Dysmenorrhea, from its Greek derivation, signifies adifficult monthly flow,and is applied to menstruation when that function becomes painful and difficult. Menstruation, like other healthy operations of the body, should be painless, but too frequently it is the case, that discomfort and distress commence twenty-four hours before the flow appears, and continue with increasing pain, sickness at the stomach, and vomiting, until the patient has to take to the bed. When the discharge does occur, speedy relief is sometimes obtained, and the patient suffers no more during that menstrual period. With others, the commencement of the function is painless, but from six to twenty-four hours after, the flow is arrested and the patient then experiences acute suffering. Pain may be felt in the back, loins, and down the thighs. Sometimes it is of a lancinating, neuralgic kind, at others, it is more like colic. Frequently the distress causes lassitude, fever, general uneasiness, and a sense of lethargy. There are those who suffer more or less during the entire period of the flow, while the distress of others terminates at the time when a membranous cast is expelled. For convenience of description, dysmenorrhea has been divided into the following varieties:neuralgic, congestive, inflammatory, membranous, andobstructive.
The neuralgic varietyof dysmenorrhea, sometimes calledspasmodicoridiopathic, occurs when there is excessive sensibility of the ovaries and uterine nerves, which sympatheticallyrespond, especially to cutaneous, biliary, and sexual irritation, and when ovarian or uterine irritation is communicated to distant nerve-centres. In the first class, usually comprising lean persons of an encephalic temperament, whatever disorders the functions of the general system, instantaneously reflects upon the ovaries and uterine nerves, and the menstrual function Is correspondingly disturbed, and, instead of being painless, the flow becomes spasmodic, with paroxysms of distress. In the second class, which includes those persons who are plethoric, the ovarian and uterine nerves seem to be the origin and centre of irritation, which is sometimes so severe as to cause indescribable pain. We have known women who affirmed that the severity of labor pains was not so great as that from this cause. In one instance, the subject suffered thus for eleven years, and then became a mother, and has ever asserted that her periodic suffering was far more intense than the pain experienced during her confinement. These neuralgic pains fly along the tracks of nerves to different organs, and capriciously dart from point to point with marvelous celerity, producing nausea, headache, and sometimes delirium.
In the congestive varietyof dysmenorrhea, the menstrual period may be ushered in without pain; after a few hours, the pulse becomes stronger and more rapid, the skin grows hot and dry, the menses stop, there is uneasiness, restlessness, and severe pelvic pains. Evidently, the mucous membranes of the Fallopian tubes and uterus have become congested, and the pain results from the arrest of the functional process, the exudation of blood.
The causesare plethora, exposure to cold, excitement of the emotions or passions, and a morbid condition of the blood. Sometimes congestion arises in consequence of a displacement of the uterus.
In the inflammatory variety, the mucous membrane of the uterus is the seat of irritation. The blood flows into the capillary vessels in greater abundance than is natural, and those vessels become over-dilated and enfeebled and so altered in their sensibility as to produce local excitement and pain. It may be associated with inflammation of the ovaries, peritoneum, or bladder. Upon the return of the menses, there is a dull, heavy, fixed pain in the pelvis, which continues until the period is completed. There is generally tenderness of the uterus, and also leucorrhea during the intervals between each monthly flow.
In the membranous varietyof dysmenorrhea, the entire mucous membrane which lines the cavity of the uterus, in consequence of some morbid process, is gradually detached and expelled at the menstrual period.
Symptoms. There are steady pains at the commencement of the menstrual flow, and they increase in violence and become decidedly expulsive. The mouth of the uterus gradually dilates, and finally, the membrane is forced out of the uterus, attended with a slight flow of blood and an entire subsidence of the pain.
The treatment, in all the preceding varieties of dysmenorrhea, should consist of measures to determine the circulation of the blood to the surface, and increase the perspiratory functions. Congestion and inflammation of the internal organs are generally induced by exposure to cold or from insufficient clothing. Sometimes they follow from neglect of the skin, which is not kept clean and its excretory function encouraged by warm clothing. The domestic treatment at the monthly crisis should be commenced by the administration of hot foot, and sitz-baths, after which the patient should be warmly covered in bed, and bottles of hot water applied to the extremities, back, and thighs. Dr. Pierce's Compound Extract of Smart-weed should be given in full doses, frequently repeated, to secure its diaphoretic, emmenagogue, and anodyne effects, which, for this painful affection, is unsurpassed. For the radical cure of this disease, whether of a congestive, inflammatory, or neuralgic character, Dr. Pierce's Favorite Prescription, which is sold by druggists, is a pleasant and specific remedy, which will most speedily correct the abnormal condition that produces the trouble, and thereby obviate the necessity of passing this terribleordeal at every monthly period. The patient should take two teaspoonfuls of the medicine three times a day, and keep up its use in these doses for weeks. Frequently, one month will suffice to cure, but in most cases, a longer season is required. In the end, the suffering patient will not be disappointed, but will become a new being, ready for the enjoyment and duties of life. The bowels should be kept regular throughout the treatment by the use of Dr. Pierce's Pleasant Pellets, if necessary. A hand or sponge-bath should be used daily to keep the skin active, and be followed by a brisk rubbing of the surface with a rough towel or flesh-brush. A wet sheet pack will cleanse the pores of the skin and invite the blood into the minute capillaries of the surface, and thus prove of great benefit. It should be repeated after an interval of seven days, but ought to be omitted if near the approach of a menstrual period. The clothing should be warm, to protect the system against changes of temperature; especially should every precaution be taken to keep the feet dry and warm. The patient should walk in the open air, and the distance should be regularly lengthened at each succeeding walk. If the course of treatment which we have suggested be faithfully pursued, a permanent cure will be effected.
In the obstructive varietyof dysmenorrhea, some organic impediment hinders the exit of the menstrual blood from the uterus, which, consequently, becomes distended and painful. The pain may be constant, but is most acute when the uterus makes spasmodic efforts to discharge the menstrual blood. If these efforts prove successful, there is an interval of relief. Flexion or version of the womb may produce partial occlusion of the canal of the neck of the uterus, thus preventing the free flow of the menstrual fluid through it. Tumors located in the body or neck of the uterus often cause obstruction to the free discharge of the menses. Imperforate hymen and vaginal stricture also sometimes cause obstruction and give rise to painful menstruation. As these several abnormal conditions and diseases will be treated of elsewhere in this volume, we omit their further consideration here.
Partial adhesion of the walls of the neck of the womb may result from inflammation of the mucous lining, and prevent a free and easy exit of the menstrual fluid. In many cases, the contracted and narrowed condition of the canal of the cervix seems to be a congenital deformity, for we can trace it to no perceptible cause. It is also true that contraction and partial, or even complete, stricture of the cervix, or neck of the womb, often results from the improper application of strong caustics to this passage by incompetent and ignorant surgeons. Every person has observed the contraction of tissue caused by a severe burn, which often produces such a distortion of the injured part as to disfigure the body for life. A similar result is produced when the neck of the womb is burned with strong caustics. The tissues are destroyed, and, as the parts heal, the deeper-seated tissues firmly contract, forming a hard, unyielding cicatrix, thus constricting theneck of the womb, through which the menses pass into the vagina.
