. It is, as stated before, in close connection with 
 the maturing of the ovulum in the ovary; therefore no menstru- 
 ation during childhood, as long as ovaries are incapable of prod- 
 ucing mature ovula; therefore the cessation of menstruation 
 when the ovaries have ceased to produce ovula in matronhood 
 or as soon as they have been removed for some reasons by oper- 
 ation. It is true the relation of ovulation and menstruation has 
 not yet been perfectly established by science. Experiments 
 with animals and occasional experiences with persons during 
 operations need still more explanation. The opinion formerly 
 prevalent that only at the time of menstruation and never at 
 other times matured ovula were expelled, has been proven er- 
 roneous by a treatise of Dr. Leopold, of Dresden, so that it may 
 now be accepted as an established fact, that also during the in- 
 tervening time or shortly before or after menstruation a dismis- 
 sion of an ovulum may be caused by mental excitement, copula- 
 tion, etc. Some very instructive, though rare, experiences con- 
 firm this theory, since instances are known in which children, 
 who had not yet had a menstruation, cr women after the change 
 of life, or nursing mothers whose monthlies had not yet reappear- 
 ed, have been impregnated. 
 
46 
 
 It has been asked, for which reason then does the flow of 
 blood from the uterus occur at the maturing of the ovulum? 
 According to the present view it is thus: The growing ovulum 
 in the ovaries creates a nervous irritation, which produces a 
 stronger rushing of blood towards the genitals. This increases 
 the secretions in the ovisac containing the ovulum (see physiol- 
 ogy of the ovaries), which bursts, so that this, being liberated, 
 may pass through the oviducts into the uterus. 
 
 During this time a change has occurred also in the womb 
 tending to facilitate the settling and growing of the eventually 
 fertilized ovulum. It is caused by the same rush of blood towards 
 the abdomen, which has burst the ovisac. The uterus has grown 
 larger, softer and richer in sap. The mucus membrane of the 
 inner surface is thicker and over-abundantly filled with blood, 
 which escapes out of the vessels and is discharged as the blood 
 of menstruation. By this process the genital organs are freed 
 from their over-abundance of blood; they are released and return 
 to their former condition, since with the discharge of the ovulum 
 from the ovaries the nervous irritation arising therefrom has 
 ceased. Menstruation gradually stops and occurs again as soon 
 as renewed maturing of an ovulum produces a renewed rushing 
 of blood to the generative organs. 
 
 The ovulum furnished from the ovary, being in itself unable 
 to live, perishes in some unknown manner during the excussion of 
 blood. The capability to develop and grow to a ripe fruit is 
 only bestowed upon it by impregnation, i. e. by the combin- 
 ation with the male germ, the semen. The details of this 
 interesting process, which has been closely studied in animals 
 is too complicated to be discussed within the range of this book. 
 But this must be stated that a single spermatozoid, which is to 
 be described later, will suffice to impregnate and the ovulum 
 after impregnation protects itself against all others by the form- 
 ation of an impenetrable membrane. 
 
 The contrivances and means of nature facilitating the meet- 
 ing of ovulum and semen are peculiar and noteworthy. 
 
 The ovulum, the female germ, drops into the cavity of the 
 abdomen when the ovisac,. in which it has grown, bursts and is 
 carried forward without its co-operation, by the continually mov- 
 ing ciliar eqithel which is found in the oviducts and the womb. 
 
47 
 
 (See figure 9.) The male sperm, however, possesses self-acting 
 faculties. It consists of a somewhat thiekish substance, in 
 which there are numerous minute so-called spermazoids or 
 spermatozoa moving quickly in all directions. Figure 11 shows 
 under strong microscopic magnifying a minute part of this sub- 
 stance with its lively but quickly mortifying inhabitants. Sim- 
 ilar to the tail of a frog larva swimming in water, the thin thread- 
 like section is also the only organ serving for propulsion of this 
 spermatozoon, that is to say animal cular of the semen, called 
 so on account of its similarity to independent creatures of the 
 
 Figure 11 — Spermazoids 
 
 animal kingdom. The whipping motions of the threadlike end 
 are comparatively strong, at least stronger than the motion of 
 the cilia on the epithets, because the spermazoid has to over- 
 come these in creeping to the ovulum which is to be fertilized. 
 If this is not found, the sperm will not stop on its way until it 
 has reached the ovaries, on which it has been observed alive in 
 suddenly deceased women. The vast number also has its rea- 
 son; it is on account of the difficulty of two such minute bodies 
 to meet on the comparatively great surface of the interior of the 
 uterus. Only one of the numerous sperms is destined to fulfill 
 its purpose. 
 
 The only point regarding the travel of the spermazoid, on 
 which authorities disagree, is to entering the uterus. Like a 
 
48 
 
 tower whose walls are the only safe retreat from destruction 
 threatening from all sides, the uterus has to be ascended by the 
 spermazoids. As long as these have not reached this place their 
 existence is endangered on account of the different reactions of 
 the mucus in the different places. The mucus of the vagina has a 
 sour reaction and is, as every sour reacting liquid (see footnote) 
 hostile to the life of the fertilizing sperms of the male semen, i. 
 e. it destroys them in time; the mucus of the uterus, however, 
 has an alkaline reaction, and is very favorable to them. It is, 
 therefore, generally disadvantageous to the semen to remain for 
 a long time in the vagina, and again the entrance into the cav- 
 ity of the uterus, the outer mouth of the womb, is comparatively 
 small and narrow. There are different views as to how nature 
 overcomes these hindrances. One of the most popular and clear- 
 est theories says, that the probe of tough and glassy mucus, 
 which fills the neck of the uterus, is pressed outward at the 
 height of sexual excitement by a contraction of the walls of the 
 uterus and returns again at their relaxion with the adhering sperm- 
 azoids, which are in this manner brought into the safe retreat of 
 the uterus. The facts agree exactly with this supposition, since 
 impregnation is most certain when both parties are at the same 
 time in the state of highest excitement, because the projected 
 probe is then best reached by the injected semen. This is, how- 
 ever, not to be understood as though the semen deposited in the 
 vagina was always lost for fertilizstion. On the contrary numer- 
 ous cases are known in which on account of unfavorable circum- 
 stances the spermazoids had to work their way through the en- 
 tire length of the vagina and still caused impregnation. And 
 this is but natural, since even if there are profuse noxious secre- 
 tions in the vagina, only the exterior of the semen will be touched 
 by them and consequently a certain number of sperms will al- 
 ways remain capable of fertilizing. Even without the assistance 
 of the above mentioned facilities impregnation is not rendered 
 impossible though it may be made difficult. 
 
 These achievements of science are of greatest importance for 
 the treatment of sterility and excessive fertility and we shall re- 
 
 Foot Note. — By sour reacting fluids we mean such as change the blue 
 color of the litmus to red, and by alkoline such as change red to blue. 
 
49 
 
 fer to them in their proper place in later chapters treating of 
 this subject. 
 
 It is evident from these facts that the exact place where im- 
 pregnation occurs cannot be ascertained. It must differ in dif- 
 ferent cases since ovulum and spermazoid may meet anywhere 
 and the ovulum is always capable of receiving the male sperm. 
 If we consider, therefore, that the ovulum, which may have been 
 fertilized before it reaches the womb, can also find at other places 
 than the uterus, for instance in the oviducts or even at the ovar- 
 ies themselves, a suitable, place for- settlement and growth, we 
 may understand the occurrence of extraordinary pregnancy at 
 the wrong place. This sad incident which results in the death 
 of so many women will be explained with its symptoms and causes 
 in a later chapter, that on diseases of the oviducts. 
 
 We will describe here only the normal pregnancy in which 
 the uterus itself is the receptacle of the fruit, since its derange- 
 ment produces a great number of female diseases, whose under- 
 standing is rendered almost unintelligible without this informa- 
 tion. 
 
 If the fertilized ovulum, propelled from the ovaries through 
 the oviducts, arrives at the interior of the uterus, or if it is fertil- 
 ized at this place, it lodges there in the mucous membrane wdiich 
 has been prepared for its reception and the regular pregnancy 
 begins. 
 
 The signs of pregnancy are numerous and vary greatly in 
 their reliability. Infallible are only those signs which are in- 
 dicated by the child itself, viz: the feeling of parts of the child 
 and its movements, the hearing of the beating of the fetal heart 
 and noise proceeding from the umbilical chord. But these ab- 
 solutely reliable signs are not offered before about the end of the 
 fifth month. In the previous months we have to take less reli- 
 able indications, which may, according to the circumstances, al- 
 low us to draw T rather safe conclusions, even as early as the 
 second month after impregnation. 
 
 Of least importance are the general symptoms, which are 
 ascribed to the nervous irritation caused by the growing womb 
 and since they are sometimes present, sometimes wanting, such 
 as excitement, restlessness, irritibility, headache, hemicrany, 
 nausea, frequently also vomitting especially after breakfast, rarely 
 

 50 
 
 at other times of the day, or also longing for all kinds of 
 queer things as vinegar, chalk, mortar, while regular appetite is 
 wanting, also diarrhoea, constipation, or the one changing with 
 the other, sudden stopping of the discharges, etc. 
 
 These ailments last rarely during the entire time of preg- 
 nancy, but generally disappear after its first half has elapsed. 
 
 The first important and significant sign, which is noticed 
 by every woman, is the cessation of menstruation, but since de- 
 fective conditions of various kinds or mental excitement may 
 have the same result we must add: when occurring with an 
 otherwise healthy and regularly menstruating woman under nor- 
 mal circumstances. On the other hand the reappearance of 
 menstruation is no unfailing proof that impregnation has not 
 taken place, since many cases are known in which in spite of 
 pregnancy the monthly courses recurred once or even several 
 times. But in these cases the menses, as compared with those 
 of a former period, showed a considerably weaker flow of blood. 
 
 Less striking and not so constant are the changes of the 
 color of the external parts, the vagina and the uterus, which 
 take a blueish or violet color as far as the eye may see them with 
 or without the use of instruments. 
 
 Sudden rjains in the breast, swellings and secretions from 
 them, which latter may be best perceived by a pressure from the 
 basis towards the nipple, help to prove, but are no proofs in 
 themselves as these signs are also found where a formation of a 
 tumor of the abdomen is in progress. 
 
 The most reliable proof, which, however, can only be per- 
 ceived by an experienced person, is afforded by the womb. It 
 is evident that it must grow and increase according to its con- 
 tents. This organ having in the state of non-pregnanoy not 
 quite the size of a small hen's egg, grows but little and hardly 
 perceptibly during the first month, but feels even now a little 
 thicker and softer. The little opening of the exterior mouth of 
 the uterus, having formerly an oval shape becomes round and the 
 mucous membrane is a little richer in sap. 
 
 In the second month the increase of the womb is more dis- 
 tinct, the uterus has about the size of a goose egg and grows in 
 the succeeding third month to the size of a fist. It has become 
 quite soft and may easily be missed by an inexperienced hand. 
 
51 
 
 In the fourth month the receptacle of the fetus may be felt 
 through the skin above the pube bone as a soft round body- 
 easily slipping when traced by the hand; it does not yet increase, 
 however, the circumference of the abdomen so much that it 
 might be noticed. This occurs only during the fifth month when 
 the uterus reaches half way up to the naval and on account of the 
 expansion of the abdomen the strias, small, at first pink, in later 
 years white stripes with cross folds, are created. A careful ob- 
 servation will show, as described above, that already now the 
 beating of the heart of the child and its movements may be ob- 
 served. In the center of the abdomen a brownish line will be 
 found, ascending from the mount of the venus and correspond- 
 ing henceforth in highth with the bottom of the uterus. 
 
 In the sixth month we find the bottom of the uterus the 
 width of two fingers below the naval, in the seventh just as high 
 above the same. 
 
 In the eighth month it reaches the center between naval 
 and pit of the stomach and the difficulties in breathing on ac- 
 count of the great extension of the abdomen begin. 
 
 In the ninth month the uterus has reached the highest point, 
 since its bottom is at the pit of the stomach and touches the 
 ribs on the sides. The difficulty in breathing has increased 
 and hardenings of the abdomen from time to time prove the so- 
 called insensible, i. e. unnoticed labors which inaugurate the ex- 
 pulsion of the fruit. The mouth of the uterus is now loosened, 
 and if there has been a birth before, dilated so far that the 
 finger may reach as far as to the bladder enveloping the child. 
 The vagina is considerably softened and extended and throws 
 off ample secretions. 
 
 In the tenth month (see foot note) the proceeding part of 
 the child, generally the head, lowers and the bottom of the uter- 
 us sinks a little. The difficulty in breathing, the palpitation of 
 the heart, etc. partly disappear. On account of the labor-pains 
 growing more powerful, which press the fruit downwards, the 
 mouth of the uterus is dilated more and more and when suffic- 
 iently expanded the child is expelled. The after-birth follows a 
 little later. 
 
 Foot Note — According to scientific calculation there are ten months of 
 pregnancy, instead of nine, each month numbering twenty-eight days. 
 
52 
 
 The dangers during the birth of the child cannot be discuss- 
 ed here, since 1 this lies beyond the sphere of this book and we 
 have to refer to other treatises. But we shall have to refer 
 frequently to the consequences of abnormities of the expulsion 
 of the after-birth, and will add a few words by way of explana- 
 tion. 
 
 Soon after impregnation different sections and parts may be 
 perceived in the human ovulum. The entire formation looks 
 
 Figure 12. 
 
 The cut shows the ripe fruit in the womb in the position most frequent. The 
 lower opening is the outer mouth of the womb. The dotted spot on the left 
 side which is intergrown with the walls of the womb is the placenta, the ir- 
 regularly bending line from the placenta to the child is the umbilical chord, 
 the space surrounding the child is filled up with water. 
 
 like a small bladder filled with water, which is connected with 
 the mucous membrane of the uterus only at a small place. 
 This little bladder, whose external envelope is formed by a thin, 
 but strong membrane, contains the as yet undeveloped body of the 
 child, which is surrounded everywhere by water, and is connect- 
 ed by the umbilical chord with the placenta, or after-birth. This 
 latter is a condensed and thickened part of the above mentioned 
 
53 
 
 membrane directly connected with the uterus, while the other 
 parts only touch the interior of the womb without inter- 
 growing with its lining, so that instruments may be introduced 
 between the membrane and the walls of the uterus. This rela- 
 tion remains during the entire time of the development of the 
 child. The placenta having the office of furnishing food to the 
 growing fruit, it is so arranged that the blood vessels of the 
 child are in continual communication with those of the mother, 
 furnishing in this manner food and new blood during the entire 
 time of pregnancy to the child and taking away the consumed 
 material. In order that the communication may be possible the 
 placenta must be closely grown to the walls of the uterus, as it 
 really is, as stated before. This close connection is, however, 
 loosened during and after the expulsion of the child, since every- 
 thing belonging to the fruit must be removed with it. Some 
 time after the birth, therefore, the placenta is also expelled and is 
 born as the so-called after-birth. In abnormal conditions, if 
 the loosening does not occur on the entire intergrown surface or 
 on smaller parts of it the whole after-birth or pieces of it may be 
 retained in the uterus. In the first case the fact cannot be over- 
 looked and the loosening will be produced artificially by the hand, 
 in the second case, however, it depends upon the size of the re- 
 tained parts whether their severing has been noticed or not. If 
 it has not been noticed and if a remaining piece is not removed 
 either in an artificial or a natural way, it will be overgrown by 
 the surrounding lining and creates a source of profuse bleedings, 
 which will, as a consequence of births and especially of premature 
 births gradually undermine the health of the woman. Besides 
 this inflammations will be constantly maintained by them and 
 there is always danger that they will change to injurious tumors 
 in later years. 
 
 The uterus being liberated of its contents in a normal man- 
 ner, weighing about two pounds directly after birth, begins im- 
 mediately to be reduced to its original shape. If everything 
 progresses undisturbed in its natural way, this is attained after 
 two months and the uterus is found again in its former size and 
 location inclined over its front surface. 
 
rialformations of the Womb. 
 
 All malformations of the uterus, which are comparatively 
 rare, are connected with the development of this organ, i. e. they 
 indicate a standstill in the process of development, which was 
 intended to be only transitory. All intermediate stages from 
 the entire absence to the regularly developed formation may 
 occur. We will mention but a few characteristic forms, which 
 may serve to illustrate and explain abnormities occasionally met 
 with. 
 
 The extreme link of the chain of deformities, the entire ab- 
 sence of the uterus, when even in spite of narcotism by chloro- 
 form not a trace of it can be found, is very rare. It is invariably 
 accompanied by an incomplete development of the vagina and a 
 total or nearly total absence of the oviducts and ovaries, while 
 the external parts may be perfectly normal. Since there are no 
 grieveous ailments, only the absence of menstruation, or later 
 the incapability of sexual intercourse reveal the misformation. 
 
 A separation of the interior of the womb into two sections 
 is more frequent, but likewise rarely noticeable. Either both 
 parts have grown equally (figure 13) or only one of them has 
 normally developed and the other has been retarded in its 
 growth. In this case, too, there may be no annoyances what- 
 ever, even all symptoms of the defect may ba missing, since both 
 sections, or the one more developed, may properly perform its 
 functions. Women thus have no idea of their abnormal condi- 
 tion until their attention is called to it by the obstetrician or 
 specialist. 
 
00 
 
 If the development of the uterus of the child had a normal 
 progress up to the time when it was born and the derangements 
 in the development occur afterward, the two following forms will 
 result. 
 
 We have seen in the preceding chapter the great changes 
 to which the uterus is subjected in the different ages: in the 
 new-born child it consists nearly exclusively of the neck of the 
 womb, and in the girl who has not yet reached the age of pub- 
 erty the body of the womb is only very small. If the develop- 
 ment of the womb does not keep step with the general develop- 
 ment of the body, there will always remain a fault in the con- 
 
 Figure 13 — Malformation of The Womb 
 
 a — Wall dividing the interior of the Womb into the two parts bb. 
 cc — Oviducts. 
 
 dition of that organ. It will be small and movable, the conus 
 projecting into the vagina, is not very prominent, the ovi- 
 ducts and ovaries are undeveloped and the latter usu- 
 ally incapable of producing matured ovula. Consequently there 
 is no menstruation or only very little of it; copulation is pos- 
 sible since there is a vagina, but impregnation and pregnancy 
 are rendered absolutely impossible. 
 
 There is another derangement, which has been frequently 
 mentioned in the preceding pages, and is to be explained at 
 this place in order to avoid repetition. It is the closure of 
 the genital canal in any part of its extension, with an accumula- 
 tion of mucus and blood back of it. The symptoms are ident- 
 ical whether this condition is innate or the result of diseases, 
 such as diphtheria, scarlet or typhoid fever, measles, ulcerous 
 
50 
 
 processes, parturition, etc. The innate abnormities may be 
 found at three different places; at the hymen, the vagina and 
 the womb. The first two forms are easily detected by unpro- 
 fessional, since the deviation from the normal state may be ob- 
 served at the exterior parts, or at the beginning of the vagina; 
 the third form, however, which causes the greatest troubles and 
 is most dangerous, can only be recognized with difficulty. 
 
 Yet it must be stated that the closure at the hymen or in 
 the vagina may result after a while in the same serious dfficul- 
 ties and anatomical changes, which are caused by closure of 
 the womb, if they are allowed to remain unheeded too long. 
 
 Up to the time of the appearance of menstruation such con- 
 ditions are frequently not recognized. The small amount of 
 mucus secreted under normal circumstances affords no reason 
 for complaint as it accumulates. Only the appearance of the 
 menses with the greater secretions of blood produces distinct 
 symptoms. The simple fact that a healthy non-chlorotic girl does 
 not have her menses at the same age at which her playmates be- 
 come subject to them, should be considered an indication that 
 something is wrong. If in addition to this she is seized with 
 violent, gradually diminishing, colic-like pains and cramps in 
 the abdomen, which return at regular intervals of four weeks, i. 
 e. at the time when the menses should appear, it certainly is 
 evident that there is some malformation. Even an unprofes- 
 sional person, whose attention has been called to these facts, 
 will find by examining an elastic bulging out if the seclusion is 
 formed at the hymen. Only a physician, however, is enabled 
 to ascertain the causes of the pains if the hindrance is more in 
 the interior; to him it is not very difficult, since there is no 
 other explanation for the tumor lying at the place of the womb, 
 which increases in size every month. 
 
 If the hindrance is located on the exterior genitals, at the 
 entrance of the vagina, the process is as follows : The blood sec- 
 reted from the womb is obstructed and prevented from being 
 discharged by the conclusion of the hymen and accumulates there. 
 The walls of the vagina are consequently forced apart according 
 to the amount of the secretions and thereby the first pains are 
 caused. The blood retained in the vagina shows no tendency to 
 coagulate, neither does it remain in its original condition; it 
 
57 
 
 thickens since the water contained therein is gradually absorbed 
 by the surrounding tissue and in the course of a month the 
 •original liquid is changed into a thickish, black, tar-like sub- 
 stance. The quantity is naturally diminished by this process 
 and the expanded walls of the vagina are accordingly reliev- 
 ed. The pains diminish in the same degree, but only to return 
 the more violent after four weeks, at the recurrence of the menses. 
 
 In this manner the vagina expands, since the retained sub- 
 stances increase with each month. It takes the shape of a filled 
 balloon, and the blood being stemmed back as far as into the 
 womb will also enlarge this organ. Up to this time pains were 
 the only trouble, but at this stage immediate danger is at hand. 
 At first only the womb, but later one or both oviducts, which 
 latter are mostly closed at their abdominal end, expand more and 
 more. The tumor so formed grows thicker and may easily be 
 felt through the walls of the abdomen. The further the expan- 
 sion progresses the thinner the walls of the tumor grow, so that 
 at last the sack, which is filled with a black, thickish fluid, may 
 burst occasionally. Quick motions, a fall, a blow on the ab- 
 abdomen, even coughing or sneezing is, therefore, dangerous in 
 the later stages of the disease. 
 
 As soon as the womb partakes in the trouble, the difficulties 
 increase. Being irritated by the sudden expansion and tending 
 to restore the normal conditions, the strong muscular walls of 
 the uterus contract vigorously in order to expel the contents. 
 The pains are, therefore, similar to labor pains, and radiate 
 in all directions: the back, the loins, the stomach and the 
 head. The pressure upon the surrounding organs, on account 
 of insufficient room, will cause abnormal sensations in the legs 
 and especially troubles of the bladder, rarely of the rectum, and 
 will aggravate a condition whose danger increases with the dur- 
 ation of its existence. 
 
 The treatment must, therefore, be the more careful the more 
 the process has advanced, since at a great expansion even an ex- 
 amination causing a slight pressure may burst the sack and result 
 in death. It is the principle to restore to the organs their orig- 
 inal shape and location by emptying the contents. If the 
 accumulated blood has escaped after the closure has been 
 broken, the patient must remain lying quietly upon her back 
 
58 
 
 and exercise scrupulously cleanliness. Injections are not ad- 
 visable at first, and should only be applied when the discharges 
 become offensive. 
 
 After the operation has been performed it is often very dif- 
 ficult keep the artificial passage open. 
 
 Various means have been employed to prevent a re-closure,, 
 but have not proved to be unfailing. If all means have failed 
 the physician may sometimes be compelled to remove the ovar- 
 ies in order to effect a perfect cure and allay the ever returning 
 pains. 
 
Catarrh of the Neck of the Womb. 
 
 The inflammations of the womb may be divided both anat- 
 omically and as regards the symptoms of disease, into two prin- 
 cipal forms, viz: 
 
 First — Inflammations of the mucous membrane and 
 
 Second — Inflammations of the muscular walls. 
 
 In the former we must distinguish again between (a) those 
 of the neck, and (b) those of the cavity of the womb. 
 
 Nearly all noxious influences upon the womb, be it that 
 they are caused directly by infecting germs, or be it that they 
 favor their settlement, affect the mucous membrane lining the 
 cavity more readily and more severely than the muscular walls. 
 This is the case for obvious reasons; on the one hand the germ& 
 coming from the outside through the vagina tire led directly to 
 this place, from whence thej 7 penetrate deeper; on the other 
 hand the mucous membrane, on account of its spongy texture, 
 and its abundance in blood, juice and glands is more sensitive 
 and less resistable than the firm and stiff muscular walls. It 
 may be easily understood, therefore, that most inflammatory 
 diseases of the womb start at this weakest place, and that the 
 inflammation of the mucous membrane must be considered in 
 its different forms the most frequent disease of the female gen- 
 erative organs. 
 
 It is also evident that all diseases of the mucous mem- 
 brane, resulting from microbes, excepting those which develop 
 during encouchment, will attack the neck of the womb sooner 
 than its cavity, for the way to the latter leads through the for- 
 mer, where the germs find a very fertile ground and where a 
 
()() 
 
 peculiar distribution of the blood vessels favors their settlement 
 and spreading. 
 
 (A) INFLAMMATION OF THE NECK OF THE WOMB. 
 
 From this it is evident that the first symptoms of diseases of 
 the womb in virgins, and women not having born children, usually 
 start from the mucous membrane of the neck of the womb. In 
 connection with this it may be stated that in consequence of the 
 narrow entrance of the outer mouth of the womb of such per- 
 sons, a considerable protection against microbes is offered, but 
 that on the other hand, as soon as this obstacle has been over- 
 come, the very same narrow passage, which has been of advan- 
 tage before, is now of greatest disadvantage, since the enemy is 
 thereby the more fortified and the more difficult to be driven 
 from its position. All that is necessary for the progress of the 
 disease is thus afforded. The abnormal secretions produced by 
 the settlement of microbes can not pass into the vagina through 
 the narrow mouth, as they are in the beginning of the inflam- 
 mation of a thickish, slimy substance. They accumulate and 
 irritate, by their gathering, the surrounding mucous membrane. 
 But the stronger the irritation the greater the secretions ! Thus 
 cause and effect support each other and the result is an ever in- 
 creasing change to worse in the condition of the neck of the 
 womb. The glands of the mucous membrane spread and pen- 
 etrate deeper and deeper into the muscular tissue ; the neck- 
 channel grows larger and is filled up with turbid mucus or mat- 
 ter; the layers of muscles growing to a state of chronic inflam- 
 mation caused by the constant irritation, which has thus been 
 produced, become thicker and thicker, so that at the end the 
 slender neck of the womb is changed into a spindle-shaped 
 swelling. (Figure 14.) The mucous membrane which does 
 not find sufficient room in the interior of the cavity on account 
 of its many ragged glandular formations and out-bulgings, is 
 forced outward, and becomes visible to the eye by the use of in- 
 struments, as a red rim surrounding the outer mouth of the 
 womb. 
 
 This is a so-called ulcer of the mouth of the womb. It is 
 evident that an ulcer of the mouth of the womb cannot be com- 
 pared with a common ulcer on the outer surface of the body, the 
 
61 
 
 skin. Although the name seems to indicate a similarity, there 
 are vast differences. An ulcer on the outer surface or me oody. 
 the skin, may be described as a loss of substance with or with- 
 out a mattery covering, having a tendency to penetrate deeper 
 and to grow wider, or as a developing or already developed ab- 
 cess. An ulcer of the mouth of the womb, however, is a spread- 
 ing of that mucous lining of the neck, having an epithelium of 
 one layer of cells and glands, into such places of the conns which 
 
 Figure 14 — Spindle-Shaped Swelling of the Neck of the- 
 
 Womb. 
 
 are normally covered by an epithel of many layers (see page 9) 
 with no glands. These ulcers are dark red, abundantly sec- 
 reting points, the secretion being produced by abnormally cre- 
 ated glands. An experienced person may recognize them with- 
 out using instruments, as an examination proves the diseased 
 parts to be different to the touch than their healthy surround- 
 ings. 
 
 This is, however, not the only way, in which ulcers of the 
 
62 
 
 mouth of the womb are formed. On the contrary, more frequ- 
 ently than by swelling and bulging out of the mucous membrane 
 of the interior of the womb, the ulcers are the result of the 
 corrosive effect of the secretions from the neck channel, which 
 while flowing out produce their formation. 
 
 In a third form representing the most common cases, the 
 ulcers result from lacerations of the mouth of the womb at the 
 time of parturition. If during this act a tearing has occurred, the 
 torn tissue will not grow together, because of the actions of the 
 annular muscle fibres, which have been torn and will under 
 these circumstances, when contracting, roll up the lips of the 
 mouth of the womb in an outward direction : the ulcer is created, 
 ■eccording to the definition given above, because the mucous 
 membrane of the neck channel with its tender apithel and glands 
 now projects into the vagina. Only in exceptional cases the 
 tender surface of the neck channel thus turned outward and 
 exposed to all noxious substances coming from the vagina, will 
 be covered by an epithel of several layers, which would mean the 
 healing of the ulcers. 
 
 More frequently the surrounding muscular tissue participates, 
 irritated by the abundantly produced corrosive secretions of the 
 exposed glands in the ulcers : the muscular layers of the lips as 
 well as the neck grow thicker and thicker. Finally they project 
 into the vagina as blueish hard swellings and the mouth of the 
 womb is perceived between them as an irregular opening densely 
 covered with matter. At the same time the connecting tissues 
 shrink and more or less large groups of the glands (see page 11) 
 existing here in large numbers are tied off at their opening. Thus 
 little cavities are formed, which, as secretions do not stop, are 
 filled with mucus and enlarged so as to be easily perceptible to 
 the eye and the examining finger. They can be plainly seen as yel- 
 lowish, transparent, hard, little knots, the so-called "ovula Nab- 
 oti," and they can easily be felt by the woman herself in the 
 ragged outer mouth of the womb. When existing in great num- 
 bers and penetrating deep into the muscular walls such glandular 
 formations cause by pressure on the surrounding nerves a con- 
 tinuous feeling of heaviness and discomfort in the abdomen and 
 may compel the physician to remove the entire lips of the mouth 
 of the womb in order to effect a cure, which is otherwise im- 
 
63 
 
 possible; when near to the surface of the mucous membrane 
 they may singly or in groups extend the lining so as to finally 
 produce smaller or larger formations having the shape of the 
 Tiammer of a bell, the so-called "mucous polyps or tumors of the 
 womb" (see these), which projects into the interior of the 
 neck channel or even through the outer mouth of the womb into 
 the vagina. 
 
 The causes of these conditions are evident from the previ- 
 ous descriptions. Kegarding the germs entering from outward 
 through the vagina, we may add that, like in so many other in 
 flammations of the female generative organs, it is here again the 
 germ of gonorrhoea which takes a prominent position. The neck 
 channel is its most favorite seat and even if all symptoms of 
 acute inflammation have disappeared the gonococcus may be 
 found in this hiding place protected in the folds of the mucous 
 membrane and in the branches of the numerous glands, to the 
 greatest misfortune of the poor woman, as the microbes can only 
 be reached in this place with greatest difficulty and have here 
 ■every opportunity to spread. 
 
 Not near so dangerous and harmful are the diseases of the 
 mucous membrane of the neck channel resulting from chlorosis, 
 because they are not produced by germs of such dangerous 
 character, but by general impoverishment and faulty distribution 
 of the blood. 
 
 Symptoms — The symptoms and troubles vary greatly. The 
 discharges must be mentioned first. It has been previously 
 stated that those which are usually considered as resulting from 
 catarrh of the vagina are mostly brought about by diseases of 
 the mucous membrane of the womb. Here, consequently, the 
 source of the flow must be looked for. It is, however, not only 
 the mucous membrane of the womb itself, but also the surface 
 of the ulcers of the mouth of the womb, lying toward the vagina, 
 which sometimes furnish those profuse secretions. The dis- 
 charges, at first clear, transparent and slimy, gradually grow 
 turbid and more liquid, and finally mattery. Generally the flow 
 is uninterrupted, so that in spite of careful cleanliness the priv- 
 ate parts are continually wet and the hair of the pudenda co- 
 hering. In some cases the secretions are only intermittant; the 
 mucus having accumulated is suddenly discharged by con- 
 
64 
 
 tractions of the muscles of the uterus and of the walls of the vag- 
 ina, or by the pressure in the abdomen during coughing, sneez- 
 ing, lifting, etc. 
 
 Although in some cases the loss of sap is not inconsiderable^, 
 it is not the cause of "breaking down'" of so many woman suffer- 
 ing from discharges, as is commonly supposed. The loss of 
 substances intended for building up the body is too insignific- 
 ant as to be of great importance. It is the physical and mental 
 exhaustion arising from the continual sick feeling, loss of ap- 
 petite and troubles in digestion, being caused by the original, 
 disease, which produces the increasing weakness, and the prog- 
 ressing anseniia. Even if the vaginal injections, which are in- 
 dispensible in these cases, prove almost invariable of very ben- 
 eficial effects, it is nevertheless not primarily the restriction of" 
 discharges but the healing power of the injections upon the 
 source of the disease, which produces the imr^rovement in the 
 general feeling. 
 
 How many of the troubles have to be ascribed to existing- 
 diseases of the womb and how even the remotest organs react 
 upon these may be best perceived during the progressing cure. 
 Besides the feeling of internal heat and heaviness in the abdomen 
 and the troubles at urinating and emptying of the bowels — as. 
 they are found especially when the front and rear lips are thick- 
 ened — the dull pains in the back, troubles in digestion, head- 
 ache, hemicrany, ill humor and irritability are proved to be re- 
 sults of the catarrh of the womb, since they gradually disappear 
 with the former and promptly reappear when it grows worse. 
 
 An occurence sometimes very alarming is the bleeding after- 
 copulation. Among the people this is well known as a sign of 
 cancer of the womb (see growths of the womb) and it is oc- 
 casionally difficult to convince terrified ladies that such is not the- 
 case. The cause of bleeding is in such cases an ulcer of the 
 mouth of the womb, or mucous tumors projecting therefrom, as* 
 they often bleed so easily that even a slight touch of the finger 
 or instruments, and especially the vehement irritation during 
 intercourse produce excussion of blood. 
 
 Worse than pains and sorrows many women feel their being 
 condemned to be childless. The psychical gratification hoping- 
 to behold satisfaction is greatly depressed, since the ability of' 
 
Ho 
 
 Conception though not impossible, is considerably impaired. 
 The following will explain this fact: The mucus secreted more 
 or less abundantly creates a very unfavorable condition for the 
 male sperm, since its chemical quality is changed and it takes a 
 corrosive character. Thus the sperm, which can only reach 
 the impregnable ovulum after having overcome this obstacle, 
 will be paralysed or even entirely killed and is easily carried to 
 the outside again by the discharged secretions. If impregnation 
 occurs nevertheless it is a sign that the morbid changes have 
 not yet progressed too far and that the spermazoids were able to 
 overcome also these unfavorable local conditions by their great 
 vitality. 
 
 Prevention — We shall discuss the means for prevention in 
 detail in the chapter on catarrh of the womb, since they are 
 alike in both diseases. 
 
 Treatment — The treatment of the above described condi- 
 tions must for the greater part be assigned to the physician, but 
 may be assisted very much by the well instructed patient her- 
 self. Only the catarrh of the neck of the womb with chlorotic 
 girls is an exception. Here it would be not only useless, but 
 even harmful to treat it locally, since benefit can only be expect- 
 ed from a treatment in which the evil is attacked at its root. 
 This will be found in this case not in the womb, but in the con- 
 tinually increasing impoverishment of the blood and in the in- 
 sufficient nutrition of the different organs of the body and es- 
 pecially of the womb. If the blood is restored to its normal 
 quality the catarrh and the discharges will disappear as well 
 as headache, fatigue, palpitation of the heart, loss of appetite, 
 constipation, etc., arising from chlorosis. Therefore this must 
 be attacked. Healthy food, fresh air, healthy dry appartments, 
 and moderate exercise are above all indispensible prerequisites 
 for the cure of this disease. A sojourn in healthy forest regions, 
 if possible, is desirable for those who live in cities. JVIany a 
 young girl will regain there her red, healthy cheeks without 
 taking any medicine. Milk given in all forms, pure or with an 
 addition of sugar or salt, of coffee or tea, as soup or in any other 
 way, is especially recommended as food, also meat, eggs, poultry, 
 etc. The milk should always be boiled before it is taken if it is 
 not from a cow which is known to be absolutely healthy. The 
 
66 
 
 patient ought to abstain from all abnormal things, such as vin- 
 egar, pickles, and highly seasoned food. Exercise in the open 
 air is necessary, but must be limited and ought not to be over- 
 done to such a degree as will cause exhaustion, so that in the be- 
 ginning of the treatment a walk of a few hundred steps in fresh 
 air may be considered sufficient in serious cases. Dancing and 
 wearing tight fitting corsets must be avoided. Warm baths in 
 pure water or rather with an addition of five to six pounds of 
 salt, lasting about fifteen or twenty minutes two or three times 
 a week are often of great advantage. They should be taken in a 
 warm room and be regulated in number and length according to 
 the feeling of the patient. Sea baths or cold water Mths are to 
 be avoided in severe cases and may only be tried with precaution 
 when the general health is improved. 
 
 Among the medicines used internally iron takes the first 
 place. Many different preparations have been adopted to make 
 this remedy most acceptable to the body, from the simple pul- 
 verized metal to the most complicated combinations. All prov- 
 ed unsatisfactory, however, as is evident from the great number 
 and variety of the advertised preparations. 
 
 Much indeed is required of a good, ideal iron preparation ! 
 It must be agreeable to the body and must easily be absorbed 
 into the blood, it must be entirely harmless to the teeth, stom- 
 ach and bowels, so that it may be taken for a long time without 
 any injurious effects. Such an iron preparation had not been 
 found until recently. All forms were very injurious to the teeth, 
 stomach and bowels; appetite and digestion were impaired 
 thereby as the readers will have experienced themselves. In or- 
 der to avoid these annoyances as much as possible and to pre- 
 vent the medicines to come in contact with the walls of the 
 stomach and intestines in a concentrated form, it is the rule to 
 take these preparations after meals so as to have them diluted 
 by the food as much as possible. It is, therefore, a happy oc- 
 currence that lately a preparation has been found, called "San- 
 guinol," which is not only completely harmless to the mucous 
 membranes, but is also easily absorbed into the blood. It has 
 great advantages over all other preparations, as it possesses none 
 of their faults. It is an iron preparation, but at the same time the 
 most perfect tonic. Instead of affecting the stomach and im- 
 
67 
 
 pairing the digestion it has a beneficial influence upon the func- 
 tions of this organ. After taking it for a few days a better 
 appetite will be plainly noticed, which often grows enormously. 
 The former pallor of the cheeks is substituted by a red tinge. In 
 like manner also the other troubles disappear. In order to at- 
 tain this the medicine must be brought in direct contact with 
 the mucous membrane of the stomach and must, therefore, be 
 taken not after but about half an hour or three-quarters of an 
 hour before meals. It may be given without hesitation even to 
 small children and infants, and will plainly show here also its 
 blood creating and appetizing effects. Sanguinol being free 
 from all disagreeable and injurious additions and beneficial to 
 the weakest stomach, it may be taken from one-half or one tea- 
 spoonful to one big tablespoonful according to the age of the 
 person. But in order to obtain real advantage in cases of blood 
 diseases, it will be necessary to take it for as long a time as 
 all other iron preparation. Further information can be found 
 in the appendix. (Prescription 29.) 
 
 In cases of catarrh of the neck of the womb arising from 
 want of blood the assistance of a physician is, therefore, gener- 
 ally not necessary, but the most scrupulous cleanliness must be 
 practiced. A luke-warm hip bath taken daily, or several times 
 a week, and a thorough cleansing of the external parts and the 
 hair of the pudenda from adhering particles of mucus will not 
 only help to prevent more serious consequences, but will also 
 favor general health. If there are, however, more aggravating 
 symptoms, especially pains and cramps during the time of men- 
 struation, or if the catarrh continues in a higher degree after 
 chlorosis has ceased, a local treatment must be applied as in the 
 other forms. 
 
 This latter must begin above all with the removal of all sec- 
 retions, as they do not only irritate but also favor the settlement 
 and development of all kinds of microbes. This is to be done 
 by the syringe, which must be used every day without excep- 
 tion, according to the circumstances even twice or three times a 
 day. The injections are to be taken in a lying position, observ- 
 ing the rules on pages 32 and 33. 
 
 Simply pure water without an addition of medicines will 
 hardly suffice here, as these injections are not taken merely for 
 
the sake of cleanliness or for the prevention of diseases, but for 
 the purpose of healing existing inflammations. Against tough 
 thick, sticky, non-mattery mucus there is no better remedy than 
 a solution of purified soda about half a tablespoonful to one 
 quart of water, luke-warm, once or twice a day, with or without 
 an injection of pure water afterwards. This solves the tough 
 masses, disinfects, even if but faintly, the vagina and is cheap- 
 advantages which justify the great demand which soda has for 
 this purpose. If there are greater troubles and the discharges 
 are corrosive or purulent, a sign that a worse inflammation has 
 settled in the interior of the womb. Vaginol is always preferable 
 to soda, being a much stronger yet not a poisonous antiseptic, 
 which can be used for a long time without the least danger and 
 with the best results. Injections with an addition of sulphate of 
 zinc, alum, tannic acid, etc., are also beneficial, according to the 
 circumstances. (See Diseases of the Vagina.) 
 
 Although it is a fact that the injected liquid can only reach 
 the outer mouth of the womb and at the most, when this is- 
 wider or ragged, the lower part of the affected mucous mem- 
 brane of the neck channel, yet the results are not wanting, since 
 by the removal of the products of the disease the irritation is 
 decreased and the support of the inflammation taken away. 
 
 If there are no indications of improvement at this treatment 
 or if the inflammation is from its beginning of a serious nature, 
 as in the inflammation by gonorrhoea, the assistance of a physi- 
 cian is indispensible, as the affected place itself must be attack- 
 ed with stronger medicines. 
 
 If the catarrh is located deeply and its place hidden in the 
 neck of the womb, and if the products of the disease are preven- 
 ted from flowing out on account of the narrowness of the outer 
 mouth of the womb, the mere artificial widening of the narrow 
 passage, which may be done by a very small operation, frequent- 
 ly affords the desired relief, and with careful injections the cure 
 may be attained. 
 
 But if the changes in the mucous membrane are of gross 
 nature, there being ulcers of the mouth of the womb or numer- 
 ous "ovula Naboti" the cure cannot be expected so easily. The 
 ulcers resisting persistently to the injections must be scraped 
 off with a sharp instrument or burned out with a red hot iron. 
 
(>9 
 
 They are healed in this manner in one or two weeks. The ovula 
 Naboti. which always renew the irritation, must be opened and 
 emptied by a sharp pointed knife, if not too numerous. When 
 they exist in vast numbers and deeper in the muscular layers, 
 the best and safest cure will be attained by amputating the lips. 
 In order to reach the mucous membrane located more in the 
 interior and to bring the medicines in contact with it, uterine 
 sounds, i. e. long thin flexible sticks of metal or wood especially 
 prepared for this purpose, covered at the top with .cotton and 
 dipped into a solution, are applied. Before this is done the 
 mucus covering the lining must be carefully removed with an 
 instrument of the same kind as the one just described. In this 
 manner pyroligneous and nitric acid, carbolic acid, chloride of 
 zinc and other strong corrosives are easily taken to their proper 
 place and brought in close contact with any part of the mucous 
 .membrane. 
 
 Figure 15 — Uterine Sound. 
 
 Yet even this fails occasionally, although the applied chem- 
 ical substances may be used very strong. Then it is necessary 
 to scrape away the entire mucous membrane and at proper care 
 the unhealthy lining is soon replaced by a new and healthy one. 
 
 The treatment of the lacerations of the mouth of the womb 
 acquired during delivery has been of late a subject of much dis- 
 cussion. Formerly hardly any attention was paid to them, and 
 rarely or never an operation performed for their cure; but now 
 most physicians consider them to be the source of nearly all 
 female troubles in existence and strive to heal them without ex- 
 ception. It is true that disturbances of the circulation of the 
 blood and its consequences are caused by the tearing of blood 
 vessels; it is true that the mucous membrane of the neck chan- 
 nel, thus brought into continual contact with the discharges ad- 
 hering to the walls of the vagina, is always exposed to renewed 
 
70 
 
 infection; it is true that, as the latest observations have proved, 
 even as the worst consequence of continual irritation (see Can- 
 cer of the Womb) a cancer may result sometimes, and yet it is 
 incorrect to remove by operation every one even the smallest 
 laceration of the womb, which may be found at examination. 
 For quite a few remain without causing any trouble or produc- 
 ing any discharges. But if it is ascertained that from these 
 lacerations the protraction of the inflammation arises and if it 
 is further ascertained that the troubles will not otherwise dis- 
 appear, then this comparatively small operation, which can be 
 performed without endangering life in the least should not be 
 neglected, as is often done by timorous women. Before it is 
 performed, however, care must be taken that the mucous mem- 
 brane of the neck is cured, since the original narrow opening is 
 restored to the mouth of the womb by this operation. The mor- 
 bid secretions might accumulate there and easily develop con- 
 ditions as they have been described above, when inflammation 
 exists in the neck of the womb and the passage to the vagina is 
 too narrow for the flowing out of thickish secretions. The 
 troubles instead of disappearing would increase. In order to 
 avoid such failures, which happen not rarely, the existing catarrh 
 should be removed as far as possible, and the operation should 
 conclude the treatment, or at the time of the operation the dis- 
 eased lining must be scraped out and provisions made for an out- 
 let sufficiently wide for the passage of the secretions. 
 
Catarrh of the Womb. 
 
 If the inflammation extends beyond the inner mouth of the 
 womb, i. e. the point where the mucous membrane of the neck 
 channel becomes the lining of the cavity, so that the latter is 
 also affected, then we have what is called "catarrh of the womb." 
 Under normal conditions the inner mouth of the womb is a 
 gate which the microbes can pass only with difficulty when 
 there is no pregnancy or menstruation. They usually stop there 
 for a while and mostly proceed upwards under the above named 
 favorable circumstances. The first symptoms of the diseases of 
 the cavity of the womb are, therefore, almost always in connec- 
 tion with pregnancy, birth, confinement and the time of men- 
 struation. 
 
 The forms of the inflammation are classified anatomically 
 into three groups according to the disease affecting principally the 
 glands, or the interlying and connecting tissue, or both at the 
 same time. For the treatment of the disease — and this is of 
 particular interest to my readers — the classification of an acute 
 and chronic form is more important and more easily understood. 
 We shall, therefore, describe them in this respect. In both the 
 acute and the chronic forms all three anatomical forms may 
 exist. 
 
 The acute form of inflammation of the mucous membrane of 
 the womb is always caused by the entering of microbes into the 
 cavity. But the fact previously mentioned that most diseases 
 follow pregnancy, confinement or menstruation, shows that the 
 danger of these little germs entering is not always the same, 
 
n 
 
 Generally it is not very great. The tough transparent slime 
 which is secreted in a normal condition, although in very small 
 quantity, possesses a disinfecting power strong enough to keep 
 the cavity of the womb entirely free from pathological microbes. 
 But with the appearance of the monthly flow these conditions 
 are changed. The entire mucous membrane becomes peculiarly 
 irritated, it swells, gets richer in blood and juice, and is more 
 sensitive to the touch of the head of the sound. The en- 
 trance at the inner mouth of the womb is loosened. An abund- 
 ance of blood leaves the vessels of the lining, carries off the pro- 
 tecting mucous covering, and in flowing out practically forms a 
 road on which the pathological germs may proceed. If these 
 latter have gained a foot-hold in the neck of the womb, as for 
 instance after infection by gonorrhoea, the danger of an inflam- 
 mation of the lining of the cavity is still greater and its particip- 
 ation follows soon. 
 
 Germs which were carried by the blood into the womb, as 
 for instance during scarlet fever, measles, diphtheria, typhoid 
 fever, smallpox, cholera and other diseases accompanied by fever, 
 have more seldom a chance there to develop their pernicious 
 work. This latter usually will happen only in cas^s where the 
 organ has been affected before. How this is meant will be 
 readily seen from the following : At our age the advance of med- 
 ical science has taught us that microbes are carried to all parts 
 of the body by the blood, even in a healthy condition. The or- 
 gans being in a normal state, possess the power of rendering 
 them harmless. But the existing of disease robs them of their 
 germ -killing power, or diminishes it to such an extent, that 
 the intruder becomes victorious. The microbes settle and grow 
 and begin their destructive work: the already existing in- 
 flammation grows worse and accordingly the troubles increase. 
 This theory can be best illustrated from the fact that even a 
 common cold settles at first and most readily in such a part, 
 which has already been diseased before, in the so-called "weak 
 spot" of the body. 
 
 The most pitiable of all cases of catarrh of the womb are 
 those in which the infection was caused by the hand or the 
 instruments of an inexperienced person. It is, therefore, quite 
 important that these are thoroughly disinfected before being in- 
 
_J3_ 
 
 troduced into the cavity of the womb. For although the un- 
 injured mucous lining of the womb is a great safe-guard against 
 microbes which may unfortunately be introduced, as described 
 in the first chapter, yet the most minute injury as it may occur 
 by any use of instruments is sufficient to serve as an entrance into 
 the blood and lymph vessels. Much greater is the danger after 
 birth. Part of the entire cavity, where the placenta was inter- 
 grown with the muscular walls (see figure 12) forms, after the 
 expulsion of the after-birth, a large sore surface, which is now 
 quite unprotected by a lining, but only covered by the adhering 
 coagulated blood and thus offers the most favorable opportunity 
 for the development and spreading of microbes. Child-bed fever, 
 which may, however, arise also from many other places besides 
 from the interior of the womb, for instance from lacerations of the 
 vagina, the outer parts, etc., is justly dreaded by all women as it 
 is always a sign that pathological germs have settled somewhere, 
 which is the more dangerous the more to the interior their set- 
 tlement may be. The infections proceeding from the interior 
 of the womb itself progress sometimes so rapidly that on account 
 of a permeation of the blood, with infectuous substances caus- 
 ing blood poisoning, death occurs within twenty -four or forty - 
 eight hours, even before the microbes had time to create an in- 
 significant inflammation at the place of entrance. The numer- 
 ous opened blood vessels, which served previously as a commun- 
 ication between mother and child (see page 53) just closed, grant 
 the best opportunity to the pathological germs to penetrate into 
 the vessel and to spread with the blood immediately all over the 
 body so that their fulminant activity may be readily understood. 
 The chronic in comparison to the acute form does not al- 
 ways arise from infection. The causes may be various: partly 
 remnants of the acute, partly consequences of dislocations and 
 growths of the womb. Inflammation may also result from the 
 natural functions of the uterus, child birth and confinement, in 
 the following manner : After the expulsion of the after birth the 
 womb contracts tightly and begins to decrease gradually in size. 
 The expanded and thickened mucous membrane rent consider- 
 ably at the place where formerly the placenta was intergrown 
 with the muscular walls, partakes in this process of retrogression 
 of the entire organ. All superfluous particles originating from 
 
74 
 
 pregnancy, especially remnants of the after birth, which have 
 been retained, are finally expelled and discharged. If this is 
 not done, so that larger or smaller pieces remain, they are grad- 
 ually overgrown by the mucous membrane forming again on 
 the sore places. In this case the interior of the womb will soon 
 appear uneven and rugged instead of even and smooth. (See 
 Tumors of the Mucous Membrane of the Womb.) The lining- 
 on those places, defectively and abnormally reformed, becomes 
 in the future a source of many sufferings: it is the cause of those 
 profuse secretions and abundant losses of blood during menstru- 
 ation as they are found so often after child-birth; it is the cause 
 of the continuous irritation which constantly increases the ca- 
 tarrh of the mucous membrane, and in consequence of this the 
 mattery discharges. However, the retention of particles of the 
 after-birth is not so frequent in cases of mature birth than in 
 those of premature. Indeed it is almost unexceptionally so in 
 the latter instance. It is, therefore, correct to say, with refer- 
 ence to the consequences, "It is better to have several matured 
 births than one premature.*' In many cases having such evil 
 results the women themselves are to blame. Those who have 
 been delivered too soon, having no annoyances and thus under- 
 estimating the danger, will hardly take to bed. especially if the 
 miscarriage occurs within the first few months of pregnancy, 
 or they will leave their bed too soon, not considering themselves 
 in 'confinement,' though such is really the case. 
 