Illustration: Fig. 3. THE UTERINE DILATOR. This instrument is introduced into the canal of the uterine neck with its blades closed. By means of the thumb-screw the blades are then separated as shown in this illustration, the cervical canal being thereby dilated to the required extent.Fig. 3. THE UTERINE DILATOR. This instrument is introduced into the canal of the uterine neck with its blades closed. By means of the thumb-screw the blades are then separated as shown in this illustration, the cervical canal being thereby dilated to the required extent.
Treatment. From the nature of this malady, it will readily be seen that no medical treatment can effect a radical cure. We must therefore resort to surgery. In a small proportion of cases, the stricture may be cured by repeated dilations of the constricted part of the cervical canal. This may be accomplished by using a very smooth probe which is fine at the point, but increases in size, so that its introduction will widen and expand the orifice and canal. The stricture may be overcome in many cases by using different sized probes. In some instances, we have employed the uterine dilator, represented by Fig. 3. We have also introduced sea-tangle and sponge tents into the neck of the womb, and allowed them to remain until they expanded by absorbing moisture from the surrounding tissues. The latter process is simple, and in many cases preferable. By means of a speculum (see Figs. 15 and 16), the mouth of the womb is brought into view, and the surgeon seizes a small tent with a pair of forceps and gently presses it into the neck of the womb, where it is left to expand and thus dilate the passage. If there seems to be a persistent disposition of the circular fibers of the cervix to contract, and thus close the canal, a surgical operation will be necessary to insure permanent relief. In performing this operation, we use a cutting instrument called the hysterotome (see Figs. 4 and 5). By the use of this instrument, the cervical canal is enlarged by an incision on either side. The operation is but slightly painful, and, in the hands of a competent surgeon, is perfectly safe. We have operated in a very large number of cases and have never known any alarming or dangerous symptoms to result. After the incision, a small roll of cotton, thoroughly saturated with glycerine, is applied to the incised parts, and a larger roll is introduced into the vagina. The second day after the operation, the cotton is removed, the edges of the wound separated by a uterine sound or probe, and a cotton tent introduced into the cervix, and allowed to remain, so that it will expand and thus open the wound to its full extent. This treatment must be thoroughly applied, and repeated every alternate day, until the incised parts are perfectly healed.
Illustration: Fig. 4. WHITE'S HYSTEROTOME. In operating, this instrument is introduced into the canal of the neck of the womb, when a thumb screw in the end of the handle is turned, by which a small blade is thrown out from each side, and as the instrument is withdrawn from the canal an incision is made on each side, thus enlarging the passage. The upper figure illustrates the instrument closed, ready for introduction; the lower one, with the blades projected for cutting.Fig. 4. WHITE'S HYSTEROTOME. In operating, this instrument is introduced into the canal of the neck of the womb, when a thumb screw in the end of the handle is turned, by which a small blade is thrown out from each side, and as the instrument is withdrawn from the canal an incision is made on each side, thus enlarging the passage. The upper figure illustrates the instrument closed, ready for introduction; the lower one, with the blades projected for cutting.
Many times patients cannot understand why it is that the operation of cutting the constricted cervix causes no pain; they often being entirely unconscious of the making of the incision. The explanation is easy. The cervix uteri, or neck of the womb, is supplied with but few nerves of sensation, and is almost as destitute of sensation as the finger or toe nails, the paring of which causes not the slightest pain. On this account we never find it necessary to administer chloroform or any other anæsthetic when undertaking this operation. If the patient be extremely sensitive the application to the cervix of a weak solution of cocaine is quite sufficient to completely benumb or anesthetize the parts so as to entirely avoid all pain from the operation.
Illustration: Fig. 5. STOHLMAN'S HYSTEROTOME. This instrument has two cutting blades which shut past each other, as seen in the lower figure, so as not to cut when introduced into the canal of the uterine neck. After introduction, the cutting blades are separated, as shown in the upper figure, the extent of the incision being regulated by the thumb-screw attached to the handles, as represented in the lower figure.Fig. 5. STOHLMAN'S HYSTEROTOME. This instrument has two cutting blades which shut past each other, as seen in the lower figure, so as not to cut when introduced into the canal of the uterine neck. After introduction, the cutting blades are separated, as shown in the upper figure, the extent of the incision being regulated by the thumb-screw attached to the handles, as represented in the lower figure.
The wordMenorrhagia, which is of Greek derivation, literally meansmonthly breaking away, and is employed to designate profuse menstruation. This disorder must not be confounded with those hemorrhages which are not periodical, and which are due to other causes. The termmenhorrhagiais restricted to an immoderate monthly flow. The menstrual flow may occur too often, continue too long, or be too profuse. It induces a feeble pulse, cold extremities, weak respiration, general debility, and may occur in opposite states of the system,i.e., in women who have a plethoric and robust habit, or in those of flaccid muscles and bloodless features. When the menstrual discharge is natural, it is so gradual that by mixing with the vaginal secretions it is prevented from coagulating, while in this disease, clots are often formed.
Symptoms.In women of aplethorichabit, it is ushered in by itching and heat in the vagina, pain and a feeling of weight in the loins and lower part of the abdomen, and, at times, the breasts become hot and painful. There is considerable thirst, headache, and giddiness. At last, the blood appears and flows profusely, and all the violent symptoms at once subside. The rest of the period is marked by an inordinate flow, leaving the system weak from the loss of blood. It oftener occurs, however, in persons who are naturally weak and delicate, in which case the periods are more frequent and continue longer, and after a time they are renewed by any bodily exertion or mental emotion, so that a constant drain exists. If the flow of blood is not continuous, leucorrhea intervenes. The patient gradually loses strength and becomes languid, her face is pale and usually bloated, livid circles appear around the eyes, the appetite is impaired, the bowels are constipated, and the feet and ankles swollen. Lack of blood in the brain is indicated by headache, ringing in the ears, and dizziness. The patient is nervous and irritable, being disturbed by the slightest noise, and the heart palpitates after the least exertion.
Causes.Thefirstform is caused by eating too much rich and highly-seasoned food, drinking wine, porter, ale, or beer, want of exercise, in brief, whatever induces plethora; thesecondresults from an insufficient or poor diet, leucorrhea, frequent abortions, want of ventilation, inherent feebleness, and whatever depresses the vital powers. Either form may be due to syphilitic taints, excessive sexual indulgence, accidents of pregnancy, or organic diseases of the womb. The morbid affections of the womb most likely to induce menorrhagia, are granular ulceration of its mouth and neck, fungous degeneration of its lining membrane, and tumors within that organ. As these subjectswill be severally considered hereafter, we shall here dismiss them with this brief notice.