 Catarrh of the womb, in consequence of flexions forward,, 
 backward, to the right and to the left, furthermore prolapsus^ 
 descend of the womb and all those abnormities, which produce 
 a displacement of the uterus in any direction, as for instance 
 tumors of the muscular walls, of the surrounding, etc., develops 
 more gradually and slowly. What has been created in the first 
 case by pathological microbes, in the second by retained partic- 
 les of the after-birth is here caused by the disturbance of the 
 circulation of the blood. Thus the refuse or venal blood which is 
 easier stopped than the arterial, is stemmed back and produces in 
 this manner the same chronic congestion with swelling and irrit- 
 ation of the mucous membrane, as we have seen before, in which 
 the muscular walls fjartake from the beginning under these cir- 
 cumstances. 
 
to 
 
 In like manner chronic congestion of all parts of the womb 
 and its consequences result from other ailments, such as heart 
 diseases, chronic liver or lung troubles, etc., which produce dis- 
 turbances in the circulation throughout the body and especially 
 in the abdomen. These organs should, therefore, be carefully 
 examined in all cases of long standing and exhausting monthly 
 bleedings. 
 
 In all these enumerated congestive but in the beginning 
 non-infective catarrhs of the lining of the womb, microbes will 
 also settle sooner or later in the mucous membrane so that, if 
 there is no remedy sought, both causes combining will produce 
 an ever increasing suffering. 
 
 Symptoms — The symptoms of the acute inflammation of the 
 mucous membrane of the womb vary greatly according to the 
 cause of their origin. There is nearly always fever in the begin- 
 ning and a sensation of heat and burning, of soreness, heaviness 
 and bearing down in the abdomen. While the womb when 
 pressed between the hands during examination (see Displace- 
 ments of the Womb) is only slightly sensible, the pains are exceed- 
 ingly severe when the mucous membrane is touched by the uterine 
 sound. The discharges are abundant mucously turbid or mat- 
 tery and contain the germs of the disease, which may be occa- 
 sionally found by microscopic examination. If the inflammation 
 progresses the entire womb becomes sensitive and swells. The 
 stools are retained and the bladder shows a slight irritation 
 causing a frequent desire to urinate. Great sensitiveness of 
 the abdomen indicates a participation of the peritoneum of 
 the pelvis (see page 13). The pains in the lower part of the 
 back extend upwards between the shoulder blades. The appetite 
 is lost, the digestion poor and continuous headache troubles the 
 patient. If the beginning of the disease occurs during menstru- 
 ation the flow of blood may suddenly cease, the cessation being, 
 however, not the cause but the consequence of the disease. Under 
 proper treatment the troubles will gradually decrease and finally 
 disappear entirely, provided a change from the acute to the 
 chronic form of the disease can be avoided. 
 
 The chronic catarrh has three principal symptoms: Varia- 
 tions and irregularities of menstruation, discharges and pains. 
 The large quantity of blood in the uterus produced by conges- 
 
76 
 
 lion and inflammation, which is greatly increased during the 
 monthly rush, causes an over-abundant filling of the blood 
 vessels in the mucous membrane, and in this manner a protrac- 
 tion and increasing of the secretions of blood. The latter, nor- 
 mally thin and liquid, coagulates in the womb and while for- 
 merly it could easily escape through the narrow inner and outer, 
 month, it is now forcibly pressed in lumps through these gates 
 by cramplike contractions of the muscular walls. Intelligent 
 women will often have noticed after such spells the discharged 
 coagulated pieces. Thus menstruation, becomes painful and 
 lasts now from eight to fourteen days instead of from three to 
 five days. In the meantime also there are often traces of blood 
 in the discharges. The worst cases, however, in which the pro- 
 tracted flowing continues with only brief interruptions, and the 
 time of the real menstruation is only indicated by a more pro- 
 fuse flow, occur almost exclusively when after premature or 
 mature birth smaller or larger particles of the after-birth are re- 
 tained, or when the circulation of the blood in the entire body 
 is greatly disturbed! as We have seen in consequence of diseases 
 of the heart, liver, etc. 
 
 The statement often made that particles of skin of larger 
 or smaller size are always expelled is seldom correct, since the 
 supposed bits of skin are mostly coagulated blood, which is dis- 
 charged in a flattened shape. But it really does happen that in 
 some rare instances parts of the surface of the mucous membrane 
 are discharged during every menstruation under labor-like pains. 
 If. however, this occurs only once it must create suspicion of an 
 abortion, which has taken place in one of the first months of preg- 
 nancy. Of this only a microscopical test can give absolute proof. 
 
 Less injurious but just as characteristic of the chronic ca- 
 tarrh of the womb is the passing of secretions. 
 
 Many attempts have been made to ascertain the quantity 
 and quality of the normal secretions of the mucous membrane 
 of the womb and various means and methods have been applied. 
 Kuestner, of Breslau, Germany, has succeeded in proving posit- 
 ively that in a normal healthy condition only such a quantity of 
 secretions is produced by the lining of the womb as is necessary 
 to keep the inner surface moist and lubricous. Ths same result 
 had baen obtained b >fore, although not so precisely, by B. S. 
 
It 
 
 Schulze, of Jena, Germany, by placing a test tampon (see foot 
 note > in front of the outer mouth of the womb of healthy wo- 
 men. When they were removed in a healthy condition of the 
 woman no accumulation of mucus could be noticed on their sur- 
 face, a sign that no superfluous secretions were discharged. If 
 catarrh of the womb exists these test tampons, however, are cov- 
 ered with secretions, which is different according to the kind 
 and intensity of the inflammation. For this reason they are 
 frequently applied to define and ascertain the form of the t-xist- 
 isting disease, as the quantity and quality of the covering mucus, 
 being ample or scant, glassy or pussy, will allow to draw rather 
 accurate conclusions. 
 
 The existence of a chronic catarrh of the womb is more 
 readily recognized by the physician by using the uterine sound. 
 In the acute as well as in the chronic forms, though less in the 
 latter, the mucous membrane is sensitive and pains when touch- 
 ed with the instrument. The cavity of tlie womb is extended 
 and offers an unusually large space to the introduced head of 
 the sound. The soft spongy feeling, when sounding, on ac- 
 count of the thickening of the mucous membrane and the bleed- 
 ing easily produced prove the fact. 
 
 The general symptoms are similar to those of the catarrh of 
 the neck of the womb. Headache, especially at the time of men- 
 struation, now in the fore-head, then at the crown of the head. 
 now in the back of the head, then only in one half of the head, 
 pains in the stomach, loss of appetite, pains in the vicinity of 
 the navel, pains between the shoulder blades, pains in the back, 
 general fatigue, constipation and frequent desire to urinate, all 
 are found, here weaker there stronger, and appear at the same 
 degree of inflammation the more intensely the more the body 
 has been weakened and the greater the general nervousness. 
 
 Another consequence of catarrh of the womb is sterility. 
 We must explain this fact more fully, as we shall have to refer 
 to it frequently because catarrh of the mucous membrane, which 
 almost always develops, is the reason why various other abnorm- 
 
 Foot Note. — By test tampon we understand a common tampon (see 
 next chapter) without string, which is placed and replaced by a phvsician 
 and remains in front of the mouth of the womb for twentv-four hours. 
 
78 
 
 ities having in themselves no relation to sterility, for instance 
 flexions and tumors, etc. result in this malady. Under such cir- 
 cumstances it is not so much the difficulty for the male sperm to 
 enter into the womb, nor only the injurious influence of the 
 noxious secretions upon their capability of moving, but a third 
 reason is here of greatest importance: the increasing diseased 
 condition of the bed into which the ovulum is to lodge. The 
 mucous membrane of the womb is unable in its changed condi- 
 tion of developing the fertilized female germ, and thus perishes 
 like a seed which has been planted on a rock. The fact, which 
 cannot be denied, that some women are easily and frequently 
 impregnated in spite of the catarrh, does not contradict this 
 statement, for it does not take long under these circumstances 
 until abortion or premature birth occurs. The reason is obvious: 
 As usually in case of existing catarrh, birth has taken place prev- 
 iously, the entrance of the womb is wide and large. The male sperm 
 easily passes through it, the ovulum is fertilized, settles and be- 
 gins to grow. But the mucous membrane of the womb, which 
 is not yet inflammed too much, is like a rocky soil which has 
 some good ground. The attempt is made to shelter the germ, 
 but it usually fails. The seed takes root and sprouts, but must 
 perish as the soil is unfit for a fully developed plant. There is, 
 however, this difference: while in nature everything is ended 
 with the dying off of the plant, the symptoms of inflammation 
 grow more serious and the troubles increase at every abortion or 
 premature birth, which may occur. 
 
 Prevention — It is not an easy matter to evade the origin 
 of this disease. On the one hand it is not within the power of 
 the wife to prevent infection, as it results for instance from gon- 
 orrhoea, since she must rely in this regard entirely upon the 
 honesty of her husband; on the other hand on account of the 
 various social circumstances, it is often impossible for her to 
 care for herself properly during the most dangerous times: the 
 time of menstruation and confinement. And yet much can be 
 done if health is regarded of greater importance than amusement 
 and debauchery. It must be remembered that the time of men- 
 struation is to women always a crisis, a time in which the body 
 compels the mind to think not only of business and amusement, 
 but also of its own requirements. Then rest and care of the 
 
• 79 
 
 body are necessary and if they are not granted it will demand 
 them by pains. By rest we do not mean, however, rest in bed, 
 but abstaining from excessive physical exertions, as they are 
 connected with dancing, horseback riding, excursions, extended 
 foot or bicycle tours, playing ball, skating, etc. An intelligent 
 conversation or reading a good novel at the time of a festival 
 will especially on the following morning, prove to be more sat- 
 isfactory than the festival itself could have been, especially when 
 we consider that a good service has thus been rendered to health. 
 Besides, under still other disadvantages the indispensible care and 
 cleanliness can not be practiced. Even if the best preparations 
 are made, all bandages will loosen and the dust rising every- 
 where will easily find its way to the blood, which usually flows 
 more profusely under such circumstances. 
 
 Figure 16 — Bandage. 
 
 But even if the described harmful exercises are avoided a 
 decomposition caused by the air coming in contact with the sec- 
 xetions must always be expected. In order to avoid this and to 
 render the issuing blood immediately harmless the bandages, 
 which are almost universally used, are of excellent service. 
 They are of long pads made of dry, soft, absorbent, eventually 
 antiseptic material and are attached to the corset and secured 
 by bandage or belt in such a manner that they are pressed 
 against the genitals and constantly remain in close contact with 
 them. By absorbing the blood immediately they keep the priv- 
 ate parts clean as far as it is possible; the staining of tighs, 
 -chemise and drawers is entirely avoided in this manner and great 
 danger averted as decomposition of the blood is prevented. 
 
 Other precautions may also be taken. In spite of the most 
 scrupulous care, some little lumps and crusts will adhere to the 
 hair of the pudenda. These must be removed by washing with 
 
80 
 
 warm water in a warm room once a day. A certain superstition 
 for many years prevalent among the occidental nations, teaches 
 that it is improper and even harmful to touch the genitals or in 
 any manner manipulate with them during menstruation. Even 
 a change of underclothing is not permitted. Horrible stories 
 are told in legends, illustrating the results of disobeying these 
 rules. Happily, however, opposition against this superstition 
 arises everywhere so that the absurdity may soon be entirely 
 done away with. Among the oriental nations the rules for clean- 
 liness have always been different and better, as the hot climate 
 in which they live, alone would not have permitted a wearing of 
 blood stained underclothing on account of the disagreeable odor 
 they would unavoidably create. Here the women take baths 
 and change clothes as often as they wish taking, of course, the 
 necessary precautions. If a" woman complains that menstruation 
 which has just ceased, reappears every time she changes clothes 
 she may be right, But if she is careful not to take the clothes 
 directly from the cloth press, but to warm them to the temper- 
 ature of the body before putting them on, and to dress in a warm 
 room she will find that this annoyance will not occur any more. 
 Vaginal injections may be done aw T ay with during menstruation 
 by a healthy woman, only in case the blood should be odorous 
 and corrosive, or greatly mixed with mucus they should never- 
 theless be taken with boiled warm water, or antiseptic solutions, 
 as for instance Vaginol, etc. 
 
 In the third place the bladder and the rectum must be 
 frequently emptied. As we shall see later, the filling up of' 
 these organs has a great influence upon the location and condi- 
 tions of the womb and since this is more liable to react upon 
 eventual noxious influences at the time of menstruation when 
 the tissues have an abundance of blood, than during the mean- 
 time ladies should rather evade any cause which might produce 
 a disease by following this advice. 
 
 It is obvious that copulation must cease during the time of 
 the menstrual flow and it is not necessary to describe its harm- 
 fulness. But it seems sufficiently important to me to call once 
 more the attention to the danger which lies in the action of so 
 many girls and woman who for some reason try to produce men- 
 struation earlier than it should come, or to induce it when it 
 
• 81 
 
 fails to come. Hot and cold water injections, foot-baths in near- 
 ly boiling water or with an addition of mustard and chemicals, 
 hot hip-baths and similar manipulations frequently hasten the 
 appearance of menstruation, if there is no other reason for its 
 non-appearance, but they will not do any good (see Weakness 
 or Absence of Menstruation), or at least very seldom if there is 
 really a suspected impregnation. Such means may have, how- 
 ever, serious results in the future by producing inflammation of 
 the abdomen and should, therefore, be avoided. 
 
 Treatment — The treatment of the catarrh of the womb 
 generally requires some length of time. In the acute form, 
 cleanliness, rest, ice, opium and frequent emptying of bladder 
 and rectum will suffice. Cleanliness, in so far as all secretions 
 should be removed once or twice a day by lukewarm disinfecting 
 injections (see Diseases of the Vagina). By rest we mean rest 
 in bed. It does not only heal but also mitigates the pains, es- 
 pecially if a light ice bag is allowed to develop its salubrious 
 effect through the walls of the abdomen upon the womb in the 
 manner previously described. Opium three times a day in form 
 of a tincture, from ten to twenty drops, reduces the activity of 
 the bowels and has a quieting effect, but is liable to produce 
 constipation. It is, therefore, better, in order to avoid the latter 
 annoyance, to take the opium in form of pills or suppositories 
 in connection with extract of belladonna and hyoscyum three 
 times a day (prescription 30), one or two pills at a time intro- 
 duced as far up into the rectum as is possible, so that they may 
 act directly at the place of the disease without affecting the 
 other bowels. 
 
 In order to avoid a greater accumulation of excrements it is 
 advisable to partake only of such food as will leave comparativ- 
 ely little indigestible substances, such as milk, broth, fried meat, 
 eggs, fresh vegetables, etc. 
 
 Even without medical treatment most cases will heal nicely 
 if these directions are followed carefully and exactly. Neverthe- 
 less in serious cases it is advisable to consult a physician, who 
 can afford further relief and accelerate the cure by taking other 
 steps, which may be necessary, at the right moment. 
 
 In the chronic form these means generally will not suffice. 
 It is true the troubles may also in this case be much relieved by 
 
82 
 
 simple treatment with medicines. But even if the discharges are- 
 restricted by frequent injections and the abundant menstrual flow 
 is checked by taking fluid extract of hydrastis or fluid extract of 
 ergot (prescription 31), the latter eventually combined with tinc- 
 ture of cinnamon, the suffering is thus reduced, the disease, how- 
 ever, is not yet cured. The same is true of all those patent med- 
 icines which are claimed to cure nearly all kinds of female 
 troubles, even a falling of the womb. Although this is a non- 
 sense, they have sometimes a beneficial effect if they are used 
 against a profuse discharge. This is to be explained thus: Since 
 in the state of a chronic catarrh the cavity of the womb is ex- 
 panded, as we have seen before, the mucous membrane is wider 
 and larger, and offers, therefore, a better chance to the glands, 
 to produce an abundance of secretions. But as soon as the 
 muscular walls of the womb contract, the space of the cavity is 
 reduced, the blood vessels in the lining grow smaller and the 
 glands are checked in their activity : the secretions get less and 
 the woman feels better. Everything that keeps the womb in a 
 continuous contraction (see Weakness or Absence of Menstru- 
 ation) must have the same effect, and in this manner patent 
 medicines containing such a substance, as for instance oil 
 of savin in Dr. Pierce's Favorite Prescription, work. Accord- 
 ing to an analysis by Dr. Hagen in Germany this preparation 
 is made as shown in prescription 32. 
 
 The mucous membrane itself must be attacked by the 
 physician's hand. There are different ways leading to the 
 same goal. The most lenient but also the most protracted 
 is by Schulze's uterine injections. In these injections the 
 tube, which is especially constructed for that purpose, is not 
 as usually introduced into the vagina but into the cavity of the 
 womb; the injected liquid while running out again takes all the 
 products of the disease along. If the mouth of the womb is 
 wide and broad enough on account of preceding births to allow 
 the instrument to pass, the injections may be commenced with- 
 out further preparations, and can be administered within a few 
 minutes. If the mouth of the womb is too narrow, however, as- 
 is usually the case with those who have not yet given birth to a 
 child, it must be widened at first. This, may be done gradually 
 and without pains by laminaria sticks. These are little hard 
 
83 
 
 sticks about two inches in length, which absorb the moisture as 
 soon as they come into moist surroundings and swell quickly. 
 Twenty-four hours after they have been placed into the neck of 
 the womb they have increased greatly in thickness and the chan- 
 nel is sufficiently expanded to render these injections possible. 
 If they are taken daily, thirty or thirty-five, even less, will 
 generally suffice to cure the catarrh. The general symptoms, as 
 headache, hemicrany, pains in the stomach, back, etc., usually 
 disappear much sooner. But as the womb generally contracts 
 during the course of the treatment, it frequently happens that the 
 neck-channel grows too narrow again and must be widened anew. 
 This is often very painful and may be avoided by filling the 
 womb, especially during the first days, with gauzy bandage. It 
 is more troublesome for the physician, but does not only keep 
 
 
 Figure 17 — Scoop. 
 
 the channel expanded as desired, but also greatly speeds the 
 cure. 
 
 Another method is to apply caustics ; it is easier done but 
 more dangerous and painful. The mucous membrane is des- 
 troyed by the medicine and scales off like a wound after burn- 
 ing. The chemicals may be applied in various manners. Sounds 
 covered with cotton at the head are dipped into a caustic liquid 
 and then introduced, or the caustics are injected into the cavity 
 of the womb by a syringe especially constructed for this pur- 
 pose, or they are mixed with cocoa butter and inserted as little 
 sticks, which melt at the temperature of the body. Such treat- 
 ments are given but once or twice a week and are often succeed- 
 ed by severe colics and cramps resulting from violent painful 
 contractions of the womb. 
 
 To obtain the same effect, i. e. the removal of the mucous 
 membrane, it is more advisable to scrape the cavity of the womb 
 by a scoop, a spoonshaped metal instrument whose edges are 
 sharp. With this it is possible to take away the entire 
 diseased lining down to the muscular walls. Since the fundus 
 

 84 
 
 (see figure 8) of the glands, however, extends into the latter, 
 it remains and starts the regeneration of the mucous membrane 
 so that after two or three weeks the cavity of the womb is cov- 
 ered again by a new healthy lining. Only a few days rest in bed 
 are necessary after the operation which is entirely without any 
 danger, under normal circumstances. The further treatment is 
 very simple and consists only of vaginal injections. Narcosis 
 by ether or chloroform is not always necessary, as the operation 
 is not very painful. It must only be used with sensitive and 
 nervous women, but may be applied in any case. 
 
 Relapses, i. e. the recurrence of the disease is much more 
 seldom after this method than after the former. But even here it 
 may happen that the operation must be repeated once or twice 
 to attain a satisfactory result. Generally, however, there is a 
 quick and lasting cure. The discharges cease, menstruation be- 
 comes regular and of normal quantity and quality, and pregnan- 
 cy occurring now lasts to its normal end. The women recover 
 very soon mentally and physically and a comparatively short 
 time will witness a wonderful change to the better. 
 
 The treatment of the general symptoms of catarrh of the 
 womb is the same as in the catarrh of the neck of the womb, 
 which is described in the^preceding chapter. 
 
Inflammation of the Womb. 
 
 In comparison to catarrh, we understand by inflammation 
 of the womb the inflammation of the muscle-layers which form 
 the thick muscular walls. As in the preceeding chapter we div- 
 ide also here the inflammations into two classes : the acute and the 
 chronic. 
 
 The acute form occurs more seldom and generally origin- 
 ates from the same noxious influences as we have described them 
 in speaking of the acute inflammation of the mucous membrane. 
 In most cases even both inflammations, i. e. inflammations of 
 the lining and those of the walls, do not only occur at the same 
 time, but arise one from another, the mucous membrane being 
 affected at first and later also the walls. An inverted order is 
 exceptional. Naturally menstruation and confinement take a 
 prominent position in both cases, as opportunities for the origin 
 and progress of diseases are particularly favorable during these 
 periods. Infection by gonorrhoea and diseases of the womb 
 caused by influenza, scarlet fever, typhoid fever, small pox, etc., 
 or by operations and injuries may easily be traced to their origin. 
 
 The causes of the chronic form are much more various and 
 numerous, as on the one hand the acute inflammation may take 
 a chronic character, and on the other hand all the circumstances 
 which cause too strong, frequently recurring affluxion or insuf- 
 ficient defluxion of the blood may create this form. All excess- 
 ive exertions of the lower part of the body, as they are connect- 
 ed with too much walking, excessive dancing, too long heavy 
 labor, etc., may be said to come under the former class. In the 
 same manner chronic inflammation of the womb may result from 
 
86 
 
 self -pollution and unsatisfied sexual excitement. The latter is 
 much more frequent than is commonly supposed. It is caused 
 not only by the vain attempts of impotent men, but more espec- 
 ially by withdrawal, i. e. by interrupting coition before it is 
 finished, which is often practiced with the intention of limiting 
 the number of children. In order to make this clear it is nec- 
 essary to explain the influence of copulation upon the female 
 generative organs. In consequence of the nervous excitement 
 produced by coition the blood rushes more vehemently to those 
 organs, from which the excitement proceeds. Vagina, uterus 
 and ovaries are consequently filled with blood, which will recede 
 entirely only if the woman has been fully satisfied. So far as 
 diseases are concerned the consequences of interrupting coition, 
 therefore, depends upon the fact whether the woman has been 
 satisfied or not. In the former case there are no serious consequen- 
 ces, but in the latter, which are the common occurrance, they can 
 rarely be avoided. In a state of sexual excitement, which, how- 
 ever, is not gratified by the brief and suddenly interrupted in- 
 tercourse, the generative organs of a female remain in a conges- 
 ted condition for a long time because the artificially attracted 
 blood is retained and the natural relaxation does not occur. If 
 this happens only occasionally, it will not amount to much, but 
 if it is practiced for yearp the chronic congestion so created 
 produces various female troubles, among which chronic inflam- 
 mation of the womb takes a prominent place. 
 
 All tumors developing in the muscular walls and all dis- 
 locations of the womb are irritating and at the same time obstruc- 
 ting the defluxion of bloo. These as well as diseases of the heart, 
 liver, lungs or kidneys, may also produce chronic inflammation 
 as soon as they cause general derangements in the circulation of 
 the blood. An interrupted diminishing of the womb (see page 
 53) which has grown extensively during pregnancy must be 
 mentioned finally as one of the most frequent causes. A slight 
 increase in the size of the womb remains after birth, even in 
 normal cases, but this is always limited. 
 
 Symptoms — The symptoms of the acute inflammation of the 
 womb are similar but more aggravating than those of mere 
 catarrh (see page 75), especially the feeling of bearing down is 
 much stronger. But an examination will reveal differences, as 
 
• 87 
 
 ihe womb is usually considerably swollen, soft and extremely 
 sensitive to pressure. Even objects lying on the abdomen, as 
 for instance an ice bag, or even heavy blankets may become in- 
 tolerable. The ligaments and ovaries are always more or less 
 affected at the same time. Occasionally small abscesses form 
 within the layers of muscles. They may unite and finally penet- 
 rate the tissue in some direction causing a fatal end if they open 
 
 Figure 18 — Inflammation of the Muscular Walls of the 
 
 Womb. 
 
 a — Inflamed and Swollen Womb, b — Intergrowings between Womb 
 
 and' Peritoneum, e — Peritoneum. 
 
 towards the abdomen and produce a purulent inflammation of 
 ihe peritoneum. 
 
 The fever frequently setting in with chills is varying in 
 height. The general health is poor. The pains which are felt 
 also when no pressure is exerted upon the womb, are violent and 
 cramp-like, especially in the beginning, and radiate to all parts 
 of the body. After subsiding for some time they reappear with 
 increased violence independent from any occasional cause, or 
 
88 
 
 when by the vehement commotion of the diaphragm and bowels,, 
 as in coughing and sneezing, the affected organs are pressed 
 downward. Even speaking causes pains in severe cases. The 
 abdomen is usually bloated. Menstruation suddenly ceases if 
 the patient is taken ill at this time, otherwise it is usually in- 
 creased and accompanied by severe cramps. Constipation sets 
 in and the movements of the bowels and urination are painful. 
 The appetite is lost entirely and severe and uninterrupted head- 
 ache deprives the patient of rest and sleep. 
 
 After one or two weeks, or sooner when correctly treated,, 
 the most aggravating symptoms disappear, but even under the 
 best care it takes a long time before all troubles have vanished. 
 
 In the chronic form the size of the womb as found by an 
 examination varies greatly. Sometimes the womb is thickened, 
 only a little, sometimes it extends as far upward that it may 
 easily be traced through the walls of the abdomen as an indis- 
 tinct hard knot. In spite of their superficial similarity the 
 acute and the chronic inflammation may be easily distinguished,, 
 even without knowing their origin. Instead of a soft doughty 
 body we find a solid, firm object, which is not near as painful as 
 in the acute form previously described. Only at the time of 
 menstruation it is more sensitive and the contractions of the 
 muscular layers, which are necessary to expel the coagulated 
 blood produce pains similar to those during delivery. After 
 blood has flown out and the passage is opened again, the cramps 
 usually cease. Often the contractions of the womb, which occur 
 also between the times of the menses and which are normally 
 noticed as little as the movements of the healthy stomach, are- 
 observed under these circumstances and cause a sensation as 
 though an animal moved in the pelvis, or "as though a child 
 was striking against the walls of the pregnant womb, there be- 
 ing, however, no pregnancy at all. 
 
 All other symptoms are easily explained and understood, if 
 we consider that also in the chronic form the neighboring or- 
 gans rarely escape being affected, at least to some extent, and 
 that the enlarged comparatively heavy womb presses upon its 
 surroundings and obstructs the circulation of the blood. Con- 
 stipation and difficulty in retaining or discharging urin indicate 
 that the rectum and the bladder participate injthe inflammation. 
 
89 
 
 The pressure on the nerves and nervous plexus of the pelvis ap- 
 pears in various ways: in sharp or dull pains in the legs or the 
 back, in the hips and up the back as far as between the shoulder 
 blades. Derangements in digestion, loss of appetite, alternating 
 with ferocious hunger and followed by pains in the stomach, or a 
 sense of fulness and overloading are in other cases the prevail- 
 ing symptoms and frequently lead to the discovery of the real 
 cause of the trouble only after a long and vain treatment of the 
 stomach. Still more annoying are reflex actions from the af- 
 fected womb upon the spinal chord and the brains: palpitation 
 of the heart, rush of the blood to the head with anxiety and op- 
 pression on the brains, headache, hemicrany, a feeling as if a 
 ball rose in the throat, or as if a nail was driven into the head, 
 troubles with the eyes rendering reading and writing imposs- 
 ible, etc. All these troubles will, in the course of time, lead to 
 an ever increasing derangement of the nervous system and it re- 
 sults finally in the highest degree of nervousness and hysterics. 
 Like helpless children, always complaining, especially when 
 they yield to their humors and lose the control over their will 
 such patients are not able to fulfill the duties enjoined upon them 
 and when compelled to rouse themselves, fainting spells and 
 other conditions of weakness are the immediate result. 
 
 Prevention — The prevention of the inflammation of the 
 womb is of great importance and by some care the start of the 
 disease may frequently be avoided. Above all pessaries and 
 supporters as they are applied to keep the womb in its proper 
 place must always be closely watched and removed immediately 
 as soon as there are the least indications of discomfort caused 
 by these, as for instance the appearance of pains, increasing dis- 
 charges, etc. Catarrh of the mucous membrane should not be 
 neglected; all displacements of the uterus, as they will be de- 
 scribed later, must be corrected. The rules which must be ob- 
 served during menstruation have been given in the previous 
 chapter; those for the time of confinement will be given here in 
 detail. 
 
 As previously described the womb undergoes great changes 
 after the expulsion of the fruit, its weighth dimishing from 
 about two pounds to two to three ounzes. At first large and 
 thick it gradually takes its original form and shape and returns 
 
90 
 
 to the same location which it had before pregnancy. All dis- 
 turbances of the normal diminution change a formerly healthy 
 womb into a diseased one by stopping its regular retrogression. 
 It is, therefore, necessary to give the exact rules for conduct 
 after parturition and to demonstrate at the same time the dan- 
 gers arising from its disturbances. 
 
 Immediately after delivery the body being very much ex- 
 hausted by the act of child-birth, requires the most absolute 
 rest, both mentally and physically. Nature will hold its own in 
 this respect by giving a sound and healthful sleep, which will 
 greatly restore the wearied limbs. The bed, the home of a wo- 
 man during confinement, should under no circumstances be left 
 before the tenth day has passed, as before this time the womb 
 has not sufficiently diminished to exclude the possibility of an 
 excessive bleeding or the danger of a prolapse. It is not nec- 
 essary, however, to lie on the back during the entire time; this 
 should be observed only within the first four or five days. After 
 this it is even advisable to change the position from time to time 
 by lying on the sides, since an arising retroflexion of the womb 
 may thus be prevented. (See Displacements of the Womb.) 
 After two weeks when the womb is but one-third as heavy as 
 directly after delivery, light work about the house may be re- 
 sumed, greater exertions must yet be avoided until the body has 
 regained its former strength. If bleeding reappears or pains 
 .arise the woman should take to her bed immediately. As the 
 ligaments are yet relaxed any pressure in the abdomen, as it is 
 .always caused to a greater extent at the exertions in a difficult 
 movement of the bowels must be avoided, since thereby the womb 
 would be forced downwards too much. Close attention must* 
 therefore, be paid from the start to the emptying of rectum and 
 bladder, especially since, as we shall see later, the filling of these 
 organs with excrements and urine is of great importance to the 
 position of the womb. The rectum, which is usually thoroughly 
 emptied before birth by injections, must be relieved on the third 
 •day if there has not yet been a spontaneous movement of the 
 bowels, by an injection of one quart of boiled pure water, or 
 water with an addition of soap or one tablespoonful of glycerine. 
 It is not advisable to wait five or eight or even nine days for the 
 first passage. The bladder also should be emptied soon. Six 
 
' 91 
 
 or seven hours after delivery it is necessary to pass the water. 
 If that is impossible the urine must be taken by means of a 
 urethral sound after the external parts have been cleaned with 
 ^a solution of Vaginol, one per cent. This should be repeated at 
 least three times a day until it is possible to discharge the urine 
 spontaneously. 
 
 The genitals of the woman in confinement demand also 
 special attention. The flow following every delivery, which 
 lasts about two or three weeks, and has a bloody color for about 
 eight days, soils the bed and clothes and becomes easily odorous 
 if decomposition sets in. This may be prevented by cleaning 
 the private parts with a weak solution of Vaginol, or any other 
 disinfectant, and fastening cotton impregnated with salicylic acid 
 by a bandage against them, which absorbs immediately all sec- 
 retions and renders them harmless. If the secretions flowing 
 from the vagina become odorous in the least, vaginal injections 
 with Vaginol, carbolic acid, etc. (see Diseases of the Vagina) are 
 indispensible and must be applied with the greatest punctuality 
 in order to prevent decomposition, which easily ascends into the 
 sore womb and causes child-bed fever with all its fatal results 
 Fever caused merely by inflamed tearings of the mouth of the 
 womb, or of the vagina, or of the perineum (see Anatomical In- 
 troduction, page 5) usually disappears very soon when these 
 injections are taken. 
 
 The nursing of the child has a great influence upon the re- 
 trogression of the womb, as contractions of its muscular walls 
 are produced by the irritation of the nerves at the nipples, which 
 greatly favors its diminution. The influence of nursing is so 
 great that in case in which it is continued too long the regression 
 sometimes goes on to such a degree that the size of the womb falls 
 below the normal measure : menstruation grows abnormally weak 
 or disappears entirely. A new impregnation will be impossible 
 since also the ovaries participate in this shrinking. Many a 
 woman will here put the question: 'How long shall I nurse my 
 child?' The answer will be found in the chapter on Diseases of 
 the Breasts. 
 
 Women in confinement may partake of nearly any food. 
 Only during the first two or three days it should not be too 
 abundant and consist mainly of liquids, milk and broth. Then 
 
92 
 
 she may begin to take meat; also all food erroneously considered 
 to produce milk, as cereals, oat meal, barley water, etc., are good 
 and wholesome. Beer, wine, coffee and tea may also be taken in 
 moderate quantities by every nursing mother. 
 
 Treatment — After the removal of eventually existing causes, 
 as pessaries, we find in treating acute inflammation of the womb 
 just as in treating acute catarrh of the mucous membrane, of 
 greatest importance: rest, ice and opium. Rest and opium- 
 should be applied as described before. In the application of 
 ice, or ice bags, the following precautions must be taken. Owing 
 to intense sensitiveness, the slightest pressure upon the walls of 
 the abdomen often becomes unbearable. It is, therefore, advis- 
 able to suspend the bag above the bed, fastening it to a hook, or 
 some other object, in the proper height, so as to diminish its 
 weight without being obliged to make frequent changes on ac- 
 count of the small quantity of ice the bag could otherwise con- 
 tain. Furthermore, an ice bag should never be placed directly 
 on the skin, as the cooling effect would be too intense. Its work 
 will be much more beneficial if linen dipped in water and wrung- 
 out well is placed underneath it. It is usually taken three-ply, 
 but a layer more or less may be placed between ice bag and skin 
 in order to obtain different degrees of activity. In this manner 
 the cold effect will be equally distributed and increased or re- 
 duced at pleasure. This excellent remedy, which is the more valu- 
 able as it can only be beneficial and never harmful or injurious, 
 when used in the described manner, may be frequently applied. 
 
 In order to relieve the pains opium pills in connection with 
 extract of belladonna, which must be introduced as far as poss- 
 ible into the rectum, are recommendable. (Prescription 32.) But 
 when the pains are too severe morphine (prescription 33) is the- 
 safest remedy. 
 
 That vaginal injections with disinfectant medicines, accord- 
 ing to the rules previously laid down (Diseases of the Vagina) 
 are to be used is a matter of course, as it would be a great mis- 
 take to neglect them. Their temperature should not be too 
 high. Usually women prefer even cool water, which mitigates 
 the internal heat. One quart of water for every injection will 
 suffice. 
 
 When the inflammation has perceptibly diminished, which 
 
■ 93 
 
 -will be noticed by the cessation of the pains and the decreased 
 sensibility of the organs when touched, the ice bag may be laid 
 .aside and damp-warm or Priessnitz compresses applied instead. 
 By this we do not mean compresses with warm water, but wrap- 
 pings in the following manner: A piece of cloth is soaked in 
 cold, eventually in ice water and thoroughly wrung out again. 
 Then it is to be laid around the lower part of the entire abdomen, 
 and covered with a heavy woolen shawl. Greatest care must be 
 taken not to leave the least part of the wed cloth uncovered or 
 to let it come in contact with the cold air when the covering 
 bandage should get out of place, as the patient would inevitably 
 take cold and the opposite of the desired cure would be the re- 
 sult. The patient must directly take to a warmed bed. The wet 
 cloth soon attains the temperature of the body and the first dis- 
 agreeable chill is followed by a comfortable, warm feeling as the 
 blood vessels in the skin, which contract at first now expand the 
 more. If, on the contrary, a cloth soaked in hot water is ap- 
 plied it grows colder on the body and chills are the natural con- 
 sequence. If it is desired, however, to attain an effect by means 
 of hot water the cloths must be replaced as soon as they grow 
 cool. This procedure is also sometimes of advantage, for in- 
 stance against cramps, or if a person cannot endure the damp- 
 warm compresses. Compresses made with luke-warm water are 
 not near as effective and should, therefore, be applied only in 
 -exceptional cases, when others cannot be endured. Additions 
 of salt to the water increase the activity. Even if the soothing 
 and healing effect of such compresses does not always correspond 
 with the expectations, yet in the majority of cases the result is 
 astonishing. The pains diminish, the abdomen is no longer as 
 sensitive to pressure, the troubles in urination decrease and a 
 quiet sound sleep strengthens the patient, who has so far only 
 had disturbed and troubled nights. 
 
 In the chronic form, above all the causes, as they are found 
 in diseases of the mucous membrane, displacements of the womb, 
 tumors, etc. (see the respective chapters) must be removed. 
 Besides this the compresses above described are recommended, 
 since, when correctly applied, they cannot do any harm and do 
 not loose their beneficial activity even after having been used 
 ior months. During the day time, when the patient is out of 
 
94 
 
 bed, these compresses should not be applied because they will 
 be not only inconvenient, but might easily get out of place, and 
 thus expose the wet cloth to the cold air. Injections must be 
 taken according to the amount and the character of the flow 
 once or twice a day with an addition of the medicines enumer- 
 ated, in connection with the vaginal injections. Heavy labor 
 too much exercise and sexual excitement, especially when such 
 is not followed by gratification as above mentioned, must be 
 avoided. Absolute rest, such as lying continually in bed, to 
 which over-anxious women are inclined, is not advisable, as the 
 other healthy organs are weakened thereby, digestion and nutri- 
 tion suffer and increasing constipation only aggravates the troub- 
 les. Moderate exercise should, therefore, be had. Great care 
 must be taken to keep the bowels regular, as constipation is 
 usually a great annoyance with all chronic female troubles. On 
 account of its importance a special chapter has, therefore, been 
 devoted to this subject. (See Constipation and its Treatment.) 
 One of the most common treatments of chronic inflamma- 
 tion of the womb as well as of inflammation of the ligaments 
 and ovaries is the treatment with the so-called tampons. These 
 are little balls of about the size of a walnut or a little larger, 
 formed out of clean absorbing cotton and fastened to a thin soft 
 string. They are saturated with solutions of medines and intro- 
 duced into the vagina as far up as to the womb where they re- 
 main for a certain time. (See figure 19.) Boroglycerin, glycerite 
 of tannin, glycerite of hydrastis, glycerite of Ichthyol (pres- 
 criptions 34 to 37) are used as solutions for this purpose. Glyc- 
 erin is in all these preparations a very essential ingredient whose 
 principal office is to draw the water from the tissues and to take 
 away the inflammation. Various medicines are added according 
 to the purpose in view, their effect being soothing, absorbing or 
 disinfecting. Ichthyole is the most effective but has a strong 
 odor and is expensive. The water drawn out by these tampons 
 may occasionally become annoying and flows sometimes in 
 such a quantity that the patient becomes frightened by the in- 
 creasing profuse discharges, and after consulting the physician 
 are only at ease when the supposed change to worse has been ex- 
 plained. In order to avoid annoyances and to derive full bene- 
 fit from the tampons it is advisable to apply the cotton balls 
 
• 95 
 
 before retiring, and removing them in the morning by pulling- 
 the string. A few hours later a vaginal injection should be 
 taken. An intelligent woman can easily insert the tampon 
 herself after having received the directions, and the assistance 
 of a physician is not necessary at all. The tampons are to be 
 applied daily or every other day, until a more extensive scaling: 
 
 Figure 19 — Showing Location of Tampon in the Vagina. 
 
 a — Vagina, b — Tampon, c — String to which the Tampon is fastened,, 
 
 d — Rectum, e — Bladder f — fundus of the womb. 
 
 of epithels of the vagina demands a few days rest, after which 
 the treatment may be resumed. 
 
 The treatment with tampons is essentially aided by baths. 
 These are most effective in the form of salt baths, or especially 
 of moor baths. It is a pity that the latter can only be enjoyed 
 by wealthy people since they are offered only in special estab- 
 lishments and therefore comparatively expensive. Their excel- 
 lent effect in all cases of chronic inflammation of the female 
 generative organs is produced especially by the equal and high 
 
96 ■ 
 
 temperature of the baths, which greatly accelerates the cure of 
 old and obstinate remains of disease. If such baths are not 
 accessible the less effective warm or hot hip-baths may be used 
 to which four, six or eight pounds of some kind of spring salt 
 or of the cheaper common or sea salt is added. The temperature 
 may be nearly the same as that of the body (99 degrees). In 
 order to attain this hot water must be added while the person is 
 in the bath, as it would be impossible to endure immediately 
 such a high temperature. The patient should remain in the 
 bath from about half an hour to one hour. If the temperature 
 of the water is increased still more as it is done against severe 
 cramps caused by contractions of the womb, the bath should not 
 last longer than twenty minutes. 
 
 Hot vaginal injections of the same temperature, that is as 
 hot as they can be endured, have the same effect as they cause, 
 like baths, a more abundant rushing of healthy blood to the di- 
 seased organs. They are easily prepared and taken. In the in- 
 terior of the vagina the high temperature is not disagreeably 
 perceived, but more so on the skin of the external genitals and 
 the buttocks if the hot water comes in contact with them. Be- 
 fore taking the injections these should, therefore, be protected 
 by covering them with vaseline. 
 
 Local treatment by a physician should begin at the same 
 time, or at least if the result of the above described treatment is 
 not satisfactory. If the womb is thick, heavy and juicy and not 
 yet in the state of chronic hardening, the drawing of blood from 
 the mouth of the womb has often an excellent effect. This is one 
 of the few cases in which the drawing of blood has a scientific 
 foundation. Those times when everybody would go through a 
 similar process once or twice a year in order to get well or re- 
 main healthy are over. We know now that the body needs its 
 blood and that it cannot be taken from it without harm. In the 
 above instance, however, it is different for on the one hand the 
 amount of blood — about one spoonful — is too small and insig- 
 nificant to enfeeble, and on the other hand the beneficial results 
 of this harmless operation, which must be repeated several times, 
 can soon be noticed by the diminution in size of the womb, the 
 recession of inflammation, the loss of sensitiveness. The entire 
 organ is changed by relieving the tissues in this manner. The 
 
• 97 
 
 method of using leeches is antiquated as the same result may be 
 attained by some little cuts in the conus by means of a small 
 sharp knife. Thus the danger of one of these little animals 
 creeping through the mouth of the womb into the interior of the 
 cavity, which has happened several times, and which is followed 
 by serious consequences, is avoided. If a little blood is with- 
 drawn in such a manner shortly before menstruation, much 
 blood may be saved, as the otherwise profuse monthly losses are 
 greatly diminished. This is to be explained thus: By the mor- 
 bid changes of the uterus its muscular walls become stiff and 
 hard, and they loose their capability to contract as they could in 
 a healthy condition. The vessels of the mucous membrane sec- 
 reting the menstrual fluid are not compressed, remain wide and 
 offer abundant occasion to the blood to escape into the generally 
 enlarged cavity of the womb: Menstruation is profuse and long. 
 But by the above described small operation the blood vessels, 
 which are suddenly relieved, are forced to contract. The 
 result is an increasing capability of the entire organ in this dir- 
 ection, which is perceived during menstruation by a stronger 
 action of the muscular walls: the mucous membrane contains 
 less blood and menstruation is shorter and weaker. 
 
 Hot vaginal injections frequently used when menstruation 
 is too profuse, will act in the same manner, i. e. cause contrac- 
 tions of the muscular walls. But very often they fail when there 
 exists a chronic inflammation of the womb, while they almost 
 always prove to be of excellent value against bleeding after birth. 
 The reason is obvious. After the birth the muscular walls of 
 the womb are only tired and relaxed on account of their long 
 and heavy work during the expulsion of the fruit, and the incite- 
 ment by hot water will compel them to act again so that the bleed- 
 ing stops. In case of chronic inflammation of the womb, how- 
 ever, as we have seen before, the capability of contraction is lost 
 more or less and, therefore, the result is frequently not satisfac- 
 tory. The use of internal remedies, such as fluid extract of er- 
 got, fluid extract of hydrastis tincture of cinnamon, etc. (prescrip- 
 tion 31) are more advisable under such circumstances to stop 
 the abundant loss of blood during menstruation. They are also 
 in the meantime of great value since they will diminish the mor- 
 bidly enlarged womb if used for a long while. Nevertheless these 
 
98 
 
 hot vaginal injections should be tried against profuse menstrua- 
 tion, but they should be taken in a lying position according to» 
 the principles given before. (See Diseases of the Vagina.) 
 
 More effective than vaginal tampons and sometimes more 
 satisfactory is a brushing of the conus with tincture of iodine, 
 or a solution of Ichthyol. With nervous women or such who- 
 are suffering at the same time from inflammation of the ligam- 
 nets or ovaries great precaution is necessary, since the irrita- 
 tion might easily become too great. 
 
 Of prominent value as a treatment for chronic inflammation 
 of the womb is massage according to Thure Brandt, the prin- 
 ciples and application of which will be described later in detail, 
 and it can easily be combined with the other methods. It has a. 
 rival in the electric treatment according to Apostoli, in which 
 one end of the conductor is introduced into the womb and the 
 other placed upon the abdomen, so that the electric current 
 passes from the walls of the abdomen to the uterus. Of both 
 methods the one or the other may be the proper, according to 
 circumstances which can only be judged by sufficient experience. 
 The latter method is especially beneficial when there is a profuse 
 menstrual bleeding. It is, however, more painful than the first 
 mentioned, and not entirely without danger. Yet it is often un- 
 avoidable as it may bring relief and cure when everything else, 
 even repeated scraping, has been without result. 
 
 If a rapid cure is desired, or if all other attempts to stop the 
 chronic inflammation of the muscular walls have failed, the de- 
 sired help may be afforded by an operation. There are two 
 ways. The easier and less dangerous is the removal of a part of 
 the neck of the womb. Even before this operation was prac- 
 ticed it has been observed that if the neck of the womb was re- 
 moved for some other reason the chronic inflammation of the 
 body of the womb generally improved in a comparatively short 
 time. From this valuable hints were taken and Martin, of Ber- 
 lin, first recommended this operation in order to apply practic- 
 ally what chance had taught. A complete success may be ex- 
 pected the sooner the more the conus (see Anatomical Introduc- 
 tion) is thickened and partakes in the inflammation. From 
 seven to ten days rest in bed are sufficient to restore the patient 
 and after the material which was used to sew up the wound has. 
 
• 99 
 
 been removed simple vaginal injections will suffice for further 
 treatment. 
 
 There are cases in which all these procedures are in vain 
 and the physician has the alternative either to leave the woman 
 to her sorrow and pains, or to stop both by the removal of the 
 ovaries, and with them the menstruation and its accompanying 
 troubles. This is a serious decision and only justified after all 
 means offered by science have been tried and applied without 
 satisfactory result. To advise a patient, after having tried only 
 for a short time to cure the evil, to have this operation perform- 
 ed would be unpardonable and contrary to the physician's duty. 
 And yet it happens frequently. It is necessary to take into 
 consideration on the one hand that, since the rising and sinking 
 of the troubles have always been connected with the monthly 
 rush of blood towards the abdomen, the recovery would be prob- 
 able if menstruation ceased; on the other hand that the wo- 
 man looses her female character with the removal of the ovaries, 
 as the possibility of having children is for ever gone. The de- 
 cision is, therefore, the more serious the younger the woman 
 and the operation should not be performed if there is still a de- 
 sire on the part of the patient of having descendants. The dan- 
 ger of the operation must also be mentioned. (See Diseases of 
 the Ovaries.) 
 
 In order to aid the local treatment a general treatment which 
 tends to strengthen the entire body, will always be necessary to 
 overcome the disease more readily and sooner. Nourishing 
 food, healthy lodging, and fresh air are of greatest importance. 
 Since the formation of blood is almost always retarded when the 
 disease has existed for a long time, the appetite is lost, and nerv- 
 ous symptoms, general irritability, insomnia, etc., increase, all in- 
 structions given under Chlorosis (see page 65) must be followed 
 also in this case and we refer the reader to them. 
 L.ofC. 
 
Displacements of the Womb. 
 
 For a long time very erroneous ideas have been entertained 
 regarding the normal position of the womb. The standard was 
 taken from a position as it was found in a corpse, without con- 
 sidering, however, that the tension and elasticity of a living 
 tissue filled with circulating blood offered entirely different con- 
 ditions than a dead one. In a corpse the womb naturally would 
 sink backward towards the sacrum on account of its gravity 
 and the lying position of the body and thus cause a change in 
 the location of the womb. Only after the method of the "com- 
 bined examination" had been introduced, i. e. an examination 
 with both hands, one being placed in the vagina, the other upon 
 the walls of the abdomen (see figure 20) the conditions were 
 correctly recognized. My esteemed teacher, Dr. B. S. Schulze, 
 professor of gynaecology and obstetrics, in Jena, Germany, has 
 the great merit of having ascertained after long and careful in- 
 vestigation the normal position of the uterus in a living woman. 
 It was no easy task since, as we shall see later, the womb is con- 
 tinually moving, according to the larger or smaller contents of 
 bladder and rectum, and to the different postures of the body, as 
 in standing, sitting or lying, or in actions as coughing, breath- 
 ing, sneezing, etc. Schulze proved in his leading work on dis- 
 placements of the womb as normal position (figure 4) such a 
 one in which the body of the womb is slightly inclined for- 
 ward, like an inverted comma, its basin being behind the pube 
 bone on the crown of the bladder, but its mouth being near 
 the sacrum in the so-called "interspinal line." (Figure 1.) 
 
101 
 
 The mouth of the womb — that little hard knot which projects 
 into the vagina and is perforated in the middle by a smaller or 
 larger opening — can be reached and felt by women themselves 
 by introducing the entire finger into the vagina. (See foot 
 note.) 
 
 The angle formed by the neck of the womb and the vagina 
 is a right one in maidens and women who have not yet given 
 
 Figure 20 — Combined Examination. 
 
 Two fingers of the left hand are introduced into the vagina and lift the 
 womb, while the fore and middle fingers of the right hand from above 
 press down the walls of the abdomen. In this manner not only the 
 womb, but also the ovaries, oviducts and all other organs of the pelvis 
 may distinctly be traced. 
 
 birth to children, in such who have passed through a delivery, 
 however, an acute one. 
 
 If the bladder and rectum fill up the conditions are consid- 
 erably changed. When the crown of the bladder is raised by 
 the accumulation of urine, it raises at the same time the basis of 
 
 Foot Note — How this is changed in the different displacements of the 
 womb will be shown in the respective chapters. 
 
102 
 
 the womb, which rests upon it: the angle formed by neck and 
 body is straightened out, i. e. the womb which can be bent at 
 the place where neck and body join as in a hinge, looses its in- 
 clination over the front wall and becomes straight. When the 
 bladder expands still more the entire uterus is forced upwards 
 and backwards to the rear and pressed to the rectum and sac- 
 rum. On the other hand, when the rectum is filled, and the 
 
 Figure 21 
 
 Position and Location of Womb With Rectum 
 and Bladder Filled. 
 
 bladder is empty the neck of the womb and with it the body are 
 forced more towards the front so that they are nearer the pube 
 bone. When both organs are filled, however, the womb is 
 straightened, forced backward and raised high in the middle 
 of the pelvis. (Figure 21.) 
 