Profuse menstruation is very prone to occur in young women of a lymphatic temperament, whose organs are sleazy in texture.
Treatment. To control the excessive flow, the patient should remain in her bed, and assume the recumbent position until the period is passed. If circumstances prevent strict compliance with this rule, it should be observed as nearly as possible. Warmth should be applied to the feet, and cold cloths, which ought to be removed as soon as they become warm by the heat of the body, should be repeatedly placed upon the back and abdomen. A strong tea made from cinnamon bark, or witch-hazel leaves or bark, taken freely, will prove very efficacious in checking the flow. The fluid extract of ergot, in doses of from half a teaspoonful to a teaspoonful, in a little water or cinnamon tea, is one of the most effectual remedies in this affection. Another valuable remedy for arresting menorrhagia is an infusion of Canada fleabane; or the oil of this plant may be administered in doses of from five to ten drops on sugar. Gallic acid is also a good styptic to employ in these cases. If there is febrile excitement, a hard pulse, frequent and throbbing, and if there is headache, thirst, parched lips, hot and dry skin, as is sometimes the case, then menorrhagia is due to an augmented action of the heart and arteries, and the indication of treatment is to diminish vascular action. This may be temporarily accomplished by the use of veratrum viride, which should be continued until the flow is sufficiently diminished.
The means already suggested will generally prove effective in controlling the inordinate flow at the time. Treatment that will produce permanent relief should then be adopted. The condition of the skin, kidneys, and bowels, requires attention for noxious elements should not be retained in the system. To give tone to weakened pelvic organs we know of nothing more specific in its effects than Dr. Pierce's Favorite Prescription, which is sold by druggists. It should be taken continuously for weeks, in order to fully correct the extremely weakened condition of that organ. It also aids nutrition, and thus tones up the general system, so that in the form of profuse menstruation, resulting from debility, the patient is strengthened, her blood enriched, and her nervousness quieted, which constitutes the necessary treatment to make the cure permanent.
As women approach the critical age, and menstruation ceases, if they are anæmic, their condition is pitiable. This period is popularly denominated theturn of life. Under favorable circumstances, the vitality is decidedly enhanced, and the decline of this function is attended with a revival of the bodily powers. But when this crisis has been preceded by excessive labor, when intemperance or excesses of any kind have deranged the bodily functions and perverted nutrition, when the mind has been long and deeply depressed, or when the insidiousprogress of disease of the heart, liver, or other Important organs, occurs in consequence of irregularities of living, then there is danger of congestion of the uterus and a protracted and profuse menstrual flow, which favors a decline.
The treatment of this form of menorrhagia does not differ from that already suggested. The diet should be light and nourishing, and daily exercise, such as walking, riding, change of air and scenery, all will contribute to restoration. Especial attention should be directed to the condition of the bowels and liver. If the latter be deranged, Dr. Pierce's Golden Medical Discovery will be a most efficacious remedy. When there is a diminution of vital force, resulting in impaired nutrition and disorders of blood, an alterative is required which will insensibly and gradually restore activity by removing the causes of derangement. Impairment of nutrition is very frequently associated with functional or organic disease of the liver, and curative measures consist of the use of alteratives, friction baths, exercise, nutritive diet, and diversion of the mind. Whenever innutrition depends upon deprivation of the blood or torpor of any of the secretory organs, the "Golden Medical Discovery" will prove to be an invaluable remedial agent, for it is an alterative and at the same time a blood restorative. If the bowels be costive small laxative doses of Dr. Pierce's Pleasant Pellets should be employed. The "Favorite Prescription" regulates the menstrual function by toning up the tissues of the uterus and restraining the escape of the menses from the orifices of the blood-vessels. While the diet should be nourishing, consisting of wild game, mutton, chicken, and wine, the patient ought not to debilitate the stomach by the use of strong tea or coffee. The circulation of the blood should be quickened by riding, walking, exposure to sunlight, and fresh air. The patient ought to engage in some light occupation, in which the mind will be constantly as well as agreeably employed, but not overtaxed. By pursuing the course of treatment, invalids suffering from menorrhagia may be permanently restored to health.
Menstruation commonly occurs at regular monthly intervals, during a period of about thirty years. The time for its cessation depends somewhat upon the date of its first appearance. In the temperate zones it commences at about the fifteenth year, and, consequently should terminate at the forty-fifth year. Instances are common, however, in which it has been prolonged until the fiftieth and even to the fifty-fifth year. In warm climates it commences and terminates at an earlier age.
As women approach the critical period of life, if the general health and habits be good, the discharge may gradually diminish, and, at length, totally disappear, without producing any particular inconvenience, but this seldom happens. More frequently, the discharge is entirely absent for six or seven weeks, and when it does return, it is more copious than usual. In some cases, the flow is not only too profuse, but too frequent. Many months may elapse before the menses return, and, even then, they are apt to be very pale and deficient in quantity.
The fluctuations of this function occasion irregularities and disturbances of the general health. When the flow of blood is diverted from the uterus, it is liable to be directed to the head or some other part of the body. In fact, there appears to be constitutional agitation, and disorders of all the organs. Perhaps one reason for calling this a critical period is, that if there is a morbid tendency in the system, a disposition to develop tumors of the breast or uterus, these are very liable to make rapid progress at this time, since they are not relieved by the customary, local exudation of blood. It is a time favorable to the awakening of latent disorder and morbid growths, for, at the decline of the menstrual function, the uterus is not so capable of resisting vitiating influences.
There is greater liability to irritation of the bladder and rectum, and the menstrual flow may be superseded by a white, acrid discharge, caused by an inflammation of the mucous membrane of the vagina. Even if the system be not enfeebled by excessive losses of blood, debility may result from a continued irritation of the uterine organs, and cause the morbid discharge. The nervous system sympathetically responds, becoming exceedingly irritable, and thus implicating in this derangement every bodily organ. In some constitutions, the change of any habit is almost impossible, particularly if it is improperly acquired, or detrimental to health; and so we have sometimes thought respecting this function, that the more it has been abused and pervertedduring the time of Its natural activity, the greater is the disturbance occasioned when it ceases.
Treatment. There should be regularity in all the habits of life. Women are too apt to approach this important period without due care and consideration. When the physical system is about to suspend a function, it is folly to endeavor to perform the labor or assume the responsibilities which were permissible when the constitution was more robust.
How the duties of each day and hour weigh upon the energies of the mother! What intense solicitude and yearning she experiences! How unselfish is that mother who each day works steadily and faithfully for others, and who is conscious of the hidden dangers that lurk around her pathway! With confiding faith and love, she commends the interests of her children to Him who doeth all things well. She anticipates the wants of her family and strives to supply the desired comforts, thus wasting her strength in the labors prompted by her loving nature. Would it not be a greater comfort to those children to have the counsel of their dear mother in later years, than to have the bitter reflection that she sacrificed her health and life for their gratification?