 All these movements of the body of the womb as well as 
 those of the entire organ in the cavity of the pelvis, i. e. the 
 space surrounded by the pelvis bone (figure 1) are painless and 
 not felt in a healthy normal condition. In the state of health the 
 uterus has consequently not only a normal position, but also a 
 
. 103 
 
 normal mobility. This latter is so great that in a healthy woman 
 the womb may be raised or pressed down, inclined or stretched, 
 and the mouth of the womb be laid in all directions against the 
 "bone of the pelvis without causing pain. If any of these move- 
 ments is obstructed in any direction, so that an examination causes 
 pain, and if the womb is held in a certain position by a restric- 
 ted mobility or by having intergrown somewhere by scars, it is 
 -defective even if it has its normal position. 
 
 ANTEFLEXION OR FLEXION OF THE WOMB TOWARDS THE FRONT. 
 
 The defective position of the womb which differs least from 
 the normal is that in which the basis of the womb is inclined 
 forward, similar to a healthy condition, either with a bending 
 over its front wall, or in a straight line with the neck of the 
 womb. The bending may be greater or less, it may even be an 
 acute angle: the degree is not the most important feature. The 
 abnormity of the position lies only in the fact that the position 
 is constant and cannot be changed either by the bladder or the 
 rectum, and only with pains by a pressure with the hand during 
 examination. The organ itself is, therefore, stiff, since the nor- 
 mal mobility between neck and body of the womb is lost. While 
 formerly the bending over the front wall was removed by the 
 filling bladder, and then the entire organ pressed aside, all mov- 
 ements of the neck and the body are now made at the same 
 time, since neck and body remain in their position to each other. 
 
 The causes of this disease proceed partly from the womb 
 itself, partly from its surroundings. In both cases confinement 
 and infection take the principal place. The incomplete retro- 
 gression of the womb after birth (see page 53), especially on ac- 
 count of irregular confinement and premature birth, infection 
 by gonorrhoea and every catarrh of the womb, which occur also in 
 maidenhood during menstruation, more seldom in the intervening 
 time (see Catarrh of the Womb) produce not only the above 
 mentioned stiffness of the muscular walls, but also inflammations 
 in the ligaments, especially in the 'Douglas folds' (see page 13.) 
 These latter are contracted, become shorter by the formation of 
 scars and tie the womb backwards towards the sacrum at the 
 place where they are attached, i. e. at the place where neck and 
 body join. The vagina is lengthened thereby, the mouth of the 
 
104 
 
 womb is raised so that the patient can hardly reach it and the 
 flexion over the front surface is increased in the course of time 
 by the pressure of the intestines from above. (Figure 22.) 
 
 The Symptoms correspond exactly with these changes. 
 Since the womb is affected in its mucous membrane as well as 
 in its muscular walls, the troubles resulting therefrom, which 
 have been enumerated previously, are generally also found here. 
 
 Figure 22 — Anteflexion of the Womb. 
 
 rr — Rear Ligaments or Douglas Folds. 
 
 For a long time it was supposed that the violent cramps before 
 or at the beginning of menstruation were only due to the nar- 
 rowness of the neck channel at the. place of its flexion by which 
 the flow of blood was obstructed, but Dr. B. S. Schulze limited 
 this view since he found that in such cases it is sometimes pos- 
 sible to introduce easily the uterine sound (figure 15) into the 
 cavity of the womb. So he proved that there was ample space 
 for the passage of the blood. Under such circumstances the 
 cramps could only be the result of morbid changes of the womb' 
 (see page 88). Nevertheless — and this is more frequent — coag- 
 
105 
 
 ulation of the blood within the cavity of the womb,, the casting 
 off of particles of the nrucous membrane, or its swelling may 
 produce an obstruction of the channel of the womb at the place 
 of its bending and cause the same symptoms. This is proved 
 on the one hand by the fact that sometimes all troubles are re- 
 moved by merely introducing the uterine sound before menstru- 
 ation, by which process the passage is opened; on the other 
 hand that the pains and cramps, violent at the beginning, dis- 
 appear when the flow of blood has forced its way by the expul- 
 sion of the obstructing probes. In this case the morbid changes 
 in the walls have not yet advanced very far and only the great 
 and forcible exertions in the expulsion of the accumulated and 
 at first coagulated blood cause the pains. If the changes are 
 greater, however, even weak contractions of the muscular walls 
 are followed by the same pains, and these are the cases in which 
 the cramps continue unceasingly throughout the time of men- 
 struation in spite of free defluxion. 
 
 The frequent sterility of women affected with this disease 
 is to be ascribed principally to the existence of chronic inflam- 
 mation of the mucous membrane and the muscular walls (see 
 page 77) and only in a very limited number to the nar- 
 row passage at the place of the bending. Chlorosis and lack of 
 blood, so often found in young girls who suffer from this form 
 of the disease is usually not the consequence but, as we have 
 seen above, the cause of this ailment. 
 
 Besides the symptoms proceeding from the womb itself, 
 those coming from the rectum are sometimes very troublesome. 
 As we have seen in the Anatomical Introduction, the Douglas 
 folds extend from the inner mouth of the womb to the sacrum 
 and surround the rectum, which passes through them as through 
 a gate with their branches. All old and hardened ex- 
 crements coming from above to the lower part of the rectum 
 must pass through this gate and stretch these ligaments accord- 
 ing to their size and hardness. Therefore the pains are the 
 greater the more these folds are inflamed, and the more they are 
 shrunken or the larger the passing excrements. If the gate 
 finally grows very narrow the excrements may take the shape of 
 a ribbon or of small flat balls and every passage, if not quite 
 loose, is accompanied by violent pains which sometimes cause 
 
106 
 
 even fainting. But since the troubles arising from the rectum 
 begin only at a later stage of the disease, they are not so frequent 
 as in the next form of displacements, the retroflexion. 
 
 The bladder also frequently suffers at the same time. Partly 
 by a pulling of the tissue connecting bladder and neck of the 
 womb, partly by the pressure caused by the body of the womb, 
 which on account of its restricted mobility cannot evade the 
 bladder when filled, a frequent desire to urinate and pains dur- 
 ing the passage of the water are often produced, although they 
 may ba absent in some cases. 
 
 Prevention — Anteflexions must be guarded against even in 
 childhood. The required attention must be paid to arising or 
 existing chlorosis, abnormities of the menstruation, existing ca- 
 tarrh of the womb, and habitual constipation. The excessive 
 filling up of the bladder and all noxious things during the 
 monthly flow should be avoided. (See the respective chapters.) 
 
 Treatment — The treatment consists principally in remov- 
 ing the inflammation in the ligaments and the womb. It has 
 been tried and recommended frequently to apply pessaries 
 against the dislocations themselves, but as they are irrational 
 they have been abandoned again. Not one of the many differ- 
 ent kinds of pessaries would remove the principal evil, the in- 
 flammation, the removal of which can alone effect a cure. If 
 the disease is new, has arisen in a short time and is very 
 painful, the treatment must be commenced as in the acute in- 
 flammation of the womb (see page 92). But such cases are very 
 rare; as a rule the anteflexion develops gradually. According to 
 this such limitations are not required. A treatment as in chronic 
 inflammation of the womb is here advisable. (See page 93.) 
 Drawing blood from the conus shortly before menstruation will 
 also in this case prove frequently of great advantage. It will 
 act more energetically than the glycerine tampons inserted dur- 
 ing the intervening time, yet these also should be applied in or- 
 der to assist the former method of treatment. Suppositories wit 
 opium, extract of belladonna and extract of hyoscyum are of 
 good result when applied against sharp and cutting: pains. An 
 addition of about fifteen drops of tinoture of thebaica in each 
 tampon will act in the same manner. 
 
 The greatest care must be taken to keep the bowels 
 
107 
 
 loose and regular, even more so than under any other circum- 
 stances. It is a serious mistake to put off the passage from 
 hour to hour, from day to day, because of a fear of the 
 •ensuing pains. The latter will finally be much greater and 
 severer. 
 
 When the symptoms of inflammation are reduced in the acute 
 iorm or if the process is so chronic that from the beginning 
 only the shrinking of the rear ligaments and its consequences are 
 prevalent, a cure is effected much sooner by means of massage 
 -according to Thure Brandt. The shortened ligaments must be 
 stretched out, their quantity of blood be increased to a normal 
 .amount, the rectum must be freed from its embrace and the 
 womb regain its mobility. All this can be accomplished by 
 massage in a much shorter time and with greater certainty than 
 by any other method, in the same manner as a scar after burn- 
 ing, which twists a limb, can be lenghthened and removed much 
 easier and better by rubbing and spreading than by salves and 
 ointments Baths of the various described forms (page 95), hot 
 vaginal injections, damp-warm bandages around the abdomen 
 and vaginal tampons are a great assistance but will never pro- 
 duce the excellent results when used alone, as when applied 
 combined with massage. Simons and Sims tried to stretch the 
 rear folds permanently by operation, fastening the vaginal por- 
 tion of the womb to a place in the front wall of the vagina. 
 Such a fastening is, however, abnormal and this method, there- 
 fore, was soon abandoned. 
 
 If the inner mouth of the womb has become very narrow, 
 so that the blood is prevented from flowing freely, it must be 
 expanded. This may be accomplished either by operation or 
 by introducing gradually sounds one thicker than the other, or 
 with laminaria sticks. (See page 82.) 
 
 An impregnation in spite of the infavorable circumstances 
 must be considered as a happy event, in as much as it may 
 greatly facilitate a cure, if premature birth easily occurring un- 
 der these circumstances can be avoided. Then the womb is 
 forced up into the cavity of the abdomen by its growing con- 
 tents and lengthens the ligaments, which are now richer in 
 sap and softened; the morbid changes in the walls of the womb 
 lieal on account of the continual rush of healthy blood to this 
 
108 
 
 organ during pregnancy and nature sometimes performs in a 
 comparatively short time what human power can accomplish 
 only with great difficulty and then even imperfectly. The ail- 
 ment will not % reappear if the retrogression of the womb during 
 confinement is watched and conducted carefully. 
 
 General treatment is also of importance aside from the local 
 cure. Nourishing food, healthy appartments, moderate exercise 
 in the fresh open air, if possible near the woods, are very rec- 
 ommendable. Chlorosis must be treated according to the rules 
 laid down on page 65. 
 
Retroflexion of the Womb. 
 
 Those displacements of the womb which are caused by dip- 
 ping backwards of the body of the uterus are much more fre- 
 quent and important than the anteflexions or leaning forward. 
 
 We have to distinguish here also two forms, a simple lean- 
 ing backward and a perfect retroflexion, i. e. a condition in 
 which the womb is curved over its rear walls as figure 23 shows. 
 But the first being the preliminary stage of the second, so that 
 the one grows out of the other, we will discuss both forms to- 
 gether. 
 
 By a leaning backward we mean that condition which is 
 ■shown in figure 22. The body of the womb instead of lying on 
 top of the bladder (figure 4) takes a backward position and is in 
 «. straight line with the neck, so that neither surface shows an 
 indenture. A certain rigidity of the walls of the womb must be 
 presumed, otherwise it would curve either on one or the other 
 side. The mouth of the womb is brought forward closer to the 
 pube bone and is situated more or less anterior to the inter- 
 spinal line. (Figure IF.) As in this position it may be easily 
 touched by the finger inserted into the vagina, inexperienced 
 persons are often led to the belief that the womb has descended, 
 although this is by no means the case. The vagina is shorter, 
 more relaxed, but wider and more spacious than ordinarily and 
 its front and rear walls are of even depth. 
 
 When the womb is dipped back and at the same time curv- 
 ed over the rear wall we have what is commonly called a 
 
110 
 
 retroflexion (figure 23). Whether the body of the womb is in? 
 such ease higher, lower, or in even line with the mouth (compare 
 figures 23 and 24) is of little practical value, and thus of minor 
 interest, because the severity of the trouble is not according to 
 the degree of the retroflexion, but to the seriousness of the ac- 
 companying disorders. In this case also the mouth of the womb- 
 is brought more forward and to the pube bone, but is generally 
 situated higher than in a 'leaning back of the womb'. The more- 
 
 Figure 22 — Showing the 'Leaning Back' of the Womb-. 
 
 the body is lowered, the more the mouth will be raised (compare- 
 figures 23 and 24.) 
 
 While the rear wall of the vagina remains lax, the rear vault 
 deep, the front wall will in course of time become more rigid,, 
 the folds smoothened down, and the front vault more and more 
 flattened, so that after the time of 'change of life' it is impos- 
 sible to find the front lip of the mouth, while the rear one is- 
 thick and prominent. 
 
 The fundamental causes of the retroflexion are very various. 
 Only in exceptional cases a fall from considerable height upon 
 
• 111 
 
 the back or buttocks will cause the body of the womb, previous- 
 ly predisposed to this displacement, to dip back. In most cases- 
 this derangement is the result of long and continued injuries. 
 
 Retroflexion is, therefore, found very rarely in the newly 
 born, and then only as a cause of faulty or imperfect develop- 
 ment of the uteral walls. More often the disease is acquired 
 and found in weak girls, suffering from chlorosis, or is caused 
 by self -pollution. The change to the worse in the blood and 
 the imperfect nourishing of the body following chlorosis, as 
 well as the above mentioned unchaste pleasures will cause to re- 
 lax the organs of the pelvis, and at the same time the ligaments 
 of the womb, which serve to keep this organ in its proper place. 
 Habitual constipation, almost invariably accompanying this trou- 
 ble, causes the rectum to be constantly overfilled. The masses 
 of excrements push the mouth of the womb forward, while the 
 body will be raised and forced backward by the bladder filling, 
 or being overfilled, often from habit. In the beginning the 
 uterus returns to its original position as soon as rectum and • 
 bladder have been evacuated, but gradually the dislocation be- 
 comes habitual and the retroflexion will be the result. 
 
 Yet this form of development of the displacement is much 
 rarer than that which is caused by child-birth and confinement. 
 Retroflexions are, therefore, found unproportionately more fre- 
 quent in such women who have given birth to child, than in 
 such who have not, and in virgins. If from any circumstance 
 whatever, the return of the womb to its proper size is interrup- 
 ted, and it remains thick and heavy beyond the proper time, the 
 position generally taken during confinement, i. e. lying on the 
 back will gradually cause the heavy body of the womb to fall 
 backward until it finds support upon the chine bone. The 
 neck of the womb, being yet unmovably united with the 
 body, will consequently be pushed forward. The ligaments 
 intended to hold the womb in its place, which have become con- 
 siderably relaxed and lengthened during pregnancy, do not offer 
 the necessary support. If the woman leaves her bed, and hav- 
 ing no idea of the beginning displacement, because she will ac- 
 credit the already existing annoyances to the just passed deliv- 
 ery and confinement, begins to attend to her duties, the de- 
 rangement will be increased. To the weight of the body of the 
 
112 
 
 uterus is added the pressure of the intestines during standing 
 and walking, and especially caused by coughing, or sneezing, 
 or the efforts during difficult movements of the bowels and will 
 force the backward leaning body of the womb still more into the 
 cavity of the chine bone. The further the diminution of the womb 
 progresses, the more the neck will become flexible against the 
 ihe body where they join. But the angle which may now be 
 
 Figure 23 — Retroflexion of the Womb. 
 
 rr — Rear Ligaments or Douglas Folds. 
 
 formed between neck and body will naturally open towards the 
 back: the retroflexion is complete. 
 
 Thus several factors acting together are necessary to cause 
 a retroflexion, which factors are to be sought either in the irregul- 
 arities of the womb itself, or in those of the ligaments. If the 
 latter relax, as we have seen, in consequence of chlorosis, self- 
 pollution, etc., or if the shortening and strengthening of the 
 Douglas folds is delayed in consequence of exhausting hemorr- 
 hages, disturbed diminution of the womb during confinement, 
 or by several deliveries at short intervals, or on account of too 
 
' 113 
 
 long continued nursing, which leads to anaemia and weakness, 
 the body of the womb will fall backward at first and finally force 
 the mouth forward. 
 
 In other cases, and these are generally of an inflammatory 
 character, the circumstances are just the reverse. If an inflam- 
 mation is -caused during child birth, or in the course of confine- 
 ment, in any part of the tissues lying between the neck of the 
 womb and the front wall of the pelvis, the scar which remains 
 after the healing of the diseased parts, will in course of time 
 contract as any ordinary scar does, and may thus gradually draw 
 the mouth of the womb forward, so that as a natural consequence, 
 the body must dip backward after having been raised by the fil- 
 ling bladder. It is thus evident that two entirely different 
 causes may have the same result. And it is necessary to know 
 of the latter in order to understand such cases, in which the 
 retroflexion follows an inflammation of the tissues of the pelvis, 
 aequired either during confinement or otherwise. 
 
 Symptoms — There are some cases of retroflexion, which 
 may exist without causing the slightest annoyance, even such 
 which only become annoying when, after having been accident- 
 ally discovered, an attempt is made to correct them. Thus we 
 see that even an abnormal position of the womb, which may 
 develop in the course of time but exists without creating any 
 disturbances, cannot be called a diseased condition; yet these 
 cases are extremely rare. Generally the evil consequences will 
 soon become noticeable. 
 
 The vaginal part, pushed forward and pressing upon the 
 bladder, which is situated between it and the pube bone, will 
 cause urinary difficulties, which are, however, of an entirely dif- 
 ferent nature and more severe than in cases of anteflexion, in 
 which the mouth of the womb is drawn backward. (Figure 22, 
 page 104.) Since the bladder is pressed together from front to 
 back, a desire to urinate will be felt when the organ is only mod- 
 erately filled: the patient is obliged to urinate every half an hour 
 or quarter of an hour, although only a few drops of water are pass- 
 ed each time. It is more serious when, on account of the low- 
 ering of the body of the womb the arising neck draws on the lower 
 part of the bladder and the beginning of the urethra, so as to 
 render urination extremely difficult; not only severe pains, but 
 
114 
 
 partly inability to pass water being the result. The bowels will 
 also become irregular, though for entirely different reasons than 
 in anteflexions ( figure 22, page 104, compared with figure 23 plain- 
 ly demonstrates this.) Instead of being shrunken and shortened, 
 the Douglas folds are stretched and lengthened. These in them- 
 selves would, therefore, create no difficulty while passing the 
 stools, if the body of the womb, having been drawn down and back- 
 
 Figure 2 
 
 Retroflexion of the Womb. 
 rr — Rear Ligaments. 
 
 ward, would not close again this abnormally large passage way and 
 directly compress the rectum, which, as we know, is situated be- 
 tween it and the bone wall of the pelvis. Thus the excrements 
 passing this point, unless they be in a liquid form, must force the 
 entire uterus forward and unavoidably still more stretch the rear 
 ligaments of the womb. Severe pains are the result, severe ac- 
 cording to the degree of the existing inflammation. Even when 
 no excrements are in the rectum the sufferer will frequently have 
 a desire to go to the closet ; and even after ample and sufficient 
 
, 115 
 
 evacuation a feeling remains as if still more stools were coming, 
 as the pressure of the excrements from the inside and the 
 compression caused by the uterus from the outside produce the 
 same sensation in the rectum. 
 
 The mouth of the womb being brought abnormally forward 
 and, therefore, as before mentioned, easily reached by the finger, 
 it is evident that, the vagina moreover being proportionately 
 short, coition can only take place under pains. Every shock, 
 every violent movement of the womb, whose walls and surround- 
 ings are nearly almost diseased, is aggravating. If the body of 
 the womb is as far down as figure 24 shows, the womb is com- 
 pressed during copulation, and at the same time pressed against 
 the sacrum, so that those pains may easily be explained, which 
 extend sometimes under such circumstances to such a degree 
 as to cause fainting. 
 
 The chronic inflammation which is, in later stages, rarely 
 absent in the womb itself, depends upon the difficulty with 
 which the blood and lymph (see foot note) are distributed, on 
 account of the displacement of the organ. 
 
 It being much easier to retain the blood in a vessel leading 
 back to the heart, than in one leading from the heart to the or- 
 gan, that is to say : the affluxion of the blood being more vigor- 
 ous than the refluxion, the latter will, of course, be more influ- 
 enced by the disturbed circulation caused by the displacement 
 of the womb, and more blood will be retained than in a normal 
 condition. The womb is thus overfilled with blood, and grows 
 not only thicker and heavier in its walls, but also in its mucous 
 membrane, which swells and becomes looser. This will have 
 two consequences: changes in menstruation and discharges. 
 
 The rush of blood to the abdomen, returning monthly and 
 proceeding from the ovaries, will cause the mucous membrane 
 to secrete blood sooner. The flow is sometimes gradually, some- 
 times rapidly increased and continues from eight to ten days, in- 
 stead of disappearing in three or four days. The considerable 
 
 Foot Note — By lymph we mean that fluid which escapes from the blood 
 vessels and which, after having supplied the tissue with the nourishment it 
 contains, is carried back to the heart through the vessels designed for this 
 purpose. 
 
116 
 
 loss of fluids or humors is very exhausting and many women are 
 compelled to take to their bed temporarily. 
 
 Cramps and labor-like pains and pains at the small of the back 
 are in most cases experienced, but' are generally not so severe as 
 in anteflexion. They are conditioned by the chronic inflammation 
 of the muscular walls of the womb and its surroundings (see page 
 88), as in a case of retroflexion, generally following confinement, 
 
 Figure 25 — Intergrowings Between Womb, Rectum, Ovar- 
 ies and Oviducts. — According to Kuestner. 
 
 a — Rectum, 
 
 b — Uterus. 
 
 cc — Ovaries, 
 
 dd — Oviducts. 
 
 or caused by miscarriages, the passage way is sufficiently wide, 
 so that a stagnation of the secretions is not probable. 
 
 Besides the continual swelling of the mucous membrane by 
 which the glands are stimulated to greater activity, another fact, 
 which is to a great extent also causing the profuse menstrua- 
 tions, may serve to explain the discharges. 
 
 The greater the secreting surface and the less the pressure 
 exercised upon it, the more profuse the secretions are. (See page 
 82.) The retrogression of the womb after confinement having been 
 retarded, leaves not only this organ larger and thicker, but also 
 
 Foot Note — By mistake the printer made it read under figure 19 "Inter- 
 growings between Womb and Peritoneum," whereas it should read "Inter- 
 growings between Womb and Rectum." 
 
117 
 
 its cavity wider. The lining mucous membrane has thus gained in 
 superficial contents, and is freed from the pressure generally 
 fraught upon it, by the closely touching walls of the womb. 
 
 As at the same time the discharges are in no way obstruct- 
 ed, and there is no possibility of a stagnation, all facilities for 
 increasing the discharges are at hand. Therefore the latter are 
 unproportionately profuse. The color of the same varies accor- 
 ding to the amount of slime or matter they contain, being from 
 
 Figure 26 — Normal Condition, Situation and Relation jdf 
 the Organs of the Female Pelvis. — According to^B. 
 S. Schulze. 
 
 B— Womb. Bl— Bladder, md— Rectum, m and 1— Ovaries, 
 
 h — Douglas Folds, gg — Oviducts, i — Round Ligaments, 
 
 k — Broad Ligaments. 
 
 a yellowish white to a reddish color, which latter is caused by 
 an addition of blood. They increase before and directly after 
 menstruation. If they decompose either in the womb, or in the 
 vagina, they may become very caustic, so that ulcers at the 
 mouth of the womb and inflammation of the skin of the thighs, 
 are often the result. 
 
 Before long the peritoneum covering the womb will partake 
 of the general chronic inflammation. The exudations resulting 
 
118 
 
 therefrom will cause the uterus (see Inflammation of the Perit- 
 oneum) to intergrow with the neighboring organs, especially 
 with the rectum (compare figures 24 and 25 with figure 18.) The 
 intergrowths may become so firm that it is impossible, even under 
 chloroform, to tear them and it may become necessary to open 
 the abdomen by operation in order to separate the organs. 
 
 By the intergrowing of ovaries and oviducts, which are gen- 
 erally also dislocated and inflamed many troubles and annoyan- 
 ces are caused. 
 
 It has often been maintained that conception will occur very 
 rarely, even that retroflexion of the womb deprives women af- 
 flicted with this malady of all hopes of ever having children. 
 Such a statement, however, cannot be unconditionally accepted, 
 as facts have often proved the contrary. It can only be affirmed 
 in as much as a pregnancy existing under these circumstances 
 will more seldom last to its normal end. As the male sperm in 
 most cases enters into the womb more readily because the outer 
 and inner mouth is wider and situated more toward the front, in 
 cases in which no pregnancy occurs this must either be destroy- 
 ed or the fecundated ovulum be prevented from developing. 
 
 Both can be accomplished only by the existing catarrh of 
 the womb, if it developed to a high degree. In cases, however, 
 in which the mucous membrane is not too severely diseased, it 
 is often found that conception is even very readily attained in 
 spite of the retroflexion. Nevertheless it will not result in the 
 bringing forth of many descendants, as pregnadcy is generally 
 interrupted after a short duration. (See page 77.) 
 
 The general health is always greatly influenced by this di- 
 sease, and there is scarcely one part of the entire body which 
 does not suffer more or less. The pains arising everywhere are 
 not caused, however, by a materially diseased change of the 
 corresponding part, but are what is termed 'reflex actions', i. 
 e. a nervous transmission of the pains from the sick to a 
 healthy part or organ. That these pains are connected with 
 the disease of the womb is proved by the fact that they are 
 subject to the same fluctuations as its ally, being most severe 
 at the time of menstruation, and generally disappear as soon 
 as the normal position of the womb is regained and its di- 
 seased condition is removed. Pains in the loins, the back, the 
 
119 
 
 stomach, and dyspepsia of the most various kinds, nausea, diz- 
 ziness, headaches, hoarseness, weakness of the muscles, also 
 spasms and cramps of various kinds, palpitation of the heart, 
 congestions towards the head, in this manner prove their depend- 
 ency upon the prevailing disease of the uterus. 
 
 But as the most alarming symptoms arise only after the 
 disease has existed for a long time, most of the above mentioned 
 troubles may be said to be caused by a general nervousness or 
 hysteria, which later develops independently as a sproud taken 
 from a tree grows after having been planted in the ground. 
 
 It may be well to say here a few words in regard to hysteria. 
 This trouble presents itself in the most various forms. Although 
 the symptoms of the disease may often seem artificial and 
 affected, it would be wrong to say that hysterical people are sick 
 only in their own imagination, and to laugh at or ridicule them, 
 as is often done. True, the anatomical foundation of this trou- 
 ble has not been proved as yet, and no changes either in nerves 
 or tissue have been discovered. Thus the trouble must be re- 
 garded as being of a psychological nature, yet its connection 
 with the physical functions of the body cannot be denied. Ev- 
 ery part of the nervous system may be affected by the trouble. 
 Hearing, sight, and taste are often impaired, spasms, paralysis 
 of the limbs, or sometimes of one half of the entire body, insen- 
 sibility or the contrary, over-sensitiveness of the skin or muscles 
 and bones, larger or smaller portions being affected, especially 
 on chest and abdomen, all these may appear and disappear 
 quite suddenly. Wonderful cures, which have been made 
 even in our times, have really been brought about by the hys- 
 teria of the cured person, and are thus easily explained. 
 Limbs which have been paralyzed by cramps for a long 
 time suddenly regain their mobility; a voice that has been lost 
 by a severe agitation of the mind, is restored by another one ; in- 
 sensibility of certain parts is transposed to the other side of the 
 body by external manipulations, etc. It is as though the patient 
 often looses control over an arm, a leg, the tongue, and suddenly 
 regains it. Mental faculties are generally highly developed in 
 "the hysterical. Now laughing, then crying, now amiable, 
 attentive and obliging, then deceitful and bearing ill, they con- 
 tinually go from one extreme to the other. The patients pro- 
 
120 
 
 oeed with unusual and admirable cunning to gain an end which 
 they may have in view. Their temper is easily aroused, and 
 while in one instant they delight in complaints and exag- 
 gerations of their troubles, in another they will know nothing of 
 hysteria, and try to divert the attention of others in every pos- 
 sible manner. 
 
 Of course there is a wide stretch between light cases and 
 
 such as the above described, and it requires often some time, 
 
 ven for an experienced physician, to ascertain with accuracy 
 
 Figure 27 — First Stage of Reposition of the Womb. 
 
 how much of the existing trouble may be accredited to hysteria 
 and how much to the disease of the womb. 
 
 Prevention — In order to prevent retroflexion, all opportun- 
 ities before described, which tend to relax the ligaments, must 
 be avoided. It is necessary to watch in children, and young 
 girls that by regular evacuations of bowels and bladder, an over- 
 filling of these organs might be prevented. Chlorosis is to be 
 treated according to the laws of medical science (see page 65). 
 
 Catarrh of the womb and exhausting discharges and hemorr- 
 hages should be guarded against and in confinement the rules 
 before given should be obeyed. ( See page 90. ) If pregnancy 
 has taken place in spite of a retroflexion, the most exacting care 
 
121 
 
 must be practised. During the first month, as long as there is- 
 any danger of the impregnated womb to be hemmed in within 
 the pelvif , which is always to be feared under these conditions, 
 the normal position of the womb should be forced and later kept 
 by means of a pessary. This can be removed, however, as soon as 
 the womb has grown sufficiently large to prevent it from falling 
 back, which will be before half of the time of pregnancy has 
 elapsed. But the greatest care must be taken after the birth of 
 
 Figure 28 — Second Stage of Keposition of the^Womb. 
 
 the child, as it is often possible, by keeping the patient 'in the 
 correct position (see treatment), by regular evacuations of blad- 
 der and rectum and by the insertion of a fitting pessary together 
 with the proper administration of ergot (prescription 38) to 
 affect a perfect and permanent cure. 
 
 Also after miscarriage or premature birth the woman should 
 consider herself as being in confinement, and use all possible 
 precaution and care : often severe troubles, which will not yield 
 to years of treatment, are caused by these miscarriages. 
 
 Treatment — The treatment of a retroflexion is based upon 
 certain principles. 
 
 Those rare cases in which an accidental examination shows 
 
122 
 
 the womb is bend backward, but in which there are no troubles 
 arising therefrom, require no local treatment, since it might 
 happen that the result would be directly opposite to what was 
 intended. But as soon as troubles arise, the treatment should 
 be begun. As the inflammatory processes are, as we have seen, in 
 most cases the consequence and not the cause of a retroflexion, 
 it is natural that restoration to the proper normal position is the 
 best means for effecting a cure. This should, therefore, be done 
 as soon as possible if other circumstances do not oppose it: only 
 if it is impossible on account of existing intergrowings, or not 
 
 Eiouke 29 — Thikd Stage of Keposition of the Womb. 
 
 allowed to be performed, when there is danger of increasing the 
 existing inflammation, or when there is an accumulation of mat- 
 ter, the replacing should be delayed. 
 
 In cases which have not existed for any length of time, 
 for instance such just acquired in confinement, it is often 
 possible to effect a cure only by keeping the proper posi- 
 tion. Since the position of lying on theback facilitates the 
 displacement it is evident that a position contrary to that 
 will facilitate the replacement. Thus it is recommendable 
 if a retroflexion existed before pregnancy, or if such a displace- 
 

 123 
 
 ment is threatening during confinemement to lie on the abdomen 
 for a few hours each day. as in this manner the heavy body of 
 the womb will fall forward to its normal position. 
 
 The reposition, i. e. the restoration of the normal position of 
 the uterus may be attained by applying different means. Former- 
 ly the uterine sound was used for this purpose. It was introduced 
 into the cavity of the womb, and by a certain twist the body of the 
 womb was brought upward and forward. But the more the com- 
 
 Figure 30 — Fourth Stage of Keposition of the Womb. 
 
 bined method (see figure 20). has been developed, improved and 
 perfected, the more the use of the uterine sound has been abol- 
 ished for this purpose, as it is very dangerous in some cases, and 
 cannot be used at all in case of pregnancy. The experienced 
 gynaecologist, even every physician who can claim to have any 
 experience in treating female disorders, will use the sound only 
 in exceptional cases when the vagina is very short and narrow, or 
 when the walls of the abdomen are extremely rigid or fat, and 
 offer an unsurmountable obstacle. The reposition without a 
 
124 
 
 sound is done in the following manner, as shown in figures 27 
 to 30, according to B. S. Schulze. 
 
 The fingers of the physician having been inserted into the 
 vagina, pass upward in front of the chine bone, and press 
 the body of the womb in the same direction (figures 27 to 
 29), until it is reached from its rear surface by the upper 
 hand lying on the walls of the abdomen. This accomplished, 
 the vaginal part is forced back against the rear wall of the 
 pelvis, and the other hand, by means of a circular motion 
 dips the body to the front. (Figure 30.) In case it is impos- 
 sible to raise the body sufficiently, the vaginal portion may be 
 
 Figure 31 — Support op the Womb. 
 
 forced back sooner, and the womb being in this manner straight- 
 ened out, brought to the proper height. 
 
 •When the correct position is attained, the next point in 
 view is to retain it. The mere reposition^ rarely suffices. In 
 most cases it is necessary to apply some means of support. These 
 have been provided and of the most various constructions, and 
 all have been recommended, most of them are, however, 
 not conformable to the purpose and, therefore, useless. Es- 
 specially those fastened to a stem or handle (figure 31), which 
 leads outward, are objectionable. They facilitate infection be- 
 cause they keep the walls of the vagina and the outer parts, 
 which are naturally closed, separated and allow the air and with 
 it microbes to enter more readily. 
 
 Of all the other instruments only two are really practical r 
 one called 'Hodge's Pessary' and the other 'Schulze's Eight.' 
 
 The first mentioned (figure 32) is an instrument bent in 
 
125 
 
 ;about the shape of an { S\ but wider at the right, narrower at the 
 left end. The wider portion is placed within the rear vault of the 
 vagina, thus'giving support to the rear wall and at the same time 
 
 Figure 32— Hodge's Pessary. 
 
 keeping back the J vaginal conus fastened to it at its proper dis- 
 tance from the chine bone. If the vagina is wide and relaxed, 
 large and clumsy instruments must be inserted to accomplish this 
 
 Figure 33 — Hodge's Pessary Properly Placed. 
 
 purpose. Injorder to avoid this and in cases where this kind of an 
 instrument causes pains by the tension at the region of the in- 
 ner mouth of the womb, and cannot be endured, Schulze's "8" 
 is to be preferred. It acts entirely different, as it does not at- 
 
126 
 
 tack the vagina, but the womb itself. The vaginal conus is laid 
 into the upper smaller ring of the instrument, and is kept in 
 place by being pressed, not pulled, backwards, since that 
 
 8 
 
 Figure 34— Schulze's "8". 
 
 part of the ring which lies in front of the vaginal conus of 
 the womb is here most important. The width of the rear vag- 
 inal vault is of no account. Yet Hodge's ring is the most prac- 
 
 Figure 35 — Schulze's "8" in Proper Position. 
 
 tical of the two described instruments, and often is effective 
 when the "8" fails. 
 
 In case of severe inflammation, or accumulation of matter, 
 in the womb or the surrounding organs, the treatment is not 
 
127 
 
 so simple. The womb cannot be directly brought into the cor- 
 rect position, as the inavoidable pulling of the ligaments would 
 increase the inflammation. The womb may only then be at- 
 tacked under such circumstances when the dangerous inflamma- 
 tion has subsided to a certain degree. 
 
 The case is just contrary to the above when the womb has 
 intergrown in its reclining position (see Inflammation of the 
 Peritoneum.) Here it would be proper to replace the organ if 
 this were possible. When the womb is attached to the rectum 
 by ropy scars, these are often so ductile that the womb may be 
 easily replaced, the front wall of the rectum being at the same 
 time drawn out. But the difficulty is to keep it in place, be- 
 cause as soon as the hand is withdrawn the womb falls back to 
 its faulty position. Yet these intergrowings give less trouble to 
 the physician than those in which the womb is flatwise inter- 
 grown with other organs, or attached to the chine bone. These may 
 become so rigid and firm that the womb seems tied as though it 
 was immured, and it is impossible to move it even by force. In 
 most cases, ovaries and oviducts being drawn out of place with 
 the womb, are also intergrown, so that the entire inner generat- 
 ive organs are almost inseparably entangled. (Compare figures 
 25 and 26.) 
 
 It is evident that injections, tampons, hip-baths, etc., are of 
 no use in such cases, although long extended treatment, 
 or an easy and careful mode of living will greatly reduce 
 the troubles. But only two methods of treatment can effect sat- 
 isfactory cure, viz: massage or operation. 
 
 The removal of the troubles before described, without oper- 
 ation, has greatly improved since massage according to Thure 
 Brandt's method has been accepted by the medical practitioners. 
 It has long been a recognized fact that a prolonged and system- 
 atic stretching of the abnormal intergrowings and the shortened 
 ligaments gave great relief to the sufferer, as the womb was 
 thereby released from its bondages, and the circulation vastly 
 improved. The pulling by weight, the stretching of the short- 
 ened tissues by means of drawing the womb forcibly downward, 
 and other crude and imperfect methods had been successfully 
 employed long before the method was known which Thure 
 Brandt had perfected by many years of work and study. This 
 
128 
 
 man, a major in the Swedish army, had tried for some time to 
 make his experience universally known to the benefit of human- 
 ity so that all physicians might profit thereby. But the teach- 
 ings, coming from an unprofessional, and not bearing on the 
 banner^ the name of a well known specialist, remained un- 
 heeded. The intercession of B. S. Schulze, before whose eyes 
 he successfully treated several cases which had failed to yield to 
 years of treatment by various other methods, called the attention 
 of the medical profession to the Swedish masseur. The merits 
 of his method were recognized and appreciated. In spite of op- 
 position from some sources, the massage treatments have since 
 spread more and more, and are almost universally known in the 
 old country. It was quite natural that antagonists appeared in 
 course of time. Is anything of merit ever invented without be- 
 ing reproached, and even ridiculed, before it becomes firmly es- 
 tablished? Are there not still opponents to vaccination although 
 its benefits have been unquestionably demonstrated.? The choice 
 of unfortunate cases, insufficient capability of the attending 
 physicians, impatience of the masseur as well as of the patient, 
 cause many failures. Based upon my experience, I feel safe in 
 saying that massage applied at the right moment and at the 
 right place, together with the necessary practical knowledge, 
 conscienciousness and care, has never done any harm, but on the 
 contrary so much good that suffering women indeed owe thanks 
 to the man who has made it the aim of his life to relieve count- 
 less women of their pains. Many physicians who in the begin- 
 ning hesitated to accept his treatment, now number among his 
 friends, so that Thure Brandt's method is at this time regarded 
 as a great enrichment of the medical practice, and commands a 
 prominent place in gynaecology. 
 
 Like hemorrhages, chronic inflammations of the skin, etc., 
 are successfully treated and disappear in a proportionately short 
 time by rubbing, kneading and pressing, so massage acts in 
 the treatment of female diseases. The principle is the same. 
 Bondages are relaxed, old scars softened and stretched and their 
 contents of blood and juice increased, the nerves are restored to 
 their normal functions. The position of the female organs be- 
 ing obscure, the manipulations of the massage are not so simple 
 and necessitate a thorough knowledge of the construction, situa- 
 
129 
 
 tion of the female pelvis. And not this alone: each case must 
 be studied and all its details be clearly and distinctly recognized 
 before the massage treatment can begin: thus the latter should 
 only be performed by graduated physicians, and even these will 
 be successful only when they have practical experience in this 
 special line. One advantage of this method is that the patient 
 need not undress, and the masseur can perform his treatment 
 without embarrassing his patient. 
 
 Both hands of the physician, who is seated to the left of the 
 patient, are employed. As in the bi-manual examination (figure 
 20) the forefinger, or the fore and middle fingers are p'aced 
 within the vagina, the patient lying on her back, her knees be- 
 ing drawn upward. The inserted fingers have the purpose to 
 lift and to hold in place the organ to be treated, be it womb, 
 ovaries, oviducts, or ligaments. The massage proper is perform- 
 ed only by the outer hand, which is placed upon the walls of the 
 abdomen, while the fingers introduced into the vagina keep still. 
 
 All troubles which are in the least accompanied by fever, or 
 the presence of matter or cancer, will not allow massage treat- 
 ments. In speaking of the presence of matter we mean all such 
 inflammations which are accompanied by any accumulation of 
 matter, and in speaking of cancer all malicious tumors. These 
 latter must, therefore, be excluded before the treatment is begun . 
 The treatment may be started five or six weeks after the fever 
 subsides, but only with the greatest care, and it is to be stopped 
 immediately when there comes again a rise of temperature. 
 
 It would be beyond the range of this book to go more into 
 the details of this excellent method. The only object is to call 
 the attention to it, and to advice my readers to give it a trial be- 
 fore concluding to go through an operation. Only when the 
 massage fails, or when the treatment should prove to be too 
 much extended-, then this latter may claim its place. 
 
 The most simple operation, because it is performed without 
 the use of a knife, is the loosening of the womb by force, accor- 
 ding to B. S. Schulze. After a complete chloroform or ether nar- 
 cosis has been attained, the physician inserts two fingers into the 
 rectum, as high as to reach the base of the womb, while the thumb 
 of the same hand is placed into the vagina in order to keep control. 
 With these two fingers and the other hand, which is* lying upon 
 
130 
 
 the walls of the abdomen, the uterus is firmly held, and the 
 binding ropy fixations are torn. Flat, surface-like intergrow- 
 ings are removed by a scraping motion, from right to left and 
 opposite. When the womb is freed, and ovaries and oviducts 
 are also made movable as far as possible, the normal posi- 
 tion must be^retained also here by means of a pessary. If 
 this precaution would not be used, the womb would fall back 
 and the sore surfaces, touching each other, would soon grow to- 
 gether again, so that the whole procedure would have been in 
 vain. A few days of absolute rest in bed will suffice to restore 
 the patient 'entirely. 
 
 Although the success in this manner obtained cannot be 
 underestimated, there is always a little danger connected with it. 
 The physician is obliged to work in the dark, i. e. without the 
 aid of the eyes, and it cannot be estimated beforehand what 
 injuries might result from this procedure. If the rectum 
 should be torn, or the torn fixations bleed extensively, these are 
 serious mishaps, which cannot always be avoided even by the 
 greatest care, but^they are so seldom that this method should be 
 tried before a more dangerous operation is made. On the other 
 hand the massage treatment may be cut short by applying those 
 means, because after the fixations have been torn a few massages 
 will suffice to complete the cure. Even in cases in which it is 
 impossible to liberate the womb of its abnormal bondages, the 
 benefit of this operation is not lost, since it is now much easier 
 to proceed with the massage treatment and generally the most 
 severe pains disappear. 
 
 In order to"avoid the dangers threatening in applying the 
 method of Schulze, some physicians loosen the intergrowings 
 by hand or by means of a red hot iron, after having opened the 
 abdomen, as in this way injuries to the rectum and bleedings 
 can be guarded against. But this operation is- by no means a 
 simple one and few women would consent to it, if it did not of- 
 fer them at the same time a prospect of doing away with the pes- 
 sary. 
 
 After a suggestion of Ohlhausen, of Berlin, an attempt has 
 been made to fasten the base of the womb to the front wall of 
 the abdomen, by letting the threads used in sewing up the wound 
 pass through the uterus also. The results were satisfactory and 
 
131 
 
 many doubts which were expressed in this regard proved to be 
 without foundation. But in spite of all this the operation is to 
 be recommended only after many and persevering trials to effect 
 a cure by other methods have failed, and when it is ascertain- 
 ed that the retroflexion, and not the eventually existing indepen- 
 dent inflammation of the neighboring organs has caused the 
 trouble. General nervousness and hysterics, which will continue 
 independently afterwards, have often given great disappointment 
 as the expectations regarding the results of the operation were 
 not realized. These two troubles will subside very slowly, and 
 if the difficulties are caused chiefly by them the operation will 
 be of little value. 
 
 Another operation to prevent the womb from falling back 
 without the use of instruments, recommended by Schuecking, is 
 much simpler and less dangerous. In this the base of the 
 womb is fastened between the neck of the womb and the blad- 
 der, after these have been separated. The prostration following 
 this operation is much less than that generally following the 
 other, since the walls of the abdomen are not opened. At the 
 same time the disagreeable scars at the latter place and the dan- 
 ger of a gastrocele being caused by an expansion of it, is entire- 
 ly avoided. As the time for 'treating is also much shorter, this 
 operation is preferable to the former under certain circumstan- 
 ces, viz: when the base of the womb can be brought forward 
 without difficulty, but it will always fall back again in spite of a 
 pessary being applied. In desperate cases,' Ohlhausen's method 
 will prove the most efficient. 
 
Descent and Prolapsus of the Womb. 
 
 A third important displacement is the descent (sinking) and 
 prolapsus (falling) of the womb. While in both of the preceed- 
 ing forms, the anteflexion and retroflexion, the displaced womb 
 remained in its original height in the cavity of the pelvis, it is 
 characteristic to this third form that the uterus sinks and ap- 
 pears more or less between the external genitals. Both diseases, 
 i. e. descent and prolapsus, consequently do not differ essential- 
 ly, but are only different degrees of the same malady. The po- 
 sition of the body of the womb, either dipped to the front or to 
 the back, varies greatly in different cases. Frequently, however, 
 sinking and prolapsus are accompanied by other displacements, 
 especially by retroflexion. 
 
 Such a disease seldom originates suddenly. The cases in 
 which the womb became suddenly visible in an otherwise healthy 
 person after falling down or lifting heavy burdens, or after a 
 similar occasion may be numbered. Also colds and diseases of 
 other organs, as for instance liver, lungs, etc., even if accompan- 
 ied by severe coughing, or a great increase of the pressure in the 
 abdomen upon the inner generative organs from above, are for 
 themselves not able to force the womb outward. There^must 
 first be a disposition, i. e. certain anatomical prerequisites. 
 These are almost exclusively created by pregnancy and delivery. 
 Since a womb suspended and kept in its place by normally tight 
 ligaments, cannot be brought as far downward as to be visible 
 between the external parts by the greatest pressure, even if there 
 is a rupture of the perineum, the first condition for the occur- 
 
133 
 
 rence of the sinking is a considerable relaxation of [the liga- 
 ments. 
 
 After every birth such is normally the case. On the one hand 
 the womb finding not sufficient room in the cavity of the pelvis, 
 when the fruit grows larger, raises into the cavity of the abdomen 
 and stretches and expands all fastenings; on the other hand the 
 way for the. child beneath, the vagina, which in a non-pregnant 
 
 Figuke 36 — Showing [the Different Sections Which Are 
 Stretched in the Different Kinds of Prolapsus. 
 
 rr — Rear Ligaments, Douglas Folds. 
 
 condition serves as a support of the womb, looses its tightness 
 and elasticity in the endeavor of nature to prepare the way for 
 the coming child: it relaxes and expands to such a degree that a 
 child's head can pass through, its means of attachment to the 
 bladder and rectum being loosened. The fact, however, that a 
 prolapsus does not occur after every confinement proves that 
 there are still other causes besides. 
 
 These are to be found in the disturbances of the delivery, 
 
134 
 
 and especially of the confinement. Obstetric operations, such 
 as the application of the forceps, or dissecting and morcellating 
 the child in the womb, etc., will expand the ligaments in an un- 
 natural manner and the succeeding exhaustion will surpass the 
 normal measure. Lacerations at the mouth of the womb or the 
 vagina, with ensuing inflammation of the tissue of the pelvis 
 create abnormal scars, which when lying toward the bladder 
 will shrink and draw the neck of the womb beyond the opening 
 of the vagina, thus preparing the way for the prolapsus. Rup- 
 tures of the perineum, even those of the first degree, much more 
 those extending as far as into the rectum, deprive the walls of 
 the vagina resting ordinarily thereon of its supporting basis. 
 The front, seldom the rear wall sinks downward and draws the 
 conus of the womb with it, which is attached to its upper end. 
 This descends consequently. The prolapsus of the vagina, and 
 simultaneously the drawing on the neck of the womb is still 
 greater if the pressure by the intestines from above is increased 
 by standing and walking, or especially by resuming heavy labor 
 too soon, by the exertions in consequence of constipation, by 
 continual coughing, etc. 
 
 Under such circumstances it depends only upon the condi- 
 tions of the ligaments how far the womb can yield to the draw- 
 ing to which it is subjected. The more relaxed these are, the 
 easier, sooner and lower the womb sinks. All injuries during 
 confinement, which tend to decrease the elasticity and tightness 
 of the ligaments must therefore be enumerated among the causes 
 creating a prolapsus. There are in the first place all disturban- 
 ces of confinement which do harm to the entire organism, as ex- 
 cessive bleeding, fever and pains after delivery, unsuitable be- 
 havior, also pregnancies occurring in short intervals, heavy work 
 resumed too soon, nursing too long, etc. Further when bladder 
 and rectum are overfilled they will do their share to force the 
 womb in an erect position (figure 21), which induces the retro- 
 flexion and facilitates the prolapsus: the vaginal portion ofjthe 
 womb is brought nearer to the outlet of the vagina, and the not 
 yet dimished heavy body of the womb presses the entire organ, 
 lying as it were on an inclined plane, downward by its gravity. 
 
 But since in most cases the ligaments and the peritoneum 
 (see page 13) still afford some support, the fundus of the womb 
 
135 
 
 usually remains at a certain height without descending fur- 
 ther. Nevertheless the womb becomes visible, extending be- 
 yond the private parts. In order to understand this as well 
 as the details of the figures given in this chapter it will be 
 necessary to look closer at figure 36. We see in the neck of 
 the womb three sections separated from each other, and indicat- 
 ed by 1, 2, and 3. No. 1 includes everything below the joining 
 point of the front wall of the vagina; No. 2 all that is below the 
 
 Figure 37 — Prolapsus of the Womb. 
 
 a — Bladder, b — Front Wall of the Vagina, c— Inner Mouth of the 
 
 Womb, d — Rear Vault of the Vagina, e — Peritoneum, 
 
 g— Outer Mouth of the Womb, h— Mouth of the Urethra. 
 
 joining point of the rear wall which reaches up higher on the 
 womb than the front one; No. 3 all that is below the joining 
 point of the rear ligaments. 
 
 As previously stated the prolapsus is generally caused by 
 the walls of the vagina, which prolapse at first. If only the 
 front wall sinks and pulls on the womb, the entire drawing is 
 restricted to the section indicated by 2. This section alone is 
 
136 
 
 Lengthened thereby. The rear wall of the vagina remains in its 
 place and a condition is created as represented in figure 37 at a 
 beginning and in figure 38 at a later stage. In front of the 
 womb the vagina has disappeared since the entire front wall (b) 
 has been turned to the outside; behind the womb the vagina, 
 however, still exists. If the front and the rear walls have pro- 
 lapsed the pulling lengthens section 3, and a condition is created 
 as represented by figure 40. Neither in front nor behind the 
 womb is there anything left of a channel, since the front (b) as 
 well as rear (d) wall of the vagina has prolapsed. 
 
 In both cases whether section 2 or 3 has been lengthened, 
 it is the neck of the womb which has been stretched, while the 
 body of the womb itsetf usually remains unchanged. Consequent- 
 ly the cavity of the womb remains of the original size and reaches 
 in all figures only to the line c, while the entire rest of the chan- 
 nel between c and g is formed by the lengthened neck channel. 
 This extension is sometimes so great that the distance from the 
 outer mouth of the womb to the fundus is more than seven in- 
 ches instead of about two and one -half in the normal condition. 
 
 In comparatively rare cases prolapsus occurs with maiden 
 and women, who have never given birth to a child. As in such 
 cases the pulling down by the walls of the vagina is insignific- 
 ant, the extension of the nec'k of the womb does not occur 
 therefore, and the womb is found in the prolapsus of its normal 
 size, inclined forward or backward with its fundus. (Figure 42.) 
 