Unconsciously, perhaps, but none the less certainly, do women enter upon this period regardless of the care they ought to bestow upon themselves. Without sufficient forethought or an understanding of the functional changes taking place, they over-tax their strength, until, by continuous exertion, they break down under those labors which, to persons of their age, are excessive and injurious. Is it strange, when woman has thus exhausted her energies, when her body trembles with fatigue and her mind is agitated with responsibilities, that the menses capriciously return, or the uterus is unable to withstand congestion, and capillary hemorrhage becomes excessive? If the physical system had not been thus exhausted, it would have exercised its powers for the conservation of health and strength. It is better to be forewarned of the ills to which we are liable, and fortify ourselves against them, rather than squander the strength intended for personal preservation. Let every woman, and especially everymother, consider her situation and properly prepare for that grand climacteric, which so materially influences her future health and life.
The general health should be carefully preserved by those exercises which will equalize the circulation of the blood, and the regular action of the bowels should be promoted by the use of those articles of diet which contribute to this end. Relieve the mind of responsibility, keep the skin clean, and enrich the blood with tonics and alteratives. For the latter purpose, use Dr. Pierce's Favorite Prescription and "Golden Medical Discovery." If these remedies fail, seek professional advice. A careful regulation of the habits, strict attention to the requirements of the system, and the use of tonic medicines, will very frequently render the employment of a physician unnecessary
Leucorrhea is the symptomatic manifestation of some uterine or vaginal affection, vulgarly called "whites." We saysymptomatic, for the white or yellowish discharge, which we term leucorrhea, is not a disease, but a symptom of some uterine or vaginal disorder. We call it awhitedischarge to distinguish it from the menses and uterine hemorrhages. It varies, however, in color and consistency from a white, glairy mucus to a yellow or greenish, purulent, fetid matter. Sometimes it has a curdled appearance, at others, it is of the consistency of cream. Leucorrhea is the most common symptom of uterine derangement, and there are few females who are not affected by it at some period of life. It may originate either in the vagina or uterus, and it is accordingly termed either vaginal or uterine leucorrhea. The nature of leucorrhea is analogous to that of nasal catarrh. In a healthy state, the lining membrane of the genital organs secretes sufficient mucus to moisten them; but, if the mucous membrane is temporarily congested or inflamed, the secretion becomes profuse, irritating, and offensive. Vaginal and uterine leucorrhea are essentially different in character, the former being an acid, and the latter an alkaline secretion, and, while the first is a creamy, purulent fluid, the latter is thick and ropy, like the white of an egg. In fact, the latter discharge is rich in albuminous matter and blood-corpuscles, hence, its great debilitating effect upon the system, and, if not promptly arrested it is likely to producevaginitis, pruritus vulvce, orvulvitis.
Vaginitisis indicated by intense inflammation of the mucous membrane of the vagina. When this affection is present the patient experiences a sense of burning heat, aching and weight in the region of the vagina, violent and throbbing pains in the pelvis, and the discharge is profuse and very offensive. There is also a frequent desire to urinate, and the passage of the urine causes a sensation of scalding.
Pruritus Vulvæ. The discharge irritates the nerves of the external genital parts, thus producing an almost unendurable itching. Scratching or rubbing the parts only aggravates the affection. The patient is tormented night and day, is deprived of sleep, and naturally becomes despondent. Pruritus vulvæ, in its severest forms, is often developed when the discharge is scarcely noticeable. It is the most common result or accompaniment of leucorrhea.
Vulvitis. This term indicates an inflammation of the lining membrane of the external genital parts. Sometimes the inflammation extends to the deeper tissues, causing great pain, and even suppuration, resulting in the formation of an abscess. The attack is indicated by redness, swelling, and a feverish state of the affected parts, whichis quickly followed by a profuse flow of yellow pus, and, in some instances, small ulcers are formed on the affected parts.
Symptoms. The sufferer from leucorrhea becomes pale and emaciated, the eyes dull and heavy, the functions of the skin, stomach and bowels become deranged, more or less pain in the head is experienced, sometimes accompanied with dizziness, palpitation is common, and, as the disease progresses, the blood becomes impoverished, the feet and ankles are swollen, the mind is apprehensive and melancholy, and very frequently the function of generation is injured, resulting in complete sterility. Exercise produces pain in the small of the back and the lower portion of the spine, and, owing to a relation of the vaginal walls, the womb falls far below its natural position, or turns in various directions, according to the manner in which the weight above rests upon it. Ulcers are apt to appear upon the mouth of the womb, the matter from which tinges the discharge and stains the linen. Hysteria is often an attendant of this disease.
Causes. The immediate cause of leucorrhea is either congestion, or inflammation of the mucous membrane of the vagina or womb, or both. The exciting causes are numerous. Among others, deranged menstruation, prolonged nursing of children, pregnancy, abortions, excessive indulgence in sexual intercourse, uncleanliness, piles, uterine ulcers, and displacement of the womb, are the most common. In brief, it usually accompanies every uterine disorder which vitiates and reduces the system. During childhood, particularly in scrofulous children, discharges from the vagina are not unfrequent, owing to worms or other intestinal irritation.
Among the organic causes of leucorrhea, are ulceration of the mouth or neck of the womb and tumors. These will be considered hereafter.
Treatment. We have dwelt upon leucorrhea because of its prevalence and in order to exhibit the various forms it may assume. These reasons long ago prompted us to investigate it; and, ascertaining the derangement to consist in a relaxation of the walls of the vagina, attendant upon depressed vitality, for many years we experimented with various medicines to find those that would exercise specific properties in restoring the tissues involved to a natural condition, thereby arresting the abnormal discharge. Our efforts in that direction have been very successful, and our expectations more than realized. The treatment which we shall recommend is rational, based upon the pathological conditions of the disease, and has been attended with the greatest success.
It embraces the use of those general restoratives and specific uterine tonics, so harmoniously combined in Dr. Pierce's Favorite Prescription, a remedy which has achieved unparalleled success in the cure of this affection and won the highest praise from thousands of grateful women. It many cases, it is well to accompany its use with alterative treatment, for which the "Golden Medical Discovery" will be foundespecially effective. It is an absurd practice to arrest the discharge with astringent injectionsalone. The weak and lax walls of the vagina, as well as the other tissues of the system, require strength, and this can be gained only by the use of general and special tonics. Appropriate injections asauxiliarytreatment will very muchassistin the cure. The "Favorite Prescription" is a special tonic for the affected parts, and the "Golden Medical Discovery" is the best general alterative of which we have any knowledge. They may be taken in alternate doses every day. If the patient is very pale and anæmic, one drachm of the carbonate, or two drachms of the citrate or pyrophosphate of iron, may be advantageously added to each bottle of the "Favorite Prescription." If the carbonate be employed, as it is insoluble, the bottle should be well shaken every time before using. The functions of the skin should be kept active by frequent baths, and the patient, if able, should walk or ride in the open air, and freely expose herself to the sunshine. If the invalid be too weak to exercise much, she should go out in warm weather and sit in the open air. Sunshine is no less important in maintaining animal, than in supporting vegetable growth and health. The human being, like the plant, sickens and grows pale, weak and tender, if secluded from the sunlight. The apartments occupied should be thoroughly ventilated. Many women are sickly and feeble because they live in badly ventilated rooms.