 The causes of the displacement must then be different: Also 
 here a relaxation of the ligaments and the peritoneum, occurring 
 on account of enfeebling discharges, general disturbances of nut- 
 rition, as chlorosis and chronic diseases of the stomach and bow- 
 els, excessive or unsatisfied sexual intercourse, etc., is the first 
 presumption, but instead of the pulling down by the walls of 
 the vagina we find pressure from above resulting from the prev- 
 iously enumerated causes, as constipation, heavy work, etc. Ha- 
 bitual over-charging of bladder and rectum is also here of the 
 same importance. The disappearance of the fat in a higher age 
 at the buttocks, tighs, private parts and in the pelvis, which 
 serves also as a support for the womb, may cause a prolapsus in 
 elderly women. 
 
 Symptoms — The troubles commence quite a time before a 
 
137 
 
 bulging out projecting from the vagina can be seen. Even if the 
 womb sinks but little the drawing on the ligaments causes a 
 sensation of bearing down, as though something was about to 
 drop. Women feel as if it would be necessary to press the tighs 
 together while walking and standing in order not to loose any- 
 thing. This is a very characteristic symptom, yet it would be 
 
 Figure 
 
 Prolapsus of the Womb. 
 
 -Bag of the Bladder, below the Inner Mouth of the Womb, b — Front 
 
 Wall of the Vagina, c— Inner Mouth of the Womb, d — Rear 
 
 Vault of the Vagina, e — Peritoneum, g — Outer Mouth of 
 
 the Womb, h— Outer Mouth of the Urethra. 
 
 wrong to draw a conclusion from this alone that there is a be- 
 ginning of a falling of the womb, since other diseases may cause 
 the same sensation where an examination will prove that the 
 womb has not descended, as for instance in inflammation of the 
 large ligaments, retroflexion, etc. The more the ligaments are 
 pulled the more distinctly is the above described sensation. If 
 in the case of a beginning prolapsus the woman leaves the bed 
 after confinement the pressure downward is overwhelming on 
 

 138 
 
 account of the weight and size of the womb. All intestines 
 seem to drop out. With the retrogression and diminution of 
 the womb these symptoms gradually disappear, they reappear, 
 however, with increased vehemence after the next birth. 
 
 When delivery and confinement have laid the founda- 
 tion for the prolapsus in this manner, the above mentioned 
 harmful influences will cause the disease to develop more and 
 more. 
 
 The first perceptible and visible sign of a threatening pro- 
 lapsus is given by the lowering of the wall of the vagina, usu- 
 ally the front wall. A slowly growing, moist, wrinkled, pink 
 tumor forces itself outward through the pudenda. It is increas- 
 ed by standing, coughing and pressing, and decreased by rest 
 and lying. If the physician's assistance is not resorted to in order 
 to stop the process now, the mouth of the womb will gradually 
 appear, being visible during the day as a hard round knob with 
 an opening in the center. It regresses when the body rests at 
 night in a horizontal position, the troubles diminish and during 
 the morning, when generally the women feel comparatively well, 
 the prolapsus is not perceived. The sliding back of the tumor 
 which is yet easy and takes place without any assistance may 
 later become difficult and even impossible. The swelling of the 
 womb caused by its abnormal position, grows more and more 
 and is sometimes so great that the woman can hardly or not at 
 all force the intensely enlarged organ back through the entrance 
 of the vagina. Standing, walking and working is impossible 
 under such circumstances. At the places which are exposed to 
 pressure, or touched by the clothing and the bed while sitting 
 and lying, mattery ulcers will develop, which secrete an abund- 
 ant, odorous, corrosive fluid (see figure 39). The lining of the 
 vagina, formerly soft and lubricous, being now exposed to the 
 open air gradually grows similar to the external skin : its wrink- 
 les disappear and it becomes hard, dry, and less sensitive. 
 
 An important distinctive characteristic of the prolapsus 
 from other tumors, which may project from the vagina and 
 might be mistaken for a falling of the uterus, is offered by the 
 outer mouth of the womb, which can always be found on top of 
 the prolapsus (figure 39 a.) 
 
 Menstruation shows no significant change and is generally 
 
139 
 
 rather weaker than stronger. Fertility is not reduced, on the 
 contrary generally increased, since after the womb has been 
 forced back there is no hindrance to copulation. Many women 
 suffering from a falling of the womb feel well only during preg- 
 nancy, because the womb on account of its enlarged size cannot 
 prolapse at this time. 
 
 Figure 39 — Prolapsus of the Womb — According to Hugier. 
 
 a— Outer Mouth of the Womb, b— Ulceration surrounding the Outer 
 
 Mouth of the Womb, in shape of a circle, c — Outer Mouth of the 
 
 Urethra. 
 
 Symptoms proceed also from the surrounding organs ac- 
 cording to their participation. Displacements of the ovaries, 
 oviducts and the peritoneum (dotted line in all figures belong- 
 ing to this chapter) cause a great number of various pains: such 
 in the back up to the shoulder blades, headache, pains in the 
 stomach, loins, at the region of the navel, etc. The rectum is 
 rarely affected, the bladder, however, participates usually, since 
 
140 
 
 the front wall of the vagina, which is closely attached to it, takes 
 a leading part in the introduction of a prolapsus, as we have 
 seen before, by starting this displacement: the bladder follows 
 the drawing of the prolapsing front wall. Only in exceptional 
 cases when the connecting tissue is stretched as figure 40 h 
 shows the bladder remains in its place and then no difficulty in 
 passing water is experienced. 
 
 At the beginning of the descent of the front wall of the 
 vagina the bladder reacts upon the irritation caused in conse- 
 quence of this pulling downward by a frequent desire to urinate. 
 If later one part of the bladder comes beyond the inner mouth 
 of the urethra and a bag has formed below (a in figures 38 and 
 42) urine accumulates there and forces the Wall of the vagina 
 still more to the outside: the bearing down increases. The blad- 
 der can only be emptied partly and urination is rendered im- 
 possible in cases where the urethra is curved as shown in figure 
 42, until the prolapsus is pushed back and the bladder thereby 
 brought to its normal location. If the urine stagnates in the 
 bag for any length of time, it will decompose and cause an in- 
 flammation of the bladder, which will increase still more the de- 
 sire to urinate and makes the urine unclear and cloudy. 
 
 The seldom occurrence of the participation of the rectum is 
 explained above, since the rear wall of the vagina prolapses less 
 often and the rectum is closer attached to the sacrum (figure 1 c) 
 than to the vagina. But even if the rectum bulges out (see 
 figure 40 i) it does not cause near so many troubles as the same 
 occurrence with the bladder. 
 
 By the information thus far given it will be seen that in 
 cases represented in figures 38 and 42, the sufferer will be trou- 
 bled by disorders of the bladder, which is not so in such cases 
 as represented in figures 37 and 40. Cases represented in figure 
 40 will cause trouble by the rectum being affected. 
 
 Prevention — The origin of the prolapsus may be prevent- 
 ed partly by the obstetrician and partly by the woman herself. 
 A correct and suitable care during delivery is of greatest import, 
 ance. All haste and unnecessary interference at this time has 
 its malicious results. If ruptures of the perineum have occur- 
 red they should be removed directly after delivery, as merely 
 sewing them together will cure them permanently in most cases. 
 
141 
 
 If there have been indications of a commencing prolapsus even 
 before pregnancy, the usual time of remaining in bed will not 
 suffice. The time ought to be prolonged so that confinement 
 lasts at least three weeks. The diminution of the womb/nnust 
 be regulated by rest, givingHuid extract of ergot (prescription 
 31) and*by inserting tampons. (See figure 19.) The relaxed 
 
 Figuke 40 — Prolapsus of the Womb. 
 
 a — Bladder, b — Front Wall of the Vagina, c — Inner Mouth of the 
 
 Womb, d— Rear Wall of the Vagina, e — Peritoneum, 
 
 h — Stretched Tissue connecting Bladder and Neck of the Womb, 
 i — Bulging Out of the Rectum. 
 
 vagina should be strengthened and made firmer after the con- 
 finement flow (see page 91) has ceased, by injections with addi- 
 tions of contracting remedies (see page 35). Premature birth 
 and abortions must be considered as regular confinements. Nurs- 
 ing too long must be avoided. If the vagina begins to prolapse 
 it must be brought back and supported by a pessary. Regular 
 evacuations of the rectum and especially of the bladder, special 
 rest during menstruation, removing of the favorable conditions 
 
142 
 
 previously enumerated, causing relaxation of the organs of the 
 pelvis, are necessary prerequisites. 
 
 Treatment The cure of this sad and disagreeable con- 
 
 dition'has been tried in old times by rude manipulations. The 
 unfortunate sufferer was suspended for some time by the feet, or 
 little pieces of decaying meat were inserted into the vagina, cre- 
 ating ulcers which, while healing, closed its channel. Later 
 round or oval objects of different forms were introduced into the 
 vagina in order to prevent the womb from prolapsing. These 
 latter instruments have been gradually improved and perfected 
 and at last pessaries, as spoken of in the chapter on retroflexion, 
 were constructed, which were also applied against the prolapsus. 
 
 Figure 41— Mayer's Pessary. 
 
 Only the round pessary of Mayer, made of soft or hard material, 
 needs mentioning, since it is to be applied in some cases. 
 
 If a well fitting apparatus holds the prolapsus in its proper 
 place without causing any pressure or annoyance in any direc- 
 tion, it has fulfilled its requirements. But an ideal cure has not 
 been realized, and a pessary is only an expediency. The trou- 
 bles indeed decrease, the ulcers disappear, the- discharges dim- 
 inish, and the swelling * of the womb recedes, but heavy labor, 
 which frequently the women who are suffering from this mal- 
 ady have to do, cannot be performed. The pressure working 
 from above upon the womb, soon overcomes the supporting in- 
 strument, and forces it out again. Here, as also in cases in 
 which a pessary cannot offer the necessary help, an operation 
 must be performed. This may be recommended the sooner and 
 the more urgently, since its results are nearly always satisfac- 
 tory, and the performance itself is comparatively undangerous, 
 as the abdomen is not opened. The methods are so numerous 
 and complicated that they cannot be described here, only the 
 principle may be briefly given. This is to make the vaginal 
 tube so'narrow that the womb cannot slide through it. Decid- 
 
143 
 
 edly the best way is the narrowing of the vagina by removing a 
 piece from the front and the rear walls and removing at the 
 same time eventually existing lacerations of the perineum. Af- 
 ter uniting the wounds by sewing them together, cure will soon 
 follow, a cure which enables the patient to enjoy life again and 
 do even|hard work, generally without wearing any instrument. 
 
 Figure 42 — Prolapsus of the Womb. 
 
 -Bag of the Bladder, below the Inner Mouth of the Womb, b— Front 
 
 Wall of the Vagina, c— Rear Wall of the Vagina, d— Per- 
 
 itoneum, e — Outer Mouth of the Womb, h — Outer Mouth 
 
 of the Urethra. 
 
 The conditions created by an operation resemble the nor- 
 mal state very closely and it need not be feared that the connub- 
 ial intercourse is impaired thereby. On the contrary: the coi- 
 tion is more satisfactory. Also succeeding births are not ob- 
 structed, since the vagina, which has been artificially "narrowed, 
 is yet sufficiently extensible to allow the head of the child to 
 pass. Every delivery, however, offers the danger of a relapse 
 
144 
 
 into the old condition, because the vagina expanded so far again 
 usually remains wide and offers the womb the possibility to 
 slide to the outside again. Pregnancy should, therefore, be 
 avoided after the operation has been performed. 
 
 Those women who cannot decide to have an operation per- 
 formed should try the massage according, to Thure Brandt. Al- 
 though it has not near as good effects in this case as in other 
 displacements, i. e. ante- and retroflexions, it may still have the 
 result of improving and even completely curing when combined 
 with the prescribed gymnastic exercises. By strengthening the 
 pelvis bottom (figure 2), bringing more fresh, healthy blood to 
 these organs, stretching existing scars and by improving the 
 nutrition of the organs of the pelvis, the massage tends to make 
 the ligaments of the womb stronger, and to restore to them the 
 lost elasticity. This treatment takes, however, a long time, and 
 easily wearies the women out of patience, before the desired re- 
 sult is attained. This method is, therefore, only recommended 
 when the quicker and safer way by operation has been absolute- 
 ly refused. 
 
 It is self evident that a quiet and comfortable manner of 
 living can render these troubles endurable without any special 
 treatment, and it is, therefore, a rule that the disease does not 
 develop so highly with women who can take good care of them- 
 selves, as with those who must work all day. 
 
 No preparation taken internally is able to bring the prolapsed 
 womb back, and hold it in its' proper place, as it is claimed by 
 some patent medicines. A local treatment is absolutely neces- 
 sary if a cure is urgently desired. 
 
 As an insufficient substitute for a pessary, which may be 
 unaccessible to some women, who cannot reach an experienced 
 physician, a kind of tight belt (see figure 16) will offer some re- 
 lief since it gives a certain support. 
 
Inversion of the Womb. 
 
 By this disorder we understand a condition as it is repres- 
 ented in figure 43. The walls of the uterus have sunk more or 
 less into its cavity and project when the trouble has develop- 
 ed to a high degree through the expanded mouth of the womb 
 into the vagina and even, if prolapsus exists at the same time, 
 through the private parts to the outside. 
 
 The womb has been described in the Anatomical Introduc- 
 tion as a hollow organ formed of thick muscular layers, the in- 
 ner surface of which is covered by a mucous membrane and 
 touching each other. In a normal condition there is, therefore, 
 irrespective of the firmness of the walls, no possibility of an in- 
 version. It can occur only under two presuppositions: If the 
 cavity of the womb is expanded and a part or the entire mus- 
 cular walls are relaxed. 
 
 Both conditions exist after delivery, which offers the only 
 opportunity for a sudden occurrence of an inversion. Under such 
 circumstances they are caussd either by a drawing from below, 
 or a pressure from above. The former is more frequent and 
 caused either by some unfortunate circumstance of nature, or 
 by the impatience of the obstetrician. If the labors set in sud- 
 denly with a woman who expects to be confined and if the child 
 is expelled so soon that the mother found no time to lie down 
 in bed, the precipitating child forcibly tugs or draws by the um- 
 bilical chord, especially if this is short or wound around the 
 child's body or neck, on the after-birth. This, however, being 
 still firmly attached to the walls of the womb, cannot follow 
 

 146 
 
 without drawing the latter along. They yield to the pulling and 
 the inversion is the result. 
 
 What has happened in this case on account of unfortunate 
 circumstances is caused in other cases by the impatient pulling 
 of the midwife or obstetrician. The umbilical chord hanging 
 out of the vagina offers a convenient, seemingly innocent and 
 harmless means to accelerate the removal of the placenta. By 
 
 Figuee 43 — Inversion op the Womb, After Delivery. 
 
 a— Fundus of the Womb, bb— Front and Rear Lip of the Mouth of the 
 
 Womb, c— Mucous Membrane of the Womb, d— Placenta, 
 
 still adhering to the Muscular Wall of the Womb, e— Umbilical 
 
 Chord, ff— Peritoneum. 
 
 pulling impatiently more and more forcibly the sudden sad acci- 
 dent proves the danger of such a manipulation. 
 
 The same condition, i. e. expansion of the cavity of the 
 womb and relaxation of the walls are presupposed in those in- 
 versions of a chronic character which do not result from partur- 
 ition. Tumors are then the cause in the following manner- 
 Those originating mostly between the muscular walls project 
 
147 
 
 more and more into the cavity (see Muscular Tumors of the 
 Womb) and force the walls apart. Under this condition the 
 same results will follow as they are perceived when any foreign 
 body is lying in the cavity : the womb tries to expel by power- 
 ful contractions of its walls the abnormal contents through its 
 mouth. This latter is gradually opened thereby. When the 
 tumor is thus finally forced out, it can draw along the walls of 
 the womb if they are relaxed and weakened at that place, on 
 which the growth originated, and with which it is still connect- 
 ed (see figure 44); and an inversion exists. The deeper the 
 tumor descends the greater the inversion and in this manner 
 the entire womb may be inverted in course of time. 
 
 Symptoms — The symptoms of the sudden inversion during 
 accouchment are exceedingly alarming. Sharp pains accom- 
 panied by nausea, vomitting, even fainting spells and uncon- 
 sciousness follow under such circumstances a precipitated deliv- 
 ery or the manipulations of the obstetrician. Body, arms and 
 legs grow cold and are covered by perspiration, the pulse is very 
 quick, weak and hardly perceptible. The pains extending from 
 the abdomen to all parts of the body, are accompanied by a vio- 
 lent bearing down. By the irresistible impulse to press forcibly 
 a tumor which may become visible in front of the vulva, is forc- 
 ed down still more. The blood in most cases issues very pro- 
 fusely, and the more so, the more the after-birth has detached 
 itself. Bleeding to death, or excessive loss of blood with its 
 noxious consequences are some of the principal dangers result- 
 ing from this unfortunate occurrence. 
 
 When the inversion occurs suddenly in confinement, the 
 tumor which projects into the vagina, or even out of the exter- 
 nal parts can hardly be mistaken for something else, especially 
 if the after-birth is still attached to it. The characteristic caus- 
 ing circumstances, the blueish and easily bleeding soft surface 
 of the tumor leave no doubt as to the nature of the disorder. 
 The absence of the body of the womb at its proper place, and 
 the depression at the place of the former, which is detected dur- 
 ing an examination from the abdominal walls or from the rec- 
 tum will be marked as characteristic indications. 
 
 The gradually forming inversions may be more easily mis- 
 taken, especially by£the women themselves. Having never heard 
 
148 
 
 of this comparatively rare disease they almost always suppose to 
 be suffering from prolapsus uteri and only the examination by a 
 physician proves the real fact. The question is decided by the 
 absence of the mouth of the womb on top of the tumor, by the 
 presence of the opening of the oviducts and'; the mucous mem- 
 
 Figure 44 — Showing a Womb Just After Delivery. 
 
 a — The place where the after-birth was connected with the walls of the womb 
 (see figure 12). It is covered with coagulated blood, and the mucous 
 membrane missing, b — mucous membrane of the cavity, c — navel. 
 
 brane of the interior of the womb, and by the combined exam- 
 ination with two hands, from the walls of the abdomen and the 
 rectum. * 
 
 This disease may the more easily be mistaken, since its 
 troubles and symptoms are very similar to those of the prolap- 
 sus. Bearing down, troubles in urinating, and in emptying of 
 
149 
 
 the bowels, tearing pains radiating in all directions, and especi- 
 ally the emerging of a tumor in, or in front of the vagina, are all 
 alike in both cases. But while the menstruation is only little, 
 or not at all impaired in most cases of prolapsus, there is a pro- 
 tracted profuse bleeding in this case, which is very characteristic 
 in ascertaining this disorder. 
 
 Treatment — The treatment consists in bringing the body 
 
 Figure 45 — Inversion of the Womb, Caused By Tumor. 
 
 a — Tumor, b — Fundus of the Womb, c — Mucous Membrane 
 
 of the Womb, dd — Peritoneum. 
 
 of the womb back to its original location, which must be at- 
 tempted by all means. It would be a great mistake not to re- 
 verte immediately, if possible, an inversion which has occurred 
 after delivery. The sooner this is done the easier it may be 
 accomplished, and the more satisfactory the result; for in spite 
 of the violent symptoms the troubles usually disappear soon af- 
 ter the reversion. 
 
 Also in chronic inversions, which have existed for some 
 
150 
 
 time, it is advisable to try at first to revert the organ if neces- 
 sary by force, after the tumor causing this displacement has been 
 removed. Only after this proved unsuccessful, which it fre- 
 quently does, a gradual forcing back should be tried by a rubber 
 bladder filled with water. This being placed into the vagina 
 while the patient remains in bed, exerts a continual equal pres- 
 sure from below, which can be graduated exactly by filling the 
 rubber ball more or less. In this manner it is sometimes pos- 
 sible, provided patience and perseverance are exercised, to. cure 
 even in obstinate cases the patients of their suffering, without 
 a dangerous operation. 
 
 If excessive bleeding, prostration and impossibility to work, 
 or the social standing of the patient demand a more rapid cure, 
 the entire womb must be removed by an operation which, al- 
 though dangerous, will restore the body to perfect health in a 
 much shorter time. 
 
Tumors of the Womb. 
 
 By tumor, new formation or growth we understand an ab- 
 normal increasing and growing of any tissue of the body, which 
 does not serve the purpose of repairing a loss caused by injury 
 or inflammation, but starts from some unknown source, and con- 
 tains in itself the faculty of independent and unlimited develop- 
 ment. 
 
 It is well known that such new formations may originate 
 at all parts of the body, with men and women, with children 
 and adults. But age and sex prove to have their own peculiar 
 characteristics as to place and nature of the tumor and its fre- 
 quency. As in many other regards so likewise here the woman 
 is more subjected to suffering than the man. Although cancers 
 of the tongue, lips and stomach are far more frequently found 
 with men, yet new formations are not near as frequent with them 
 as they are with women, and especially at their peculiar organs. 
 Womb, ovaries and breasts offer so preeminently the native soil 
 for tumors, that more than one half of all cases of growths which 
 are observed, originate at these three organs. 
 
 The new formations occurring at the womb, of which we 
 speak in this chapter, are divided according to their importance 
 into two main classes: Benign and malign or malicious tumors. 
 By benign tumors we understand such as produce symptoms 
 and troubles only by their existence, but do not infiltrate the 
 vicinity; by malign or malicious, however, such as penetrate 
 into the surrounding tissues, cancering them, and lodge in lungs, 
 
152 
 
 liver, kidneys, brains, skin, etc., their germs being dissipated by 
 the blood or the lymph (see page 115) to any part of the body. 
 The first class comprises 
 
 (a) Polyps of the Mucous Membrane, 
 
 (b) Muscular Gfowths of the Womb; 
 the second 
 
 (a) Cancer, 
 
 (b) Sarcoma. 
 
 Figure 46 — Mucous Polyp Projecting From the Mouth of 
 
 the Womb. 
 
 a — Polyp, 
 
 b — Mucous Membrane of the Womb. 
 
 BENIGN TUMOES. 
 
 (a) POLYPS OF THE MUCOUS MEMBRANE. 
 
 If one of the numerous glands existing in the mucous mem- 
 brane of the womb~(see figure 8) is clogged up at its mouth the 
 fundus is filled, and expands more and more, since the secretions 
 of mucus continue. In this manner little round knots are form- 
 ed which at first appear but little above the surface of the muc- 
 
153 
 
 ous'membrane, but gradually project more distinctly and finally 
 form a club-shaped body, being suspended as an onion by its 
 stem. In these formations there are rarely one, but usually sev- 
 eral stopped up glands, frequently even a great number of them. 
 According to the greater number of glands in the neck than 
 in the cavity of the womb, the polyps of this kind are found 
 
 Figure 47— Outer Mouth oe the Womb With the Several 
 
 Projecting Mucous Polyps.— According to Winkel. 
 
 (Compare figures 46 and 47.) 
 
 more frequently in its mucous membrane, and project sometimes 
 out of the outer mouth of the womb so that they are visible by 
 means of a speculum (see figures 48 and 49), as deep red, little 
 lumps. (See figures 46 and 47.) They are soft and slippery to 
 the touch, so that they can only be felt if the examination is 
 
 Figure 48— Speculum. 
 
 made^carefully and the examining physician is experienced in 
 this direction. Nevertheless women may feel them themselves 
 if their attention is called to them and the examination is often 
 repeated. These formations may be found also in the cavity of 
 the womb, but here they are usually not so developed. They re- 
 main mostly at the first stage, having, therefore, a broad basis, 
 
154 
 
 and covering a greater surface of the cavity of the womb. (Fig- 
 ure 50.) 
 
 All causes which create a catarrh of the mucous membrane 
 of the womb (see this) can also facilitate the formation of pol- 
 yps. Any glands stopped up by some obstruction, and expand- 
 ed later, may. cause their origin. But also particles of the 
 after-birth, which have not been removed, especially after pre- 
 mature birth, frequently lay the foundation to the second form 
 which can be proved by peculiar cells found by microscopical 
 examination. 
 
 Figure 49 — Speculum. 
 
 Symptoms — The^most important symptom of the formation 
 of polyps is the bleeding. If the person is young, menstruation 
 appears at first prolonged and increased. Gradually it grows ir- 
 regular and so profuse that dangerous loss of blood may happen. 
 Bloody secretions during the intervals and reddish discharges 
 are often found. An alarming symptom, especially with women 
 more advanced in years, is bleeding during coition because 
 thereby the much feared cancer of the womb (see symptoms of 
 that disease) is supposed to exist. This happens, however, only 
 
155 
 
 when polyps project from the mouth of the womb as is shown 
 in figures 46 and 47, and these easily bleeding little tumors are 
 mechanically injured during conubial intercourse. If the time 
 of change of life is passed such bleedings justify the suspicion 
 of a malicious growth (see Cancer of the Womb) and only a 
 careful examination by an experienced physician can rectify the 
 apprehension. 
 
 The discharges existing at the same time are mostly very 
 
 Figure 50 — Mucous Tumor of the Womb With Broad Basis. 
 
 a — Mucous Tumor. 
 
 strong, and of a glassy-mucous, or mucous-pussy, or mattery 
 quality. This as well as the pains in the back, secretion of the 
 coagulated blood, labor-like pains during menstruation, etc., are 
 the consequences of existing changes of the lining and the mus- 
 cular walls of the womb. 
 
 Treatment — The treatment consists in removing the pol- 
 yps. This is easily done if they project from the mouth of the 
 womb; if they do not the mouth must be widened by laminaria 
 sticks (see page 82) and the cavity eventually searched by the 
 
156 
 
 finger. The point of attachment and the extension of the new 
 formations having been ascertained they must be completely re- 
 moved by the forceps, or the scoop (figure 17.) 
 
 The result will be a sudden ceasing of the profuse and 
 abundant flow of blood, and after the same care following the 
 common scraping out of the womb, the woman will generally 
 be perfectly cured of her sufferings. 
 
 Internal medicines and injections, as already mentioned 
 against bleeding and discharges as consequences of catarrh of 
 the womb, will offer only temporary relief, and cannot cure the 
 disease permanently. 
 
 (b) Muscular Tumoes. 
 
 The tumor occuring most frequently at the womb is the 
 Myom, or muscular tumor, so named because it is composed of 
 the same kind of tissue as the muscular walls of the womb, i. e. 
 of muscular fibres. If the interlying and connecting tissue, 
 which holds together the single muscular fibres, is developed but 
 scarcely, the tumor is soft, in the opposite case, however, harder 
 and sometimes so hard that it is nearly impossible to cut it with 
 a knife. 
 
 According to their location three kinds of muscular tumors 
 are distinguished: 
 
 First — Such as are located toward the cavity of the womb, 
 and grow in that direction (figure 51 c). 
 
 Second — Such as remain in the middle of the muscular 
 walls and project neither toward the inside nor to the outside 
 (figure 51 b). 
 
 Third — Such as are ying toward the cavity of the abdomen 
 and show their principal growth in that direction (figure 51 a). 
 
 This is not only a scientific, but also a practical classifica- 
 tion, since the symptoms of the disease vary greatly according 
 to the location of the tumor. 
 
 The place of the origin of these tumors varying from the 
 size of the head of a pin to the size of an adult's head and more, 
 is most probably in the walls of the little blood vessels which 
 penetrate the muscular walls of the womb. On these at first a 
 small condensation of muscle fibres is formed, which is not yet 
 perfectly distinguished from the surroundings. This gradually 
 
157 
 
 enlarges. Only after it has attained a circumference plainly 
 visible to the naked; eye, it limits itself by formation of a firm 
 
 Figure 51 — Showing the Different Directions in which 
 the Muscular Tumors of the Womb G-row. 
 
 a — Muscular Tumors, growing toward the peritoneum, b — Muscular 
 
 Tumors, growing neither to the peritoneum nor to the cavity of the 
 womb, c — Muscular Tumors, growing to the cavity of the womb. 
 
 and dense envelope, and secures an independent growing for the 
 future. 
 
158 
 
 As fundamental causes we have to enumerate several things. 
 Above all it is striking that the appearance and development of 
 muscular tumors depends very much upon the age of the patient. 
 It has never been noticed with new-born children, and it is 
 doubtful whether it can happen before the inner generative or- 
 gans are fully developed. (See page 39.) Only after the twen- 
 tieth year it happens more frequently, reaching its climax be- 
 tween the age of thirty and forty. Then the time of change of 
 life approaches and with it a number of tumors disappear, nature 
 itself causing a cure. Aged women suffer consequently rare- 
 ly from this disease. 
 
 The formation of Myoms is, therefore, a disease peculiar to 
 the time of sexual activity, and its causes have often been, just- 
 ly or unjustly, ascribed to the irritation to which the womb is 
 frequently subjected during this period: coition, premature birth, 
 delivery and confinement, catarrhs of the mucous membrane of 
 the uterus, violent shocks of the womb by falling, blows, or 
 by heavy labor. And yet it is a fact that the same formations 
 occur often with unmarried women, in which case the above 
 mentioned supposition does not hold good. 
 
 It is more probable that the seed for such formations have 
 been implanted even before birth, and that an irritation caused 
 by menstruation, or some other reason, is sufficient to awake the 
 dormant tumor to growth. In this manner it may also be easily 
 explained why so often sisters are affected by this disease in a 
 like manner, and why the daughter of a mother who suffered 
 from the same has to dread this malady more than another wo- 
 man. Inheritance is, therefore, very probable. 
 
 Symptoms — The symptoms and troubles arising from mus- 
 cular tumors depend, as stated above, especially upon the loca- 
 tion of the new formation. The size is of less importance, since 
 little tumors as large as cherry seeds may cause more pains and 
 annoyances than such of the size of a child's head. 
 
 If the tension in the muscular walls caused by a small 
 growth on account of its rapid enlargement, or the density and 
 resistibility of the surrounding tissue, is very great, a number of 
 painful symptoms will appear, which are unproportionately se- 
 vere compared with the minute cause creating the troubles. 
 Frequently such little muscular tumors may, therefore, justly be 
 
159 
 
 suspected if in spite of pains felt in the womb itself, of unusual 
 sensitiveness of the organ, or pains in the back, internal heat 
 and headache arising from the generative organs, there is no di- 
 seased change to be noticed by a careful examination. Then the 
 disease is mostly considered a neuralgia of the womb. 
 
 Figure 52 — Big Muscular Tumor of the Womb, Affecting 
 
 Bladder and Rectum But Little. 
 
 and 54.) 
 
 a — Tumor. 
 
 (Compare figures 53 
 
 When the tumor expands and grows towards the inside or 
 outside according to the place where it finds least resistance, the 
 tension of the surrounding tissue is gradually overcome, trou- 
 bles caused thereby disappear and the disease takes an entirely 
 different character. 
 
160 
 
 By tumors growing inwards (figure 51 c) the cavity of the 
 womb is enlarged. Its lining is changed and all troubles caused 
 by catarrh of the womb will also arise here in course of time. 
 Menstruation is disturbed; it is prolonged, grows stronger and 
 irregular; the blood coagulates and is expelled in lumps under 
 cramp-like pains; profuse, enfeebling bleeding happens occasion- 
 ally. When these tumors remain for a long time they are in- 
 clined to create a stem like the previously mentioned mucous 
 polyps (see figure 46), and are thus lying in the cavity of the 
 womb. Then they are called fibroid polyps. The bleeding is 
 now increased still more, the labor-like pains caused by the de- 
 sire of the womb to expel the abnormal contents by contractions 
 of the muscular walls grow as violent as they are in delivery. 
 Likewise the mouth of the womb is widened and the passage 
 opened. After the polyp has passed it, the contractions of the 
 womb and the pains cease. Frequently, however, as soon as the 
 muscular walls relax, the tumor glides back again into the uterus 
 and the expulsion may be thus repeated many times. It is evid- 
 ent that this is not without danger. Above all, an inversion 
 (see Inversion of the Womb) is to be feared at the place where 
 the tumor is connected with the uterine walls. Besides this 
 there is great danger of the surface of the mucous membrane of 
 the expelled tumor coming in contact with the secretions accum- 
 ulated in the vagina, and with the air. The longer the tumor 
 has remained in the vagina the more danger of infection. The 
 discharges which are always found with Myoms on account of 
 the existing catarrh of the womb, become often odorous and 
 putrid, sometimes to such an extent that it is nauseating to the 
 patients themselves. Pieces of the tumor, even the entire growth, 
 may decompose and if help is not administered in time, it may 
 poison the entire body and lead to a fatal end. 
 
 The muscular tumors growing to the outside, i. e. towards 
 the peritoneum (figure 51 a) generally cause not near so violent 
 symptoms. The mucous membrane of the womb is not affected 
 and there are no troubles arising therefrom, such as bleedings, 
 discharges, etc. Little tumors of this class are usually insigni- 
 ficant and are only found per chance during examination. Large 
 ones, however, produce according to their location more or less 
 symptoms which are not caused by inflammation, but by pres- 
 
161 
 
 sure of'the tumor upon the surrounding organs. Troubles of 
 the rectum and the bladder must be mentioned in the first place. 
 By the pressure upon the nerves of the pelvis, sharp pains ex- 
 tending down the tighs, or even weakness and paralyzing of the 
 legs are produced. The compression of the large vessels in the 
 
 Figure 53 — Muscular Tumor of the Womb — According to 
 Winkel. 
 
 One of the biggest tumors ever observed is shown in this figure. The opera- 
 tion was performed in Bucharest, Roumania, and the removed tumor 
 showed a weight of 171 pounds; the circumference in the high of the 
 navel was about 6 feet 6 inches. 
 
 pelvis conveying the blood to the heart from the lower part of 
 the body, cause swelling of the legs, usually on one side, some- 
 times on both, and also hemorrhoides. When the peritoneum 
 
162 
 
 covering the tumor is inflamed, similar troubles appear, as des- 
 cribed later in connection with diseases of the ovaries and the 
 peritoneum of the pelvis. 
 
 By far the largest size is attained by those tumor which 
 develop neither to the one nor to the other side exclusively, since 
 their development is favored by the easy affluxion of blood. 
 Tumors weighing from 100 to 150 pounds have often been 
 found. They are located, as figure 51 b shows, between them us- 
 cular layers and form no stem. There may be no trouble in 
 spite of a considerable extension of the tumor. When it has, 
 however, reached the size of a pregnant womb or more, it will 
 naturally be different. As in pregnancy, the space in the ab- 
 domen is greatly reduced; the size of the abdomen is much en- 
 larged; the blood vessels of its walls are visible as blue lines; the 
 intestines are forced out of their place, the diaphragm pressed 
 upwards. Also here inconveniences will be felt as during the 
 last month of pregnancy: difficulties in walking, standing and 
 breathing, palpitation of the heart, fatigue, troubles of digestion, 
 etc. More seldom the tumor intergrows with the abdominal 
 walls, so that it generally can be moved freely in all directions. 
 Neither are there, as a rule, symptoms caused by pressure from 
 the surrounding organs. The displacement of the ovaries and 
 oviducts, however, is always considerable with large tumors, since 
 their connection with the womb is much firmer and tighter than 
 in pregnancy, in which the tissues of the organs of the pelvis 
 are loosened and softened. , 
 
 There are various changes in the tissue of the tumor in the 
 course of time. Above all the great influence of the monthly 
 returning menstruation cannot be overlooked. The troubles and 
 pains caused by the new formation increase during these days. 
 The womb itself and at the same time the tumor being connect- 
 ed with it receives more blood and enlarges, the tension of the 
 tissue is increased and the progress of growth is favored. Con- 
 trary to this it has been noticed in many cases that the tumor 
 shrunk when after the change of life these circumstances favor- 
 ing its growth disappeared by the cessation of menstruation. 
 After this time the muscular tumors grow smaller and smaller, 
 and sometimes disappear completely. How this hint given by 
 nature has been made use of will be described later. 
 
163 
 
 Pregnancy has a similar effect as menstruation. Here also 
 abundant blood rushes to the organs surrounding the fetus, of 
 which the tumor takes advantage. It grows unproportionately 
 faster and causes often during delivery an unexpected hindrance. 
 But contrary to this, it is possible that after a favorable confine- 
 ment, when the womb commences to recede and diminish, the 
 Myom may vanish partly or completely by the same process of 
 diminution. It is only a pity that this favorable incident occurs 
 so exceptionally. 
 
 Also other changes in the tissues of the muscular tumors 
 occurring in the course of years, depend to a great extent upon 
 the affluxion of the blood. There are also other factors, which 
 have a great influence upon these changes, but which — ? that is 
 difficult to ascertain. Who could prove with certainty why in 
 one case the tumor grows partly liquid in its interior, and forms 
 cavities which are filled now with blood, then with transparent 
 contents, or with mucous matter; while in other cases it becomes 
 partly hard, and forms firm condensations ? This only is safe to 
 say that age has some influence upon these changes, since the 
 former are usually found in younger, the latter in advanced 
 years. In some rare cases the above mentioned condensations 
 may lead to a complete petrification of the entire tumor, by de- 
 positing salt of lime between its tissues. The stones created 
 in this manner sometimes remain for years at their place, with- 
 out causing any other troubles but those resulting from their 
 weight, but may also be expelled in course of time like common 
 polyps (see page 160), under violent labor pains, if they are lo- 
 cated nearer to the inside of the womb. That women may thus 
 give birth to stones, as is told in stories, is possible also today; 
 but there is this difference that such persons are not now re- 
 garded as witches, or accused of horrible crimes, since these 
 facts can be explained scientifically. 
 
 Also the changes of the benign muscular tumors into the 
 malicious forms of cancer have frequently been noticed, especi- 
 ally in those kinds growing and projecting into the cavity of the 
 womb, and must be considered in the treatment. 
 
 The influence of the Myom upon the organism is prin- 
 cipally caused by the long continued and profuse bleedings. 
 Sudden death by loss of blood occurs only exceptionally; the 
 
1(34 
 
 highest degree of impoverishment of blood, however, is ^fre- 
 quently found. The poor sufferer has only partially recover- 
 ed from one loss, when a new one throws her back to her 
 former weakness. Emaciation, weakness, which becomes so 
 great that the patient cannot even walk for a few minutes at 
 a time, headache, dizziness, fainting, loss of appetite, nausea, 
 vomitting, all caused by deficiency of blood, aggravate the sad 
 
 Figure 54 — Small Muscular Tumor Affecting Highly 
 Bladder and Kectum on Account oe its Position — 
 (Compare figure 52.) 
 
 a — Tumor. 
 
 condition of the woman, who is besides these troubles moles- 
 ted by local ailments. 
 
 Prevention — Only general directions can be given for the 
 prevention of this disease. The womb must be protected 
 against all abnormal irritations; over-exertion in connubial in- 
 tercourse must be avoided; confinement, especially after pre- 
 mature birth, must be carefully watched; existing catarrhs must 
 
165 
 
 be removed. The directions for conduct during menstruation 
 have been given previously. (See page 78.) 
 
 Treatment — The treatment of muscular tumors of the 
 womb is performed either by hygienic measures and medicines, 
 or by surgical treatment. 
 
 The patient must avoid everything that would cause a rush 
 of blood to the abdomen, as too much walking, riding, dancing, 
 hot foot-baths, hip-baths, too laxative purgatives, excessive sex- 
 ual excitement, etc. The movement of the bowels and the emp- 
 tying of the bladder must be carefully attended to. During 
 menstruation perfect rest, and even taking to bed as soon as the 
 bleeding appears to be over-abundant are advisable. In the 
 meantime the patient ought to attend especially to the strength- 
 ening of the body by partaking of nourishing food, healthy fresh 
 air, appetizing medicines and iron preparations. (See page 66.) 
 
 Although physical and mental care aid much in removing 
 the troubles, yet they alone are incapable of controlling and re- 
 stricting the effluxion of blood. And even if they could do it, 
 still the development of the tumor would not be checked, much 
 less would the tumor itself be removed thereby. 
 
 In order to reach this end it is best to use the so-called ergot. 
 The extract of this medicine, known as "fluid extract of ergot," 
 injected under the skin is the best remedy. In order to get a 
 sufficient dose, it is advisable to take a common hypodermic 
 syringe, fill it with the liquid prescribed in prescription 38, and 
 inject the contents under the skin. The solution keeps well 
 without loosing its acting power. To avoid ulcerations at the 
 place where the injection is made, greatest cleanliness is neces- 
 sary and the syringe must be disinfected every time before it is 
 used. For this purpose it must be filled several times with a 
 solution of five per cent, carbolic acid, the remnants of which 
 are removed afterwards by cleaning out the instrument with 
 fresh boiled water. The place where the injections are to be 
 applied is usually the wall of the abdomen, or rather the but- 
 tocks or the sides of the upper tighs, since the body is there 
 least sensitive. Care should be taken, however, not to put the 
 hollow needle of the syringe into a blood vessel, since this would 
 produce unpleasant consequences. This danger may be avoided 
 by introducing the needles at the abdomen and the tighs, pa**- 
 
106 
 
 allel to the skin, into a fold which has been taken up by the 
 other hand and in which there is no bluish stripe, i. e. a blood 
 vessel, to be seen. Observing these precautions, intelligent pa- 
 tients may administer these injections themselves after they 
 have seen it done a few times, and in this manner save time and 
 money, as the treatment must be long continued. As a sub- 
 stitute when this manner of applying cannot be used the same 
 medicine, i. e. ergot, may be taken internally in the form of pow- 
 ders or pills (prescription 39). The time of using these prepar- 
 ations, however, is not unlimited, since chronic poisoning may 
 be caused when used too long. The indications of this latter 
 are given with the preceeding prescription. 
 
 As indicated the cure cannot be expected too soon. The 
 bleeding ceases soon, it is true, but the diminishing of the tumor 
 progresses very slowly, so that it sometimes takes years until a 
 noticeable decrease in size can be perceived. But patience 
 will be rewarded and when persistency is practised there are 
 comparatively few cases in which only the knife can remove the 
 malady. 
 
 Fluid extract of hydrastis canadensis, twenty to thirty drops 
 three times daily (see prescription 31), will have a similar effect 
 as ergot and will, perhaps, stop the bleeding still earlier, but it 
 does not diminish the size of the tumor as well as the former. 
 
 Much more energetically the physician may suppress the 
 bleeding by stuffing the womb and the vagina with disinfected 
 gauze or by allowing blood stopping substances to work directly 
 upon the mucous membrane. 
 
 An intermediate treatment between the non-surgical and 
 the surgical is the scraping out of* the womb and the application 
 of electricity. As formerly stated the mucous membrane of the 
 womb is always in a condition of inflamed swelling when there 
 are muscular tumors projecting into the cavity of the womb, be- 
 ing one of the main causes of the profuse bleedings. It may, 
 therefore, easily be understood why it has been frequently tried 
 to create a new and healthy lining of the womb by scraping out 
 the diseased one, according to the rules described in the chapter 
 on catarrh of the womb. But it must be mentioned that the 
 root of the disease, the muscular tumor, remains and easily can, 
 or probably even will, cause a relapse to the old condition. 
 
167 
 
 Moreover, under these circumstances the scraping out is not as 
 harmless as in a case of a simple catarrh, and must, therefore, be 
 applied with precaution. 
 
 The electric treatment has been brought to its present per- 
 fection by Apostoli, in France. This also has its advantages and 
 disadvantages. Locally it produces nearly the same effect as a 
 scraping out since the mucous membrane instead of being scrap- 
 ed away is destroyed by the strong electric current, and then ex- 
 pelled. But at the same time the current has a strong effect 
 upon the tumor itself, and causes it sometimes to be diminished. 
 Especially the fact that the flow of blood is restricted thereby 
 cannot be denied, but it must be mentioned that the danger is 
 not trivial in this treatment, and it must be continued for months. 
 
 The performance of the proper operation varies according 
 to the circumstances. Those cases are connected with least dif- 
 ficulty and least danger, in which the muscular tumor bulges 
 out more or less into the cavity of the womb, or which are sus- 
 pended by a stem like a polyp (see figure 60 c). After opening 
 the mouth of the womb slowly with a laminaria stick (see page 
 82), or at once with the knife or instrument, the tumor may be 
 removed without further preparations, In all other cases will it 
 be necessary to open the abdominal cavity at first and to attack 
 the tumor from above. According to the location and the dev- 
 elopment of the tumor the operation may be accompanied by a 
 great loss of blood, and then it is dangerous. Even though by 
 the great technical improvements of the last years great progress 
 has been made, the removal of a great muscular tumor remains 
 nevertheless a difficult task, and must not be underestimated in 
 regard to endangering life. 
 
 Still another method must be mentioned, to which we have 
 already, referred above, namely the removal of both ovaries. As 
 we have learned, the development of muscular tumors is highly 
 favored by menstruation, but the new formations cease to grow 
 and even vanish generally after the change of life has passed. 
 On these facts the operation just mentioned is based. After the 
 ovaries have been removed the monthly recurring rush of blood 
 toward the inner generative organs, instigated by the irritation 
 originating from the ovaries ceases; menstruation disappears im- 
 mediately or after a short time and all changes succeeding the 
 
168 
 
 cessation of menses under normal circumstances, and also the 
 diminution of existing muscular tumors is the result. 
 
 Since this operation, although generally much easier to 
 perform and less dangerous than the former, maims the woman 
 and deprives her of her female character, it should only be re- 
 sorted to in cases where all other means to stop the rapid growth 
 of a muscular tumor in a young woman have failed, or when the 
 tumor is difficult to remove on account of its location, or other 
 circumstances. Only under these conditions the removal of the 
 ovaries is justified and the success corresponding to the danger 
 can be expected. 1 ; 
 
 MALIGN TUMORS. 
 
 (a) CANOEE OF THE WOMB. 
 
 The most dreaded disease of the female generative organs is 
 the so-called "cancer" of the womb. And this fear is fully jus- 
 tified ! What woman who pursues with interest the sufferings of 
 her relations and acquaintances, has not heard of this dreaded 
 spectre, what woman who has ever observed a person afflicted 
 with it was not deeply moved ? If, as the statistics prove, two or 
 three times as many women as men die of this malignant growth, 
 this is, to a great extent, owing to the womb. That organ is 
 extraordinarily inclined toward this malady and offers more 
 frequently than any other part of the body the issuing soil for 
 cancer. Also here it is as treacherous and malicious as in other 
 organs, i. e. stomach, liver, intestines, etc., but if recognized at 
 an early stage there is more hope for cure and recovery when in 
 the womb, since the removal of the diseased parts is in the be- 
 ginning comparatively easy, and a spreading of the seed of the 
 new formation (see figure 60) by the fluid circulating in the 
 body, as it will be described later, will usually happen only after 
 the cancer has existed for a longer time and penetrated deeper 
 into the tissue. It is, therefore, of greatest importance for a 
 woman to be able to recognize a beginning cancer as early as 
 possible — and this is easily done after a thorough study of this 
 chapter — and consult a physician before it is too late. 
 
 The causes of cancer cannot be ascertained with accurracy, 
 as little as those of muscular tumors. Various theories about 
 
109 
 
 the source of the disease have been given, but all are unsatisfac- 
 tory. The mystery is but incompletely unveiled by different 
 facts disclosed by experience. Even a superficial study will 
 show that cancer of the womb as well, as cancer of other organs 
 of the body, is found almost invariable in persons of advanced 
 years. The greatest percentage is found during or shortly after 
 the cessation of menstruation, i. e. between the age of 45 and 55. 
 The less the number of years the less the number of its occur- 
 rance, and below the age of 25 only very few exceptional cases 
 have been observed. 
 
 The connection of cancer with preceeding births is less 
 known. It has been proved that women who have passed 
 through many especially difficult deliveries and confinements 
 
 e* 
 
 vmzmmmm 
 
 mmmm 
 
 j^gS^^Sf: 
 
 Figure 55 — Beginning of a Cancer. 
 
 a — normal layers of epithelular cells, b — conus-like in the underlying 
 
 tissue spreading cancerous, i. e. epithelular cells. 
 
 are more frequently affected by cancer then unmarried and 
 steril women. Probably the reason is to be sought in the mech- 
 anical insults so frequently occurring during this time, such as 
 lacerations, and bruises at the mouth of the womb, with succeed- 
 ing catarrh of the mucous membrane. This accounts also for the 
 fact that cancer of the womb occurs more frequently among the 
 poor than among the wealthy classes, since on the one hand the 
 number of children is generally greater among the former, and on 
 the other hand they cannot take care of themselves as they ought 
 to, being compelled to resume work soon in order to make a living. 
 Besides, lacerations of the mouth of the womb having occurred 
 during delivery, remain uncared for in spite of annoyances aris- 
 ing therefrom, and according to the latest discovery may cause 
 
170 
 
 cancer to develop under certain circumstances (see page 70). 
 The irritation by coition, however, cannot be made accountable 
 for its origin. 
 
 It is very doubtful whether long mental emotions or inher- 
 itance, as has been frequently claimed, take a prominent posi- 
 tion. The latter appears more reasonable as sometimes sisters, 
 or mother and daughter are affected by this disease. 
 
 Figure 56 — Cancer of the Mouth of the Womb. 
 
 a — cauliflower growth of the rear lip of the mouth of the womb, 
 changed front lip of the mouth of the womb. 
 
 b — un- 
 
 Every attentive reader will ask here: 'What is cancer, what 
 is to be understood by it?' The name indicates an animal and 
 many women are thus led to the belief that such a one has gain- 
 ed a hold there, and penetrates into the tissue. This is, how- 
 ever, entirely erroneous. In order to understand cancer and its 
 nature it is necessary to refer to the description of the anatom- 
 ical construction of the womb as given in the first chapter of 
 this book. As we have seen there, the sexual channel, i. e. vagina, 
 
171 
 
 uterus, and oviducts, is covered on its surface by a protecting 
 lining, the 'epitkel,' which is composed of single cells, the 
 'epithelular cells.' These are arranged in several layers in the 
 vagina as far as into the vicinity of the outer mouth of the 
 womb; but above this through the womb and oviducts there is 
 but one layer, each cell having a cilium. (See page 12.) These 
 epithelular cells are of greatest importance in the formation of 
 
 Figure 57 — Cancer of the Mouth of the Womb. 
 
 a — Cancerous Ulcer. 
 
 cancer, since it is just their abnormal spreading into the under- 
 lying tissues that forms it. Cancer is, therefore, not a new or 
 foreign substance in the body, as for instance a seed which lod- 
 ges in the bark of a tree and develops there as a parasite, but it 
 is only an excessive spreading of a normal tissue of the body, 
 contrary to the laws of nature, which while growing infringes 
 upon the existence of its neighborhood. (Figure 55.) When 
 the development has once started the new formation has the 
 power and capability of spreading in itself, as a stone rolling 
 
172 
 
 down a steep hill. If the stone is not stopped it rolls until it 
 reaches the valley, if the growth is not radically removed it 
 progresses until death brings relief. 
 
 There is a great variation in the different cases, as to the 
 vitality of the new formed tissue, and accordingly two forms of 
 cancer are distinguished: the cauliflower growth and the cancer- 
 ous ulcer. If the new formed tissue is of duration, the former, the 
 cauliflower growth, is formed (see figures 56 and 57), which 
 takes its name from its resemblance to a cauliflower head. 
 Smaller and larger lumps are formed; the place where it is lo- 
 cated, i. e. the lips of the mouth of the womb, grow thicker and 
 thicker, become shapeless and fill the upper part of the vagina, 
 where the uneven surface of the tumor may easily be felt with 
 the finger introduced into the vagina. The tumor spreads in all 
 directions, and soon goes from the one lip to the other, and then 
 to the body of the womb, more seldom to the walls of the vagina. 
 Afterwards, sometimes only after its extension has reached the 
 size of a fist, it ulcerates and produces the troubles resulting 
 therefrom, as subsequently described. If, however, the vitality of 
 the spreading epithelular cells is but little, ulcers are formed from 
 the beginning, since the cancer penetrating in the shape of 
 cones into the underlying tissue soon ulcerates again after its 
 formation. In this manner the second class is formed: the can- 
 cerous ulcer, which spreads on the one and ulcerates on the other 
 side. 
 
 Symptoms — The symptoms of an arising cancer are com- 
 paratively characteristic and can easily arouse the suspicion of 
 the presence of a malignant tumor with a woman who pays at- 
 tention to her own body. 
 
 Above all the attention must be called to irregular bleed- 
 ings. In itself these may be insignificant with women who are 
 not yet past the change of life, and are not very much heeded 
 during this time. It is, however, very ominous if after the ces- 
 sation of menstruation bleedings occur again. The existence of 
 a polyp, or of an ulcer of the mouth of the womb is very seldom 
 the cause. Under such circumstances we warn very urgently 
 against being satisfied with the thought that menstruation has re- 
 curred, as it is done so frequently, although the discharges of 
 blood are entirely devoid of the characteristics of menstruation, 
 
173 
 
 since they appear irregularly at indefinite intervals, and are accom- 
 panied by the symptoms which will be described later. In the first 
 case, when menstruation still exists, it is true the woman cannot 
 recognize the disease so easily, but yet she may ascertain the 
 existence of cancer with certainty by a digital examination of 
 her own if, as it is generally found, the origin is at the lips' of 
 the mouth of the womb, and her attention is called to it by the 
 symptoms. More profuse and irregular menstruation, which 
 
 Figure 58 — Cancer of the Womb. 
 
 The cancer is located in the cavity of the womb. The larger piece is crum- 
 bled on the surface, but not the three smaller ones. The mouth of the 
 womb is unchanged. 
 
 also accompanies various other diseases, especially catarrh of the 
 mucous membrane offer alone little characteristics. If, however, 
 there are quantities of blood discharged during the intervals be- 
 tween menstruations, or if such is brought on by mental or physic- 
 al exertion, or coition, these facts should create suspicion of an 
 existing cancer, when a woman has reached the above mentioned 
 age. But since, as previously described, also mere ulcers of the 
 mouth of 'the womb, or polyps projecting therefrom may cause 
 the same symptoms under such circumstances, a digital examin- 
 
174 
 
 ation should be made by way of deciding the question of exist- 
 ing or non-existing cancer. On the other hand these symptoms 
 may partly be missing. This is found, when, as it happens 
 in rare cases, the new formation originates not at the lips, but 
 in the neck or in the body of the womb (see figure 58), so that 
 the very sensitive newly formed cancerous tissues are protected 
 from mechanical insults by the usually unchanged outer mouth. 
 In this case the woman can — it is a pity — hardly recognize her 
 malady since the digital examination will not prove anything 
 and the poor sufferer is restricted in her judgment to the symp- 
 toms alone. 
 
 These include besides the flow of blood the discharges of 
 mucus. Sometimes quite a while before, sometimes with or 
 after the beginning of irregular bleedings they appear and may 
 become so abundant that they attain a quantity almost as pro- 
 fuse as menstruation. They are tough, thin, or mattery, as 
 long as there are no ulcerations. When these form, their color 
 may show all shades according to the contents of blood, from a 
 pale red to black. At the same time the discharges grow usual- 
 ly odorous and putrid by the spreading decomposition, and are 
 nauseating even to the patient herself. Only with a scrupulous 
 cleanliness the objectionable odor which is nearly always per- 
 ceived can be avoided during the entire sickness by removing 
 frequently the easily decaying secretions. 
 
 Still more characteristic than bleeding and discharges, I am 
 safe to say is the passage of small, hard pieces, decaying par- 
 ticles of the tumor, which are thrown out by the discharges, or 
 can be loosened from the new formations by the finger. They 
 must not be confounded with the soft easily mashed lumps of 
 coagulated blood, or parts of worn-out skin. When examined 
 under the microscope, cancer can be ascertained unquestionably 
 by its peculiar formation and in no suspicious case should an 
 examination by microscope be neglected. (See foot note.) 
 
 Soon, sometimes very soon the pains commence which tor- 
 ment the sufferer most. Bleedings and discharges would not 
 
 Foot Note — For the benefit of those women who have no opportunity 
 to have suspicious discharges, or particles loosened by the hand, examined 
 under the microscope, it may be stated here that such examinations will be 
 made by the author of this book. 
 
175 
 
 impair the general health so quickly as they do, were it not 
 for these. Pains in the back, with a sensation of heaviness in 
 the pelvis are at first noticed, usually before there are any other 
 indications of destruction of the tumor. During the time of 
 menstruation, especially before its beginning and during the 
 nights when there is more blood in the abdomen, they are in- 
 creased and are caused partly by the catarrh always accompany- 
 ing the beginning of a cancer, and partly also by the pressure 
 
 Figure 59 — Cancer of the Mouth of the Womb. 
 
 a — Cancer at the rear lip of the mouth of the womb, b— Cancer at the 
 
 front lip of the mouth of the womb penetrating into the bladder. 
 
 and compression of the nerves in the tissues, which have become 
 hard and stiff by the immigration of the cancerous cells. The 
 further the new formation spreads the more the pains are gener- 
 alized, since more and more nerves are surrounded and compres- 
 sed. Besides the pains in the back there arise pains in the legs, in 
 the entire pelvis radiating up the back to the shoulder blades, head- 
 ache, hemicrany, troubles in the stomach and bowels, etc. When 
 
176 
 
 the tumor ulcerates, and on account of this the bleedings and 
 discharges grow profuse, the pressure in the tissues is diminish- 
 ed, the nerves are liberated or being laid bare in the ulceration, 
 die off and the patient feels relieved for some time. 
 
 But since the cancer, having once started, has the capabil- 
 ity of spreading the neighboring organs are gradually attacked, 
 and above all the broad ligaments which contain the blood and 
 lymph vessels leading to and from the womb. These ligaments 
 grow stiff, thick and hard, and hold the womb firmly as though 
 it were immured. The troubles begin anew, grow more severe 
 than before, and reach their highest point when bladder and 
 rectum are affected also. If the wall of the former is intergrown 
 only to a small extent the function of the entire organ is dis- 
 turbed. A frequent desire to pass water proves an existing ir- 
 ritation. The water, clear as yet, as soon as the cancer has pen- 
 etrated as far as the mucous membrane of the bladder, shows a 
 mixture of matter and blood, and becomes putrid and odorous. At 
 a still later stage when the newly formed cancerous tissues ul- 
 cerate and die off again, abnormal connections between bladder 
 and vagina, or between bladder and womb (see figure 10) arise 
 and the water passes involuntarily out of the vagina. Still worse 
 conditions are created by the surrounding and conclusion of the 
 ureters, two thin tubes conducting the urine from the kidneys 
 to the bladder and passing near the neck of the womb. The 
 water secreted by the kidneys cannot flow off into the bladder, 
 and is held back. The harmful substances contained therein 
 are absorbed into the blood again and poison the body which 
 usually succumbs soon after. 
 
 Much more seldom such violent symptoms proceed from the 
 rectum on account of different reasons. On the one hand the 
 rectum is not so often attacked by cancer, and on the other its 
 functions are not so easily disturbed as those of the bladder. 
 Even if the rear ligaments, between which the rectum passes, 
 grow hard and stiff by cancer, thus rendering the passage of 
 stools extremely difficult, it will hardly ever happen that the 
 passage of excrements is impossible ; especially by regulating the 
 food the accumulation of stools can be reduced to a minimum. The 
 rectum is affected directly only when the cancer creeps down the 
 rear wall of the vagina and spreads in the tissues lying between 
 
177 
 
 vagina and rectum (see figure 56). Then at first symptoms of 
 catarrh of the rectum are noticed: painful movements of the 
 bowels, and blood and matter expelled with the stools. Only 
 later, if death has not occurred meanwhile, abnormal communi- 
 cations between vagina and rectum are formed with the conse- 
 quences described in the chapter on fistulse. (See page 37.) 
 
 Like the ligaments, bladder, rectum, and all tissues which can 
 be reached, so are also the vessels, everywhere present in the 
 body, intergrown by the cancerous formation. Thus this latter 
 comes in direct contact with the fluids circulating through the 
 body, i. e. the blood and the lymph (see page 115) and the dan- 
 ger of transplantation of the cancer to other parts of the body 
 begins. For it is a peculiarity of all malignant growths that the 
 
 Ci 
 
 
 
 n. 
 
 
 
 
 ^ 
 
 
 
 c« 
 
 
 §&%*!' W 
 
 
 
 
 Figure 60 — Showing How Malign Growths Are Transported 
 to Other Parts of the Body. 
 
 a — Represents the walls of a vessel, blood or lymph vessel. They are penet- 
 rated at the lower side by spreading cancerous cells b. The top of it 
 (c) is broken off and carried by the fluid circulating in the vessel in 
 the direction of the arrow and will grow in the body wherever it is 
 held up. 
 
 most minute part, even one single cell of it, if conveyed to an- 
 other part of the body may settle and develop into the same 
 tumor as the one from which it came. Wherever the current 
 of blood or lymph throws per chance such little particles of can- 
 cer, which it takes along (see figure 60), there they settle and 
 thus may start colonies at different parts of the body. It 
 may, therefore, be easily understood how cancer can be trans- 
 ported from the womb to the liver, lungs, intestines, kidneys, 
 and especially to the lymphatic glands, which are always affect- 
 ed in later stages of cancer of the womb. 
 
 Cancer may also be carried to other persons but only under 
 certain conditions, which cannot be described here in detail. 
 An infection as in scarlet fever, diphtheria, small pox, measles, 
 
178 
 
 etc... is impossible and the fear of catching it by touching or 
 even by merely visiting the patient, is not only without founda- 
 tion but also inhumane. It is an impardonable injustice to shun 
 such patients like the pestilence, and to deprive them of the 
 consolation in their suffering to be assured of the sympathy of 
 their acquaintances. 
 
 The suffering is great, indeed! There is hardly any disease 
 that torments like cancer, which undermines life treacherously, 
 slowly but surely until death brings deliverance in the full sense 
 of the word. Bleedings, discharges, pains by day and by night, 
 loss of appetite, nausea, cause a rapidly growing weakness. 
 Emaciation, tired, sluggish gait, combined with infirm bearing, 
 flabby skin with a brownish tinge, a dull expression, and a certain 
 apathy against the surrounding tell the experienced physician 
 directly the nature of the disease even before the poor sufferer 
 opens 'her mouth to enumerate the well-known complaints. An 
 examination nearly always confirms the supposition. 
 
 Prevention — In order to prevent this malicious new form- 
 ation the same precautions shouM be observed which have been 
 enumerated previously in the chapter on muscular tumors of the 
 womb. But to prevent the start of the disease is not so easily 
 placed within the power of a woman as it is to learn to recognize 
 the disease as early as possible. In order to be enabled to do 
 this it would be well for every woman to practise self-examina- 
 tion until she is able to detect even the slightest change at the 
 mouth of the womb. Besides it is advisable to remove existing 
 lacerations at the mouth of the womb if possible, and if there is 
 any annoyance arising therefrom. In case an operation has been 
 refused after cancer has been ascertained an impregnation must 
 be avoided by all means, since the new formation is favored by 
 pregnancy as well as the Myoms, as we have seen before. We 
 state here once more that as soon as there is any suspicion of 
 cancer, be it that the ladies themselves find changes at the mouth 
 of the womb, be it that only the symptoms show the above-named 
 characteristics, a physician, if possible a specialist, should be con- 
 sulted and the sense of false modesty be set aside. Only thus 
 the first stages of a beginning tumor can be discovered and by 
 an early performed operation terrible consequences avoided. 
 
 Treatment — As soon as the presence of a cancer has been 
 
179 
 
 ascertained an operation must be performed. A cure without 
 surgical aid is impossible, and has never come under observation. 
 No help can be expected from all such means as cauterizing, 
 burning, etc. They must be condemned principally because 
 they waste precious time, a time in which the only correct rem- 
 edy, i. e. the radical removing of the diseased organs is yet prac- 
 ticable. Even if it is difficult to resolve to undergo so danger- 
 ous an operation, and even if social and family relations are op- 
 posed to it, yet a woman would hardly hesitate, after the facts 
 have clearly been proven, to consent if she knew the pitiable and 
 lamentable lot otherwise in store for her. I will readily agree 
 that the consent is the more difficult to obtain the less the troub- 
 les arising from the beginning cancer are, so that it frequently 
 takes quite a while to convince women who are as yet slightly 
 affected of the necessity of this step: but just under such cir- 
 cumstances ladies should not hesitate since only at this time 
 there is still hope of a perfect cure. 
 
 There must be no doubt left, of course, as to the real pres- 
 ence of cancer, although in some cases it may be very difficult 
 to ascertain the malignant growth which is proven by the fact 
 that many cancerous ulcers are treated in their first stages as 
 simple ones until after a few months their real character is evid- 
 ent by the progress. In such doubtful cases, however, certainty 
 can always be gained by means of the microscope. A little piece 
 cut out or crumbled off by the finger from the suspicious place 
 and prepared in the proper manner showing either formations of 
 epithelular cells (see figure 55) characteristic to cancer or not, 
 will prove the existence or non-existence of a cancerous growth. 
 In advanced stages a simple digital examination will disperse all 
 doubt. 
 
 The operation consists in the resection of the entire womb, 
 and only in rare cases a partial removal might suffice. But since 
 it can never be reliably proven whether or not minute particles 
 of the new formation (see figure 60) have already been trans- 
 ported into the tissue of the body of the womb, it is always pre- 
 ferable to remove the entire organ since for reasons previously 
 stated further child-bearing is rarely desirable. 
 
 There is, however, another question which must be consider- 
 ed thoroughly before operation : Is it not yet too late ? Is it still 
 
180 
 
 possible to remove all diseased parts? Only in case the general 
 surgical principles can be followed, i. e. to operate by all means 
 in healthy unaffected tissue when resecting malicious growths in 
 order to remove all noxious particles, a lasting cure may be ex- 
 pected. The further the growth has spread the more difficult 
 the circumstances, so that at last the operation becomes impos- 
 sible. 
 
 The existing condition decides which method is to be ap- 
 plied. The simplest and that which is most commonly used, is 
 the removal of the womb through the vagina, by which the dan- 
 ger accompanying an opening of the walls of the abdomen is 
 avoided. Under difficult circumstances, however, this cannot be 
 evaded and it may happen that an operation begun from below 
 through the vagina must be completed through the walls of the 
 abdomen. 
 
 But with many women, when they come to be treated, the 
 proper time for help has elapsed. The uterus is highly thicken- 
 ed, the lips of the mouth of the womb project as big lumps into 
 the vagina ulcerating on its surface, or the tracing finger feels 
 on the place of the mouth a crater-shaped opening. The lig- 
 aments are intergrown with cancerous cells, are stiff and hard, 
 numerous glands arranged in lines prove by their enlarged size 
 their being aifected also. The womb normally movable is im- 
 movable and firm and many little hard lumps break off the tumor 
 during the examination, causing heavy bleedings. 
 
 It is one of the saddest duties of a physician to be forced un- 
 der certain circumstances to reveal to such a poor tormented 
 woman her real condition without being able to give her hope of 
 restoring her health. If nevertheless a resection is undertaken, 
 the result is nearly always very unsatisfactory. For even if 
 bleeding and discharges decrease the particles of the tumor 
 which could not be removed will spread and the pains will soon 
 return, so that the danger to life arising from operation, highly in- 
 creased in a later stage of cancer, is not outweighed by the success. 
 
 Under such circumstances as well as when in spite of a time- 
 ly operation a relapse has occurred on account of the transport- 
 ation of particles nothing can be done but to make the life of the 
 sufferer as easy as possible. Bleedings and discharges must be 
 checked. If a large tumor projecting into the vagina Is ulcerat- 
 
181 
 
 ing and bleeding, it must be removed as much as possible by the 
 scoop (see figure 17), after which proceedure the bleeding will 
 decrease. Also caustic means may be applied. I have attained 
 satisfactory results by repeated injections with alcohol or pyoc- 
 tanin in the tumor itself. This shrinks considerably and the 
 troubles subside greatly after a while. 
 
 A dry treatment by inserting dry tampons covered with 
 powders, such as tannic acid, alum, sulphate of zinc, etc., is best 
 against discharges. These tampons are, however, placed correct- 
 ly only with difficulty and, therefore, not well adapted for self- 
 treatment. Vaginal injections are more easily administered and 
 are more convenient. The additional chemicals must be different 
 according to the object in view. Against decomposition and in- 
 significant bleedings Vaginol takes the first place. (Prescrip- 
 tion 20.) Also Creolin, carbolic acid, a solution of tannin and 
 alum render valuable services. In order to remove the dis- 
 agreeable odor permangate of potash is recommendable (see 
 prescriptions 20 to 28). In case of emergency, when the other 
 remedies are not to be had, vinegar, one part to nine parts of 
 clean water will render fair services. The injections should be 
 taken twice or three times a day, eventually still more frequent- 
 ly, in a reclining position. 
 
 Wholesome and nourishing food is of great importance. 
 Definite rules are not necessary for the patient knows best her- 
 self what she likes. Only such victuals which produce much 
 stool, as rye bread, potatoes, etc., should not be taken abund- 
 antly. If the appetite decreases, appetizing medicines ought to 
 be taken. Walking in fresh air must be continued as long as 
 possible, as the close, odorous air is very unhealthy and de- 
 pressing. Regular movements of the bowels should be cared 
 for and if necessary the directions given under Constipation 
 should be applied. 
 
 If a profuse bleeding takes place suddenly, the patient must 
 take to the bed immediately. A light ice-bag is to be applied 
 upon the abdomen above the pube bone and the pelvis has to 
 rest in a higher position. If the bleeding is dangerous, a phy- 
 sician must be called to assist. He may apply remedies at the 
 proper place. Meanwhile the legs must be raised almost per- 
 pendicular and the head should lie low so that the blood flows 
 
182 
 
 from the legs, and gives to the brains the necessary amount to 
 live. If a sufficient amount of water is administered to the pa- 
 tient by injections of solutions of common salt (one-half spoon- 
 ful to one quart of water) heated to the temperature of the body 
 or by drinking plenty of warm beverages, she usually recovers 
 soon even after heavy losses of blood, since the body is capable 
 of regaining in a remarkable short time what it has lost. 
 
 Soothing medicines are indispensible at the later stages of 
 incurable or relapsed cancer. Besides moist warm compresses 
 (see page 93), warm sand or hop bags, chloroform ointment 
 (prescription 40), vaginal and rectal pills (prescription 30) are 
 to be applied. The best medicine is morphine administered in- 
 ternally, or by injections under the skin. Since it is, however, 
 very strong, the doses should be very small at the beginning. In 
 the course of weeks and months they must be increased at any 
 rate, because always a higher amount is necessary to allay the 
 unbearable pains. It is of no account if the patient thus be- 
 comes accustomed to morphin, because her days are numbered, 
 and it is the principal aim to render her last days as agreeable 
 as possible . ( Prescription 41 . ) 
 
 (b) sakkoma. 
 
 The sarkoma, also called flesh tumor, in every regard so 
 closely resembles the other tumors, especially to cancer that it 
 is impossible for women to distinguish them from each other. 
 This subject may, therefore, be treated briefly. 
 
 The peculiar name of this malicious new formation is not 
 derived from the fact that it is composed of the same or of a 
 similar tissue as the muscles, i. e. meat as used for food, but the 
 name has only been chosen on account of its external resembl- 
 ance. It differs materially from cancer, for which it frequently 
 is and easily may be mistaken, cancer being created by the 
 spreading of epithelular cells (see figure 55), sarcom arising, 
 however, from an entirely different tissue. It represents, there- 
 fore, also a completely different aspect under the microscope 
 and renders it possible to the physician to recognize it with cer- 
 tainty. 
 
 Nevertheless there are noteworthy distinct traits which the 
 experienced person can perceive. The place of its origin is 
 

 183 
 
 characteristic, the favorite seat being not the lips of the mouth, 
 but the body of the womb, similar to figure 58. It might then 
 be easily mistaken for muscular tumors, especially since sarkoms 
 are likewise found more frequently with unmarried and childless 
 women than with such as have born children, and since one form 
 may turn into the other, i. e. a muscular tumor may develop into 
 a sarkom. But the entire appearance of the disease resembling 
 in general that of cancer, except the severe pains, prove its mal- 
 ignity. Numerous lumps crumbled off the growth, which are, 
 however, not hard, but soft and easily crushed (see foot note on 
 page 174) are carried out also here with the discharged blood and 
 secretions. 
 
 Teeatment — The treatment and the prospects are in sarkom 
 exactly the same as in cancer and it is of little practical import- 
 ance whether the presence of one or the other has been ascer- 
 tained. The removal of the entire womb is always the only cure. 
 If it is too late to offer help in this manner, the only treatment 
 is to render the last days as endurable as possible by the means 
 enumerated in the preceeding part of this chapter. 
 
Diseases of the Oviducts. 
 
 The oviducts, or Fallopian tubes, (see Anatomical Introduc- 
 tion) have, as the name indicates, the function of carrying or 
 conducting the ovulum which has grown and matured in the 
 ovary and emptied into the abdominal cavity, from the place of 
 its origin, the ovaries, to the place of its further development, to 
 the cavity of the womb. Nature has provided a number of pre- 
 cautions in order to facilitate this process. The peculiar, trum- 
 pet-like shape of these organs is very appropriate to their func- 
 tions. The human ovulum, a very minute body, visible only 
 with the aid of a microscope, does not require a wide passage- 
 way and the canal in the center of the oviducts is accordingly 
 very narrow. Naturally this canal could not be so narrow at its 
 extremity at the ovaries, since it would have been only a matter 
 of chance if a matured ovulum found its way into this extremely 
 narrow passage. Nature, however, does not deal with chance 
 and in order to overcome the above described difficulty, it creat- 
 ed this spacious, funnel-shaped enlargement, a wise and approp- 
 riate provision, to receive the ovulum which is detached from 
 the ovaries, as a ripened fruit drops from a tree. For this very 
 reason the opening has been made so large that it could almost 
 cover one surface of the ovary, and has been placed so close to 
 the latter that the detached ovulum has little chance of escaping. 
 Whether the fringe reaching from the ovary to the oviduct, 
 which is much longer than the other fringy appendages and 
 which, in fact, forms a sort of a gutter or furrow connecting both 
 
185 
 
 organs, aids in carrying the ovulum along on its passage-way., is 
 not definitely ascertained, but such is very probably the case. 
 
 The female ovulum, however, in contrast with the male 
 sperm, has not the power to move along independently. Thus 
 there must be some means to carry it along in addition to those 
 provided to receive it. This is done by the ciliar epithel, which 
 is found on the inner surface of the oviducts, and which has 
 been described in the first chapter (see page 12). The motion 
 of the cilia being perpetual and continuous in a healthy woman 
 during all her life, carry along everything coming within their 
 reach, and thus also the ovulum which reaches its destiny, i. e. 
 the womb, without its own individual action. The work of these 
 fine hair-like organs is, therefore, not to be underestimated, and 
 their great importance will be shown in the discussion of their 
 partial or entire destruction by catarrh or inflammation in the 
 chapter treating of pregnancy in the oviducts. 
 
 While the womb, on account of the many glands contained 
 in its mucous membrane secretes mucus to some extent also in 
 a healthy condition, this is not the case with the oviducts, as 
 their lining has no glands. Neither mucus nor any other li- 
 quid is, therefore, present in the oviducts in a healthy, normal 
 condition. Only at the time of menstruation some blood may 
 be found within the canal, which has been there secreted. The 
 amount varies, it is, however, very little in comparison to the 
 amount of blood coming from the mucous membrane of the 
 womb, and is of no importance at all as addition to the menstru- 
 al flow. 
 
 (a) inflammation of the oviducts. 
 
 Disturbances of the normal condition and function of the 
 oviducts are caused chiefly by catarrh. As these tubes are hid- 
 den deeply within the abdominal cavity, they are not subject to 
 influence of the weather, which so often causes catarrh of nose, 
 throat and lungs, so that the cause of their being affected is al- 
 most invariably to be laid to a disease of the neighboring organs, 
 above all that of the womb. Inflammation may be transferred 
 or carried over to the oviducts in different manners — either 
 through the opening from the abdominal cavity, or from the 
 womb, or directly from the neck of the womb, skipping the cav- 
 
180 
 
 ity of the womb. This latter instance is brought about by 
 lymph vessels (see page 115), which extend from the lower part 
 of the womb, the neck, obliquely upwards and sidewards to the 
 ovaries and oviducts, and serve the pathological germs as a 
 means for spreading. The fact that inflammation of the neck 
 of the womb, in which the membrane of the body did not par- 
 take, could be transferred to the ovaries and oviducts had long 
 be known, but could not be satisfactorily explained, until the 
 course of the above described canals had been ascertained. On 
 the first way the disease very seldom proceeds into the Fallopian 
 tubes, oftener in the second. It would indeed be very surpris- 
 ing if in the numerous cases of inflammation of the lining of the 
 womb, the catarrh would not often proceed by means of the 
 ways and passages offered. In general the very fine opening of 
 the oviducts to the womb, which is extremely difficult to be 
 found, offers an obstruction which is not so easily overcome, and 
 thus protects the oviducts from disease. But just as it is the 
 case with the mouth of the womb, the narrow opening here also 
 proves extremely disadvantageous when the pathological germs 
 have once passed through it. The inflammatory swelling of the 
 lining of the oviducts closes the opening at their entrance en- 
 tirely, so that the abnormally secreted discharges cannot flow out 
 into the womb, are retained and increase the inflammation. 
 
 Excepting diseases caused by parturition and confinement, 
 or such originating during measles, scarlet fever, small pox, 
 typhoid fever, intestinal inflammations, by which generally the 
 entire womb is affected, we must lay also here the main blame to 
 the infection by gonorrhoea, which in many cases causes inflam- 
 mation of the oviducts. We have already stated in a previous 
 chapter that the neck of the womb afforded great advantages for 
 the lodging and development of the gonoccoccus. Although these, 
 directly after the infection has taken place, may proceed from 
 there upwards and lodge also in the mucous membrane of the 
 womb, this is an exceptional occurrance, as the inner mouth of the 
 womb is an obstruction which presents mostly a hindrance to their 
 progress for years. (See Catarrh of the Neck of the Womb.) If 
 during this time the cause of the disease has not been eradicated 
 by proper treatment, the oviducts will in course of time become 
 affected. This comes on very gradually and shows itself only in 
 
187 
 
 an increasing of the troubles. Life is not so much endangered 
 in these chronic cases as it is in a sudden maturation of the lin- 
 ing of the oviducts, but as consequence of the slow progression 
 of the pathological germs years of sickness and infirmity will 
 follow, as generally the ovaries and the lower portion of the per- 
 itoneum will partake in the inflammation. (See Schrceder's 
 words, page 28.) 
 
 Symptoms — The symptoms of a disease of the oviducts vary 
 greatly according to the form and stage of inflammation. A 
 slight degree of the [latter is .when in connection with womb 
 troubles not noticeable to the patient, as the annoyances caused 
 
 Figure 61 — Sack-shaped Enlargement of the Oviducts. — 
 According to Hennig. 
 
 a — Womb, b — Oviducts, only a little enlarged at the beginning of the 
 
 womb, c — Oviducts, considerably enlarged and forming sacks at 
 
 their abdominal ends, e — Ovaries. 
 
 by it can not easily to be located correctly. Only after the 
 disease has attained a more advanced stage, the symptoms be- 
 come more characteristic. Dull, drawing, or undistinct pains 
 on one or both sides of the womb guide a person in locating 
 the trouble more accurately. Colic and labor-like pains, but 
 not so severe, extending from the sides toward the center set in, 
 when the oviducts are gummed up at the abdominal and uterine 
 end, and the very fine canal is enlarged by accumulating dis- 
 charges. (See figure 61.) It is surprising what dimensions 
 this enlargement of the Fallopian tubes may attain, often the 
 tumor being the size of a child's head, and even larger. 
 
 The contents of the sack thus formed varies according to 
 
188 
 
 the nature of the disease of the lining, being thin or tick, or 
 more or less mattery. The more matter contained the greater 
 the danger, because the fluid being subjected to a great pressure 
 on account of the tension of the walls, will be partly absorbed 
 into the blood again, thus being a harm to the entire body. If 
 the matter accumulates rapidly, nightly fevers result which con- 
 tinue for weeks and months and will not cease until the secre- 
 tion of new matter has stopped. If the microbes causing the di- 
 sease die off, the rise of temperature will gradually leave and the 
 ailments begin to decrease. 
 
 But there still remains danger! Like the carrier of a bomb 
 filled with explosives, ready to burst at any moment, so a woman 
 being afflicted with such a sack filled with matter is constantly 
 in danger of life. Hard work, a sudden fall or jarring, may at 
 any moment cause the sometimes partly very thin walls to burst 
 so that the putrid contents flow into the abdominal cavity caus- 
 ing a fatal inflammation of the peritoneum. 
 
 But if, on the contrary, the contents of the sack is watery, 
 slimy or bloody, its emptying into the abdominal cavity is gen- 
 erally without evil results. This has been proved innumerable 
 times by the old method of letting out the fluid contents by in- 
 troducing forcibly a hollow metallic instrument through the 
 walls of the abdomen into the tumor, by which process a portion 
 of the fluid almost always flows into the. abdomen. 
 
 The above mentioned colic or labor-like pains extending 
 from side to center, are caused by the attempt of nature to re- 
 store the normal condition: the muscular walls of the enlarged 
 oviduct, which are under such circumstances often very much 
 thickened, contract in order to expel the contents through the 
 orifice lying toward the womb. If these attempts are entirely or 
 partially successful, the walls will relax on account of the dim- 
 inished contents and the pains caused by the contractions will 
 subside. Intelligent and attentive women will mostly observe 
 the fluid escaping after such spells and may, if acquainted with 
 the facts here given, and considering the characteristic pains 
 which preceed easily ascertain the nature of their trouble with- 
 out a medical examination. If in course of time the secretions 
 again accumulate, the same pains reappear and the above des- 
 cribed process recurs. The pains will, however, rarely occur 
 
189 
 
 continually and independently, but are generally brought on by 
 some reason, as for instance mental excitement, sexual inter- 
 course, hard work, caustiveness, lifting, coughing, riding or sim- 
 ilar exercises. Menstruation also has some influence, as during 
 this time the womb naturally contracts, and also the oviducts 
 and the pains caused thereby are, of course, much increased 
 under the above described circumstances. 
 
 Whether pressure upon the neighboring organs occurs also 
 in these tumors depends upon the size and the location of the 
 enlarged oviduct. Very large sacks which are discernable through 
 the abdominal walls as thick lumps may, if they grow slowly 
 and do not irritate the peritoneum, create comparatively little 
 disturbance, while smaller ones falling back of the womb, which 
 often happens, and being there firmly wedged in, create grievous 
 troubles of bladder and rectum. (Compare Muscular Tumors of 
 the Womb, figures 52 and 54.) 
 
 One consequence of diseases of the oviducts, which is of 
 greatest importance concerning family life, is the sterility of 
 women eifected thereby. A simple catarrh having no evil con- 
 sequences in itself, may partly or entirely destroy the ciliar 
 epithel, and deprives the Fallopian tubes of the capability of 
 transporting the matured ovulum from the ovaries to the cavity 
 of the womb. If at the same time the funnel-shaped orifice is 
 closed so that the connecting tube between ovaries and womb is 
 obstructed, the possibility of bringing forth children is entirely 
 obliviated. This condition, however, cannot always be discern- 
 ed even by a physician, as it can only be accurately ascertained 
 when an enlargement and thickening of the oviducts can dis- 
 tinctly be felt in an examination. 
 
 Prevention — Diseases of the oviducts can only be avoided 
 by promptly and properly attending to existing diseases of the 
 other generative organs. 
 
 Treatment — A perfect cure, i. e. a restoration of the nor- 
 mal conditions, is not to be expected in any serious case of in- 
 flammation of the oviducts. Their position is too much hidden 
 to get at the seat of the trouble without surgical operations. 
 These may allay the disease, but can never restore the normal 
 and proper functions of these organs. 
 
 In all suddenly arising inflammations connected with severe 
 
190 
 
 troubles a forced treatment does more harm than good. The 
 disappearing of the accompanying fever must be awaited, the pa- 
 tient keeping meanwhile quietly in bed, using vaginal injec- 
 tions, applying an ice bag on the abdomen, and inserting even- 
 tually pills (prescription 30) into the rectum to allay the pains. 
 All such manipulations of the physician which necessitate a 
 drawing down, or any displacement of the womb are to be avoid- 
 ed, as an emptying of the putrid substance into the abdominal 
 cavity is always to be feared under such circumstances. Even 
 the examination by the physician, who is to be called always to 
 ascertain the nature of the trouble, must be made with the ut- 
 most care. 
 
 If with the observance of these precautions the most alarm- 
 ing symptoms have subsided, and the soreness has decreased, 
 then treatment by means of warm water applications should be- 
 gin as we have seen in the chapter on Chronic Inflammation of 
 the Womb. Damp-warm compresses according to Priessnitz, 
 with or without salt, also warm hip, moore or sand baths. Med- 
 icated cotton, or small balls of cocoa butter inserted into the 
 vagina (prescriptions 34 to 37), are advisable when a disease of 
 the womb exists at the same time, which must always be taken 
 into consideration, as a satisfactory cure cannot be accomplish- 
 ed unless this is done away with. 
 
 This treatment must be patiently continued for months and 
 even years in order to attain a good result. Several methods of 
 treatment have been advised by means of which a more speedy 
 cure could be attained, but these are almost invariably connect- 
 ed with so much danger that they have not gained many friends. 
 The only non-surgical method recommendable aside of the above 
 described treatments is the massage performed according to cer- 
 tain fixed rules. This form of treatment should, if possible, be 
 tried before concluding to perform an operation. The only pre- 
 requisite is that there exists no fever nor accumulation of mat- 
 ter. If an experienced and skillful physician performs it, there 
 is no danger that the sack might burst. As many individual 
 cases, however, require a deviation from the rules fixed for the 
 practise of this kind of massage and also the continuance and 
 the strength of the same must be governed by different circum- 
 stances, it is well to employ a physician who has experience in 
 
191 
 
 gynaecology, and beware of all those practising without any an- 
 atomical knowledge whatever and who are simply taking advan- 
 tage of the credulity of the patients and generally doing vastly 
 more harm than good. 
 
 The removal of the diseased parts by a surgical operation 
 may be reserved for all such cases which will not yield under 
 the above described treatment, or which showed from the begin- 
 ning that these methods would be insufficient. The manner of 
 the operation varies according to the nature of the tumor and 
 the accompanying circumstances. In some very rare cases an 
 emptying of the sack by puncture, i. e. by the introduction of a 
 hollow tube-like instrument into, the tumor, by means of 
 which its contents are drained, may be successful. Generally, 
 however, the liquid will accumulate again sooner or later and the 
 condition is the same as before. 
 
 The most radical cure, and one which is now almost invari- 
 ably practised, is effected by the removal of the diseased ovi- 
 ducts. After opening the abdominal cavity, the seat of the di- 
 sease, which is now laid open to hand and eye, can with the ex- 
 ercise of proper precautions be easily loosened and removed 
 from the surrounding tissue. When the operation is performed 
 on both sides further pregnancy is, of course, entirely out of 
 question, although menstruation continues, if the ovaries or some 
 part of these have been left. But if these are removed also the 
 monthly flow will cease suddenly, or after a few months, and the 
 troubles caused thereby will disappear. 
 
 (b) pkegnancy or the oviducts. 
 
 Not only the cavity of the womb, but also the oviducts and 
 even the ovaries, may in some cases furnish the seat for the dev- 
 elopment of the fecundated ovulum. In a normal natural preg- 
 nancy, i. e. one in which the developing child is placed within 
 the interior of the womb, the process is — as we have seen in the 
 chapter treating of the physiology of the womb — such that the 
 fecundated ovulum after having been lodged within the womb, 
 buries itself like a parasite into its mucous membrane. 
 
 The connection between the ovulum and the mother being 
 loose at first, grows firmer in the course of weeks and months, 
 and only begins to loosen again at the approaching birth. Dur- 
 
192j 
 
 ing the entire time of pregnancy the child receives its nourish- 
 ment through the blood of the mother, as this is carried to the 
 fruit and back by means of the placenta. 
 
 The ovulum develops in the same manner when on its jour- 
 ney to the womb it lodges in the mucous membrane of the ovi- 
 ducts, before it has reached its destination. This being an ab- 
 normal occurrence, abnormal conditions must be the cause of it. 
 A simple catarrh of the oviducts, which has existed for any 
 length of time, may cause this, for, as we have seen, one of the 
 first consequences of this disease is the destruction of the ciliar 
 epithel. Thus on the one hand the ovulum, which cannot move 
 independently, is robbed of its propellor, while on the other 
 hand the self active sperm, provided its vitality is not diminish- 
 ed by diseased secretions, can pass more easily through the ovi- 
 ducts, because of the actions of the ciliary motion toward the 
 womb. The lodging and settlement of the ovulum in the Fal- 
 lopian tubes is the more favored, since the bends and bulgings 
 'of the oviducts caused by the catarrh offer many difficulties and 
 obstructions on its journey so that it has ample opportunity to 
 hide and to settle. 
 
 If this has taken place, the symptoms may in the beginning 
 be the same as in a regular, normal pregnancy : vomitting, nau- 
 sea, headache, longing for strange food and drink, tension of the 
 breasts, etc. Also the womb changes accordingly; it becomes 
 larger, richer in juice and softer. Menstruation ceases entire- 
 ly or is much reduced both in quantity and time of duration. 
 Exceptionally it reappears regularly. At the same time, how- 
 ever, pains begin on the side where the abnormal pregnancy 
 has happened, with more or less violence. An examination will 
 disclose the presence of a soft, exceedingly sensitive tumor which 
 is situated to the right, left, or rear of the womb, and shows a 
 very characteristic growth in the succeeding time. 
 
 One of the most characteristic proofs of the existence of 
 such an abnormal pregnancy is furnished by the discharge of 
 a skin or membrane, ejected after some months in one or 
 more pieces, which when examined under the microscope, will 
 on account of its peculiar cells, leave no doubt as to the state 
 of affairs. 
 
 Naturally these abnormal pregnancies cannot come to a 
 
193 
 
 normal end. Even if without any incident the child would 
 attain its full development, its removal from the mother by the 
 natural passages, through womb and vagina, would be impos- 
 sible. 
 
 But accidents are rarely evaded. The oviduct cannot resist 
 the enormous and especially rapid enlargement, and will burst 
 after a certain time has elapsed. This generally occurs in the 
 third or fourth month, sometimes earlier. The impregnated wo- 
 man in such a case suddenly faints away, sometimes with a ter- 
 rible shriek, if severe pains in the side have not compelled her 
 to take to her bed previously. All indications are those of a heavy 
 loss of blood. The face grows pale, hands and feet cold, the 
 pulse is scarely noticeable; severe pains in the right or left side 
 indicate the seat of the trouble. The consequences are incalcul- 
 able. It depends upon circumstances and the speed with which 
 medical aid can be summoned, whether or not the life of the pa- 
 tient may be saved. Terrible hemorrhages coming from rent 
 blood vessels, are the chief source of a sudden threatening 
 death. This danger is all the greater for the fact that the acci- 
 dent may happen several times in longer or shorter intervals. 
 The blood accumulates within the pelvis, i. e. in the Douglas 
 space between the womb and rectum (see hematocele), and may 
 be felt there later from the vagina. If the life of the woman is 
 saved, the blood is gradually absorbed again and disappears 
 slowly from that place. 
 
 A very fortunate termination of a pregnancy in the oviducts 
 which, however, is rarely attained without artificial aid is the 
 dying off of the fruit. The tumor lying aside of the womb, 
 which contains the dead fruit, gradually diminishes in size and 
 may also disappear entirely in course of some years. 
 
 But in opposition to this there is a by far greater number 
 of cases, in which the patients die of a sudden loss of blood, or 
 the enfeebling and weakness resulting therefrom, or of an in- 
 flammation of the peritoneum, so that any pregnancy happening 
 in the oviducts must be regarded as an extremely serious and 
 life endangering occurrence. 
 
 Treatment — The treatment differs according to whether the 
 oviduct has burst or not. The sooner the abnormal pregnancy is 
 ascertained the more fortunate for the patient, for every woman 
 
194 
 
 afflicted with this malady must be called a patient. But it is gen- 
 erally very difficult to state this condition with accuracy and it 
 requires often weeks of careful watching and repeated examina- 
 tions. 
 
 If the condition has been ascertained and the oviduct has 
 not yet burst, all danger may be evaded at once by removing the 
 oviduct, and at the same time the fruit, after the abdomen has 
 been opened. If this is not granted, an expectative treatment 
 must begin. In any case the growing germ must be destroyed, 
 otherwise the danger for the mother's life will increase with 
 each month. Whether electricity or injections of morphine into 
 the sack containing the fruit are to be applied for this purpose 
 depends upon circumstances, and is of no importance to the final 
 result. For if the child is dead it will be absorbed sooner or 
 later, according to its size, o at least so changed, for instance 
 calcined or petrified, that danger of death to the mother is evad- 
 ed. Only in some very unfortunate cases the dead fruit may 
 afterwards cause the same accidents as the living. 
 
 If the bursting of the oviduct is the first cause of summon- 
 ing a physician, an operation must be advised. For although 
 absolute rest in bed and the application of ice may be beneficial, 
 repeated attacks must be expected at any moment, which, in the 
 worst event, may cause sudden death; in the best, however, 
 greatly reduce the probability of attaining a satisfactory cure. 
 
 Only when the patient is so far down that she would not en- 
 dure the loss of blood, necessarily caused by an operation, it 
 may be allowed to wait, exercising the necessary care and pre- 
 caution. 
 
Diseases of the Ovaries. 
 
 The ovaries are small, flattened organs of about the size of 
 a peach stone, destined to produce the ovulum. This very small 
 organ is, therefore, the one which gives to the woman her female 
 character, since all other generative organs only serve the purpose 
 of assisting in the development of the beginning created there. 
 Even nature clearly indicates the eminent position due to the 
 ovaries, since, as we have seen in a previous chapter, the devel- 
 opment of all other parts of the generative organs as well as of 
 the entire body, depends upon the development of the ovaries. 
 (See Physiology of the Womb.) At their maturing the child 
 becomes a maiden, the hair of the pudenda grows, menstruation 
 commences, and capability of procreation begins; at their degen- 
 eration and shrinking at the time of change of life menstruation 
 ceases, the woman has fulfilled the purpose of propagation, and 
 becomes a matron. 
 
 The first formation of ovula, whose number in the ovaries 
 is said to be about 40,000, is started long before birth and is 
 completed with the latter, i. e. what does not exist at this time 
 will not be created afterwards. The ovaries have, therefore, dur- 
 ing the time of life only the purpose to mature the ovula, which 
 exist already in an undeveloped state. 
 
 Since it is not only very interesting and instructive, but 
 facilitates also the understanding of many symptoms, we will put 
 the question : How are the ovula formed in the ovaries ? and 
 will answer it in detail. 
 
 Like all other organs in the pelvis, the ovaries are covered 
 
196 
 
 on their surface by the peritoneum, as we have seen in the An- 
 atomical Introduction. In adults this is everywhere alike and 
 at the ovaries exactly the same as at the other organs. In unborn 
 children this is different. Here the cells covering the ovaries 
 are considerably larger than on the womb ligaments, etc., are 
 clearly marked from the surrounding and form the so-called 
 "germ epithel" (figure 62 a), of which the future ovula are 
 created. Some of these cells of the germ epithel grow larger than 
 the others and are called "primitive germs" (figure 62 b). They 
 penetrate singly or in groups with their smaller neighbors, probe - 
 like, similar to epithelular cells at the formation of cancer (see 
 figure 55) into the tissues of the ovaries (figure 62 c and g.) 
 Later they are separated from the surface, i. e. their connection 
 with the germ epithel is severed (figure 62 f ) and after having 
 separated from each other so as to form single bodies, they re- 
 main as undeveloped ovula (figure 62 d) until nature matures 
 them gradually. The large cells (figure 62 b) develop to the real 
 human ovulum (figure 63 f), while the smaller ones serve as a 
 lining and filling (figure 63 g) of the ovisac, i. e. of that little 
 sack of the ovary in which the ovulum is lodged. (Figure 63 a.) 
 In this stage the ovula are in the ovary of a new-born child. 
 After birth the germ epithel perishes and the ovaries are later 
 found covered by the same smooth envelope by which all organs 
 of the abdomen are covered. The possibility of developing new 
 primitive germs is now excluded for ever, and there are no new 
 ones added to the supply existing at this time. The undeveloped 
 ovula lying in the substance of the ovaries grow gradually, not all 
 at the same time but one after the other, so that all stages of 
 development, i. e. all stages from the primitive germs to the 
 matured ovulum may be found under the microscope in the 
 ovaries at the time of attained puberty (figure 63.) The nearer 
 the maturing of the ovulum the greater the accumulation of 
 liquid in the interior of the ovisacs. This approaches thereby 
 closer to the surface of the ovary and finally bursts at its thin- 
 nest place, emptying the ovulum into or near the funnel-shaped 
 abdominal opening of the oviducts, provided the ovary is in its 
 normal location. The hole thus formed in the tissues of the 
 ovary fills with blood and heals like any other wound, forming a 
 scar at that place and a little depression. When the first ovulum 
 
197 
 
 is expelled a bleeding from the genitals, i. e. menstruation oc- 
 curs almost without exception for the first time and is repeated 
 as often as matured ovula are cast out from the ovaries. 
 
 MALFOEMATION OF THE OVAEIES. 
 
 The ovaries may eventually be deformed as well as any 
 other organ of the body. Their complete absence, which most- 
 ly is combined with a missing womb, occurs very rarely and is 
 of little practical interest. An incomplete development, how- 
 ever, occurring with young, undeveloped chlorotic girls, is to be 
 found far more frequently and is, therefore, of greater importance. 
 The tissue of the ovaries exists, but their functions are imperfect, 
 there being but few or no matured ovula expelled, since there 
 are either no primitive germs at all, or those which are present do 
 not develop. Menstruation is accordingly weak and irregular, 
 occurring only at great intervals, because there is no irritation 
 produced by maturing ovula which would cause the blood to 
 rush to the pelvis. 
 
 A local treatment is consequently not advisable in most 
 cases, there being no special trouble. It requires only a general 
 strengthening of the body by healthy food, exercise in fresh air, 
 and blood creating medicines. (See page 66.) 
 
 INFLAMMATION OF THE OVAEIES. 
 
 The inflammation of the ovaries is a disease affecting seri- 
 ously not only the sexual but also the social life of women, since 
 procreation as well as physical and psychical health are influenced 
 thereby to a great extent. 
 
 It is divided into an acute or rapidly, and a chronic or slow- 
 ly developing form. 
 
 The causes of the acute form are usually severe sudden di- 
 seases of the entire body, no matter whether they commenced at 
 the genitals or not. The former is usually the case at or after 
 delivery, if pathological microbes settle in the inner generative 
 organs. The resulting inflammation of the womb and ovaries, 
 although usually very aggravating, is then only a part of the di- 
 sease of the entire body, called blood poisoning. On the other 
 hand, however, also malicious germs circulating within the blood 
 in diseases as scarlet fever, measles, typhoid fever, cholera, small 
 
198 
 
 pox, etc., may settle at the ovaries and the womb and may have 
 just as pernicious effects as when brought to this place through 
 the vagina. Infection by gonorrhoea, which must be considered 
 the most frequent cause of the rapidly and vehemently appear- 
 ing inflammation of the ovaries, is usually confined to this place 
 without poisoning the entire body, spreading perhaps only to an 
 inflammation of the peritoneum of the pelvis. 
 
 The chronic inflammation of the ovaries is either a remnant 
 of the acute form, or is originating from a gradual development 
 of morbid changes. There may be the most various causes. 
 Here again primarily the sneaking infection by gonorrhoea must 
 be named, which, after having seized the oviducts and passing 
 through these reaches the ovaries. Furthermore there are all 
 those causes which may produce an affection of the generative 
 organs, since every disease of the surrounding parts may pro- 
 ceed to the ovaries: carelessness during menstruation, taking 
 cold, wet feet, exhausting walking, continual hard work, over- 
 charging of the organs of the pelvis with blood by running the 
 sewing machine, great sexual excitement without gratification, 
 when married to an impotent man; furthermore chlorosis, dis- 
 placements of the ovaries with or without displacements of the 
 womb, development of tumors at the womb, or the neighboring 
 organs, etc. 
 
 Symptoms — The symptoms of the inflammation of the ovar- 
 ies are very different in the acute and the chronic form. 
 
 The symptoms of the acute inflammation of the ovaries are 
 usually not predominating, since the general health is yery much 
 altered. Fever, violent pains spreading everywhere, headache, 
 troubles with the stomach, intestines, bladder and rectum, sup- 
 pression of or profuse menstruation, etc., must be ascribed partly 
 to the inflammation of the ovaries, partly to that of the other 
 organs. The contemporaneous disease of the ovaries can be 
 noticed, but not always ascertained to its full extent. The most 
 characteristic sign of the latter is the extreme sensitiveness at 
 the sides of the abdomen, either the right, or left, or both, which 
 causes at every movement, or especially at every pressure upon 
 that place most violent pains, so that a small ice bag or even a 
 heavy blanket is frequently intolerable. 
 
 The symptoms of the chronic form, though also accompani- 
 
199 
 
 ed and mostly caused by an existing disease of the vagina, womb 
 and oviducts are more distinct. Also here the sides of the lower 
 abdomen are sensitive, but only when pressed in more deeply. 
 Since there is a close connection between ovaries and menstrua- 
 tion, changes in the latter are noticeable from the beginning: it 
 becomes irregular, profuse and long. The pains arising in the 
 abdomen and in the legs are not like cramps and labor pains, as 
 in the disease of the womb, but drawing and tearing; neither do 
 they diminish when the menstrual blood flows freely, but are 
 most severe when menstruation is at its height, since the ovaries 
 are then most swollen. The so-called middle pain is very char- 
 acteristic. It is a pain arising exactly in the middle of the time 
 lying between two menstruations, and lasting a few hours or 
 longer. It is probably caused by the ovaries which, after being 
 completely reduced in size from the last menstruation, now com- 
 mence gradually to swell again. If greater morbid changes have 
 occurred at the ovaries after the inflammation has existed for 
 some time, and if the immature ovula in the ovaries perish in 
 consequence of this, the menstruation, formerly profuse, may 
 gradually diminish and disappear at an age when other women 
 might be fruitful yet for many years. 
 
 The painful sensations mentioned above generally do not 
 exist continually but are produced by certain influences. Be- 
 sides menstruation, which occurs naturally, there are such causes 
 as can easily be avoided, i. e. dancing, riding, jumping, excessive 
 work, lifting heavy burdens, etc. Pains during the movement 
 of the bowels will occur when the ovaries are so displaced that 
 the hard stools on their way to the outside press them. The 
 pains during copulation result partly from the same source, i. e. 
 they are caused by a direct pressure on the ovaries, when they 
 have sunken behind the womb, but partly also from the greater 
 amount of blood in the organs aduced by the excitement. These 
 pains may become so great that an inconquerable aversion arises 
 against connubial intercourse, and that the wife evades anxious- 
 ly the husband's approach. A pressure upon the ovaries during 
 examination is very painful and the very same sensation by 
 which the woman is troubled may often be produced in this 
 manner, so that it is clearly proven that they result from the 
 existing disease of the ovaries. 
 
200 
 
 Since there are a great number of nerves connecting the 
 ovaries with all parts of the body the affection of this central 
 female organ cannot be without influence upon the general 
 health. The troubles formerly described in the diseases of the 
 womb, which are experienced in the most different and remotest 
 parts of the body, i. e. in the head, the heart, the lungs, the 
 stomach, the rectum, the skin, the arms, the legs, etc., must be 
 ascribed partly to the simultaneous affection of the ovaries. It 
 is almost incredible how numerous and variable the' painful 
 sensations are which are transported by the nerves from the 
 ovaries to other parts of the body. By the protracted sufferings, 
 
 d c o k 
 
 ct- 
 
 Figure 62 — Microscopical Picture of an Ovary of a Child 
 Before the Birth, Showing the Origin of Ovula tn 
 the Ovaries. 
 
 a — Germ Epithel, b — Primitive Germs, c — Primitive Germs be- 
 
 gin to penetrate into the tissue of the ovary, d — Single Primitive 
 
 Germ, e — Two Primitive Germs separating from each other, 
 
 f — 'Accumulated Primitive Germs separated from the surface. 
 
 which are increased by the least cause, kind and intelligent[ladies 
 are driven to such a degree of nervousness [and hysterics that 
 they are unfit for work and neglect their duties as mothers and 
 wives, and are only a burden to themselves and others. 
 