We cannot too strongly urge in this, as in all other chronic diseases peculiar to women, that the bowels be kept regular. Frequent, but small doses of Dr. Pierce's Pleasant Pellets will prove most beneficial. If the vaginal passage is tender and irritable, an infusion, or tea of slippery-elm bark is very soothing, and may be used freely with a vaginal syringe. Whatever injection is employed, should be preceded by the free use of Castile soap and warm water, to thoroughly cleanse the parts. One part of glycerine to six parts of water is a soothing lotion when there is much tenderness, heat, and pain in the vagina. If there be no great tenderness in the vagina, or if the acute, inflammatory symptoms have yielded to the lotions already suggested, then a tonic and astringent injection should be employed.
For this purpose a wash made by dissolving one of DR. PIERCE'S PURIFYING AND STRENGTHENING LOTION TABLETS, in one pint of hot water is a superior application and will not fail to be of great benefit in controlling the disagreeable drain. If your medicine dealer is not supplied with these, mail 25 cents in one-cent stamps to us and we will forward a box of the Lotion Tablets by return post.
These Lotion Tablets have for many years been used in the treatment of obstinate cases of leucorrhea at the Invalids' Hotel and Surgical Institute, and their efficiency has been alike gratifying to both patient and physician.
Ifpruritusor severe itching, be also a symptom, the itching will readily yield if the parts be cleansed with Castile or other fine soapand warm water, followed by the application of a compound composed of two ounces of glycerine, one ounce of rose-water, and one drachm of sulphite of soda; or, for the sulphite of soda, two drachms of borax may be substituted. The following lotion is a good one to relieve pruritus: sugar of lead, two drachms; carbolic acid, half a drachm; laudanum, four ounces; glycerine, four ounces; water, four pints; mix. This may be applied to the itching parts, and also injected into the vagina.
Illustration: Fig. 6. FOUNTAIN SYRINGE.Fig. 6. FOUNTAIN SYRINGE.
How to Use Vaginal Injections. We usually recommend the Fountain Syringe illustrated in Fig. 6, as the most convenient instrument for administering vaginal injections. The fountains supplied by us are of soft rubber, and have extra nozzles, with which to make rectal, nasal or ear irrigations. There is also a large, long nozzle for vaginal injections.
Illustration: Fig. 7. SOFT RUBBER-BULB SYRINGEFig. 7. SOFT RUBBER-BULB SYRINGE
It is channeled so is to permit the free clearingaway of the secretions as the Douche is employed. The Fountain Syringe can he used without assistance, the flow of fluid is gradual, and with a force that can be varied, by raising or lowering the reservoir, yet is never so great as to be liable to produce injurious effects.
The syringes usually sold with small nozzles or pipes are of little or no value for vaginal injections. In many instances so small a tube will pass readily into the canal of the uterus, and hence there has frequently resulted an injection of a portion of the fluid into the uterus itself, producing severe pain. It is important, therefore, in using the Vaginal Douche to employ only a large tube that has grooves in its surface for the free clearing away of the fluid as it runs from the fountain.
Where it is desired to obtain relief from a congested, inflamed or sensitive and irritable state of the mucous surface, the employment of a large quantity of water as hot as it can be borne, is of the greatest remedial value. It rapidly diminishes the size of the blood vessels, and aids in bringing about a normal circulation in the parts.
As a rule, in taking the Douche with the Fountain Syringe the rubber bag is filled, and suspended from a nail or hook at a height of from two to five feet above the patient, and the fluid passes through the tube by force of gravity, thus requiring no muscular exercise. The force of the stream depends upon the height of the fountain above the outlet nozzle. It is only necessary that the patient should assume a comfortable position where the fluid which comes from the vaginal canal can flow into a water closet, or any convenient vessel.
After a thorough cleansing of the vaginal surfaces of mucus, by means of the warm or hot water, it is sometimes advisable to inject remedial fluids. These injections may readily be made with the fountain or bulb syringe, introducing not less than from two to four ounces. This may be retained sufficiently long to exert its remedial effects upon the mucous surface, which usually takes from five to eight minutes. The hips should be elevated, and the nozzle of the syringe surrounded by a napkin or other similar material, upon which moderate compression can be made so as to retain the fluid in the vagina for the necessary period.
When suffering from any uterine trouble, it is necessary to avoid severe fatigue. The amount and character of exercise should be suited to the condition of the patient; while, most important of all, the strictest abstinence from sexual intercourse should be observed.
To those who are unable readily to obtain the Fountain Syringe above recommended we can send by mail, post-paid, one of these instruments on receipt of $2.00.
A Soft Rubber-bulb, or Pump Syringe (illustrated in Fig. 7), not so good for making vaginal injections, can be sent by us, post-paid, for from 75cts. to $1.50, the price varying with the quality and size.
Real sentiment and interest center in fecundity, since the desires and happiness of mankind are consummated in marriage and procreation. How dreary would life be without love, companionship, and the family! How precious are the ties that bind our hearts to father, mother, daughter, and son! The love of children is innate in the heart of every true man and woman. Each child born supplements the lives of its parents with new interest, awakens tender concern, and unites their sympathies with its young life.
How dreary is the thought that one may attain a ripe old age with neither son nor daughter to smooth the decline of life, or sorrow for his or her departure! How many women desire afirst-bornof love, the idol of their waiting hearts, a soul, which shall be begotten within, clothed with their own nature, and yet immortal! It is a natural instinct, this yearning of the heart for offspring; and yet little is said upon this subject, in which so much is experienced. All that is beautiful and lovely in woman, finds its climax in motherhood. What earthly being do we love so devotedly as our mother?
Illustration: Fig. 8.Fig. 8.
Men and women exhibit but little concern, mere idle curiosity, perhaps, on this subject, unless, perchance, there is no evidence of their own reproductive powers. If, however, these appear to be deficient, then few topics are more deeply interesting or investigated with greater personal solicitude. Such persons will seldom submit their condition to the family physician, for it is a delicate subject, involving personal considerations, and, therefor, they prefer to consult with one who cannot connect their unfortunate situation with any of the incidents which enter into the history of their lives. This is very natural, and sometimes is the only way to keep private matters profoundly secret. Being widely known as specialists, devoting our undivided attention to chronic affections, and having unusual facilities for the investigation and management of such cases, we have been applied to in innumerable instances, to ascertain the causes of barrenness and effect its removal.
It is admitted that the question of a woman's sterility is practically decided in the first three years of married life, for statistics show that less than ten out of a hundred women who do not indicate their fertility in the first three years of wedlock ever bear children. We have treated many who gave no evidence of fertility for a much longer period of married life, and who afterwards gave birth to children.We are unable to state the proper ratio of the number of the married who are childless; much less have we the right to assume that all who decline the responsibilities of motherhood are necessarily barren.
Causes. The causes of barrenness may be obliteration of the canal of the neck of the womb, sealing up of its mouth, or inflammation resulting in adhesion of the walls of the vagina, thus obstructing the passage to the uterus. In the latter case, the vagina forms a short, closed sac. In some instances, the vaginal passage cannot be entered in consequence of an imperforate hymen. Again, the cause of barrenness may either be a diseased condition of the ovaries, preventing them from maturing healthy germs, or chronic inflammation of the mucous membrane of the neck of the uterus, which does not render conception impossible, but improbable. It is one of the most common causes of unfruitfulness, because the female seldom, if ever, recovers from it spontaneously. It has been known to exist for twenty or thirty years.
Chronic inflammation of the vagina also gives rise to acrid secretions, which destroy the vitality of the spermatozoa. Suppression of the menses, or any disorder of the uterine functions, may disqualify the female for reproduction. Flexions of the uterus, displacements, congestions, and local debility, may likewise prevent fertility. Sterility may result from impaired ovarian innervation or undue excitement of the nerves, either of which deranges the process of ovulation. Even too frequent indulgence in marital pleasures sometimes defeats conception. Prostitutes who indulge in excessive and promiscuous sexual intercourse, seldom become pregnant. Any thing that enfeebles the functional powers of the system is liable to disqualify the female for reproduction.
Treatment. An extensive observation and experience in the treatment of sterility, convinces us that, in the majority of cases, barrenness is due to some form of disease which can be easily remedied. If the passages through the neck of the uterus be closed or contracted, and this is the most frequent cause of sterility, a very delicate surgical operation, which causes little if any pain or inconvenience to the patient, will remove the impediment to fertility. In many of these cases, we have succeeded in removing the contraction and stricture of the neck of the womb by dilatation. When the vaginal walls are so firmly united as to prevent copulation, a surgical operation may be necessary to overcome their adhesion. When the hymen obstructs the vaginal orifice, a similar operation may be necessary to divide it. Vaginismus, which will be treated elsewhere, sometimes causes sterility.
It is proper that we should suggest to the barren, that if sexual intercourse be indulged in only very abstemiously, conception will be more likely to occur than if moderation be not exercised. We may also very properly allude to the fact that there is greater aptitude tofecundation immediately before and soon after the menstrual periods than at other times. In fact, many medical men believe that it is impossible for conception to occur from the twelfth day following menstruation up to within two or three days of the return of the menses.
Elongation of the Neck of the Womb. An elongated condition of the neck of the womb, illustrated by Fig. 9, is frequently a cause of sterility. If this part is elongated, slim and pointed, as shown in the illustration, it is apt to curve or bend upon itself, thus constricting the passage through it and preventing the transit of seminal fluid into the womb. An eminent author says, "Even a slight degree of elongation, in which the cervix, or neck, has a conical shape, has been observed to be frequently followed by that condition [sterility]." Our own observations, embracing the examination of hundreds of sterile women annually, lead us to believe that this condition is among the common causes of barrenness. But, fortunately, it is one of those most easily overcome.
Illustration: Fig. 9. Conoid Neck.Fig. 9. Conoid Neck.
Treatment. If the neck is only slightly elongated, this consists in dividing the slim projecting part, by the use of thehysterotome, If it be a more aggravated case, a portion of the womb must be removed. This operation is perfectly safe and simple, and, strange as it may seem to those who are not familiar with operations upon the womb, is not painful. We have never seen any bad results follow it, but have known it to be the means of rendering numerous barren women fruitful.
Illustration: Fig. 10. Flexion, u, Uterus, B, Bladder.Fig. 10. Flexion, u, Uterus, B, Bladder.
Illustration: Fig. 11. Version, u, Uterus, B, Bladder.Fig. 11. Version, u, Uterus, B, Bladder.
Flexions and Versions of the Womb. Flexion of the uterus, in which it is bent upon itself, as illustrated in Fig. 10, produces a bending of the cervical canal, constricting or obliterating it, and thus preventing the passage of spermatozoa through it. Version of the uterusin which its top, orfundus, falls either forward against the bladder (anteversion), as illustrated in Fig. 11, or backward against the rectum (retroversion), may close the mouth of the uterus by firmly pressing it against the wall of the vaginal canal, and thus prevent the passage of spermatozoa into the womb. 'The treatment of these several displacements will be considered hereafter. We may here remark, however, that they can be remedied by proper treatment. Our mechanical movements, manipulations, and kneadings are invaluable aids in correcting these displacements.
Disease of the Ovaries. Sterility may be due to disease of the ovaries. Chronic inflammation of the ovaries may result from uterine disorders or peritonitis, and is commonly attended with a sense of fullness and tenderness, and pain in the ovarian region. These symptoms are more apparent upon slight pressure, or during menstruation. This disease is curable, although it may require considerable time to perfectly restore the health. When this chronic affection is the result of other derangements, the indications are to restore health in the contiguous organs, and to relieve excessive congestion and nervous excitement in the ovaries. The patient should be very quiet during the menstrual period and avoid severe exercise or fatiguing occupations, not only at those periods, but during the intervals. All measures calculated to improve the general health should be adopted. Use injections of warm water, medicated with borax, soda, and glycerine, in the vagina every night and morning. The surface of the body should be kept clean by the daily employment of hand-baths, followed by brisk friction. The bowels, if constipated, should be regulated as suggested for constipation. The system should be strengthened by Dr. Pierce's Favorite Prescription, and, if the blood be disordered, no better alterative can be found for domestic use than Dr. Pierce's Golden Medical Discovery. If the patient does not in a few months improve under this treatment, the case should be placed under the immediate care of some physician well qualified by education and experience to critically examine and successfully treat this affection.
Chronic Inflammation and Ulceration of the Uterus, a Cause of Sterility. When enumerating the causes of barrenness we mentioned that chronic inflammation of the mucous membrane of the mouth and neck of the womb was the most common affection that defeats conception. Of all diseases of female organs, this is, without doubt, the most common, and, since it does not at first produce great inconvenience or immediately endanger life, it does not excite the attention which its importance demands. It is overlooked, and, when the attention is directed to the existence of this long-neglected disease it appears so trivial that it is not regarded as being the real cause of infertility in the patient.
When this disease has existed for a long time, the very structure of the parts involved becomes changed. The glands of the cervical membranesecrete a glairy mucus, resembling the white, or albuminous part of an egg. The secretion is thick and ropy, and fills the entire mouth and neck of the uterus, thus preventing the entrance of the spermatozoa. The mucous membrane becomes thickened, the inflammation extends to the deeper structures, and, on examination through the speculum, we find the mouth of the uterus inflamed, hardened, and enlarged, as represented in Fig. 22, Colored Plate IV, or in Fig. 23 of same plate. Fig. 25, Plate IV, shows the mucous follicles just as they are found all along the neck of the womb, in a state of inflammation and enlargement, and filled with a fluid resembling honey, giving rise to ulceration and a thick discharge, as illustrated in Fig. 23, Colored Plate IV.