 A symptom nearly always accompanying the acute as well 
 as the chronic form is sterility. It is but natural that when no 
 impregnable ovula are produced that there are no prospects for 
 procreation even if womb and oviduct would be healthy. A 
 
201 
 
 hindrance of ovulation, i. e. of tha expulsion of ripened ovula 
 may result from various reasons. If the ovaries perish entirely 
 by suppuration, as it may happen in the acute form, the undev- 
 eloped ovula are lost with the ovarial tissue. If this latter re- 
 mains but is constantly inflamed, as in the chronic form, the 
 primitive germs gradually die off, and naturally cannot mature. 
 But even if this is not the case, and if ovula are matured, they 
 sometimes cannot be expelled because the ovaries are so inter- 
 grown by the simultaneous inflammation of the surrounding 
 parts and so enveloped by morbid exudations that they are 
 encircled as by a wall, rendering the passage of ovula impossible. 
 
 Ot- 
 
 Figure 63 — Development of the Ovula After Birth. 
 
 a — Ripening Ovisac, b — Less Developed Ovisac, c — Primitive 
 
 Germ (see d in figure 62)1 f — Human Ovulum emanating from 
 
 cell b in figure 62, g — Inner Lining of the Ovisac originating from 
 
 the smaller cells of the germ epithel in figure 62, h — Space filled 
 
 up with liquid, which byjts further_accumulation will burst the ovisac 
 thus letting the ovulum out of the ovary. * ti _. 
 
 of [the 
 
 ovaries 
 
 Treatment — The treatment of the disease 
 is different in the acute and in the chronic form. 
 
 In the acute form rest in bed is the first requisite. A light 
 ice bag placed upon the paining side cannot be dispensed with. 
 It will usually reduce not only the pains but also the fever. 
 Morphine in drops internally (prescription 33), or in pills intro- 
 duced into the rectum (prescription 30) will afford still more 
 relief. If there is an accumulation of matter it must be with- 
 
202 
 
 drawn by operation. Food must bo liquid at first, later on it 
 may be given according to the rules previously and repeatedly 
 given for regulating food during fever. Kegular evacuation of 
 the bowels is of great importance and must eventually be forced 
 by injections. (See chapter on Constipation.) But these should 
 not be used too frequently. It is absurd to molest sick people, 
 who eat nothing but easily digestible food and this only in small 
 quantities, daily with injections, which will hurt more by pains 
 and irritation than profit by the removal of that small quantity 
 of stools. 
 
 In the chronic form which does not require rest in bed, the 
 manner of living must, above all, be regulated. All causes which 
 produce repeated and continued rush of blood to the pelvis (see 
 causes of the chronic inflammation) must be avoided. But al- 
 though bodily rest is very beneficial, yet a continuous lying in 
 bed, to which some delicate wealthy ladies might be inclined, is 
 not only unnecessary, but even harmful, since it has a detri- 
 mental influence upon the general condition of the body, weak- 
 ening the functions of the healthy organs. Healthy food, reg- 
 ulating of the movements of the bowels, amelioration of the blood 
 (see page 65) are at least just as important in the chronic in- 
 flammation of the ovaries as the local treatment which we will 
 describe in the following lines. 
 
 Since the location of the ovaries is so deep, ocult and hid- 
 den that they cannot be reached by the medicines, we can exert 
 a beneficial influence upon these organs only partly directly, but 
 partly by the removal of the cause ffom which it originates. 
 This is generally a disease of the womb, which exists almost in- 
 variably at the same time. All the different kinds of treatment 
 enumerated in the respective chapters are, therefore, also here of 
 great value, such as inserting tampons, taking blood from the 
 vaginal conus, hot or warm vaginal injections, damp-warm com- 
 presses around the abdomen, the different kinds of baths, as 
 hip, sand, and especially moor baths, etc. If there are displace- 
 ments of the womb they must be rectified and in the proper 
 manner prevented from relapsing, since only in this way the 
 chronic congestion arising therefrom can be done away with and 
 the consequences be removed. 
 
 Not only in chronic inflammations of the ovaries, but espec- 
 
203 
 
 ially when there is a gumming up and intergrowing with the 
 neighboring organs, Thure Brandt's massage is recommendable 
 as the best treatment. It is the only unbloody means by which 
 the seat of the evil itself can be attacked, and by which as com- 
 plete a cure can be attained as is desired. Although other and 
 proper treatments may gradually allay the inflammation, the ab- 
 normal intergro wings (see figure 25) are not removed thereby. 
 The massage treatment will bring to the affected parts better, 
 quicker, safer and more perfect results than all vaginal tampons, 
 which are praised very much and used everywhere. The pains 
 grow less, the swelling disappears, the abnormal fixations are 
 lengthened or torn, and the ovaries are freed from their embrac- 
 ing fetters; the morbid exudations cease, and the enlarged organs 
 gradually return to their normal size. 
 
 There is no danger from this treatment when the cases are 
 properly selected and the massage is performed in a correct 
 manner. Among the numerous patients I have attended to in 
 this way, there has not been a single case in which a contrary 
 result occurred. But the patients should not expect too much, 
 and suppose that disorders, that have existed usually for years, 
 can be removed in a very short time. Patience and persever- 
 ance ! The result will seldom be looked for in vain and many 
 women will be the more willing to submit to this treatment since 
 in numerous cases a dangerous operation can thus be avoided. 
 
 Only if all the means mentioned are without effect an oper- 
 ation, i. e. the removal of the ovaries can be recommended, but 
 it is not as easy a task as is frequently supposed. Even if on 
 account of the recent progress in surgery life is not endangered 
 as much as in former years by this operation, and even if — as 
 statistics of large clinics, where all conveniences and proper ar- 
 rangements are at hand, show — there are on an average 93 to 
 94 out of 100 who survive, still the percentage of those who suc- 
 cumb in the hospitals with imperfect equipment and in the 
 private houses is not so favorable. Furthermore it must be con- 
 sidered that the surrounding of the ovaries is usually affected also 
 and that it is difficult or impossible to remove all diseased tissues, 
 whichwould be necessary in order to do away with all troubles. 
 A satisfactory result may, therefore, be expected only when most 
 of the troubles arise from the diseased ovaries themselves, that 
 
204 
 
 is to say when they are local troubles and increase and decrease 
 principally with the appearance and disappearance of menstrua- 
 tion. The more the nervous system is attacked, i. e. the more 
 the general nervousness and hysterics are developed, the more 
 unsatisfactory the result. Besides the hopes are often dis- 
 appointed by a source of chronic inflammations, which remain 
 at the place where the operation has been performed, since these 
 frequently cause the same or greater troubles then the ovaries, 
 which have been taken away. All these facts should be duly 
 considered by the patient before deciding on the operation. 
 Not too urgently can I warn of the overhasty conclusion of hav- 
 ing the ovaries removed before everything else has been tried. 
 Even against the persuasion of physicians, who— it is pity — so 
 often unnecessarily propose this operation, women should be 
 firm. For what is removed with the knife can never be regained. 
 
 Nevertheless in some rare cases the removal of the ovaries 
 is under proper circumstances a very beneficial operation, and 
 able to restore health in a comparatively short time, which could 
 not have been accomplished by any other means. 
 
 The removal of the ovaries has a vast influence upon the 
 entire organism. Most conspicuously is the cessation of men- 
 struation, which occurs either suddenly or gradually after hav- 
 ing recurred several times irregularly. All changes in the genit- 
 als and in the other parts of the body previously described, which 
 accompany the change of life are experienced also here, so that 
 a woman deprived of the ovaries may be considered as having 
 attained the change of life in early years. If a highly suffering, 
 I will say, a gradually dying woman has regained rest and plea- 
 sure in living in this way, the price paid is not too high, but it 
 is too high if the mutilation could have been avoided by per- 
 se verence and good will. 
 
 TUMORS OF THE OVARIES. 
 
 The great disposition of the female generative organs to 
 offer the native soil for the development of tumors is also found 
 in the ovaries, and even in a high degree. Next to the womb 
 they are most inclined to new formations. The kinds are, how- 
 ever, materially different from those of the womb. While in the 
 latter the muscular tumors, i. e. firm, solid growths having only 
 
205 
 
 rarely cavities in their interior prevail, the ovaries produce most- 
 ly the so-called Cystes, namely smaller or larger bags filled with 
 liquid contents and having walls of varying thickness. 
 
 The origin of these cystic tumors of the ovaries is in close 
 connection with their function, i. e. the production of human 
 ovula. If an abundant supply of liquid accumulates abnormally 
 in the maturing or matured ovisac (see figure 63) without burst- 
 ing the walls, the little sac enlarges more and more, rises above 
 the surface and develops finally into a cystic tumor. 
 
 More frequently than in this manner the tumors of the 
 ovaries develop from those cone-like probes which penetrate 
 from the epithelular covering of the ovaries into the underlying 
 tissue as shown in figure 62 g. The tumors arising from their 
 degeneration are perhaps the largest of the entire body and may 
 cause the same ugly disfiguring as we have seen in figure 53. 
 They have been observed in every age, even as innate, but most 
 frequently with women between the age of thirty to forty. Unmar- 
 ried ladies are more frequently taken with this disease than mar- 
 ried women, the latter, however, equally, whether they have had 
 many children or few. 
 
 The fact that cystic tumors of the ovaries have been found 
 even with new-born babies, and their frequent occurrence among 
 sisters and relatives, as well as the existence of pieces of cartilage 
 and bones, furthermore teeth, hair, etc., in the interior of a cer- 
 tain kind of them, indicate an existing predisposition by birth. 
 
 Symptoms — The symptoms of an arising tumor of the ovaries 
 vary greatly. Such of smaller size, and even such of the size of 
 a fist are sometimes found by chance when a patient is examined 
 for some other reasons, as there were no troubles arising from 
 them. Also such of large size must not necessarily cause pains, 
 but will not be overlooked because they expand the abdomen 
 more or less. How often for this reason unmarried ladies are 
 suspected to have had forbidden intercourse, or how often do 
 the friends of a married lady expect in vain the occurrence of a 
 happy event! But the time of confinement does not arrive, the 
 abdomen grows thicker and thicker, so that even an inexperienc- 
 ed person can not overlook the real fact at last. 
 
 Even the women themselves may be doubtful at first if the 
 tumor develops comparatively fast, since sometimes the breasts 
 
206 
 
 swell and changes in the menstruation set in. Usually this lat- 
 ter is, however, quite normal in spite of the tumor, since the 
 origin of cystic growths of the ovaries is not the consequence of 
 inflammatory processes, but starts from the development of ab- 
 normally growing tissues. If catarrh of the womb, or other dis- 
 orders in the generative organs exist at the same time their char- 
 acteristic troubles are easily understood. 
 
 Contrary to menstruation, fertility is influenced very much. 
 Even if the tumor is but small and only on one side, impreg- 
 nation usually does not occur for various reasons. 
 
 A great number of tumors of the ovaries cause pains and 
 derangements in the functions of bladder and rectum in course 
 of time. These are induced mostly by displacements of the 
 tumors to the rear, or more seldom to the front of the womb. 
 The pressure exerted thereby upon the surroundings, acts in 
 the same manner as we see in the muscular tumor shown in 
 figure 54. If the tumor attains the size of a pregnant womb, it 
 becomes troublesome besides its pressure, by filling the abdom- 
 inal cavity and by its weight. It produces inconveniences in 
 walking, standing, sitting, also shortness of breath, disturbances 
 of the stomach and digestion, swellings of the external genitals 
 and legs, varices, hemorrhoides, etc. A swelling and tension in 
 the breasts, formation of so-called striae (see page 51), a dark 
 line arising in the middle of the abdominal wall, gives in many 
 cases still a greater similarity to pregnancy. 
 
 Treatment — A kind of a cure by nature herself is the emp- 
 tying of smaller or larger cystic tumors to the outside without 
 the aid of a physician. Such cases are, however, very rare, and 
 are caused by the intergrowing of the sack with the bladder, the 
 rectum or the abdominal walls and by a final perishing of the 
 separating tissues. In the first and second cases the contents 
 flow out by way of the urethra or rectum, in the third, however, 
 directly to the outside. But since through the same opening, 
 through which the contents have left, pathological germs usually 
 penetrate into the evacuated cystic tumor and may cause decom- 
 position and severe inflammations, this emptying is not by any 
 means always a happy occurrence, even though the troubles fre- 
 quently disappear. 
 
 The only satisfactory treatment of tumors of the ovaries 
 
207 
 
 is by surgical aid, as there are no medicines by which such a 
 tumor could be forced to disappear, as little as it is possible to 
 prevent its development by proper precautions. The operation 
 is, however, not always indispensible. Some tumors of the ovar- 
 ies remain for years unchanged and of the same size without 
 growing perceptibly and without causing annoyances. Under 
 such circumstances it is only necessary to prevent accidents and 
 to regulate the manner of living in such a way as to prevent an 
 eventual inflammation or bursting of the sack. All heavy work, 
 all straining amusements which are connected with concussion 
 of the body, as riding, dancing, etc., must be avoided, the bowels 
 must be kept loose. Pregnancy favoring generally the growth 
 of all abdominal tumors, should be avoided as much as possible. 
 Should inflammatory symptoms nevertheless occur, they ought 
 to be treated according to the rules laid down previously for the 
 diseases of the ovaries. 
 
 In all these advices it is presupposed that the patient is able 
 to take the required care and rest. This is usually, however, im- 
 possible for women who are obliged to support themselves by 
 manual labor. In this case as well as in all cases in which a per- 
 ceptible growing of the tumor is evident, or the change into 
 cancer is noticed or must only be suspected, an operation is un- 
 avoidable and becomes the more difficult and dangerous the 
 longer it is put off. A complete removal of the tumor by gast- 
 rotomy is the common and most appropriate process. If the 
 tumor of the ovaries is, however, not too large and too much in- 
 tergrown with the surroundings, it may be removed also by way 
 of the vagina. In this manner the dangers of gastrotomy are 
 partly evaded, and the disagreeable scar on the abdominal wall 
 is avoided. 
 
 After a successful operation the prospects are bright. If 
 only one ovary had been affected frequently only the scar in- 
 dicates what has happened, menstruation and fertility remain 
 uninfluenced. But if tumors existed on both sides and both 
 ovaries had to be removed, all changes appear which result from 
 the removal of both ovaries. 
 
Diseases of the Connective Tissues of the 
 
 Pelvis. 
 
 Since the organs of the pelvis, i. e. the inner generative 
 organs, the bladder and the rectum do not completely fill the 
 space lying within the pelvis bone (figure 1), the so-called cav- 
 ity of the pelvis, there must necessarily be something to fill this 
 space. This is done by a tissue called "connective tissue of the 
 pelvis," which derives its name from its service of connecting 
 the organs of the pelvis with each other and with the pelvis 
 bone. Besides it serves on the one hand to hold the organs of 
 the pelvis in their respective position, location and relation and 
 on the other hand to support all blood and lymph vessels and 
 nerves. These connective tissues can, therefore, not be hard, 
 stiff and sinewy, but must be adjustable, elastic!" soft and loose 
 in order to enable the womb, bladder and rectum to accommodate 
 themselves to their varying dimensions and to facilitate their 
 mobility. Nearly all that is lying at the sides of the womb, 
 especially the large ligaments (see page 13) are mainly formed 
 of these tissues. An inflammation of these ligaments is, there- 
 fore, nothing but an inflammation of the connective tissues of 
 the pelvis, which, consequently, is also discussed in this chapter. 
 
 The loose and soft quality as well as the abundance in juice, 
 blood and lymph vessels and nerves cause the connective tissues 
 of the pelvis to partake the more readily of all inflammations of 
 the embraced organs. No wonder it is also affected in nearly all 
 diseases of the inner female generative organs, and is more or 
 less the cause of the existing troubles. 
 
209 
 
 The inflammations of the connective tissues of the pelvis 
 are divided into two classes: in an acute and in a chronic form. 
 
 Both forms proceed principally along the way where the 
 tissues are most compact, namely along the right or left side of 
 the womb into the interior of the large ligaments, while that part 
 of them which is lying in front or in the rear of the womb is 
 more seldom attacked. In the following we will speak, there- 
 fore, in general of the inflammations of the large ligaments. 
 
 The acute form occurs mainly after parturition and confine- 
 ment and for special reasons. It is an established fact that all 
 sudden inflammations of these tissues are caused by microbes. 
 Their sudden entering into the tissues is, however, only possible 
 when there exists a wound or an ulcer at any part of the womb, 
 since the sound surface of the mucous membrane offers an in- 
 vincible safeguard against them. But at what time are injuries 
 of the inner generative organs more frequent than after delivery? 
 The great forcible expansion of all parts, especially that of the 
 inner and outer mouth of the womb, taking place in a compar- 
 atively short time, is naturally always connected with lacerations 
 and bruises of greater or less extent at these places. Then it 
 depends only upon the presence or absence of pathological mic- 
 robes. Generally their interference is not to be feared when the 
 generative organs are healthy and when a careful disinfection 
 and cleanliness was practised during delivery, but it is to be feared 
 when catarrhs and inflammations of the womb, which so often 
 cause abortion and premature birth, have existed previously. 
 The frequency of inflammations of the ligaments directly after 
 these occurrences is consequently due to the existence of these 
 presuppositions: presence of pathological germs, injuries, and 
 generally also insufficient care. The danger connected with abor- 
 tion and premature birth lies, therefore, not only in the remain- 
 ing of remnants of the ovulum (see Catarrh of the Womb), but 
 also in beginning inflammatory processes of the neighborhood 
 of the womb. 
 
 More seldom the cause of the acute form must be looked for 
 in ulcers of the vagina and the womb, produced by the pressure 
 of foreign bodies or pessaries, or in injuries, or unfortunate 
 manipulations at the womb, such as expansion of the mouth of 
 the womb, removing the lining of the womb by the scoop, etc. 
 
210 
 
 Under these circumstances they are, however, usually not so 
 severe and more limited. 
 
 Symptoms — The symptoms of a beginning acute inflamma- 
 tion of the tissues of the pelvis are very aggravating. The pa- 
 tient usually after a short illness is seized with chills. Under gen- 
 eral prostration the temperature of the body rises higher and the 
 chills are succeeded by fever. A local pain at the lower part of 
 the abdomen to the right or the left side, now sharp and severe, 
 then less violent, indicates the seat of the disease. The pulse 
 beats faster and faster. Headache, fatigue, pains at all move- 
 ments of the body, compel the patient to take to bed, if she is 
 not yet there. Insomnia, loss of appetite, even disgust of food, 
 indigestion, pains during the movements of the bowels and dur- 
 ing urination annoy the sick woman. 
 
 In the abdomen, at the point of the severest pains, which 
 radiate in all directions, on the right or the left, or both sides, 
 an extremely sensitive more or less distinct swelling develops. 
 When it attains the size of a fist it may be felt from the outside 
 through the walls of the abdomen as a hard tumor above the 
 region of the groin. It is produced by an abnormal exudation 
 from the blood vessels between the fibres of the connective 
 tissues. 
 
 If the condition improves, the fever gradually subsides, the 
 pains decrease and by absorbtion of the abnormal exudations 
 swelling and hardness regress: recovery is at hand. If the condi- 
 tion does not improve the entire swelling may commence to put- 
 rify. The matter cannot be absorbed and tries to find a passage 
 most frequently through the vagina, or through the walls of the 
 abdomen. Only when this has happened the temperature of the 
 body sinks to its normal degree and the recovery will begin. 
 
 Pkevention — The prevention of the acute inflammation of 
 the connective tissues of the pelvis lies mainly in the hands of 
 the physician. He must proceed with the utmost care and 
 cleanliness during delivery so that no pathological microbes are 
 brought by the hands or the instruments to those smaller or lar- 
 ger lacerations and bruises, in the interior or at the mouth of the 
 womb, which are always unavoidable in every case of confine- 
 ment. If microbes are already settled in the inner generative 
 organs bafore delivery on account of existing catarrh etc., they 
 
211 
 
 may reach such sore places without the fault of the physician. 
 Not only during delivery, but also afterwards the necessary care 
 and accuracy must, therefore, be practised. (See page 90.) 
 
 When pessaries are worn it should never be forgotten that 
 these instruments *as all foreign things in the vagina may cause 
 penetrating ulcers and putrif action when neglected and not kept 
 clean. This danger is avoided when the instrument is well fit- 
 ting and when frequent injections are applied. (See Diseases 
 of the Vagina.) 
 
 Treatment — The treatment of the existing disease requires 
 
 Figure 64 — Section Through the Pelvis Showing Sinewy 
 Degeneration of the Connective Tissues at the Left 
 Side. 
 
 aa — Section through the pelvis bone, b — Womb, c — Pelvis bot- 
 
 tom (compare figures 3 and 4), d — Vagina, e — Connective tissues 
 of the pelvis, fixing the womb to the left pelvis bone, g — Peri- 
 
 toneum. 
 
 above all rest and ice. The patient should not only take to bed 
 immediately, but also lie very quietly. Every movement, espec- 
 ially that of the legs is painful and harmful, as it irritates the di- 
 seased tissue. Fomentations, so frequently used, are not recom- 
 mendable in the beginning, as long as fever still exists. An ice 
 
212 
 
 bag applied according to the rules given previously (see page 92), 
 however, will have a very beneficial effect. The same is true 
 of hot vaginal injections: they are also to be rejected in the 
 beginning. Only after the fever has disappeared and the 
 pains have diminished, the absorbtion of the exudation may be 
 accelerated by damp-warm compresses on the walls of the ab- 
 domen, or by applying hot cataplasm or hot vaginal injections. 
 All these warm and hot applications must, therefore, be avoided 
 in the beginning, because they facilitate putrifaction which 
 afterwards requires an operation: this is usually prevented when 
 the ice bag is applied in time. 
 
 If the swelling begins to putrify nevertheless, which is rec- 
 ognized by its softening in some places while the fever contin- 
 ues, a repression is impossible. Then the putrifaction must be 
 accelerated so that the matter may break through to the outside, 
 by hot injections, cataplasm, poultices, hot hip-baths, etc., or a 
 passage way must be formed — and this is much better — artific- 
 ially by an operation. If this is done the high fever will de- 
 crease immediately and the general health will soon improve. 
 
 During the whole time of sickness care must be taken that 
 the bladder and the rectum are frequently emptied. But this 
 must not be overdone, tormenting the sick person incessantly 
 thereby with numerous injections in the rectum. The harm 
 done by irritating the diseased parts would be greater than the 
 benefit derived from the removal of the stools. It must be re- 
 membered that on the one hand little food is taken on account 
 of lack of appetite, and on the other hand the food is so to be 
 selected that it leaves no stool whatever, or at least very little. 
 Milk, eggs, gravy, meat and fresh vegetables answer this pur- 
 pose best. If there is no special reason, an injection every second 
 day, or a spoonful of castor oil will be sufficient. 
 
 If the pains are very severe in spite of rest and the applica- 
 tion of the ice bag, they may be mitigated by the pills in pre- 
 scription 30, which are to be introduced into the rectum. 
 
 The chronic form of the inflammation of the connective 
 tissues of the pelvis presents an entirely different aspect. There 
 are no alarming symptoms of sudden fever and sharp pains. The 
 exudations into the tissues of the ligaments are less and 
 commence gradually. In many cases they never exist and the 
 
213 
 
 morbid changes consist only of a hardening and shrinking of 
 the normally elastic and soft connective tissues, which become 
 more and more tenacious and stiff. The blood vessels and ner- 
 ves passing through these tissues are impaired thereby, the cir- 
 culation of the blood is hindered and the organs are restricted 
 in their mobility, and dislocated. All this happens, as stated, 
 only slowly and gradually. The inconveniences which consisted 
 at first of discharges and abnormities in menstruation, increase; 
 troubles from the bladder and rectum are added; pains are felt 
 in the loins; nervousness and insomnia begin, and the appetite 
 is lost. All these troubles increase by occasional colds, careless- 
 ness during the time of menstruation, etc., so that the patient 
 grows worse gradually. 
 
 The physician, who is usually consulted too late, will find 
 by examination the chronic changes in the ligaments which have 
 just been described, and they immediately explain to the expert 
 the increasing sufferings. True, only the experienced specialist 
 can recognize the conditions exactly, but also the woman herself 
 can suspect the existence of such abnormal, shrinking scars, 
 when she finds in examining that the normal mobility of the 
 mouth of the womb (see pages 102-103) is lost and that it is fix- 
 ed to the right, or left, or to the rear. 
 
 These chronic changes of the ligaments occur nearly after 
 all diseases of the womb, which have existed for a long time. 
 This accounts for their extraordinary frequency. But above all 
 catarrhs of the womb beginning in confinement or on account 
 of infection, for instance by gonorrhoea, are succeeded almost 
 invariably in later years by more or less severe affections of the 
 connective tissues of the pelvis, since the microbes proceed from 
 the interior of the womb to the ligaments. 
 
 Symptoms — The symptoms of the chronic disease of the 
 connective tissues of the pelvis are very various, since many or- 
 gans are afflicted thereby at the same time. The blood vessels 
 imbedded in the scarred and shrinking tissues are pressed to- 
 gether by the surrounding indentations and bent, the blood re- 
 turning to the heart is stemmed back on its way and the existing 
 catarrh increases (see Catarrh of the Womb) : the discharges be- 
 come more abundant and the troubles during menstruation 
 more aggravating. Thus catarrh produces chronic inflammation 
 
214 
 
 of the ligaments and this again increases the catarrh: cause and 
 effect interchange, and one makes the other worse. The nervous 
 suffering is caused in a like manner, the nerves being also sur- 
 rounded by the scarry tissues and pressed together. The con- 
 sequences are pains and general nervous ailments: pains in the 
 back, pains during coition, pains in the loins radiating down- 
 wards to the legs and upwards between the shoulder blades, head- 
 ache, pains in the region of the navel and stomach, etc. 
 
 The troubles are similar to those described with chronic in- 
 flammation of the womb and ovaries. This similarity is evident 
 if we consider that the blood vessels .and nerves of the womb, 
 oviducts and ovaries must pass through these diseased connective 
 tissues and are usually made to contribute to its sickness. Every 
 woman must decide by self-examination whence the pains and 
 what the cause. For this purpose advices have been given in 
 previous chapters. But this may be emphasized that she can 
 recognize best and easiest the affection of the ligaments by the 
 restricted possibility of moving the womb, and by the pains 
 when she tries to displace the vaginal conus. It will hardly be 
 possible for her to feel the separate strings and their quality on 
 account of the difficulties in doing this. 
 
 Prevention — As the sinewy degeneration of the connective 
 tissues of the pelvis may occur with every protracted disease of 
 the inner generative organs the prevention has a wide field. All 
 that has been said in the respective chapters of prevention and 
 treatment of the different diseases, especially of that of catarrh 
 of the neck of the womb and of the womb itself would have to 
 be repeated here. It may be read in their respective places. 
 
 Treatment — Formerly the physicians were nearly helpless 
 in cases of chronic shrinking of the connective tissues of the 
 pelvis. This and that was tried, but nothing proved to be satis- 
 factory especially since the expensive baths that were resorted 
 to, were out of reach for the poor people. Today we have far 
 better facilities, as the massage of the generative organs accord- 
 ing to Brandt enables us to remove even the most obstinate ab- 
 normal strings. Like a scar on the epidermis that twists a fin- 
 ger, arm, or leg, gradually becomes soft and elastic by massage, 
 so the same result is accomplished in the degenerated sinewy 
 connective tissues of the pelvis. Even before Thure Brandt 
 
215 
 
 published his method, similar attempts had been made by others 
 who tried to stretch the shortened ligaments by forcibly pnlling 
 down the womb, if necessary while the patient was nnder the in- 
 fluence of chloroform. Unquestionable successful results were 
 sometimes thereby attained, but the frequent changes to the worse 
 deterred. The process was yet crude and imperfect, which cannot 
 be said of Brandt's massage. His method was gradually built up 
 by years of experience and will, when correctly and properly ap- 
 plied, do only good and never harm. The shrunken tissues are 
 stretched, not forcibly but gently and gradually: the blood is 
 brought to the diseased parts by the massage: the blood vessels 
 and nerves are delivered from their captivity : the radiating pains 
 vanish: the movements of the bowels become regular and free, 
 and the discharges and irregularities of menstruation subside 
 since blood can now circulate more freely. It is wonderful how 
 often these disorders, which have been treated in vain for years 
 by other methods, disappear in a comparatively short time. Cer- 
 tainly also here the necessary patience and perseverance is in- 
 dispensible and the more so the longer the disease has existed. 
 If symptoms of general nervousness and hysterics have already 
 arisen (see page 119) the prospects are less encouraging as they 
 may continue still for a long time in spite of the improvement 
 of the local disease. 
 
 Those means rarely attaining satisfactory results when used 
 alone are not to be despised as a means of assisting the treat- 
 ment by massage. All manipulations serving to bring a greater 
 amount of blood to the abdomen, as we have described them 
 in the treatment of chronic inflammation of the womb, i. e. 
 damp-warm compresses around the abdomen, hot vaginal injec- 
 tions, hot hip, moor and sand baths, etc., assist in softening the 
 strings and accelerate the beneficial effects of the massage. The 
 mildly acting vaginal tampons (see page 94), when applied for 
 a long time, will have the same effect. 
 
 What the physician strives to attain by massage and other 
 remedies, nature frequently attains in a much simpler and less 
 annoying way by pregnancy. The principle is, however, also 
 here the same. By the lodging of the growing child within the 
 womb an abundance of blood rushes to the organs of the pelvis 
 and produces a more extensive softening of all parts and also of 
 
21() 
 
 the sinewy strings than could be produced artificially. The womb 
 growing gradually and rising from the pelvis into the cavity 
 of the abdomen, exerts a continual gentle pulling by day and 
 night on the abnormal strings and stretches them considerably. 
 There are, indeed, also many pains and troubles during the first 
 half of the time of pregnancy, which must be ascribed to this 
 tension, but they diminish in the later months. The occurrence 
 of pregnancy must, therefore, be considered a happy event for 
 women, under such circumstances, especially since they may 
 hope to be cured permanently when they will use proper care 
 during confinement. 
 
 An operation at the diseased parts themselves is impossible, 
 as they cannot by removed by the knife. The scraping out, how- 
 ever, (see page 83) eventually necessary for the treatment of 
 catarrh may be required under certain circumstances, but only 
 after the morbid changes of the ligaments of the womb have been 
 improved. 
 
Diseases of the Peritoneum of the Pelvis. 
 
 In treating of the different diseases of the womb, the oviducts 
 and the ovaries the inflammation of the peritoneum of the pelvis, 
 i. e. of the lining which surrounds and covers the organs of the 
 pelvis (see figure 4) has been mentioned. It must be distinguished 
 from the inflammation of the entire peritoneum (see page 13), 
 since it is usually confined to the lower part, i. e. to the pelvis, 
 and is here separately discussed because it accompanies in very 
 many cases the diseases of the female generative organs. Its 
 participation is so frequent that Professor Winkel, of Munich, 
 was able to prove in one third of all deceased bodies of women 
 traces of a formerly existing disease of this membrane. 
 
 This is not astonishing if we consider that the majority of 
 women are affected with some irregularity of their internal or- 
 gans of generation. And as in a fruit, inwardly decaying, the 
 shell which surrounds it is finally also destroyed, so the periton- 
 eum can likewise not escape when an inflammation spreads from 
 the interior of the womb, oviducts or ligaments. In all chronic 
 diseases of the organs of the pelvis its participation is, therefore, 
 in the course of time an absolute necessity. There is but this 
 difference that the inflammation appears sooner and more vio- 
 lently in cases produced by immigration of microbes than in 
 other cases, caused only by the disturbances of the circulation of 
 the blood, as we have seen in displacements and tumors of the 
 womb, etc. In acute inflammations of the womb, oviducts and 
 ligaments it exists from the beginning. 
 
 One of the worst consequences of nearly all acute and 
 chronic inflammations of the peritoneum are the intergrowings 
 
218' 
 
 remaining at that place where the peritoneum of the different 
 organs touch each other. They are of great importance as well 
 regarding the general health of women, as regarding the under- 
 standing of many symptoms. 
 
 The surface of the peritoneum, lubricous and smooth in a 
 normal condition, grows uneven and rough as soon as it becomes 
 inflamed since the blood vessels secrete a liquid which coagul- 
 ates on the surface of the peritoneum. If the disease is but 
 slight there is comparatively little of this secretion, but this 
 little quantity is sufficient to paste the organs, formerly sliding 
 easily, together as with glue and to make them immovable. If the 
 inflammation is serious, abundant liquid and even pus is secreted 
 which gathers in the deepest place, the Douglas space (figure 4 s). 
 While the patient recovers, all exudations are gradually absorbed 
 again, but generally leave as remnants the same intergrowings 
 These latter can easily be separated when they have not existed 
 for a long time, but after years may become so tight and solid 
 that they cannot be torn even by the full strength of a man. 
 Figure 25 shows such intergrowings as they chain together 
 womb, ovaries, oviducts and rectum. Figure 18 b shows the 
 same from a side view. 
 
 In the course of time nearly all intergrowings cause distor- 
 tion and displacement of the ovaries and oviducts. Like every 
 scar on the skin, the strings thus formed gradually shrink more 
 and more and diminish in length. The organs must follow this 
 traction. In this manner the ovaries are drawn to the womb 
 (figure 25), the oviducts are fastened to abnormal places and 
 even the womb may become dislocated. And all this the more 
 the longer the disease exists. 
 
 Symptoms — If any disease of the generative organs is for 
 some reasons followed by a severe inflammation of the periton- 
 eum of the pelvis, the patient may easily mistake the symptoms 
 thereby caused for those of an acute inflammation of the con- 
 nective tissues of the pelvis (see preceeding chapter). This 
 may happen the more easily since the latter is always combined 
 with more or less irritation of its peritoneum. The pains are in 
 the same place, i. e. the lower part of the abdomen, but usually 
 they are more severe and are felt also when the patient is lying 
 quietly on her back. When the other part of the peritoneum is 
 
219 
 
 also somewhat affected the abdomen will be bloated and very 
 sensitive: belching and vomitting set in. Usually, however, the 
 intestines will soon locate themselves in such a manner as to 
 shut off the inflamed peritoneum of the pelvis from the other 
 cavity of the abdomen (see figure 65 c) and exclude a more severe 
 participation of the latter. In this manner all fluid morbid 
 secretions are also retained in the pelvis. They accumulate at 
 the lowest point, as already said, within the Douglas space, and 
 bulge this out downward (figure 65). Thus a tumor is formed 
 in the pelvis, differing, however, materially from that which is 
 found in consequence of inflammation of the connective tissues 
 of the pelvis, since it is located at the rear of the womb and re- 
 sembles in location and quality a hematocele. A very character- 
 istic feature is the quick and soft pulse, contrary to the low fever 
 usually existing at the beginning, while in an inflammation of 
 the connective tissues of the pelvis the temperature is high. 
 
 If a tumor has formed the consequences depend upon the 
 nature of the morbid secretions. If it is purulent the fever will 
 soon decrease, but the healing will nevertheless take a long time. 
 But if it is mattery the fever will be higher and of longer dura- 
 tion. The accumulated exudation, whether mattery or not, con- 
 denses and is gradually absorbed. 
 
 The symptoms of an inflammation of the peritoneum of the 
 pelvis caused by chronic gonorrhoea, keep the middle between 
 the acute and chronic forms and are often very characteris- 
 tic. The troubles here appear seldom suddenly, but arise gen- 
 erally within a comparatively short time. The wife, before mar- 
 riage healthy and fresh, begins to have more or less white dis- 
 charges during the intervals between the menstruations and 
 cramps during the menstrual flow; the blood is expelled in 
 lumps. Every month the pains seem to increase. Then during 
 menstruation, or more seldom in the time between the monthly 
 flows, a more violent attack is experienced. The wife is forced 
 to take to her bed. The whole body seems to be broken up. 
 Pains are felt in every part of the body, especially in. the back, 
 the legs and in the lower part of the abdomen. They do not 
 continue steadily in one place, but — and this is a very character- 
 istic point — move around, being now in the back, then in the 
 abdomen, now in the legs, then in the breasts, etc. Day after day 
 
220 
 
 spells come on and although there is no fever, the poor sufferer 
 is run down by pains, sleeplessness, loss of appetite, vomitting 
 etc. After longer or shorter time the pains decrease, but are li- 
 able to return with the next monthly. (See Schroeder's words, 
 page 28, in regard to the consequences. ) The husband, perhaps 
 newly married, must spend his time in nursing his wife, and 
 his money to pay the doctor. And although he is fond of her, 
 he is mostly the first to become tired of everything and 
 regrets to have entered married life. But he has no right to do 
 so. He may look back at his past years, at his past sins and 
 with very few exceptions he will under such circumstances find 
 the source of the malady. Even if he believes that the gon- 
 orrhoea he suffered from, perhaps years ago, is entirely cured, 
 he may convince himself about it by looking at the first urine 
 passed in the morning and collected in a clear, transparent 
 bottle. If he finds there, after shaking the bottle, little thin 
 strings or small pieces of tissue, which settle slowly to the bot- 
 tom, he may accuse himself, and only himself — and not blame his 
 wife or fate — since just these small pieces originating from 
 the sick place of the diseased urethra and transposed to the wife 
 with the ejaculations are the supporters of the microbe of the 
 gonorrhoea, the gonoccoccus. (Compare chapter on diseases of 
 the vagina and chapter on sterility.) 
 
 The chronic inflammation of the peritoneum of the pelvis 
 produces in the course of time an ever increasing intergrowing 
 of all organs of the pelvis and at the same time an ever increas- 
 ing suffering. The troubles existing under such circumstances, 
 as pains in the back, either when moving or resting, pains in the 
 legs, dull or sharp sensations in the lower part of the pelvis, pains 
 during coition, cramps during menstruation, increased menses, 
 sterility, etc., are partly consequences of the inflammation of the 
 pelvis, partly results of the original disease of the different organs. 
 
 Prevention — The prevention of this disease lies as well in 
 the hands of the physician as of the woman. Scrupulous care 
 and cleanliness during delivery and confinement, avoiding im- 
 proper behavior during menstruation (see page 76) treating ca- 
 tarrhs of the womb or its tumors and displacements in due time, 
 opposing chronic constipation, etc., are necessary to prevent such 
 conditions. 
 
221 
 
 Treatment — The treatment of the inflammations of the 
 peritoneum of the pelvis, accompanied by fever, must be accord- 
 ing to the stage in which the inflammation is found to be. If 
 the exudation is just developing, i. e. not yet secluded from the 
 abdominal cavity, which can be ascertained by examination, it 
 must be the aim to accelerate this limitation by absolute rest in 
 bed, by the application of a light ice bag upon the abdomen and 
 opium internally. (Prescription 42.) The best means to allay 
 vomitting are rinsings of the stomach, or little pieces of ice taken 
 and melted in the mouth, or opium as mentioned. Also coffee 
 and tea, if taken cold by mouthfuls, may be tried. 
 
 When the aim in view is gained and the exudation is ex- 
 cluded from the abdominal cavity, which may be recognized by 
 the quality of the tumor lying behind the womb, the absorbtion 
 may be waited for, or the exudation emptied by an operation 
 which will restore health in a much shorter time. 
 
 In the chronic form the removal of the cause is the first re- 
 quirement. In the second place those means described in chronic 
 inflammation of the connective tissues of the pelvis (see this), 
 massage, damp-warm compresses, baths, vaginal injections, tam- 
 pons, etc., must be applied. When chronic intergro wings and 
 displacements exist simultaneously, the abnormal fixations must 
 be torn by force, according to Schulze, while the woman is under 
 chloroform or ether. The treatment by massage following this, 
 and performed with care, hastens the cure and recovery. (See 
 treatment of retroflexion.) 
 
Hematocele. 
 
 By the expression 'hematocele' is meant an effusion of blood 
 into the abdominal cavity, which accumulates on its remotest 
 and deepest point, in the Douglas space, in that depression or 
 cavity of the peritoneum which is found between the womb and 
 the rectum. 
 
 The first question that arises is this : where does the blood 
 come from in such a disease ? The very fact that it is mentioned 
 within the range of this book will probably give my readers 
 some idea in regard to this. Although in some rare cases it 
 comes from some other abdominal organ, for instance from milt, 
 liver and kidneys, yet its source is most frequently to be found 
 in the generative organs. Above all pregnancy within the ovi- 
 ducts will cause such an effusion of blood. It has been mentioned 
 before (see pregnancy in the oviducts), in speaking of this ab- 
 normal and extremely harmful pregnancy, and its dangers were 
 pointed out. We have seen that the growing ovulum bursts 
 after a certain time, emptying its contents into the abdominal 
 cavity. The ensuing bleeding from the opened blood vessels at 
 the place of the tear cause the main danger, and may even lead 
 to sudden death. The fluid and blood thus expelled accumulate 
 at the above mentioned place and there undergoes the change 
 hereafter .described. 
 
 Another by far more rare cause of these conditions may be 
 offered by the monthly bursting of the ovisac which occurs at 
 the time of menstruation. Under normal conditions the bleed- 
 ing caused thereby ceases as soon as the cavity, created by the 
 receeding of the ovulum, is filled up. But if accidentally larger 
 
223 
 
 blood vessels are torn by the bursting of the sack, or if the bleed- 
 ing from the blood vessels is not stopped at the proper time, on 
 account of exhausting pleasures, too hard work, exciting sexual 
 intercourse, etc., during the menses, the bleeding into the ab- 
 dominal cavity may become quite severe. The same is the case 
 if intergrowings containing larger blood vessels are torn in forc- 
 
 Figuke 65 — Hematocele. 
 
 -Coagulated blood collected in the Douglas space between rectum and 
 womb, b — Womb, c — Piece of the intestines keeping the 
 
 blood from entering the abdominal cavity, d — Bladder, e — Rec- 
 tum, ff— Peritoneum. 
 
 ibly trying to correct displacements of the womb, which, how- 
 ever, rarely occurs. 
 
 Symptoms— The symptoms of this serious accident are quite 
 characteristic, especially when caused by abnormal pregnancy 
 within the oviducts. As we have seen on page 193, the patient 
 having been pregnant for some months, is suddenly seized with 
 severe pains in the abdomen. All signs of a great loss of blood 
 
224 
 
 appear. The skin becomes pale, hands and feet cold, sparks are 
 seen, the ears ring, fainting spells happen repeatedly. The ab- 
 domen is very sensitive and bloated. Nausea and vomitting are 
 in accompaniment. The pulse beats rapidly but weak. Fever 
 often is present. The tongue is dry and the patient very thirsty. 
 After some time an examination from the vagina reveals a tumor 
 behind the womb, which forces this against the pelvis bone and 
 consists of coagulated blood (see figure 65.) 
 
 Also here the intestines separate the escaped fluid from the 
 abdomen, as we have seen it in the preceeding chapter. Bladder 
 and rectum are pressed together and frequent desires to urinate 
 and difficulties in emptying of the rectum are the result. 
 
 The accumulated mass of blood decreases more and more in 
 course of time, by absorbtion. The tumor back of the womb 
 becomes harder and more uneven. Frequent discharges of thick, 
 dark-colored, tar-like masses of blood from the womb occur and 
 last for some time. The fever vanishes and the pains cease, so 
 that in most cases a complete cure is gained in course of time by 
 the absorbtion of the blood, provided, however, that no new at- 
 tack ensues. 
 
 But unfortunately this is often the case in abnormal preg- 
 nancies (see them), in which sometimes one attack closely fol- 
 lows the other, and commands a rapid and decided interference. 
 When microbes penetrate through the oviducts or the walls of 
 the rectum into the hematocele, the entire masses of blood may 
 maturate and cause all the serious evidences of an inflammation 
 of the peritoneum. 
 
 Tkeatment — The first requisite in the treatment of this 
 malady is to stop the bleeding. Absolute rest in bed, lying 
 quietly upon the back, application of an ice bag upon the ab- 
 domen (see page 92), taking opium internally (prescription 
 42), in order to quiet the intestines fulfill all requirements. 
 Nevertheless a physician must unconditionally be summoned. 
 During the first week only liquid food should be taken. To 
 effect a moving of the bowels only small injections consisting of 
 one-half to one tablespoonful of glycerin or suppositories of soap 
 are allowed. 
 
 When a decrease of the troubles shows that the bleeding has 
 ceased and that absorbtion has advanced, the latter should be 
 
225 
 
 facilitated by hot or damp-warm applications upon the walls of 
 the abdomen, or by hot vaginal injections. This should, how- 
 ever, never be begun except under supervision of a physician. 
 
 After recovery all exertion is to be avoided for a long time, 
 especially during the time of menstruation. Then as much rest 
 as possible has to be taken, so as not to renew the bleeding. 
 
 In this manner an operation may be evaded which always is 
 dangerous, but may effect a more speedy and safer cure. But in 
 case death by bleeding is to be feared, or if it is ascertained that 
 the bleeding is caused by the bursting of an abnormal preg- 
 nancy, then it is preferable to remove the source of the bleeding 
 and with it the danger by gastrotomy. 
 
Diseased Menstruation. 
 
 After having discussed the principal diseases of the female 
 generative organs inasmuch as they influence menstruation, a 
 few cohering words may be said in regard to the abnormities 
 appearing at the monthly flow. Although very few new facts 
 will be mentioned, it will be beneficial as well as interesting to 
 treat collectively the various changes of menstruation, which 
 were spoken of in the preceeding chapters separately, and which 
 often plainly indicate the existence or acquisition of a disease. 
 
 ABSENCE OR INSUFFICIENCY OF MENSTRUATION. 
 
 The non-appearance of menstruation in a healthy girl of 16 
 to 18 years of age, or the cessation of the same in a non-preg- 
 nant woman, who has not yet passed the change of life, must be 
 considered although not always diseased, yet at least abnormal. 
 Two different circumstances may be the cause : a local or a gen- 
 eral trouble, i. e. the absence of menstruation is based either 
 upon abnormal conditions of the sexual organs themselves, or 
 upon diseases of the entire body and nervous influences without 
 the sexual organs being affected directly. 
 
 The abnormal conditions at the sexual organs are caused 
 either by incomplete development, or by a disease of the same. 
 
 The principal forms of incomplete development of the differ- 
 ent organs have been described in previous chapters and we 
 
227 
 
 would refer the reader to these. (See Physiology of the Womb 
 and Malformations of the Womb and Ovaries.) It may suffice 
 to say here once more that in all these forms of disorders, though 
 menstruation is very weak or entirely absent, there are no annoy- 
 ances caused thereby. Only those cases are excepted in which 
 menstruation exists, but is not noticed, because the blood instead 
 of being discharged is retained at some place in the vagina or 
 the womb. But in such cases troubles as described on page 25 
 will soon arise and are so characteristic that a confounding of 
 the two forms is hardly possible. 
 
 Diseases of the inner sexual organs, the womb, oviducts and 
 ovaries, which generally have results contrary to the above, i. e. 
 increase the menstrual flow, are on account of the morbid chan- 
 ges rarely followed by the gradual decrease of the flow, or by the 
 entire cessation of menstruation at an unusually early age, some- 
 times even at the age of 30. 
 
 Most generally the absence of menstruation, or the insuffic- 
 iency of the same, is the result of disturbances in the general 
 nourishing of the body. Very often chlorosis is the cause. If 
 menstruation has not yet started when this blood disease first 
 appears, the menstrual flow will generally set in later, so that the 
 cases in which the monthlies do not appear before the age of 20 
 are by no means rare. The cause must be looked for in the 
 change to the worse of the blood and the resulting insufficient 
 nourishment and development of ovaries and womb, which can- 
 not perform, consequently, their normal functions. These facts 
 also explain the cessation of the menses in women who have just 
 recovered from a serious disease as typhoid fever, small pox, 
 pneumonia, etc., or in those who are in the last stages of con- 
 sumption, or are suffering from some other chronic and wasting 
 disease. In such cases, cause and effect are very often confound- 
 ed, the general belief being that the insufficient discharge of 
 blood at the menstrual flow causes the disease while on the con- 
 trary the existing disease suppresses the menses; insufficient 
 men struation is, therefore, not a disease, but a symptom of a di- 
 sease. 
 
 An^experience which I had some time ago is very charac- 
 teristic in illustrating the above. I was summoned to the 
 sickbed of a woman by her husband, who remarked that men- 
 
228 ' 
 
 struation would not appear, and that the retained blood was 
 crushing the heart out of his wife. On my arrival I found a 
 woman in the last stages of consumption, dying and miserable. 
 One glance told me enough. It was not suppressed blood which 
 made the dying woman so pitiable, but the wasting disease had 
 progressed so far that there was no more blood to be lost, con- 
 sequently there could not be any menstruation. If in such cases 
 the general condition can be improved the menstrual flow will 
 reappear. 
 
 The occasional total cessation of menses in young women, 
 on account of too long continued nursing, is partly founded upon 
 the same ground, i. e. the weakening of the body, partly, how- 
 ever, upon other circumstances which will be described later. It 
 is a fact well known among the people that a woman while 
 nursing and not yet menstruating again, is comparatively pro- 
 tected against impregnation. In order to profit hereby the 
 child will in very many cases be nursed by the mother's breast 
 far beyond the usual and proper time. (See Diseases of the 
 Breasts.) This may have two different evil results. In the 
 first place the mother will be very much weakened and in the 
 second place the long continued sucking at the nipples, which 
 peculiarly irritates the womb and is of great influence upon the 
 retrogression of this organ, will cause it to shrink sometimes be- 
 yond the normal measure, so that it becomes small, flabby and 
 withered, and is no longer able to perform its natural functions. 
 The monthly flow then ceases, and further child bearing is ex- 
 cluded for ever. 
 
 Also various mental influences may suppress menstruation 
 for a longer or shorter space of time. In cases of serious nerv- 
 ous troubles, as general nervousness and hysterics, this is fre- 
 quently experienced. 
 
 But also less significant circumstances may produce the 
 same effect. Often the excitement caused by a change of res- 
 idence, in which case, of course, the change in the mode of liv- 
 ing, climate, etc., participates, will suffice to suppress menstrua- 
 tion. A sudden fright or scare, or even the fear of being preg- 
 nant, may produce the same result. But then the absence of 
 menses is only of short duration and the flow reappears, after 
 some months with the usual regularity. 
 
229 
 
 A very peculiar phenomenon often found when there is an 
 abnormal or insufficient menstruation, deserves to be mentioned. 
 This is the so-called substitute or vicariating bleeding. At the 
 time when menstruation should appear, a discharge of blood 
 from various parts and organs of the body takes place instead, 
 the blood coming from nose, mouth, stomach, skin, breasts, etc. 
 This peculiar phenomenon, which is often very alarming, has 
 not yet been satisfactorily explained, but it is agreed that it is 
 to be brought in connection with the insufficient or missing 
 menstrual flow. 
 