Feebleness of the constitution, impoverishment of the blood, a scrofulous diathesis, want of exercise, uncleanliness, tight lacing, disappointment, excessive excitement of the passions, the use of pessaries for displacement of the uterus, overwork, and taking cold, all predispose the cervical membrane to chronic ulceration.
The inflammation may be so mild, and the discharge so trifling in quantity, as scarcely to attract attention. But after it obtains a firmer hold, and, in most cases, it is aggravated by exposure or neglect, the patient experiences dragging sensations about the pelvis, and pain in back and loins, accompanied with a bearing-down sensation and numbness or pain extending to the thighs.
The discharge is thick, starch-like, and generally irritating. The patient becomes irascible, capricious, querulous, and sometimes moody and hysterical. She is easily discouraged, her appetite and digestion become impaired, and she grows thin and does not look or act as when in health.
Treatment. In offering a few hints for the domestic management of these abnormal conditions, we would at the same time remark, that, while health may be regained by skillful treatment, recovery will be gradual. We especially wish to guard the patient against entertaining too strong expectations of a speedy recovery. Although she may employ the best treatment known, yet from three to five months may elapse before a perfect cure can be effected. In persons of scrofulous diathesis, in whom the recuperative forces are weakened, it is very difficult to effect a radical cure. It is equally true, however, that under domestic management alone, thousands have been restored to perfect health and fruitfulness.
Hygienic management consists in toning the functions of the skin by daily bathing the surface of the body, and quickening the circulation by brisk friction. The patient should rise early in the morning, and exercise in the fresh and invigorating air. Those who sleep in warm rooms, or spend much of their time in bed, will continue to have congestion of the uterus, and habitual discharges from this enfeebled organ. The patient should take daily walks, increasing the length ofthe excursion from time to time, but not to the extent of producing fatigue. The bowels, if constipated, should be regulated. Strengthen the system by using Dr. Pierce's Favorite Prescription, to each bottle of which add two drachms of citrate or pyrophosphate of iron. The mouth and neck of the uterus should be thoroughly cleansed by the use of the syringe, as suggested for the treatment of leucorrhea. The use of the solution of Dr. Pierce's Purifying and Strengthening Lotion Tablets there advised will also be beneficial, if thoroughly applied.
A most valuable course of local treatment, which may be adopted by any intelligent lady without the aid of a physician, and one that will result in the greatest benefit when there is morbid sensibility, congestion, inflammation, or ulceration about the mouth or neck of the womb, consists in applying to those parts a roll of medicated cotton or soft sponge, allowing it to remain there for twelve hours at a time. A piece of fine, soft, compressible sponge, as large as a hen's egg, or a roll of cotton batting of two-thirds that size, is thoroughly saturated with pure glycerine. Securely fasten to it a stout cord a few inches long. The vagina and affected parts having been thoroughly cleansed with warm water and Castile soap, as advised in the treatment of leucorrhea, the sponge or cotton should be passed up the vagina with the finger, and pressed rather firmly against the mouth and neck of the womb, which, being enlarged, and, consequently falling below its natural position, will generally be low down in the vagina, and so hardened as to be unmistakably distinguished from the surrounding parts by the sense of touch. The glycerine, having a very strong affinity for water, will absorb large quantities of theserum, which has been effused into the affected tissues in consequence of their congestion and inflammation, and thus reduce the inflammation and enlargement. This is the cause of the profuse, watery discharge which follows the application. In twelve hours after the sponge or cotton has been applied, it should be removed by means of the attached thread, one end of which has been purposely left hanging out of the vagina. Then thoroughly cleanse the vagina with warm water, use the solution of Dr. Pierce's Lotion Tablets as suggested for the treatment of leucorrhea, and repeat the glycerine application the following day or every other day.
If there is no irritation or tenderness of the vagina, add one drachm of tincture of iodine to each ounce of the glycerine, alternating the use of this with that of pure glycerine; or, the iodine and glycerine may be used every third day, and the glycerine alone on the two intervening days. As the iodine will color the finger somewhat, it is well to know that this unpleasant effect may be almost or entirely avoided by coating that member with lard, sweet oil, or vaseline. The stain may be readily removed with a solution of iodide of potassium. The use of Dr. Pierce's Antiseptic and Healing Suppositories as advised on an other page under the head of Ulceration of the Uterus will aid greatly in effecting a cure.
If your medicine dealer does not have these Suppositories in stock, mail 25 cents in stamps to Dr. R.V. Pierce, Buffalo, N.Y., and a box will be sent you by return post.
It is well to alternate Dr. Pierce's Golden Medical Discovery with Dr. Pierce's Favorite Prescription, taking of each three times a day. By persevering in this course of treatment, nine-tenths of those who are thus afflicted will improve and be fully restored to health, fruitfulness and happiness. If barrenness continue, the case should be unreservedly submitted, either in person or by letter, to a physician skilled in the diagnosis and treatment of these affections.
From the foregoing remarks, the reader will perceive that there are a variety of diseased conditions, any one of which may produce sterility. It is equally true that nearly all these conditions may be easily cured by proper medical or surgical treatment. A frequent cause of barrenness is stricture of the neck of the uterus. No medicine that a woman can take or have applied will remove this unnatural condition. Fortunately, however, the means to be employed cause no pain, are perfectly safe, and the time required to effect a cure is short, rarely over twenty or thirty days.
The relative positions of the womb and surrounding organs, when in a state of health, are well illustrated by Fig. 1,page 680. The womb is supported in its place by resting upon the vaginal walls, and by a broad ligament on either side, as well as by other connective tissues. By general debility of the system, the supports of the womb, like the other tissues of the body, become weakened and inadequate to perfectly perform their duty, thus permitting various displacements of that organ.
Prolapsus, or Falling of the Uterus, is a common form of displacement. It has been erroneously regarded as a local uterine disease, requiring only local treatment instead of being considered as a symptom of general derangement, and, therefore, requiring constitutional treatment. Hence, variously devised supporters have been invented to retain the womb in position after its replacement. It is a law of physiology, that the muscular system is strengthened by use, and that want of exercise weakens it. The blacksmith's arm is strengthened and developed by daily exercise. Support his arm in a sling, and the muscles will be greatly weakened and wasted. So when artificial supports are used to retain the womb in position, thereby relieving the supporting ligaments and tissues of their normal function, thenaturalsupports of the uterus are still further weakened, and the prolapsus will be worse than before when the artificial support is removed. Besides, all these mechanical contrivances are irritating tothe tissues of the womb and vagina, and frequently produce congestion, inflammation, and even ulceration, thus rendering the patient's condition much worse than before their employment. These worse than useless appliances should never be resorted to for the temporary relief which they sometimes afford. Constitutional treatment together with appropriate applications is the only effectual method of remedying this morbid condition.