 Treatment — As has been previously stated, local treatment 
 is entirely useless, yes frequently even harmful, in most of those 
 cases where, aside from the absence of the menses, or the insuf- 
 ficient flow, there are no annoyances. Of what use would such 
 a treatment be if there is an imperfect development of the or- 
 gans? Of what use would it be if the root of the trouble lies in 
 some other, remote part of the body? Little or nothing can be 
 attained thus, as the absent menstruation is not a disease, but 
 merely a symptom of a disorder. A general treatment is, there- 
 fore, mostly much more beneficial. If there are any signs of 
 anaemia', or chlorosis, these must first be done away with, accord- 
 ing to the rules given on page 65. The same can be said in 
 regard to great exhaustion resulting from a past or existing di- 
 sease. Fresh air, healthy food, regulating digestion and strength- 
 ening the body in general, also here take the principal positions. 
 Long contiued nursing has to be avoided under all circumstan- 
 ces, as the body of the mother is thereby unnecessarily weaken- 
 ed, and the prospects of thereby avoiding an impregnation are 
 very often mistaken, as a case may prove, observed by myself, 
 in which a woman did not menstruate for eleven years, because 
 she was always pregnant again before the reappearance of her 
 menstruation. With nervous or exitable women or mentally 
 over-burdened girls, rest and recreation are the main requisites. 
 Not only the study hours must be limited, but also fancy work 
 should be left aside. A change of residence is often very advis- 
 able. A soiourn in a small country town, near the woods, or by 
 the seashore, away from heavy household duties and from all so- 
 called social pleasures, which are always noisy and exciting, often 
 do more good than the most tender care at home, where the old 
 
230 
 
 surroundings, the old mode of living, and memories pleasant or 
 sad, will not allow the mind to rest. 
 
 The most varied means have been employed by the people 
 to regain the suddenly interrupted menses. They all aim at one 
 thing namely to force the womb to contract and to secrete blood 
 by drawing greater masses of blood to the abdomen and especi- 
 ally to the generative organs. But all of these are uncertain and 
 unreliable, as they sometimes have effect and sometimes are en- 
 tirely useless, the latter being generally the case when a feared 
 and supposed pregnancy is really existing. 
 
 There are better prospects, i. e. a more satisfactory result 
 will be attained if these means are employed at a time when 
 the menses should naturally appear. For even if a discharge of 
 blood does not occur, nevertheless the blood will rush toward 
 the abdomen at that proper time. This rush of blood, if assisted 
 and supported properly by the artificial means may rise to such 
 a force that the desired result is attained, if this is possible, by 
 the woman herself. 
 
 Under these remedial measures to induce the menstrual 
 flow hot water takes the principal position. Hot hip and foot 
 baths, as hot as they can be endured, the latter with or without 
 an addition of mustard meal, pepper, vinegar, etc., are so uni- 
 versally known that most women and girls use them at the least 
 delay of the menstrual flow. Much less known, but more satis- 
 factory in their results are hot injections into the vagina, as de- 
 scribed in the chapter on diseases of . the vagina. These are 
 taken several times a day, with hot water — also here as hot as it 
 can be endured — without any additions. The good results at- 
 tained by them are dependent upon the fact that the tender in- 
 ternal tissues react more readily upon heat than the proportion- 
 ately thick outer skin. Forcible contractions of the womb which 
 are felt as cramp and labor-like pains, rarely fail when the injec- 
 tions have been properly used. 
 
 Still more energetic in producing the desired result is a 
 short massage of the womb, which can, however, only be perform- 
 ed by a physician. If there is no fever massage will also be ben- 
 eficial against the existing inflammation, which eventually caus- 
 ed the suppression of the menstrual flow, provided it is practised 
 in the proper manner. 
 
231 
 
 Against suppression of the menses in consequence of men- 
 tal excitement, opium and above all bromides (prescription 43) 
 take the principal part. 
 
 Medicines used internally, such as aloes, savine and ergot, 
 to regulate the menstrual flow, must always be taken in large 
 doses or for a longer time. 
 
 Aloes is a purgative and acts only upon the rectum when 
 in moderate doses. In larger doses it acts also upon the womb. 
 It is one of the most used and most universally known remedies 
 against weakness or absence of menstruation. The dose varies 
 from 2 to 20 grains, according to the degree of the desired re- 
 sult. (Prescription 44.) 
 
 Savine is also a medicine which is extensively used for the 
 same purpose. But it is also used with good results against 
 heavy bleedings of the womb, in leucorrhoea, in gout and rheu- 
 matism. It acts very forcibly upon the womb. Large doses 
 may at the same time produce inflammation of the intestines. 
 If there is a suspicion of pregnancy this remedy is to be avoided, 
 as it may easily produce a miscarriage or premature birth, for 
 which purpose it is often used with criminal intentions. (Pre- 
 scription 45.) 
 
 Ergot is less used and less effective. This also acts directly 
 upon the womb, as it causes forcible contractions of its walls. 
 It must, therefore, also be avoided in cases of pregnancy. It 
 can be taken in pills, powders or as fluid extract. (Prescrip- 
 tion 46.) 
 
 TOO PROFUSE AND IRREGULAR MENSTRUATION. 
 
 Before entering upon this subject it will be necessary to as- 
 certain under what circumstances the menstrual flow may be 
 called too profuse, as this differs greatly with different individ- 
 uals. Naturally a healthy but otherwise delicately developed 
 girl cannot loose as much blood as a robust and strong person. 
 Yet this does not imply that the latter, although she may loose 
 two to three times as much blood, suffers from too profuse men- 
 struation. Thus different measure must be applied in different 
 cases. Only the general health before and after the flow may 
 be taken as a guide, and not the amount of blood secreted. As 
 
232 
 
 soon as the body becomes weakened and shows unmistakably 
 signs of loss, the monthly discharges of blood may be designated 
 as too profuse. The symptoms arise in different cases from 
 hardly perceptible to very pronounced troubles. When the 
 flow is but little more than normal, there will be only an un- 
 usual fatigue in consequence of too much loss of blood, which, 
 however, disappears soon after the menstruation ceases. But 
 in other more severe cases the symptoms may become quite 
 alarming. Those surrounding the patient will already notice 
 the extreme pallor of the face, lips, gums, and eyes. Hands 
 and feet are cold, and cannot be warmed even by warm cov- 
 erings; ringing in the ears, swimming sight, impaired eye- 
 sight, distressing headaches, palpitation of the heart, heavy 
 breathing, and general nervousness show the disorder of the 
 nervous system. Indigestion, loss of appetite, irregular bowels 
 are also symptoms. The body will be more and more weakened 
 so that it may become impossible for the patient to perform her 
 duties, or to do even the slightest work. 
 
 These alarming symptoms rarely appear suddenly. They 
 are generally the result of often repeated weakening losses of 
 blood, caused by profuse menstruation. During the time be- 
 tween the monthly courses the body revives considerably, but 
 not to such an extent as to regain its former strength, so that 
 the woman runs down gradually, almost unobserved, but never- 
 theless surely. 
 
 The causes for profuse menstruation are to be sought partly 
 in local troubles, i. e. in diseases of the generative organs, partly 
 in diseases of other organs of the body. To the first class be- 
 long catarrhs of the womb, remaining of particles of the placenta 
 after regular, or more especially after premature births, chronic 
 inflammation of the mucous membrane and of the walls of the 
 womb, tumors and displacements of the womb, diseases of ov- 
 aries and oviducts (see disease of the respective organs), etc. 
 Which of these troubles is existing may be ascertained by the 
 patient herself by means of self-examination, provided she is ac- 
 quainted with the symptoms described in the previous chapters. 
 
 It is much more difficult and even impossible for the patient 
 to understand her condition if the profuse bleeding is caused by 
 diseases of the second class, i. e. chronic diseases of the heart, 
 
233 
 
 lungs, liver, kidneys, and intestines, for instance heart trouble, 
 consumption, Bright's disease, etc. They may, as has been prev- 
 iously stated, disturb circulation, and although no disorder at 
 the generative organs is present, cause very profuse monthly 
 bleedings. In such cases there are often in the beginning no 
 remarkable signs arising from the really diseased organs, but in 
 course of time their characteristic symptoms, such as heart 
 troubles, with heart diseases; shortness of breath, and cough, 
 with lung diseases; dropsie, with kidney diseases, etc. will be- 
 come more and more prominent, and then it is much easier to 
 ascertain the cause of the profuse bleedings which occur with- 
 out the womb being apparently affected. Such a condition may 
 be supposed by women themselves, when besides the abnorm- 
 ally strong menstrual flow there are neither discharges and pains, 
 nor any other abnormities in the generative organs. A medical 
 examination with this end in view should then be made. 
 
 In very fat persons the profuse menses are also caused by 
 the impaired circulation and the chronic stagnation of the blood 
 in the abdomen arising therefrom. That long continued and 
 heavy bleedings are often connected with the change of life, has 
 been already stated in a previous chapter. 
 
 If the profuse and weakening hemorrhages, which neverthe- 
 less occur at normal monthly intervals, are of great importance, 
 how much more attention must be paid to the irregularly ap- 
 pearing, now weak, now profuse hemorrhages, which occur with 
 or without an apparent reason, at abnormal times ? Their source 
 is always to be looked for in some womb trouble. 
 
 As we have seen before, menstruation generally becomes ir- 
 regular at the more advanced stages of certain diseases, such as 
 catarrh, chronic inflammation of the womb and ovaries, etc., dif- 
 fering in length of duration as well as in intensity from 
 the former condition. But still the menses may yet be recog- 
 nized as such. This is altered when all regularity is lost 
 and every exertion, excitement, caustiveness, coition and other 
 occasional causes produce a more or less profuse hemorrhage. 
 Tumors at the mouth of the womb or polyps projecting therefrom 
 may produce similar effects, but nevertheless such circumstances 
 always create suspicion that there is a malignant tumor, i. e. a 
 cancer". It is still more probable that the patient is affected with 
 
234 
 
 this new formation when the discharges almost invariably exist- 
 ing, become mixed with blood and little hard particles as des- 
 cribed on page 174. As in such cases a proper examination can- 
 not be avoided, it would be well to seek medical aid as soon as 
 such symptoms are observed, and to submit to a timely operation 
 which gives better prospects of a cure than if it were delayed. 
 
 Treatment — The treatment of irregular and profuse men- 
 struation can only be effectual when an examination has re- 
 vealed the cause thereof, and this is removed, for the profuse 
 menstruation is no more a disease in itself, as is the absence of 
 menstruation, both being symptoms of some existing trouble. 
 
 If after a delivery or miscarriage particles of the placenta 
 have remained, these must be removed. Displacements of the 
 womb are to be rectified, tumors, catarrhs and congestions of the 
 same must be properly treated. (See the respective chapters.) 
 If the existence of catarrh is proven, this must be removed with- 
 out delay. 
 
 The direction for regulating the general mode of living have 
 been given in the previous chapters, but they may here be col- 
 lectively repeated, inasmuch as they serve to restrict the enorm- 
 ous losses caused by the profuse monthly flow. 
 
 As soon as the time for menstruation approaches, rest, ab- 
 staining from sexual intercourse, avoiding heavy labor, and in 
 serious cases a recumberent position in bed are required. By 
 the observance of these rules the rush of blood toward the ab- 
 domen and accordingly the loss of blood is greatly diminished. 
 Although bladder and rectum should be regularity emptied, all 
 strong laxatives, which are generally used, must be avoided 
 because they increase the menstrual flow. Caustiveness is to 
 be allayed by means of injections. Good and nourishing food 
 should be taken, boiled milk, milk soups, meat, poultry and fresh 
 vegetables. Potatoes and rye bread are to be avoided as they 
 produce too much excrements. Beer, wine, coffee and tea may 
 be taken in larges quantities only when the patient feels very 
 weak and requires a stimulant; but they are best entirely avoid- 
 ed. All excitements, sorrow and anger are extremely harmful 
 and should be kept from the patient. 
 
 If this does not suffice, the bodily and mental repose may 
 be assisted by the application of external remedies, or by med- 
 
235 
 
 icines taken internally. Among the first hot injections into the 
 vagina are to be mentioned above all. But the effects of these 
 are always doubtful, as they are based upon contractions of the 
 womb and will fail in cases of .displacement or chronic congest 
 tion, because the diseased muscular walls have lost the power of 
 contracting (see page 97.) Sometimes iced injections into vagina 
 or rectum, or the application of an ice bag upon the abdominal 
 walls (see page 92) will be of more service than the hot water. 
 This must be tried. 
 
 Medicines taken internally can generally not be avoided, 
 and they are given in the chapters treating of chronic catarrh 
 and chronic inflammation of the womb. 
 
 Headaches, seeing sparks before the eyes, ringing in the 
 ears, which occur with profuse bleedings and which are caused 
 by the absence of blood in the brain, may be allayed by lowering 
 the head, raising the limbs, drinking quantities of weak tea or 
 coffee, and by injections of warm water (see page 182) into the 
 rectum. The water should be retained in the rectum from 
 whence it will be absorbed into the blood vessels. Thus the cir- 
 culation is assisted and supported, and this will soon produce the 
 desired effect. The pulse, before scarcely noticeable, will be- 
 come stronger, the faint feeling disappear and the general condi- 
 tion will rapidly improve. 
 
 In very serious cases it is absolutely necessary to summon a 
 physician who will stop the bleeding by means of so-called styp- 
 tiga or plugging up of the womb and vagina. 
 
 The strengthening and care of the body during the time be- 
 tween the menstruation is of great importance. But, alas, this 
 is sadly neglected. Very much can be done by the patient her- 
 self, if she strives to regain the strength which was lost during 
 the excessive flow. 
 
 Especially those women approaching the critical age, i. e. 
 the change of life, should heed this warning. The following 
 short directions have, therefore, to be closely observed by them 
 because this time offers great opportunity for the arising of many 
 diseases. Heavy bodily or mental work should under all cir- 
 cumstances be avoided. Contrary to this it is not well to have 
 too little exercise, as the action of the different organs is thereby 
 impaired, and causes fat to accumulate. Short walks, which in 
 
236 
 
 winter are to be taken during noon hour, and in case of unfavor- 
 able weather light gymnastic exercises indoors are advisable. 
 Lying in bed late in the morning, and staying up late at night 
 on account of social pleasures is also harmful. The clothing 
 should be of cotton and very comfortable, the drawers closed and 
 the shoes not pressing the feet, the corset not be laced too tight. 
 Digestion must be regulated by means of appetizing remedies, 
 and by keeping the bowels loose. Fleshy women have to ab- 
 stain from wine, beer, coffee, and tea, and weaker ones may take 
 these beverages in moderate quantities only. Frequent warm 
 baths increase the activity of the skin. In summer cold sponge 
 baths are preferable to warm baths. They are quickly prepared 
 and should be taken also. The skin is immediately afterwards to 
 be well rubbed with a Turkish towel until it reddens. Coition 
 is to stop entirely. To regain the lost blood the medicines men- 
 tioned on page 66 are to be taken. 
 
 PAINFUL MENSTRUATION. 
 
 As we have seen in the chapter 'Physiology of the Womb,' 
 the monthly flow of blood to which woman is subjected, occurs 
 without any pain whatever under perfectly normal circumstan- 
 ces. It comes and goes without further trouble, except perhaps 
 an increased feeling of fatigue. But as has been stated before, 
 the very designation of "being unwell" shows that such normal 
 cases are not too numerous and that generally more or less an- 
 noyances and troubles are connected with the flow. It must, 
 however, be perfectly understood that in spite of this frequency 
 and prevalence of a painful menstruation, this cannot be called 
 a normal state or condition. The pains are always the outcome 
 of some abnormity in the sexual apparatus, be it ever so slight. 
 Even if all friends and acquaintances suffer from pains during 
 the monthly flow, they are by no means natural, neither should 
 these pains be a cause of complaint of their own especially un- 
 happy condition, as is so often done. 
 
 The quantity of blood discharged is of no account in regard 
 to the nature or the severity of the pains. These may be as 
 severe and as continual when only a few drops are expelled, as 
 they are in the most profuse flow. The abnormal sensation, 
 which may be slight, scarcely perceptible, or of overwhelming 
 
237 
 
 severity, presents itself as boring, drawing, or piercing, but gen- 
 erally cramp-like pains, resembling the "after pains." The time 
 of the occurrence of these pains, be it before, at the beginning j 
 or during the flow, is, on the contrary, somewhat characteristic 
 as to their origin, although not to such an extent that an exact 
 conclusion may be drawn therefrom. 
 
 The most pains are caused by some hindrance which pre- 
 vents the blood, secreted by the mucous membrane of the womb, 
 to flow out freely, so that the muscular walls must forcibly con. 
 tract in order to expel the blood. In one case the cause must 
 be looked for in the narrowness of the channel at some places 
 as it occurs in flexions of the womb, especially in those over 
 the front surface (see anteflexions). Here the narrow passage 
 at the inner mouth of the womb is generally also obstructed by 
 an accumulation of slime which must first be expelled before the 
 blood is allowed to flow freely. Under these circumstances the 
 main pains are, therefore, at the beginning of the menses, and de- 
 crease as soon as the blood escapes freely. 
 
 In other cases, and these occur generally in retroflexions, 
 the passage is wide enough, but the blood cannot flow out be- 
 cause it abnormally coagulates within the womb. The coagul- 
 ated lumps must then be pressed through by force and the pains 
 will be the more severe the narrower the passage or the more ad- 
 vanced the disease of the muscular walls of the womb. (See 
 page 88.) An attentive lady will under such circumstances 
 notice a profuse discharge of coagulated blood after an attack of 
 these cramp-like pains. In these cases the pains occur period- 
 ically, and may appear at any time during the entire duration of 
 the flow. 
 
 If, however, the severity of the pains is in proportion to the 
 quantity of the blood discharged, i.e. the pains are stronger the 
 more profuse the flow, even if no coagulated blood is expelled 
 they must generally be traced to a disease of the ovaries. For 
 the monthly recurring flow of blood toward the abdomen causes 
 all abdominal organs to swell. This swelling will be increased 
 the more blood is carried towards them, and thus in a propor- 
 tional degree the womb is influenced to yield a more profuse 
 flow of blood, and the diseased extremely sensitive ovaries to 
 cause more pain. 
 
238 
 
 An irritation,- or an inflammation of the peritoneum of the 
 pelvis, i. e. of that part of the peritoneum covering the organs 
 of the pelvis (figure 4) is of great importance in regard to pain- 
 ful menstruation. Naturally a disease of this membrane will 
 cause pains outside of the menstrual flow also. But these are in 
 no comparison to those arising during the menstruation, as its 
 sensitiveness is greatly increased at that time. A good many of 
 the pains radiating to all parts of the body, may be traced to 
 this source, and they are to be regarded as menstrual troubles, 
 because they are dependent upon the time and course of men- 
 struation, i. e. because they generally arise or increase at the be- 
 ginning, during or after the monthly discharge of blood. Fre- 
 quent desire to urinate, constipation and stomach troubles, 
 nausea, palpitation of the heart, headache, flushes of heat, etc. 
 vary in the different cases. 
 
 Treatment— The treatment of painful menstruation depends 
 upon the kind of the morbid changes, as the pains are not a di- 
 sease, but simply the symptoms or signs of an existing disorder. 
 Diseases of the womb, ovaries, oviducts and peritoneum are to 
 be treated in the proper manner. (See the respective chapters.) 
 
 During the time of menstruation mental and physical rest 
 is necessary. In severe cases the patient should take to bed. 
 Cold applications in shape of an ice bag, or cold compresses are 
 rarely agreeable, while damp-warm compresses (see page 93) are 
 generally of better results. Very often they offer great relief. 
 But if the pains occur by spells, and are cramp or labor-like, hot 
 applications are preferable. They can be used either wet or 
 dry; wet, by soaking a cloth in hot water and applying it to the 
 abdomen as hot as it can be endured — the cloth must be chang- 
 ed as soon as it gets colder — ; dry, by heating bags filled with 
 middlings, or hops, or light sand bags on the top of the stove 
 and applying these in a like manner. Hot cataplasm and poul- 
 tices answer the same purpose. Mustard plasters and similar 
 preparations, which act by an irritation of the skin, are not near- 
 ly as beneficial. 
 
 To prevent the coagulation of the blood within the womb, a 
 solution of sodium of salicilic acid (prescription 47) is to be re- 
 commended, and it should be taken one or two days before the 
 beginning of the flow. 
 
289 
 
 Among the pain expelling remedies, which are to be taken 
 internally, the rectal suppositories given in prescription 30 are 
 of good result. 
 
 Morphium should be taken only in cases of extreme neces- 
 sity, as the morphium habit is too easily acquired, and this has 
 been the doom of many a woman. 
 
 A drawing off of blood at the vaginal conus before the begin - 
 ing of menstruation, electric treatments or massage, all of which 
 are often very beneficial, should be trusted only to a skilled phy- 
 sician and never to a midwife or an unprofessional. 
 
Diseases of the Breasts. 
 
 Since the breasts are so closely connected with the functions 
 of the female sexual organs, a discussion of their physiological 
 functions and diseases should certainly receive a position within 
 the scope of this book, and the more so because they partake, as 
 we have seen in different chapters though not very conspicuous- 
 ly, yet sometimes not insignificantly in the diseases of the female 
 generative organs. 
 
 It is the function of the breasts to furnish to the child after 
 its birth the food necessary for its life and development in such 
 a form as the weak little body requires it. As every woman 
 knows the glands of the breasts are, however, capable of produc- 
 ing such nourishment only at a definite time, namely after the 
 birth of a child. Only in exceptional cases secretions may be 
 squeezed from the nipples when pregnancy does or did not exist- 
 
 The mammary glands are not throughout the lifetime in this 
 highly developed state, which is necessary to produce and yield 
 the nourishment of the child. Their development coincides with 
 the development of the generative organs. 
 
 Directly after birth the breasts of the male and female child 
 are exactly alike. But very soon differences appear, created by 
 the regression of these organs in the boy, and their progression 
 in the girl. At the beginning of puberty, i. e. when the ovaries 
 commence to expel matured ovula, when the first menstruation 
 occurs (see Physiology of the Womb) and the girl becomes a 
 maiden, there are also noticeable changes in the breasts: they 
 
241 
 
 swell and grow more prominent and rounder, like all forms of the 
 body. Not only the fat under the skin increases but also the 
 mammary glands in the breasts develop to such an extent that 
 considerable pains are sometimes caused by the tension of the 
 skin. But nevertheless the glandular tissues serving the pro- 
 duction of the milk remain inactive until an occurring impreg- 
 nation excites them to secrete. If the possibility of procreation 
 has ceased with the change of life, the mammary glands have 
 also served their purpose, and nature does not need them any 
 more. As superfluous organs they dwindle away. This regres- 
 sion at a higher age, i. e. the vanishing of the real lacteal gland, 
 is much less conspicuous than its development in youth, as the 
 external form remains in spite of the inner changes. The loss 
 of glandular tissues is replaced by fat, so that in elderly women 
 the breasts, sometimes very prominent, consist only of fat. The 
 nipple remains unchanged. 
 
 Defective Changes in the Functions of the Breasts. 
 
 The secretion of milk commencing after the birth of a child 
 is abnormally changed in some cases by furnishing milk either 
 too scarcely or too abundantly. 
 
 It happens very seldom that there is no secretion of milk at 
 all on account of the complete absence of glandular tissues in the 
 breasts, but more frequently that the amount is insufficient for 
 the nourishment of the child. This may be the result of various 
 circumstances. Besides incomplete and defective development 
 of the secreting glands, disturbances or insufficient nutrition of 
 the woman's body, which exert harmful influences, must be men- 
 tioned first. Diseases of the body and of the mind, especially 
 when chronic, have also a reducing effect upon the secretions of 
 milk, likewise profuse losses of blood during delivery and in 
 confinement and weakening discharges. The rapid and early ab- 
 sorbtion or drying up of the milk, after having been abundant- 
 ly secreted in the beginning, must be ascribed to the same causes. 
 Furthermore the manner of living, the interference of menstrua- 
 tion as well as the selection of food are also of influence. The 
 latter is seen plainly in wet nurses taken from the country. 
 Although blooming and healthy they sometimes suddenly loose, 
 without the existence of a trace of sickness, the previously 
 
242 
 
 abundantly secreted milk soon after their coming to the city. 
 After having returned again from the city to the country to their 
 accustomed surrounding, food and labor, the subsided secretion 
 is soon regained. 
 
 The existence or arising of insufficient secretion of milk has 
 in itself no special influence upon the body of the mother, con- 
 trary to the opposite state, i. e. the secretion of an over-abundant 
 quantity. Milk flows out of the breasts either continually, or a 
 long while every time after the child has been nursed. Besides 
 the continual wetting of the clothes which produces other di- 
 seases, as diseases of the skin, colds, etc., the loss of substance 
 from the body — for the milk is a liquified tissue of the body it- 
 self — is not insignificant. General health is considerably im- 
 paired thereby. The blood grows thin, the skin pale, the musc- 
 les weak and are easily exhausted. The milk itself is poor and 
 watery, and contains only little of nourishing substances so that 
 the children do not thrive well upon it. Loss of appetite, stom- 
 ach troubles, constipation, headache, sparkling before the eyes, 
 weakness of sight, palpitation of the heart, drawing pains and 
 weakness in the back are the result in the course of months, sim- 
 ilar to the ailments caused when the child is nursed too long. 
 The weaker a person the sooner these troubles usually appear, 
 but also the strongest are affected thereby. 
 
 Treatment — The treatment of insufficient secretion of 
 milk consists, besides treating eventually existing diseases, es- 
 pecially in regulating the food. It is very advisable not to 
 change the food materially after the birth of a child. Wet nurses 
 taken directly from the country must get their food as similar as 
 possible to their accustomed victuals. Milk, meat and eggs are 
 best adapted, but also all kinds of fresh vegetables and the much 
 favored cereal soups are recommendable. Sour, highly seasoned 
 and greasy food should be avoided as it restricts the production 
 of milk. Alcoholic drinks, as wine and beer, serve to strengthen 
 the body of the mother and may, therefore, be taken unhesitat- 
 ingly by nursing mothers in small quantities. A glass of good 
 beer may be recommended to every young mother if she is used 
 to alcohol, but coffee and tea should be taken only in a weak 
 form and in limited quantities. The breast must be freed from 
 every pressure, as it is so often exerted by corsets and tight cloth- 
 
243 
 
 ing, since it is essential that the blood can circulate freely to 
 and from the breasts. In case of aneemia see pages 65 and 66. 
 
 Against over-abundant secretion and flowing off of milk a 
 bandage should be applied first, which holds the breasts upward 
 and presses them firmly against the body. (See figures 66 and 
 67.) Instead of the bandage a piece of cloth properly folded 
 may be used. This must also be tied over the shoulders in order 
 to answer its purpose. A thick woolen rag, which must be 
 changed as soon as it is wet, is to be placed as lowest layer dir- 
 ectly on the skin. 
 
 Figure 66 — Showing How the Bandage is to be Applied 
 On One Breast. 
 
 Potassium of iodine (prescription 48) can be taken inter- 
 nally. Besides healthy, nourishing food must be taken in order 
 to replace the losses caused by the escaping milk. The child is 
 to be taken to the breasts less frequently. 
 
 As soon as the above mentioned troubles are experienced, 
 the nursing must be stopped entirely and the recreation of blood 
 assisted and supported by taking blood creating iron prepara- 
 tions. (See page 66.) 
 
244 
 
 Malformations of the Breasts. 
 
 Malformations of the breasts are of interest only as far as 
 they pertain to the nipples, since the cases in which the breasts 
 are missing entirely or existing in too great a number, there be- 
 ing a third or a fourth more or less developed mammary gland 
 at some part of the body, the breast, the abdomen or even the 
 tighs, are too rare. 
 
 The nipple is, however, more frequently incompletely dev- 
 eloped. This is of great importance since nursing may be rend- 
 ered impossible thereby, though the lacteal glands of the breasts 
 are perfect and the quality and quantity of milk sufficient. If 
 the nipple is too small or sunken the offspring cannot grasp it 
 with his lips and after vain attempts to nurse the babe the mo- 
 ther is compelled to make it drink by the use of an instrument, 
 called "nipple shield" (see figure 68), or to feed it artificially. 
 
 It is essential to know this abnormity, since the defect may 
 be removed to a certain extent if steps are taken in time. 
 
 Treatment — When the nipple lies deep and is sunken it 
 should be grasped with the fingers several times every day dur- 
 ing the last month of pregnancy and be pulled out well or should 
 be raised and made prominent by wearing a rubber ring around 
 the nipple, similar to Mayer's ring (see figure 41), only, of 
 course, much smaller and thinner. 
 
 Inflammation of the Breasts. 
 
 We cannot speak here of all diseases of the skin, which may 
 attack any part of the body and occasionally also the breasts. 
 This would lie beyond the purpose of this book. Only the sore- 
 ness arising in the fold between the hanging breasts and the skin 
 of the body with heavily perspiring and especially corpulent wo- 
 men, may be discussed briefly. It is caused by the continual 
 wetness of both surfaces of the skin, which rub against each 
 other. In order to remove this, wash the skin with a solution 
 of boric acid (prescription 1), or lead (prescription 2) and keep 
 it dry afterwards or powder it with lycopodium or zinc powder 
 (prescriptions 49 and 50). Besides it is necessary to raise the 
 breasts continually by a bandage, as is shown in figure 67. Such 
 
245 
 
 treatment generally has better results than the application of 
 salves. 
 
 •A peculiar inflammation of the breasts arises sometimes at 
 the time of puberty with boys as well as with girls. They in- 
 flame and swell considerably. But though this process is very 
 painful a maturation seldom will set in and after a treatment ac- 
 cording to the principles discussed later on a cure is soon at- 
 tained. 
 
 The main danger is brought on by the fulfillment of mater- 
 nal duty, since then the mammary glands answer the natural 
 
 Figure 67 — Showing How the Bandage is to be Applied 
 on Both Breasts. 
 
 purpose. The nipple has to suffer most and is, therefore, gen- 
 erally the starting point of arising inflammations. 
 
 Even under entirely normal and favorable circumstances 
 there is a loosening and scaling off of the upper layer of the 
 horny texture of the skin (see figure 6) by the long and fre- 
 quently repeated wetting of the nipples by the moist lips of the 
 child. This, however, extends only so far that under normal 
 circumstances and the necessary care the nipples regain sufficient 
 resistability during the. intervals between nursing. But if 
 there exist abnormal conditions, i. e. if the skin is from the be- 
 ginning weak and delicate, or the nipples so small and sunken 
 that the child must try to hold them during nursing by biting 
 
246 
 
 and squeezing little cracks and injuries are inavoidable. At an- 
 other place of the body, which can be kept clean and undisturbed, 
 such would be of little or no importance at all, but not so at the 
 nipples. For on the one hand the mouth of the child is always a 
 place where thousands upon thousands of microbes are present, 
 even if it appears ever so clean, and on the other hand, every 
 time the child nurses the same harmful attacks are made upon 
 the nipple, so that an existing wound finds no rest to heal up. 
 And as soon as microbes have settled in a wound it begins to 
 ulcerate. The danger of the arising of a disease during the time 
 of nursing is, therefore, the greater the more delicate and resist- 
 less the skin of the mother, and the more unfavorable the condi- 
 tions at the nipples are. 
 
 The first symptom indicating a beginning disease at a nip- 
 ple is the pain arising when the child begins to nurse or is nurs- 
 ing. The sore place developing later in an ulceration, may still 
 be so small that it cannot be perceived with the naked eye. Little 
 or no attention is, therefore, paid to it, and the mother believes to 
 be doing a good work by nursing the babe right along in spite 
 of the pains. But these grow more and more intense, and at last 
 plainly visible ulcers, mattery or non-mattery, appear in semi- 
 lunar shape around the nipple. Sometimes also fever sets in. 
 But the mother sets her teeth, endures the pain, and continues 
 nursing until finally the pains are so intense that even the 
 bravest one cannot stand them any longer. Only then it 
 seems to be time to do something for it. For a few days the off- 
 spring is taken from the breast. Then the performance commences 
 anew without giving the wound sufficient rest to heal perfectly. 
 Gradually the nutrition of the mother is impaired, appetite and 
 digestion are affected, the rest at night is disturbed, nervousness 
 and excitement set in, and even without a serious inflammation 
 of the breasts the condition of the mother is very disagreeable 
 and unpleasant. The proper treatment then only commences 
 and soon a satisfactory result is attained. 
 
 Prevention — None of the diseases described in the pre- 
 ceeding chapters is so easily and simply prevented as the ulcer- 
 ous inflammations at the nipples. Every woman should do this 
 by the proper provisions. Of course there is a little trouble con- 
 nected with it and only too many women are inclined rather to 
 
247 
 
 risk such a disease than to go to a little trouble once or several 
 times a day, which cannot be avoided. But very often the neg- 
 ligence takes revenge and when the disease exists it is too late. 
 In order to harden the skin at the nipples, which is often 
 too tender and delicate, it is advisable to wash these during the 
 last months of pregnancy once or twice a day with fresh cold 
 water, and afterwards with diluted alcohol or brandy. Tight 
 dresses pinching the breasts should not be worn and when nec- 
 essary the above mentioned protecting ring should be applied. Be- 
 sides sunken or but little projecting nipples must be pulled out by 
 the fingers, so that they may more easily be taken hold of by the 
 expected suckling. In confinement and later the mouth of the 
 child has to be cleaned before and after every nursing with a 
 
 Figuke^68— Nipple Shield. 
 
 solution of boric acid [(prescription l)^half a teaspoonful in a 
 glass of water, and the nipples carefully dabbed and dried. 
 Nursing should not be continued beyond its proper time. 
 
 Here a question arises which has been touched several times 
 in the range of this book and which we will answer here in de- 
 tail. It is the question: How long shall a mother continue nurs- 
 ing her child*? There is generally such a want of knowledge 
 among the people regarding this point and the fixed rules are dis- 
 regarded frequently in a senseless manner to such an extent that 
 it is of greatest importance to devote some attention to this dis- 
 cussion. 
 
 The time when the child should be weaned, i. e. when it 
 should be accustomed entirely to other food than to mother's 
 milk it not to be chosen at one's pleasure, but is fixed by nature 
 herself. The cutting of the first teeth, generally between the 
 seventh and ninth months indicates that the time has arrived to 
 inaugurate a change in the food. What are teeth destined for? 
 
246 
 
 To out the food, is the answer. When nature begins, therefore 
 to furnish the means for this action, it should be taken as a hint 
 for the mother to have the child now make use of them, i. e. to 
 wean it. This does not mean, however, that the child must be 
 deprived of the breast as soon as the first teeth are present. On 
 the contrary! A child should always be weaned gradually so 
 that the little babe is not harmed by the sudden change of food. 
 Let the mother commence, therefore, between the seventh and 
 eighth months, feeding the child with broth mixed with the 
 yolk of an egg, seasoned but little, or milk or pap soup in addi- 
 tion to the breasts. Between the eighth and tenth months it 
 should be kept so that the offspring receives the breasts more and 
 more seldom until it is completely weaned. 
 
 Nursing for a longer time, frequently even to the eighteenth 
 and twentieth month and longer, believing erroneously that the 
 absence of menstruation would exclude pregnancy, is dangerous 
 to both mother and child. The development of the infant body 
 is retarded and the mother is weakened abnormally. For on the 
 one hand the food will not be sufficient for the child and on the. 
 other hand the mother gives away with the milk more of her flesh 
 and blood than she can spare. Besides the danger of the arising 
 of an inflammation of the breasts is much greater as soon as the 
 teeth of the child commence to develop. The dull teethless gums 
 of the suckling could pull and squeeze the nipples with less dan- 
 ger than the sharp teeth with the cutting edges which injure them 
 easily. Existing wounds will form ulcers and these again will cre- 
 ate, as we shall see later, the source of severe mattery inflamations 
 of the breasts. Condemnable as the custom of some wealthy ladies 
 to deny to the child the mother's milk for reason of convenience 
 or pride in order not to loose the round forms of the breasts, just 
 as condemnable is the custom of too long continued nursing for 
 the above mentioned reason, since the mother thereby under- 
 mines voluntarily her health for ever, or at least for a long time. 
 
 Treatment — If the nipples are affected, the treatment 
 should commence directly, since there is always danger of a 
 penetrating and mattery inflammation of the entire breast. The 
 lips of the child must be prevented from touching the diseased 
 place, and a nipple shield (figure 68) is, therefore, to be used when 
 nursing. The ulcer itself must be washed several times a day 
 
249 
 
 with a solution of boric acid (prescription 1) and protected from 
 touching the dress by a piece of linen which has been covered 
 with a salve of boric acid, resorcin, or iodoform (prescriptions 
 51, 52, 9). Also compresses with lead water (prescription 2) 
 are recommendable. 
 
 If the cure is not soon attained by this treatment the child 
 must be taken entirely from the breast. Then by the same treat- 
 ment, or by the use of stronger medicines, as for instance a solu- 
 tion of nitrate of silver, which may, however, be only applied by 
 a physician, the cure will be attained almost without exception 
 in a short time. 
 
 Xot so simple as the ulcers are the deep inflammations of 
 the breasts, i. e. the inflammations which are not located on the 
 outer skin, but in the inner tissues. They start nearly always from 
 sores and ulcers at the nipples. If infectious microbes penetrate 
 from these ulcers deeper into the tissues, a hard, very sensitive 
 knot is formed, which intergrows later with the skin. Moving 
 the arms produces pains, the lymphatic glands in the cavity un- 
 der the shoulder swell, and may be felt as sensitive little lumps. 
 The temperature rises and the fever is very high in many cases. 
 The induration in the beginning hard, grows soft at some places 
 and maturates. Fever continues until the matter has been re- 
 moved to the outside either naturally or artificially. After that 
 the diseased breast will gradually heal. 
 
 But this comparatively favorable end is not always attained. 
 Usually these indurations are not limited to one or two in num- 
 ber, but the entire breast is filled by such, one close to the other. 
 When they grow soft they form one great abscess. The healing 
 requires then a comparatively long time and the general health 
 of the patient is greatly affected. 
 
 Peeventiox — The rules for prevention of these serious 
 maturations of the breasts are prescribed by the knowledge of 
 the fact that nearly always ulcers at the nipples, even if they 
 seem quite harmless, are the cause of the same. All precau- 
 tions against the origination of these ulcers and due attention 
 and early proper treatment of every soreness at the nipples offer 
 protection against the arising of the described suffering. 
 
250 
 
 Treatment — According to the stage of the inflammation the 
 treatment has to pursue different courses, the proper treatment 
 of the original ulcer at the nipples being naturally presupposed. 
 If there is yet only a hard, sensitive knot, whose maturation has 
 not yet commenced, it must be the aim to prevent the latter if 
 possible. The hot fomentations and poultices generally recom- 
 mended and used are not to be applied at this stage, since they 
 would create the very same thing that is to be avoided, namely 
 maturation. The woman must take to bed, tie the breast firmly 
 upward to the body (figure 66) and lay an ice bag upon it. If 
 this cannot be endured, even under the precautions formerly 
 described (see page 92) luke-warm, not hot lead water compres- 
 ses (prescription 2) should be applied every five minutes. If 
 the induration has thus diminished and the pains have subsided 
 almost entirely, apply three times a day a salve with potassium 
 of iodine (prescription 53), or blue ointment (prescription 54) 
 under slight massage to subside the last remnants. Only in case 
 the induration grows in spite of proper precautions and the mat- 
 uration cannot be debarred, hot fomentations and poultices are 
 to be used, for then it must be the aim to remove the matter as 
 soon as possible. But under these circumstances it is by far 
 better to open the abscess artificially. To wait until the matter 
 breaks through itself, as is usually done, must be dissuaded from 
 since the disease is unnecessarily prolonged thereby and the 
 pains are more severe than if an operation were performed. The 
 sooner the better is the artificial emptying by the knife, which 
 brings the desired relief almost with absolute certainty in the 
 shortest time possible. 
 
 TUMOES OF THE BREASTS. 
 
 Like all other parts of the female generative organs, so also 
 the breasts are greatly inclined to offer the native soil for tum- 
 ors. Yes, it may be said that they do as much as womb and 
 ovaries to raise the percentage of the new formations in woman 
 in comparison with those in man. The question "Why?" must 
 also here be left to the future to answer more satisfactorily, since 
 the common explanations, "a blow against the breasts," "inher- 
 ited inclinations," etc. are not yet proven. The origin of tumors, 
 
251 
 
 however, seems to be extremely favored by preeeeding inflamma- 
 tions in the tissues of the breasts. 
 
 Similarly as in tumors of the womb, age has also here an 
 influence upon the kinds of the tumors. While the benign 
 tumors, and of the malignant the sarcom (see page 182) usually 
 arise in youth, the cancer of the breasts is like the cancer of the 
 womb a disease of later years. 
 
 Symptoms — We can hardly speak of special symptoms of 
 tumors growing in the breasts as long as they are in the first 
 stages, since most of them develop so unnoticed that they after 
 having attained a certain size are only discovered per chance 
 by the ladies, while washing or bathing. Then they are gen- 
 erally watched for a while, but if they do not change, or cause 
 troubles, they are soon forgotten. Thus some ladies are afflicted 
 for years, scores of years, with small tumors in the breasts, even 
 as large as a hen's egg, without experiencing special annoyances 
 by them. 
 
 In this case women may be right in waiting, for it is not at 
 all necessary to have every knot in the breasts removed directly by 
 operation. A certain length of time for observance is required 
 also by the most experienced physician under such circumstan- 
 ces in order to ascertain whether the new formation is of benign 
 or malignant character. 
 
 The case is, however, different if from the very beginning 
 of such a tumor there are dull or drawing pains in the breasts, 
 or if a tumor, which has existed for years without increasing in 
 size or causing pains, suddenly commences to grow and to create 
 annoyances. Under these conditions and also when a tumor 
 develops after the thirty-fifth year, there is always good reason 
 to suspect a malignant new formation. The suspicion is mostly 
 confirmed soon. The knot becomes larger and larger and its 
 growth can be clearly perceived from month to month, from 
 week to week. A slight pressure on the tumor causes pains. 
 The skin on top of it, formerly movable and unchanged, begins 
 to turn red and intergrows with the new formation beneath. By 
 the decay of the tissues of the tumor ulcers are created, which 
 proceed on the one side and while healing form scars at the 
 other. If the malignant growth is near the nipple, this is usually 
 drawn inward — a characteristic sign of cancer. 
 
252 
 
 The malignant character of the new formation becomes 
 evident meanwhile also by the participation of other parts of the 
 body. (See page 177.) The lymphatic glands in the cavity 
 under the shoulders begin to pain; they swell and may be felt 
 as hard lumps. Later on they intergrow with the surrounding 
 nerves and blood vessels and cause the severe tearing pains ex- 
 perienced in later stages of cancer of the breasts in the arm 
 of the respective side and also its occasional swelling. Then 
 there is a rapid decline, and the sufferings and troubles increas- 
 ing from day to day make death a welcome deliverer. 
 
 The following rules may, therefore, be given to women: If 
 they discover per chance a knot in the breasts, which does nei- 
 ther pain nor grow, they may well be unalarmed. But as soon 
 as pains arise, or the observation proves the tumor to be growing, 
 preparations should be made to remove it by operation. Also 
 those knots which are believed to be formed of condensed or 
 coagulated milk are frequently nothing but malignant tumors 
 growing rapidly during or after confinement. 
 
 Tkeatment — The treatment of the tumors of the breasts is 
 nearly always of a surgical nature. Only small knots which 
 prove to be benign by being painless and unchanged in size for 
 months, may be left unattacked but must always be carefully 
 controled, since a change into malignant forms has frequently 
 been observed. Growing or painful tumors, however, must be 
 removed as soon as possible by an operation, like all new form- 
 ations which are suspicious from the beginning, since salves and 
 plasters and similar applications are of no use. At the first 
 stages the operation is still simple and easily performed and the 
 cure completed in a few days. If the above mentioned glands 
 are, however, affected, which happens very soon in a cancer, 
 these must be removed also. Thereby the operation becomes 
 more dangerous and it takes quite a while for the large wound 
 to heal. ' 
 
 The fate of those who allow the proper time^for the opera- 
 tion to pass by and of those with whom cancer relapsed after the 
 operation has been performed, the chance being excluded to re- 
 move it again — as it happens so frequently — is a sad one. Their 
 lot is almost the same as that spoken of in connection with can- 
 cer of the womb. (See pages 180, 181.) 
 
Sterility. 
 
 There is hardly a woman who does not, in her mind, com- 
 bine the idea of marriage with the desire to bring forth children. 
 Marriage in itself, the association with the husband, will alone 
 not for ever content a noble and in her heart spotless woman. 
 In the course of time there will always be the desire to possess 
 a being of her own flesh and blood, to love, cherish, care and 
 provide for, which strengthens the energy of the husband and 
 comforts the lonely hours of the wife. Therefore, a marriage 
 without children will never be one of the happiest. 
 
 After the passions have flown, the children are the links 
 which in the hours of sorrow and disharmony form an unbreak- 
 able chain, uniting man and wife; a chain, which is stronger than 
 that formed by the most passionate love. 
 
 But how many couples are denied the happiness of posse- 
 sing children! The mental agony at the loss of that which they 
 have never possessed is often far greater than bodily sufferings, 
 and the discontent with themselves and fate often makes a most 
 respectable character lead a seemingly useless life. 
 
 There has always been a strong inclination to blame the 
 wife for the existence of such circumstances. But today, after 
 this matter has received scientific attention, we are of different 
 opinion, and we may unquestionably believe the statement of 
 experienced scientist, who claim that in every third or fourth 
 case the husband is responsible for the fault. 
 
 It is, therefore, not very conscientious to submit the wife to 
 all sorts of manipulations, even of forbidden operations, in such 
 
254 
 
 an event, before ascertaining whether the man is to be blamed 
 or not. 
 
 If the husband is altogether incapable of performing the act 
 of copulation, there can be no doubt as to who must be 
 blamed, and in that case the wife will probably never submit her- 
 self to a medical treatment. But if the power of the husband is 
 apparently uninjured the circumstances are different. As we 
 have seen in the chapter treating of the physiology of the womb, 
 the male sperm must be united with the female germ in order to 
 bring about the fecundation of the latter. 
 
 This may be prevented on the part of the husband if in 
 spite of proper copulation no spermazoids (figure 11) are con- 
 tained in the fluid secreted during the sexual act, or if they are 
 not properly deposited within the vagina. 
 
 Both abnormities are almost invariably the consequence of 
 either a faulty development of the male sexual organs, or of con- 
 tagious sexual diseases, gonorrhoea or syphilis. By neglecting a 
 gonorrhoea, or by improper treatment of the same, incurable 
 consequences may remain. Every inflammation of the testicles, 
 caused by the progress of the gonoccoccus (figure 69) may lead 
 to lasting barrenness, as the morbid changes taking place in the 
 sperm preparing organs render the creation of the fecundating 
 sperms impossible. In such cases a fluid is discharged during 
 coition, but as it does not contain spermazoids it cannot produce 
 pregnancy. 
 
 If spermazoids are normally formed but are improperly de- 
 posited within the female organs, this may also render the marri- 
 age fruitless. Such is the case when the semen is not thrown 
 against the mouth of the womb as it should be (see Physiology 
 of the Womb), but simply flows into the vagina, either on ac- 
 count of an abnormal opening of the urethra, usually existing 
 from birth, or strictures, i. e. abnormal narrow places of the male 
 urethra, caused by chronic gonorrhoea. But as the secretions of 
 the vagina are acid (see page 48), and the spermazoids cannot 
 live in acids, they are killed before they reach the protecting 
 neck of the womb. 
 
 If none of these abnormities exist in the husband, i. e. if a 
 microscopical examination proves that there are numerous well 
 developed, quickly moving and vital spermazoids, and if the'ab- 
 
255 
 
 sence of malformations and strictures is ascertained, then the 
 source of the trouble must be sought for with the wife. 
 
 Here the causes may be far more various. The most not- 
 able is the total inability of a sexual intercourse on the part of 
 the wife, be it either on account of malformotions of the sexual 
 parts, or of an existing vaginism, i. e. of severe cramps of the 
 pelvis bottom at the approach of the husband. (See page 26.) 
 If the vagina is normal or nearly normal, the insufficient devel- 
 opment of the internal female organs: of the womb, ovaries and 
 oviducts, may produce the same results. (See malformations of 
 
 -h 
 
 Figure 69 — Microbes of gonorrhoea, Goxoccoccus. 
 
 a— Microbes free in the secretions, b — Microbes included in pus 
 
 cells, c — Pus cells without microbes. 
 
 the respective organs.) Also morbid changes may produce ster- 
 ility in preventing the union of male sperm and female germ in 
 two different ways: By weakening and destroying the vitality of 
 the male sperms and by obstructing their progress in rendering 
 the passage more difficult. 
 
 Before the spermatic animalculse have reached the womb, 
 death threathens them from the acid reactions of the vaginal 
 secretions. The danger of being killed is the greater the more 
 acids are created within the vagina. When the spermazoids 
 come in contact with these, their vitality is destroyed, they are 
 killed before they have reached the protecting cavity of the 
 womb. The narrowness of the outer mouth of the womb may 
 have a share in rendering the entrance to the womb more diffi- 
 cult, since the finding of this opening and the reception into it 
 is the more difficult the narrower this passage, but it is not an 
 
256 
 
 absolute barrier as these spermazoids are so minute that they 
 can easily pass the most narrow opening. 
 
 Of much greater importance than the narrowness of the 
 mouth of the womb itself are its consequences. In previous 
 chapters (see Catarrh of the Neck of the Womb) we have seen 
 how easily catarrhs and inflammations of the lining of the neck 
 channel are caused in such cases, because the secretions cannot 
 flow out freely and are stemmed back. Both factors, i. e. the 
 narrowness of the opening and the presence of abnormal secre- 
 tions generally act simultaneously in the so-called anteflexion of 
 the womb (see figure 22, page 104), in which case on account of 
 the increased bending over the front surface, the channel in the 
 interior of the womb is almost pressed together and closed at the 
 inner mouth. 
 
 Under such circumstances sterility is much more common as 
 in retroflexions, in which case catarrhs of the mucous membrane 
 may also exist, but the channel of the womb is much wider on 
 account of previous births. It is, therefore, absolutely erroneous 
 to say that in a case of retroflexion it is impossible for the wo- 
 man to become pregnant, as is often claimed. The fact that very 
 many women after the acquisition of a retroflexion do not get 
 children any more is due to miscarriages caused by the displace- 
 ment and the inflammation of the mucous membane of the womb. 
 The limited fruitfulness of women affected with uteral tumors is 
 also due to the catarrh of the womb generally existing at the 
 same time. 
 
 Catarrh of womb and of the lining of the oviducts are suffi- 
 cient in themselves to produce sterility without the existence of 
 further abnormities. Although delivery and confinement very 
 often cause such inflammations of the mucous membrane they 
 are generally due to direct infection by gonorrhoea, especially in 
 such cases where a pregnancy never has existed. Much more 
 often than the wife the husband will bring such an infection 
 into marriage. He often has no idea that a trouble long since 
 apparently cured could have such consequences. The diseased 
 inner surface of the womb on account of the abnormal poisonous 
 secretions weakens and kills the male sperm, and at the same 
 time is unable to develop an ovulum which has been fecundated 
 in spite of the existing difficulties. (See page 78.) The ciliar 
 
257 
 
 epithelium in the oviducts perishes and to the noxiousness exis- 
 ting in the womb the fact is added that the ovulum, which in it- 
 self has not the capability of moving forward, is deprived of its 
 propeller. Thus the difficulties are increased. The further the 
 inflammation proceeds the less chance will there be of attaining 
 pregnancy. Inflammations of the peritoneum of the pelvis cause 
 intergrowings of the womb, occlusions, and occasional sack-shap- 
 ed enlargements of the oviducts (see figure 61), and in serious 
 cases also surround the ovaries with such abundant exudations 
 that it becomes impossible to expel matured ovula. (Compare 
 figure 25.) 
 
 Further we must refer to the different chapters, as sterility 
 has been especially noted in each separate case. 
 
 Treatment — The treatment of sterility is entirely governed 
 by the cause thereof. 
 
 If the fault lies with the husband his troubles are to be done 
 away with if possible. The presence or absence of spermazoids 
 is to be proven by the use of a microscope. (See foot note.) 
 