Symptoms. When the displacement is sufficient to cause any serious disturbance, the prominent symptoms are a sensation of dragging and weight in the region of the womb, pain in the back and loins, inability to lift weights, great fatigue from walking, leucorrhea, a frequent desire to urinate, irritation of the lower bowel, and derangement of the stomach. The womb may protrude from the vaginal orifice; in very rare cases, wholly protrudes, and may be inverted.
Causes. As we have already stated, general debility favors prolapsus of the womb, but various general and local circumstances and conditions also favor its occurrence. Wearing heavy garments supported only by the hips, compressing the waist and abdomen with tight clothing, thus forcing the abdominal organs down upon the womb, are fruitful causes of this affection. Excesses in sexual intercourse give rise to leucorrhea, producing a relaxed condition of the vagina, upon which the womb rests, and, in this way, one of its supports is weakened. Enlargement of the uterus from congestion, and inflammation or tumors also favor prolapsus. Abortion may leave the womb enlarged, its supports weakened, and result in this displacement.
Illustration: Fig. 12. Retroflexion, U, Uterus (Womb), B, Bladder.Fig. 12. Retroflexion, U, Uterus (Womb), B, Bladder.
Flexions and Versions. Instead of sliding down into the vagina, as in prolapsus, the uterus is liable to fall or be forced into other unnatural positions. When the uterus is bent upon itself, it is calledflexion. If the bending is backward, it is calledretroflexion; if forward,anteflexion.Fig. 12, represents the former condition, the uterus being flexed backward so that the fundus, or upper part of the womb, is pressed against the rectum, while the neck of the uterus remains in its natural position. This is a common form of displacement, and generally occurs between the ages of fourteen and fifty.
Symptoms. The prominent symptoms of retroflexion of the uterus are a sense of weight in the region of the rectum, difficulty in evacuating the bowels, and, sometimes a retention of the feces. There may be suppression of the urine and the menses may be diminished inquantity. If retroflexion is due to a chronic enlargement of the uterus, caused by abortion or parturition, the patient suffers from an immoderate menstrual flow.
Causes. The principal causes of retroflexion are congestion, enlargement and tumors of the uterus. Congestion is liable to occur in women possessing an extremely active temperament, as well as in those of sedentary and indolent habits. Retroflexion is a common displacement in both married and unmarried women; it is a secondary affection, and, when it is caused by congestion, the menses are painful and reduced in quantity, and there is pain in the back and a sense of weight in the region of the rectum. In some instances, there is a reflex irritation of the mammary glands, and a consequent secretion of milk. There may also be nausea and vomiting, which often lead to the erroneous opinion that the patient is pregnant.
Anteflexionof the uterus denotes a bending forward of the body and fundus of the uterus, while the neck remains in its natural position.
In versions of the uterus, neither the body nor the neck of the womb is bent upon itself, but the whole organ is completely turned backward or forward.
Illustration: Fig. 13. Retroversion. B, Bladder. U, Uterus (Womb).Fig. 13. Retroversion. B, Bladder. U, Uterus (Womb).
Retroversionof the uterus, illustrated by Fig. 13, signifies a change in the position of the womb, so that the upper, or fundal portion of the organ drops back toward the concavity of the sacrum, while the neck preserves a straight line in the opposite direction. The fundus presses forcibly against the rectum, while the upper part of the vagina bends abruptly and forms an acute angle near the mouth of the uterus.
Symptoms. Retroversion is indicated by bearing-down pains in the loins and difficulty in evacuating the bowels. The feces may accumulate in the rectum, because they cannot pass this obstruction.
Causes. Jumping, falling, or undue pressure from the contents of the abdomen, may suddenly cause retroversion of the uterus. Sometimes retroversion results from obstinate constipation.
Anteversion. This term designates another unnatural position of the uterus, in which the fundus, or upper part of the organ, falls forward, as illustrated by Fig. 14, while the neck points towards the hollow of the sacrum. This position of the womb is the reverse of that of retroversion. In its natural position, the fundus of the uterus is slightly inclined forward, and any pressure, or forward traction, is liable to cause it to fall still further in that direction.
Illustration: Fig. 14. Anteversion, U, Uterus, B, Bladder.Fig. 14. Anteversion, U, Uterus, B, Bladder.
Symptoms. One of the most common symptoms of anteversion is a frequent desire to urinate, in consequence of the pressure of the uterus upon the bladder. The free flow of the menses is sometimes obstructed.
Causes. The causes are tight lacing, prolapse of the abdominal organs, weakness of the supporting ligaments, and enervating habits.
Treatment. In treating all the various displacements of the uterus, the prominent indication is to tone up the general system, for by so doing we also strengthen the uterine supports.
Digestion should be improved, the blood enriched, and nutrition increased, so that the muscles and ligaments which retain the womb in position may become firm and strong. The womb will thus be gradually drawn into position by their normal action and firmly supported. It is a great mistake, made by physicians as well as patients, to consider a displacement of the uterus alocaldisease, requiring only local treatment. A restoration of the general health will result in the cure of these displacements, the uterus will regain its tone and muscular power, and the local derangement, with its attendant pain and morbid symptoms, will disappear.
It is true that displacements of the womb may be associated with inflammation and ulcers, which require local treatment, as elsewhere suggested; but simple displacement of the uterus may be remedied by pursuing the following course of sanitary and medical treatment. Sleep on a hard bed, rise early, bathe, and take a short walk before breakfast. Dress the body warmly and allow sufficient space for the easy and full expansion of the lungs. Eat moderately three meals a day, of those articles which are nutritious and readily digested. Keep the bowels regular by the use of proper food. If they are constipated, use Dr. Pierce's Pellets to keep them open and regular. Avoid retaining the standing position too long at a time, especially when the symptoms are aggravated by it. Many energetic women disregard their increasing pains, and keep upon their feet as long as possible. Such a course is extremely injurious and should be avoided.
As a general restorative and uterine tonic, nothing surpasses Dr. Pierce's Favorite Prescription, which is sold by druggists and accompanied with full directions for use. If leucorrhea is an attendant symptom, the treatment suggested for that condition should be employed. The use of Dr. Pierce's Antiseptic and Healing Suppositories, applying one every third night After having firstcleansed the vagina and neck of the womb thoroughly by the use of warm water and soap as an injection, will prove of great benefit in giving strength to the supports of the womb and its appendages.
Illustration: Fig. 22. Fig. 21. Fig. 23. Fig. 24. Fig. 25. Fig. 26.Fig. 22. Fig. 21. Fig. 23. Fig. 24. Fig. 25. Fig. 26.
By persevering in the rational treatment which we have suggested for the various displacements of the womb, nearly all who suffer from such derangements may be fully restored to health. The patient should not expectspeedyrelief. Considerable time will be necessary to bring the general system up to a perfect standard of health, and, until this is accomplished, no great improvement in the distressing symptoms can be expected. Mechanical movements are especially effective in this class of cases. We have successfully treated many obstinate cases in which the displacements were very serious.