 Only when it is certain that the husband is not to be blamed, 
 the wife should subject herself to proper treatment. In cases of 
 malformation of the female generative organs generally nothing 
 can be done; as that which has been denied by nature usually 
 cannot be supplied by artificial means. 
 
 Vaginal rinsings or injections with a solution of bicarbonate 
 of soda (prescription 55) or phosphate of sodium (prescription 
 56). are recommended against abnormal acids in the vagina. 
 Other abnormal changes, catarrhs, diplacements, tumors, etc. are 
 to be treated according to the rules previously given. 
 
 If there are no symptoms of disease in the woman, if men- 
 struation is regular, of medium quantity and passes off without 
 cramps or trouble, if there are no discharges, no pains during 
 coition, nor any other sign of a trouble, then an observance of 
 the following rules may often have the desired result. 
 
 Above all the sexual intercourse must be regulated. It is 
 wrong to believe that the more often the act of copulation is per- 
 formed the more hope will there be for pregnancy. On the con- 
 
 Foot Note — Microscopical tests of this kind will be made by the author 
 himself. 
 
258 
 
 trary ! When the sexual intercourse is practised too much, the 
 sexual desire of the wife is diminished and to the male sperm is 
 not given time enough to develop and mature. The former is 
 of importance because, as we have seen on page 48, conception 
 is attained most certainly when man and wife at the same time ar- 
 rive at the height of excitement. But when the sexual desire is 
 diminished or lost, it will never come to that point on the par 
 of the wife. The husband should, therefore, not waste his power 
 but safe it for a time when copulation will most readily have the 
 desired result. This is at the time directly after menstruation 
 It is a fact acsertained by careful observation that at the end of 
 the monthly flow during which, according to the present opinion 
 a mature ovulum is expelled from the ovaries, an impregnation 
 is most easily attained. Gradually the fruitfulness of the wife 
 diminishes after menstruation, i. e. the more days have passed 
 since the menses ceased the less probability of impregnation, al- 
 though conception is possible at any time or at any hour during 
 the entire month. It is, therefore, very practical for the husband 
 to refrain from an intercourse with his wife a week or two before 
 menstruation and to practise copulation just after the complete 
 cessation of the same, and once on each of the two following 
 days. Afterwards the woman should remain lying quietly upon 
 her back, so as to prevent the semen from escaping from the 
 vagina. If she suspects an acid reaction of the vaginal secre- 
 tions an injection with a solution of phosphate of sodium may 
 be taken a few hours before. 
 
 In this manner the sexual excitement of the wife which is in 
 itself more pronounced after the menses, will be stimulated by 
 abstinence of two weeks, and the male sperm has ample time to 
 develop fully and thoroughly. 
 
 Weak and chlorotic women should take good, nourishing 
 food, a blood enriching medicine (see page 66) and, if possible, 
 a change of residence in order to cure sterility ; these often being 
 more beneficial than a forced local treatment. How often does 
 a physician see that a delicate chlorotic woman conceives and 
 brings forth a healthy progeny, after a successful treatment of 
 chlorosis, or after an extended sojourn in some watering place or 
 near the woods, or by simply removing to some more wholesome 
 climate. — These facts may serve as a hint. 
 
Over=Fruitfulness in Marriage. 
 
 In taking the liberty to say a few words with regard to over- 
 fruitfulness in marriage, I wish to state, before entering upon 
 this subject, that I intend to take a perfectly objective stand- 
 point. It is far from being my intentions to recommend any one 
 of the preventatives here mentioned, but I simply wish to en- 
 able my readers to have their own judgment about this matter, 
 which is of so much importance to the general welfare, by giv- 
 ing an appropriate criticism and by explaining scientifically the 
 principles upon which each one is based. 
 
 Whether it is justified either from a moral, religious or so- 
 cial point of view, to limit the number of children by applying 
 artificial means, each one must decide for herself, as the opinions 
 upon this most delicate subject are too vastly different. An ideal- 
 ist will condemn it by all means; the cynic will unconditionally 
 recommend it, and good common sense will permit it .only con- 
 ditionally. To what rich people intending to keep together their 
 fortune, inherited or acquired, by cunning calculation, the pool , 
 working day by day in the sweat of their brow in order to pro- 
 vide for those depending upon them, are driven by the most 
 bitter necessity, by hunger and cold, viz, to artificially limit the 
 number of offsprings. 
 
 The system of having but two children, which is universal- 
 ly practised in so many countries, especially in France, is a re- 
 sult of the first, i. e. the cunning calculation; ihe. result of the 
 second, i. e. of a forcing necessity and the observance of the law of 
 self-preservation, is the outcry of poor, almost frantic women, as 
 I have so often witnessed in free clinics for women in Germany: 
 
260 
 
 "What shall I do that I may not have any more children? With 
 the greatest efforts, with the best good will, I can hardly provide 
 for those who are living!" Sad, indeed, are the pictures which 
 are but too often unfolded before the eyes of the physician, pic- 
 tures of misery and need which touch the heart. One of many 
 may here be described by way of explanation. 
 
 Weak, pale and feeble enough to drop, a woman comes to 
 my "free dispensary," after having completed her hard, daily 
 toil, with the question whether or not she is "family ways." All 
 her actions, the questioning look in her eye, during examination, 
 shows the anxiety with which she awaited the answer. The ex- 
 amination left no room for a doubt: it was a pregnancy in the 
 third month. This revelation was enough to make the poor wo- 
 man break down completely — a picture of the utmost despair. 
 With streaming eyes she thereupon told me her fate. She was 
 a wash-woman, a woman who day after day performed this 
 hardest of labor, which above all other toils ruins the strength 
 of a woman. Married for eleven years she had eleven living^chil- 
 dren — no twins — and the twelfth was coming. Since the day of her 
 marriage she had not seen her menstruation any more, as she 
 was always family ways again before the monthly flow recurred. 
 The hard work she had been doing for years, the many confine- 
 ments, poor nourishment, the ever troubled and disturbed nights, 
 had so weakened her entire system that only the exertion of the 
 greatest will power enabled her to keep up. But what could be 
 done ? Her children cried for bread. The husband, a drunk . 
 ard, spend in liquor whatever he could get hold of, and left the 
 care of the children entirely to her. Many woman will say, "I 
 would have long before this left such a man." She may be right 
 from her own point of view. But strange to say the woman lov- 
 ed her husband in spite of all her" hardships and trembled at the 
 thought of his eventual unfaithfulness. 
 
 Is it allowed to limit the number of children under such 
 circumstances ? 
 
 I entirely except such cases in which a pregnancy condemns 
 a woman to death, on account of the existence of abnormal cir- 
 cumstances. Here as a physician I must sanction the employ- 
 ing of such preventatives, and oppose those who say that in this 
 case the husband should refrain from all intercourse with his 
 
261 
 
 wife. This can never be done. Marriage is a sacred and wise 
 institution. It gives to those concerned privileges, but it also 
 gives them duties, which, if not performed, sever the bonds of 
 matrimony, according to the laws of all civilized nations. This 
 should by all means be prevented. But the first and greatest 
 duty is the permission of sexual intercourse. Of course there 
 are strong men, strong of mind and will power who, thanks to 
 their training, are able to suppress the instincts -of nature, but 
 we have here to deal with the average person, i. e. with such as 
 are generally met with in life; he is not made for these denials. 
 If a man is sensible and I may say noble enough not to 
 sever the bonds once entered into, and his home does not offer 
 him what he wishes for and what is his due, he will seek it out- 
 side of his home. And this is much more abominable than the 
 use of some harmless means which will enable the husband to 
 make use of his privilege and at the same time protects the wife 
 from danger. 
 
 From that which has been said in the chapter on physiology 
 of the womb in regard to bringing about fertilization, it may be 
 understood that all those means which are employed to limit 
 progeny have one and the same destination or aim — i. e. to pre- 
 vent the union of the male sperm and female germ. Several 
 ways lead to this end. Either care must be taken so that the 
 male sperm does not enter the vagina at all, or that its progress 
 to and entrance into the womb is prevented. 
 
 Naturally the first way was the one which was most readily 
 chosen. Although the construction and functions of the female 
 sexual apparatus was very little known to the ancients, so much 
 was recognized that as the rain fertilizes a dry field, so the fluid 
 secreted by man impregnated the woman. What was more na- 
 tural then to keep this fluid away from the place of its destina- 
 tion and thus have the satisfaction without bearing the conse- 
 quences. 
 
 First — At that time instruments and apparatus were entirely 
 out of the question and thus the simplest precaution, which is 
 even now most universally employed, was suggested. This is 
 done by interrupting coition before the emission of the semen . 
 
262 
 
 We have spoken of this previously (see page 86) and have seen 
 that occasionally very disagreeable diseases may be caused there- 
 by in course of time. Besides the chronic congestion of the fe- 
 male organs mentioned before which lays the foundation to 
 chronic inflammation of the "walls of the womb, oviducts and 
 ovaries, it is said that displacements, muscular tumors and even 
 cancer may be the result. Although this latter is not definitely 
 ascertained it is a fact that the interruption of the sexual act in 
 this manner may have surely many evil consequences for both 
 man and wife. 
 
 The reason that this means to attain an artificial sterility is 
 so universally employed by the people is because on the one hand 
 it is the simplest, requiring no trouble and no expense — its evil 
 consequences being very little known; on the other hand because 
 it is an absolute safeguard if care is exercised. 
 
 And yet pregnancy follows not so seldom, caused either by 
 a conscious or unconscious mistake, or because coition has been 
 practised several times in succession. As the male sperm passes 
 through the entire length of the urethra, remnants of it will al- 
 ways remain in the latter and these may, if they enter the vagina 
 during a second co-habitation, produce pregnancy, since — as we , 
 have seen above — one spermazoid is sufficient to fertilize. Simp- 
 ly passing urine before the repetition of the sexual act, as is 
 often done, in order to eject the remaining remnants of semen 
 does not altogether suffice to remove the danger of conception. 
 
 Second — A second precaution, not so well known, and more 
 rarely used in marriage is a so-called Condom. This is made of 
 thin rubber or animal membranes and covering the male organ 
 is intended to serve as a receptacle for the semen ejaculated dur- 
 ing coition. Much has been said as to its usefulness and use- 
 lessness, and one prominent authority pronounces it as being "a 
 stone wall against pleasure and a cob web against danger." This 
 holds good in regard to those condoms made of rubber. They 
 are thick and thus materially lessen the sexual satisfaction for both 
 man and wife. If they are made thin they tear, and in that case 
 are so much more dangerous, as the couple trusting them fails 
 to take other precautions. 
 
 The condoms made of animal membrane are very much bet- 
 ter and preferable. In good qualities the membrane is so thin 
 
263 
 
 that the satisfaction is in no way obstructed by them and with 
 some care there is no danger of their tearing, thus being a sufficient 
 safeguard. But nevertheless they are used seldom since some 
 unavoidable trouble is connected with applying them and since 
 they are comparatively expensive. 
 
 The means hereinafter described are contrivances of recent 
 date, as they could not be invented before the construction, sit- 
 uation and relation of the internal female organs were better 
 known. They are applied by the women and serve the purpose 
 
 Figure 70 — Pessarium Occlusivum in its Proper Place. 
 
 to prevent the male sperm, which has been deposited in the va- 
 gina, to enter the womb or to destroy it before it has reached the 
 place of its destiny. 
 
 It would lead too far to enumerate all the different means 
 invented by an ingenious human mind, either with human [ or 
 material intentions to simplify the achievement of this end. It 
 may suffice to mention and critisize the principal methods. 
 
 Among these are to be numbered above all 
 
264 
 
 Third — The Pessarium Occlusivum, also called womb veil. 
 This is a thicker or thinner rubber ring similar to that shown in 
 figure 41), but closed from below by a semi-spherical rubber bag. 
 This apparatus is so turned over the womb that its mouth is 
 placed within the bag, and is thus entirely separated from the 
 vagina (see figure 70). In this way the male sperm is prevented 
 from entering the womb and the aim in view is reached. 
 
 Although this instrument does not afford an absolute guar- 
 anty, it is a comparatively good safeguard if the pessary is fitted 
 by a professional man and the woman is properly instructed in 
 its use. 
 
 One great advantage of this instrument is this that an intel- 
 ligent woman will soon learn to apply it by one instruction, and 
 does not need the aid of a physician any more. 
 
 There is generally a- slight decrease of the sexual pleasure in 
 
 Figre 71 — Uterine Stem. 
 
 the beginning, but this is done away with as soon as the woman 
 has become accustomed to the use of the instrument. 
 
 To increase the safety the instrument is generally dropped 
 into some sperm destroying fluid before placing it. One of the 
 most commonly used is given in prescription 57. It makes at 
 the same time the instrument slippery so that it may be readily 
 introduced. Also here a vaginal injection before and after co- 
 pulation (see page 267) has frequently been recommended by 
 physicians. 
 
 But the use of this instrument has also disadvantages. 
 These consist mainly in the troublesome preparations which are 
 necessary each time in placing it. Messinga, the inventor, has 
 recommended to wear the pessary continually, but this should 
 not be done because the vagina will be widened thereby and a dis- 
 agreeable discharge and odor arises in course of time, as it oc- 
 
265 
 
 curs with every soft rubber pessary which is worn continually. 
 We have spoken of this before in the chapter on retroflexion. 
 
 Fourth — The disadvantages enumerated above are not found 
 by using the "Uterine Stem," that small instrument which is 
 seen in figure 71. 
 
 It is made of very light material, namely of aluminum, and 
 is placed in such a position that the stem enters the neck chan- 
 nel and the plate below closes the mouth of the womb (see 
 
 Figuee 72— Uteeine Stem Peopeely Placed. 
 
 figure 72.) It has been much in use lately and has given full 
 satisfaction. The only disadvantage here is that the placing 
 and removal of the instrument is connected with greater dif- 
 ficulty and in most cases necessitates the aid of a physician. 
 Only the skillful and adept woman can learn to apply it her- 
 self. This apparatus remains in place during the entire month 
 and is only removed at the time of menstruation. It causes no 
 trouble to either man or wife and there is no danger of its caus- 
 
266 
 
 ing discharges. But also in this case vaginal rinsings before 
 and after coition are absolutely necessary. 
 
 Fifth — By far the most unreliable means are the so-called 
 Sponges. These are small soft sponges and are introduced like 
 tampons (see figure 19). They are attached to silk ribbons 
 and are intended to be placed before the mouth of the womb 
 so that the male sperm may not enter this. In some cases 
 they answer the purpose very well if the construction of the 
 
 Figure 73 — Parisian Sponge in Rear Vault of Vagina. 
 
 a — Sponge, b — Silk Ribbon to which the sponge is fastened. 
 
 vagina is favorable. But if the rear vault is wide and spacious, 
 as it is in many cases, the sponge will very easily slip into this 
 (see figure 73) leaving the mouth of the womb free, so that the 
 spermazoids enter it just as easily as though there were no pre- 
 cautions at all. 
 
 Sixth — As it is necessary in the application of the instru- 
 ments and means of prevention described in numbers 3, 4 and 5, 
 to introduce foreign objects into the vagina, which is objection- 
 
267 
 
 able to many, very many ladies— and justly so — attempts have 
 been made to find a method to avoid this. Dr. Knowlton, of 
 Boston, was the first to recommend simple vaginal injections for 
 that purpose. 
 
 The idea, at the first thought, seems to be very simple and 
 is readily understood, and yet the conditions are in this case 
 most complicated. It is entirely erroneous to believe that in or- 
 der to be safe it will suffice to remove or to wash away the male 
 sperm by an injection of water. A little earnest consideration of 
 the matter will easily reveal the mistake. The injected liquids 
 reach only the mouth of the womb, everything higher up being 
 beyond their reach. Now, if the male sperm would be simply 
 deposited into the vagina, an injection taken at once might suf- 
 fice, destroying and washing them away. But such is not the 
 case. As we have seen in the chapter on physiology of the 
 womb (see page 48) nature has provided means to facilitate the 
 entrance of the spermazoids into the interior of the womb al- 
 ready during coition and to insure their existence. At the mo- 
 ment the woman reaches the height of sexual excitement by a 
 contraction of the muscular walls of the womb a probe of mucus 
 is pressed out of the neck channel which retreats immediately 
 after the womb has relaxed, saving thus eventually adhering 
 spermatic animalculee. These, of course, cannot be reached any- 
 more even by an injection taken at once. If, therefore, these in- 
 jections should be effective the following conditions must be 
 fulfilled. 
 
 (a) The injection must be taken immediately after coition. 
 Every second's delay makes success more doubtful, as spermat- 
 ozoids may meanwhile enter the womb. Injections taken one- 
 half or one hour later, or even the next morning are absolutely 
 useless. 
 
 (b) The couple must avoid to reach at the same moment 
 the height of sexual excitement, and if possible the wife should 
 be gratified before the husband. Then the dangerous probe of 
 mucus will have retreated into the the neck channel; the semen 
 is deposited entirely into the vagina and may thus be re- 
 moved. 
 
 (c) Instead of pure water sperm destroying liquids should 
 be used. Solutions of sulphate of zinc, or alum, half a teaspoon- 
 

 268 
 
 f ul to a quart of water, and simple soda, half a tablespoonful to 
 one quart of water, or an addition of vinegar to the water have 
 been recommended for this purpose. Vaginol, or a combination 
 of Vaginol, one-half teaspoonful and one-half tablespoonful 
 of soda to one quart of water, has given the most satisfactory 
 results. 
 
 (d) The injections should be taken in a reclining position 
 according to the rules given in the chapter on Diseases of the 
 Vagina. They must be luke-warm, as cold injections may cause 
 inflammation of womb, oviducts and ovaries. 
 
 If these rules are strictly observed vaginal injections are 
 quite a good preventative of pregnancy. No other apparatus 
 than a simple syringe is necessary. Many cases have come to 
 my knowledge in which these injections have acted promptly, 
 but they are no absolute safeguard. Rinsings in this manner 
 are used by a great many ladies for cleanliness' sake only with- 
 out any other object in view. 
 
 In regard to the danger of impregnation in the different 
 days between the menstruations see chapter on Sterility. 
 
Chronic Constipation; Its Causes and Its 
 Treatment. 
 
 Chronic and obstinate constipation, a trouble existing either 
 independently or in connection with some other disorder in the 
 abdomen, causes so much annoyance to very many ladies and 
 the complaint of it is so universally heard that it seems to me 
 but just and proper that it receives room and is discussed within 
 the range of this book, the more so because unproportionally 
 more women than men are suffering from it. 
 
 Before entering, however, more definitely upon this subject, 
 we must at first clearly understand what constipation is and how 
 it is brought about. 
 
 The English expression used to designate a passage of ex- 
 crements, "movement of the bowels,'" gives us a hint. For if 
 according to this expression a passage is produced by^the move- 
 ment of the bowels, constipation must necessarily be the result 
 of an abnormal inactivity of the former. And this is really the 
 case. 
 
 In looking at the intestines of animals it seems almost im- 
 possible that the thin walls are capable of performing so much 
 work as they really do. They must not only digest the food and 
 absorb the nutritious matter, but they have to carry it also on 
 and to throw off the waste matter. In order to accomplish this 
 latter part of the work assigned to them the walls of the stomach 
 as well as those of the intestines contain numerous layers of mus- 
 cular fibres which contract unvoluntarily, i. e. without our per- 
 ception. But as these muscle fibres run circularly around the 
 
270 
 
 intestinal tube, the inner cavity of this grows narrower by their 
 contraction. This is of great importance. For there is here also 
 a certain regularity of motion, just as we have seen in describing 
 the motion of the ciliar epithelium of the womb. (See page 12.) 
 The contractions begin at the stomach and proceed as a wave 
 upon the water, along the intestines, forcing onwards the con- 
 tents and bringing about the necessary mixture of the food with 
 the digestive juices. Who ever saw the motions of a creeping 
 worm will easily understand these worm-like motions of the in- 
 testines. 
 
 Under normal conditions the food passes through the small 
 intestines in about three hours, while it remains in the large in- 
 testines for about twelve hours. There the excrements are thick- 
 ened more and more by absorbtion of the water contained there- 
 in, and may grow as hard as stones if they remain there too long, 
 as it often happens in cases of constipation. 
 
 If the motions of the intestines are too rapid and forcible, 
 they become very irritating and painful, causing the so-called 
 colics. The contents are carried on too rapidly h and thrown off 
 without being thickened: diarrhea is the result, which generally 
 follows colics. 
 
 If, on the contrary, the motions of the intestines are slow 
 and sluggish, especially those of the large intestines (see figure 
 74), the contents are not carried along as they should be and re- 
 main entirely within the large intestines without being thrown 
 off: constipation and indigestion is the result. 
 
 In public opinion a regular evacuation of the bowels is the 
 first requisite to retain and regain perfect health and, therefore, 
 this matter is generally given very much attention by persons of 
 either sex. 
 
 A great many different remedies placed on the market in 
 different forms are used by the people to bring about this nec- 
 essary regularity. Very rarely a physician is consulted on this 
 matter, but the well-known drugs are simply purchased at any 
 store. All kidney, liver and blood purifying pills which are so 
 extensively advertised in all newspapers consist of nothing but a 
 common laxative and act in the same manner. The public buy- 
 ing them receives the same otherwise cheap remedies in a more 
 palatable but also much more expensive form. 
 
271 
 
 In an occasionally occurring constipation it may, perhaps, 
 be proper to use once in a while these remedies, but as soon as a 
 continuance of the trouble proves it to be the result of some ex- 
 isting disorder this habit is absolutely objectionable. As the 
 causes are by no means always the same and a treatment, when 
 proper, must necessarily be based upon an accurate knowledge 
 of the former each separate case should be thoroughly invest- 
 igated. A careful examination of the organs of the pelvis, is, 
 therefore, often unavoidable in women, as we have seen in pre- 
 vious chapters that displacements of the womb, shrinking of its 
 supporting ligaments, uteral and ovarian tumors, enlargement of 
 the oviducts, etc., may compress the rectal passage and cause 
 habitual constipation by preventing the stools to pass by. It is, 
 therefore, so much more objectionable if even physicians, from 
 a want of thoroughness, fail to make a careful examination and 
 unscrupulously prescribe a laxative, which the sufferer has to 
 take then for years. 
 
 Besides local troubles also other causes which are not aris- 
 ing from certain organs may start constipation. Some of the 
 most important may be enumerated and discussed in detail since 
 .the ladies themselves will after that in many cases easily recog- 
 nize the source of the evil and have the chance to remove it 
 entirely without the aid of a physician. 
 
 Besides chlorosis, which is a trouble mainly peculiar to wo- 
 men and which has been treated of a*t length in the chapter on 
 catarrh of the neck of the womb, custom, habit and manner of 
 living are of material influence upon the arising of chronic con- 
 stipation in women. 
 
 In the division of work which is governed by natural need 
 the care of the household has been alotted to woman. Her 
 strength would not suffice to do a man's work, or to perform the 
 man's labor, which is generally harder and wearying. The duties 
 of home give her ample occupation, but they rarely require much 
 physical exertion. A great part of her work, such as sewing, 
 mending, embroidery and fancy needle work compel her to sit 
 perfectly quite even for hours together, the hands and fingers 
 being the only portions of the entire body which are kept moving. 
 Thus passes day by day week by week, and even month by 
 month, the indoor excercise being the only one for very many 
 
272 
 
 women. The lack of muscular exercise, the partially foul air in 
 the rooms, the pressure of the vapor-filled atmosphere of the 
 kitchen, the want of diversion and encouragement often increase 
 the want of appetite, disturb digestion and cause constipation in 
 so many women and mothers. 
 
 Even worse is the lot of those poor creatures who while 
 earning .their own livelihood are compelled to deny themselves 
 even that little exercise, to which the housewife is forced in the 
 discharge of her daily duties. Look at the poor girls sitting at 
 the office desk, bent over their books and accounts, working 
 mentally day by day. While a man earning his living under the 
 same conditions after his daily duties are performed has diver- 
 sions of the most various kind, such as walking, rowing, cycling, 
 etc., and spends pleasant evenings with his friends refreshing 
 thereby his body, supplying his muscles with new energy, accel- 
 erating breathing and the circulation of blood, and at the same 
 time improving the actions of the bowels by an increased activity 
 of the whole organism, custom forces the girl to seek modestly 
 her home and the family circle after her work is done. She is 
 deprived of all open air exercises and shares the lot of so many 
 other companions in this misfortune, who — partly on account of 
 their position in life, as seamstresses, factory girls, or partly also 
 on account of an over-careful yet decidedly faulty draining, — 
 are run down and troubled by habitual constipation. That which 
 the struggle for an existence* does in the first instance is done in 
 the second by the over-refinement of our fashionable world. 
 How often do we find the latter in the family of the wealthy ! 
 The daughter must play piano, do fine needle work, draw, paint, 
 etc., and if she has no natural talent for these arts, hours of prac- 
 tice each day must make up for the natural deficiency. The 
 mind is trained and cultivated at the expense of flesh and blood. 
 How much better would it be to allow the half grown girls to 
 care for the development of their body! 
 
 Faulty nutrition is not so much a result of the social condi- 
 tions of life, as it is of ignorance and negligence. Although the 
 proverb "That which is palatable is also beneficial to the stom- 
 ach," may be in some measure correct, it does not hold good 
 with very many ladies. 
 
 If children are continually fed on candy to keep them quiet 
 
273 
 
 and well behaved; if young girls, simply from choice, or in order 
 to be "interestingly pale" drink vinegar and only want sour 
 dishes; or if ladies live almost entirely on cakes, pies, lemonade, 
 and ice cream, this is by no means beneficial to the stomach, al- 
 though these things are very palatable. Digestion suffers ma- 
 terially, appetite is lost and constipation results. 
 
 It is also wrong for a healthy person to take only such food 
 as is almost entirely absorbed by the bowels and leaves little or 
 no waste, such as meat, eggs, and milk. Over-careful persons 
 who have suffered of catarrh of the stomach and intestines and 
 have been ordered a strict diet on account of this, are only too 
 easily led to continue this diet long after the disease has been 
 cured. All kinds of preparations which are claimed to contain an 
 immense amount of nourishing substance in a comparatively small 
 bulk are taken and the ordinary victuals are rejected. This is 
 absolutely wrong. Unless certain diseases demand it, the vic- 
 tuals should be chosen in a variety, i. e. a necessary amount of 
 such food must be taken, which cannot be absorbed entirely in 
 the intestines, and leaves a waste which is thrown off as stools. 
 For if this waste is too little it will not irritate the walls of the 
 intestines sufficiently to bring them to activity : they move too 
 sluggishly and constipation is the result. 
 
 Treatment — Before entering upon the manner of treatment 
 of constipation I will lay down as a fundamental rule: "Avoid 
 laxatives and purgatives as long as they can possibly be avoided." 
 
 It seems so easy to take only a cup of tea, a pill or two, or 
 a powder and then be free of annoyance and gain regularity. 
 Those who do this think only of the present and not of the 
 future. A purgative has the same influence upon the rectum as 
 the whip has upon a tired and over-burdened horse : for the mo- 
 ment it runs quicker, but then comes the reaction, i. e. the slug- 
 gish rectum is for once forced to activity, but afterwards the 
 condition is so much worse. In the course of time the dose 
 must be continually increased to produce the desired effect, and 
 the more this is done the worse for the body. 
 
 Instead of chemically forcing the rectum to activity by using 
 purgatives, it is, therefore, incomparably better to assist nature 
 by natural means, which while working always in the same manner 
 cannot spoil the health and help to correct an existing disorder. 
 
274 
 
 This can be done above all by a reasonable and proper 
 mode of living. Those of sedentary habits should equalize the 
 lack of exercise by a morning's and evening's walk in fresh air. 
 If this is not possible, as in winter, indoor gymnastics, especially 
 exercising the lower half of the body should be substituted for 
 these walks. Cycling is also beneficial and highly recommend- 
 able if it is not overdone and if there are no special female trou- 
 bles. Fresh air and care of the skin are of importance. Besides 
 frequent warm baths, cold washing in morning and evening (see 
 page 236) are recommendable. 
 
 Above all, however, the rectum must be directly influenced 
 by trying several times each day to bring about a passage. At 
 a certain hour, I would almost say at a certain minute, the pa- 
 tient has to go to the closet and see if a movement cannot be 
 produced. The best time is in the morning after rising and in 
 the evening before retiring. Great exertion and remaining on 
 the closet for a long time are unnecessary and even harmful. 
 Repeat the above day after day, and you will be rewarded for 
 your patience and perseverance. 
 
 A regulation of the food is of equal importance. It should 
 not consist only of meat, milk, eggs, etc., but also of bread, 
 potatoes, etc. — provided, of course, that no stomach or bowel 
 disease prohibits this — as these contain a certain amount of in- 
 digestable substance and by filling the rectum with waste will 
 drive this to activity. Graham bread is for this reason very rec- 
 ommendable for persons habitually constipated. Besides filling 
 up it irritates the bowels mechanically but not chemially, and 
 forces them to move. 
 
 On account of the variety of victuals it will be necessary to 
 give a short review of those which cause and those which pre- 
 vent constipation. 
 
 Among the latter fruit is to be' mentioned above all. Apples, 
 pears, plums, peaches, cherries, grapes, etc., are very good to over- 
 come constipation and in light cases suffice to bring about reg- 
 ularity. It is immaterial in what form they are taken, whether 
 raw or cooked. Therefore fruit should be taken with each meal. 
 If it is cooked the juice also must be made use of, as it contains 
 inany substances which act favorably upon the intestines. 
 
 Honey is equally recommendable, Furthermore fresh veget- 
 
275 
 
 ables are beneficial, although not so pronounced in their effect: 
 spinage, cauliflower, green peas, onions, white and red cabbage 
 should, therefore, also always accompany the meals. 
 
 Milk varies in regard to its effect, and must be tried in each 
 separate case. It quite as often causes diarrhea as it does con- 
 stipation. Even whether it be boiled or not makes a difference. 
 As milk is so often prescribed for women and young girls it 
 would be well to sweeten it with honey in order to avoid con- 
 stipation. 
 
 All farinaceous substances such as cakes, pies, sago, rice, 
 etc., are liable to cause constipation. Furthermore all highly 
 seasoned dishes and also cocoa, chocolate, cheese, and dry or 
 warm bread. Tea and coffee increase constipation if taken too 
 strong. 
 
 Our main victuals, meat, oysters, fish, eggs, etc., are of no 
 consequence regarding constipation, as they will neither cause 
 nor allay it. 
 
 A simple and often very effective means of regulating the 
 bowels is to drink a glass of fresh water before breakfast, or to 
 take an apple or an orange after rising or before retiring. 
 
 As in obstinate cases a regulation of the manner of living 
 and of the food will not suffice to produce the desired effect, it 
 must be aided by other means tending to effect a movement of the 
 bowels without the use of medicines. Among those massage of 
 the abdomen takes the most prominent position. It is executed 
 in such a manner that the abdomen is energetically rubbed and 
 kneaded in the direction indicated by the arrows in figure 74, but 
 without creating pains. According to the course of the large in- 
 testines the massage begins at the lower part of the abdomen at 
 the right side, then progresses upward to the right ribs, then hor- 
 izontally accross the abdomen from the right to the left lower rib, 
 and then on the left side downward. Thus the contents of the 
 large intestines are artificially pressed forward and at the same 
 time the intestinal walls aroused to activity. 
 
 With the necessary persistency this is an excellent method 
 to improve irregular and sluggish movements. The massage 
 must be made two or three times daily and continued for one- 
 quarter to one-half an hour each time; the patient must be in a 
 reclining position and relax the abdominal walls as much as pos- 
 

 276 
 
 Figure 74— Showing Location and Situation of the Large 
 
 Intestines. 
 
 The arrows in the interior mark the direction in which the ex- 
 crements have to pass within them. 
 
 -End of breast bone with the lower rips branching off to both sides, 
 c — Entrance of the small intestines into the large intestines, 
 d — Space in which the small intestines are lying, 
 e — Rectum. 
 
277 
 
 sible which can be done with very little practice. It is well to 
 take the massage shortly before going to the closet. 
 
 Very often damp-warm compresses or packings of the ab- 
 domen during the nights (see page 93) are very beneficial. The 
 result of these will be even better if the abdomen is sponged with 
 cold water immediately after removing the compresses. If the 
 skin is afterwards well rubbed with a coarse towel until it begins 
 to redden, and then protected by warm clothing, there is no dan- 
 ger of taking cold. 
 
 The gymnastic exercises recommended against constipation 
 are not so effective and are too numerous to receive here closer 
 attention. 
 
 Another means which on account of its inconvenience may 
 be used when everything else has failed must yet be mentioned. 
 This is enemas, taken only to regulate the bowels and not to 
 produce a passage. By this I mean injections of a small quan- 
 tity of water — say one pint — into the rectum at a temperature 
 of sixty-eight to seventy-five degrees Fahrenheit. They are 
 meant to act upon the intestines in the same manner as cold 
 spongings act upon the epidermis. As they serve only to ob- 
 durate the intestines and not to produce a passage, the water 
 should be allowed to escape again without any exertion after 
 about three minutes. These enemas must be taken daily for 
 about four to six weeks and at a certain hour of the day. In 
 most cases the result will be ample reward for the trouble. 
 
 Also in the beginning of the treatment, as long as there is no 
 natural passage purgatives have to be avoided by all means and 
 if necessary the movement of the bowels must be forced by en- 
 emas. But for this purpose they are to be taken in a different 
 way than before mentioned. 
 
 The patient should not lie on the back but take the here 
 described position : Lie down with legs drawn up, so as to rest 
 upon knees and elbows. The body thus being in an oblique posi- 
 tion, the pelvis is the highest part. But as this position is un- 
 comfortable and not very aesthetic, another one, likewise approp- 
 riate, may be taken. Lie on the right side with knees half way 
 drawn upward, so that you may rest also partly upon the ab- 
 domen. In taking either of these positions the water will flow 
 through the entire large and even as far up as the small intestines. 
 

 278 
 
 The temperature of the water must be luke-warm and the 
 quantity from one to three pints. To produce a stronger action an 
 addition of soap or one tablespoonf ul of glycerine may be recom- 
 mended. Pure water is, however, generally sufficient to produce 
 the desired effect. The water has to be retained for about one- 
 half an hour. If the abdomen is slightly massaged during this 
 time the intestines, filled with liquid, can be plainly felt. 
 
 An ordinary fountain syringe (see page 32) is sufficient for 
 taking enemas, but the reservoir should be suspended as high as 
 possible to increase the pressure of the water. 
 
PRESCRIPTIONS 
 
 Prescription i. 
 Bpracic Acid. 
 Dissolve a teaspoonful in a pint 
 of boiled water and use the solu- 
 tion for compresses. They can be 
 renewed as often as agreeable. 
 
 Prescription 2. 
 
 Solution of Lead Subacetate, 
 2 fl oz. 
 Mix one teaspoonful with a cup- 
 ful of water and use for compresses. 
 
 Prescription 3. 
 
 Corrosive Sublimate, 
 Chloride of Sodium (common 
 
 salt), each 75 gr. 
 Water, 4 oz. 
 
 Dissolve by shaking. 
 POISON! Mix one to two tea- 
 spoonfuls with a quart of water. 
 Use a silver spoon to measure it! 
 This solution is best to be used 
 as a wash three times a day. After 
 the wash dry by dabbing with ab- 
 sorbent cotton. If the solution pains 
 take less than a teaspoonful in a 
 quart of water. 
 
 Prescription 4. 
 
 Liquid Carbolic Acid, 2 oz. 
 
 Dissolve one to one and a half 
 teaspoonful in a pint of boiled water 
 
 This is the most common solu- 
 tion. But since it bites when taken 
 stronger and does not disinfect en- 
 ough when it is taken weaker, pres- 
 criptions 3 or 6 are preferable. 
 
 Prescription 5. 
 Creolin, 4 oz. 
 Mix one or two teaspoonfuls with 
 a pint of boiled and recooled water. 
 
 Prescription 6. 
 Yaginol, 4 oz. 
 
 One-half to three-quarters of a 
 teaspoonful to a quart of water. 
 
 Solutions from prescriptions 5 
 and 6 are best used as washes three 
 to four times a day. Also here a 
 drying off afterwards with absorb- 
 ent cotton is advisable. 
 
 Prescription 7. 
 
 Solution of Lead Subacetate, 
 
 30 min. 
 Lard, 6 drachm. 
 Mix! Apply two to three times 
 a day. . 
 
 Prescription 8. 
 
 Ointment of Zinc Oxyde. 
 Apply two or three times a day. 
 
 Prescription 9. 
 
 Iodoform Ointment, U. S. P. 
 Apply two or three times a day. 
 
 Prescription 10. 
 
 Liquid Carbolic Acid, 90 min. 
 Water in sufficient quantity to 
 make 4 oz. 
 Mix by shaking. Apply once or 
 twice a day, 
 
280 
 
 Prescription ii 
 
 Hydrochlorate of cocaine, 15 
 
 grains, 
 Distilled water, 2 1-2 drachms. 
 Apply with a brush two to three 
 times a day. 
 
 Prescription 12 
 
 Carbolic acid, 30 min., 
 Petrolatum, 6 drachm. 
 Mix. Apply two or three times a 
 
 day. 
 
 Prescription 13 
 
 Hydrochlorate of cocaine, gr. 
 
 XV, 
 Petrolatum, 2 1-2 drachm- 
 Dissolve the hydochlorate of co- 
 caine in about five drops of distil- 
 led water and mix it with the 
 petrolatum. Apply with a brush 
 two or three times a day. 
 
 Prescription 14 
 
 Santonin troches, 1-2 grain. 
 Give children one year old or less 
 one third of a troche three times a 
 day. Children one or two years old 
 take one-half troche three times a 
 day. From two to five years old 
 give one troche three times a day. 
 Children from five to seven years 
 give four troches a day, and older 
 children give two troches thrice a 
 day. This must be continued in all 
 cases for three days. After three 
 days give a purgative, the best is 
 castor oil. 
 
 Prescription 15 
 Calomel. 
 Apply the powder with a brush 
 once a day. 
 
 Prescription 16 
 
 Carbolic acid liquid, 15 min. 
 Hydrochlorate of cocaine, 15 
 
 grains, 
 Petrolatum, 2 1-2 drachm. 
 Dissolve the hydrochlorate of co- 
 caine in the liquid carbolic acid in 
 a mortar and add the petrolatum. 
 
 Prescription 17 
 
 Solution chloride of iron. 
 Dab the pointed condylomata 
 once a day with this solution. 
 
 Prescription 18 
 
 Corrosive sublimate 
 
 Chloride of sodium (common 
 
 salt) each 2 drachm. 
 Water in sufficient quantity to 
 make 4 oz. 
 Dissolve by shaking. Mix one- 
 half tablespoonful with a quart of 
 water and use it as an injection. 
 Measure with a silver spoon. 
 
 Prescription 19 
 
 Chloride of zinc, 
 
 Water, each 2 oz. 
 Dissolve. One tablespoonful for 
 a quart of water of about 86 degrees 
 Fahrenheit to be used as an injec- 
 tion twice a day in a lying position. 
 
 Prescription 20 
 Vaginol, 4 oz. 
 One-half to one teaspoonful mix- 
 ed with a quart of water for injec- 
 tions once or twice a day. 
 
 Prescription 21 
 Boracic acid, 
 Dissolve one-half to one table- 
 spoonful m a quart of water and 
 use as an injection. 
 
 Prescription 22 
 
 Salicylic acid. 
 
 Mix one- third to one-half of a tea- 
 poonful to a quart of water. 
 
 Prescription 23 
 
 Liquid carbolic acid 
 One to three teaspoonfuls to a 
 quart of water just as the patient 
 can endure it. ft is much less ef- 
 fective than Vaginol. 
 
 Prescription 24 
 Creolin, 4 oz. 
 Two to four teaspoonfuls to a 
 quart of water as injections. 
 
 Prescription 25 
 
 Permanganate of potash 
 Dissolve one ounce in a pint of 
 clear water and add of this solution 
 so much to a quart of water that it 
 appears dark red. 
 
281 
 
 Prescription 26 
 
 Alum powdered, 4 oz. 
 One-half to one teaspoonful to a 
 quart of water as injection. 
 
 Prescription 27 
 
 Tannic acid (tannin) 1 oz. 
 One teaspoonful to a quart of wa- 
 ter as injection. 
 
 Prescription 28 
 
 Sulphate of zinc, 2 oz. 
 
 One-half to one teaspoonful dis- 
 solved in a quart of water as injec- 
 tion. 
 
 Instead of alum, tannin and sul- 
 phate of zinc each single, a mixture 
 of them prepared of equal parts, 
 one-half to one teaspoonful to a 
 quart of water, is generally used. 
 These same medicines are in a com- 
 bination with a narcotic, as for in- 
 stance morphine, hydrochlorate of 
 cocaine, etc., often used in vaginal 
 suppositories and compressed vag- 
 inal tablets. They contract the 
 vagina so narrow that it is hardly 
 possible to introduce the vaginal 
 tube of the syringe. Many ot my 
 readers will now remember the ac- 
 tions of some patent medicines 
 which have the same effect and are 
 claimed to cure nearly all female 
 disorders. In a few cases they may 
 have the promised result, but in the 
 majority of cases they only help on 
 account of the narcotic as long as 
 they are taken. It is the more con- 
 demnable when even physicians 
 prescribe in every case ot female 
 diseases the same vaginal tablets 
 without having examined the pa- 
 tient, and on account of that with- 
 out knowing the cause of the trou- 
 bles. The narcotic does its work and 
 the patient feels well as long as she 
 uses them. But this is no cure, no 
 satisfaction. 
 
 Prescription 29 
 Sanguinol. 
 One tablespoonful three times a 
 day, one-half hour before meals. 
 
 Prescription 30 
 
 Extract of belladonna, gr. VII, 
 Extract of henbane, gr. X, 
 
 Extract of opium, gr. X. 
 Powdered licorice root and 
 powdered extract of licor- 
 ice enough to make twenty 
 pills. 
 Introduce one or two pills three 
 times a day into the rectum as high 
 as it can be done. The use of one 
 pill three times a day is mostly suf- 
 ficient. 
 
 Prescription 31 
 
 Fluid extract golden seal, 2 oz. 
 Take 25 to 30 drops three times a 
 day. 
 
 Prescription 31 a 
 
 Fluid extract ergot, 2 oz. 
 Take 25 to 30 drops three times a 
 day. 
 
 Prescription 31 b 
 
 Fluid extract golden seal, 
 
 Fluid extract ergot. 
 Mix in equal parts. 
 This mixture is preferable to the 
 preceeding prescriptions and is 
 taken three times a day 40 to 50 
 drops. In cases of dangerous 
 bleedings the dose may be increas- 
 ed to one teaspoonful three times 
 a day. 
 
 Prescription 32 
 
 Fresh savine tops, 75 grains, 
 
 White agaric, 75 grains, 
 
 Cassia, 75 grains, 
 
 Peruvian bark, 150 grains. 
 Boil with enough water to make 
 7 oz. of a liquid in which dissolve 
 
 Gum Arabic, 4 drachm, 
 
 Sugar, 75 grains, 
 add 
 
 Tincture digitalis, 
 
 Laudanum, each 1-2 drachm, 
 
 Oil of anise, 8 drops, 
 
 Alcohol, 1 1-2 oz. 
 By prescription 32 on page 92 is 
 meant prescription 30. 
 
 Prescription 33 
 
 Sulphate of morphine, gr. II, 
 Bitter almond water, 
 fluid drachm III. 
 POISON! Take 10 to 20 drops 
 three times a day. 
 

 282 
 
 Prescription 34 
 
 Glycerite of Boroglycerin, 
 U. S. P. 
 
 Prescription 35 
 
 Glycerite of tannin, 10 per cent. 
 
 Prescription 36 
 
 Glycerite of hydrastis, U. S. P. 
 
 Prescription 37 
 
 Glycerite of ichthyol, 10 per 
 cent. 
 
 Prescription 38 
 
 Solid extract of ergot, 75 grains, 
 Distilled water, 1 oz. 
 Salicylic acid, 1 i-2*grains. 
 Dissolve. 
 
 Take a hypodermic syringe con- 
 taining about 15 min. 
 
 Prescription 39 
 Ergot ine, 
 
 Solid extract gentian, each 75 
 grains. 
 Divide into 100 pills. 
 Take one pill four times a day. 
 If this medicine is taken for a 
 very long time it may cause a 
 chronic poisoning of the body in 
 rare cases. The symptoms are 
 a crawling and tickling feeling in 
 the hands and feet. When this 
 arises the medicine should be dis- 
 continued for a short time. 
 
 Prescription 40 
 
 Oil of henbane boiled germ. 
 
 pharm. 
 Chloroform, each 1 oz. 
 
 Liniment. 
 
 Prescription 41 
 
 Sulphate of morphia, 5 gr. 
 
 Distilled water, 1 oz. 
 This solution can be taken either 
 internally as drops (20 drops three 
 times a day), or subcutaneous, as it 
 is explained on page 165. In the 
 latter instance a common hypoder- 
 mic syringe full (corresponding 20 
 drops) is taken three times a day. 
 In this manner the effect is quicker 
 and stronger. 
 
 Prescription 42 
 
 Tincture of opium (laudanum), 
 1 oz. 
 Take at first 10 drops four times 
 a day. If the effect is not yet suf- 
 ficient and the medicine is endured 
 well the patient may take as many 
 as 20 drops four times a day. 
 
 Prescription 43 
 
 Bromide of potassium, 
 Bromide of sodium, each 4 
 
 drachm, 
 Bromide of ammonia, 2 drachm 
 Mix. 
 
 Dissolve one to two points of a 
 knifeful in a glassful of water and 
 drink it one-third in the morning, 
 one-third about noon, and one-third 
 in the evening. 
 
 Prescription 44 
 Aloes, 2 drachms, 
 Powdered Castille soap, 1 dr., . 
 Diluted alcohol sufficient to 
 make a pill mass. 
 Divide into 60 pills. 
 Each pill contains 2 grains aloes. 
 Take 1 to 4 pills three times a day 
 according to the reaction of the 
 body and the limit in view. Begin 
 four to five days before the mens- 
 trual flow is expected. More than 
 5 pills three times a day may cause 
 inflammation of the bowels and kid- 
 neys. 
 
 Not to be taken when Preg- 
 nancy MAY BE SUPPOSED. 
 
 Prescription 45 
 
 Oil of savine, 60 drops. 
 Solid extract of ergot, 40 gr. 
 
 Powdered extract of licorice and 
 powdered licorice root enough to 
 make 60 pills. 
 
 Take one to two pills three times 
 a day, beginning four to five days 
 before the menstrual flow should 
 commence. Highest dose allowed 
 is five pills three times a day. An 
 arising poisoning of the body shows 
 the following symptoms: violent ab- 
 dominal pains, bloody vomitting 
 and purging, diminution or suppres- 
 sion of urine, unconsciousness, dis- 
 turbed respiration and convulsions. 
 
 Must Positively Be Avoided 
 
283 
 
 When Pregnancy May Be Sup- 
 posed. 
 
 Prescription 46 
 
 Powdered ergot, grains VIII. 
 
 Make such doses No. XXIV. 
 
 Use one powder three times a 
 day. 
 
 For pills see prescription 39. 
 
 For fluid extract see prescription 
 31 a. 
 
 Not To Be Taken When 
 Pregnancy May Be Supposed. 
 
 Prescription 47 
 
 Salicylate of soda, 2 drachm, 
 Distilled water, 6 oz. 
 Take a tablespoonful three times 
 a day beginning one to two days be- 
 fore the menstrual flow begins. 
 
 Prescription 48 
 
 Iodide of potassium, 75 grains, 
 Distilled water enough to make 
 6 oz. 
 Take one-half tablespoonful three 
 times a day. 
 
 Prescription 49 
 
 Lycopodium, 1 oz. 
 
 Prescription 50 
 
 Oxyde of zinc, 75 grains, 
 Lycopodium, 1 1-2 oz. 
 Mix. 
 
 Prescription 51 
 
 Boric acid, 30 grains, 
 Petrolatum, 5 drachm. 
 Mix. 
 
 Apply the salve on a piece of 
 linen. 
 
 Prescription 52 
 
 Resorcin, 30 grains. 
 Petrolatum, 5 drachm. 
 
 Apply the salve on a piece of 
 linen. 
 
 Prescription 53 
 
 Potassium iodide, 30 grains, 
 
 Dissolve in as little water as pos- 
 sible and add 
 
 Petrolatum, 5 drachm. 
 
 Apply three times a day. 
 
 Prescription 54 
 
 Mercurial ointment, U. S. P. 
 
 Apply in the morning and in the 
 evening. 
 
 Prescription 55 
 
 Bicarbonate of soda. 
 
 Dissolve one-half to one teaspoon- 
 ful in a quart of water and use it as 
 injection. 
 
 Prescription 56 
 
 Phosphate of sodium. 
 
 Add two oz. to a quart of water 
 and use as injection. 
 
 Prescription 57 
 
 Boroglycerin, U. S. P., 5 drachm 
 Glycerite of hydrastis, 1 1-2 oz. 
 Glycerine, 1 1-2 oz. 
 
 Mix. 
 
■*g : .X 3ESE :-BS23E£3S '££' ~K 'ZS&i 
 
 NOTICE. 
 
 For the benefit of those ladies who 
 cannot get the prescriptions enumerated 
 in this book filled, or who for some 
 reason or other cannot easily reach a 
 drugstore, we wish to say that they 
 can get any prescription most carefully 
 compounded, or any instrument men- 
 tioned in this book, by addressing the 
 
 Superior Chemical Co., 
 
 WEST SUPERIOR, 
 
 WISCONSIN 
 
 S3ESaK55EaE53E53KaES!^!ES5K( 
 
Index. 
 
 Preface - - - - — ~ — — — i — 2 
 
 Anatomical Introduction - — - 3 — 14 
 
 Diseases of the external parts — — - 15 — 23 
 
 Diseases of the hymen..... _ 24 — 26 
 
 Diseases of the vagina.— _. 27 — 38 
 
 Physiology of the womb — .._. — 39 — 53 
 
 Malformations of the womb.... 54 — 58 
 
 Catarrh of the neck of the womb - 59 — 70 
 
 Catarrh of the womb — 71 — 84 
 
 Inflammation of the womb .'. 85 — 99 
 
 Displacements of the womb ....ioo — 103 
 
 Anteflexion of the womb 103 — 108 
 
 Retroflexion of the womb..... _ 109 — 131 
 
 Descent and falling of the womb .'...... 132 — 144 
 
 Inversion of the womb 145 — 150 
 
 Tumors of the womb..... .....151 — 152 
 
 Polyps of the mucous membrane 152 — 156 
 
 Muscular Tumors..... .156 — 168 
 
 Cancer.... 168 — 182 
 
 Sarcoma 1 82 — 1 83 
 
 Diseases of the oviducts: physiology, inflammations, pregnancy of 
 
 the oviducts 184 — 194 
 
 Diseases of the ovaries: physiology, malformations, inflammations, 
 
 tumors of the ovaries 195 — 207 
 
 Diseases of the connective tissues of the pelvis.— .208 — 216 
 
 Diseases of the peritoneum of the pelvis.... ....217 — 221 
 
 Hematocele _ .....222 — 225 
 
 Diseased menstruation — 
 
 Absence or insufficiency of menstruation 226 — 231 
 

 286 
 
 Too profuse and irregular menstruation 231 — 236 
 
 Painful menstruation .236 — 239 
 
 Diseases of the breasts- 
 Physiology of the breasts 240 — 241 
 
 Defective changes in the functions of the breasts .....241 —243 
 
 Malformations of the breasts 244 
 
 Inflammations of the breasts .....244 — 250 
 
 Tumors of the breasts 250—252 
 
 Sterility 253 — 258 
 
 O ver-f ruitf ulness in marriage 259 —268 
 
 Constipation; its causes and its treatment 269 — 278 
 
 Prescriptions : 279—283 
 
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