A treatise on the diseases of females

Front matter

£*2

TREATISE

DISEASES OF FEMALES.

CHAPTER I, Page

Of the Peculiarities of the Female System, • - -13 CHAPTER II.

Of the Diseases of the External and Internal Organs, - 21 Sect. I. Of the Tumours and Excrescences of the External

Parts, 22

II. Of the Diseases of the Nymphce, ... %b.

III. Of the Diseases of the Clitoris, - - - 24

IV. Of the Adhesion of the Labia Pudendi of Children, 25 V. Of the Abscesses of the Labia, - - 28

VI. (Edematous Swelling of the Labia, - 29

VII. Of Bloody Infiltrations in the Labia during or after

Delivery, - - - - - 31

VIII. Imperforalion, and too great Density of the Hymen, 38 IX. Of Pruritus, or Aphthous Condition of the Vulva

and Vagina. - - - - - 42

CHAPTER IV. Of Leucorrhcea, • - - - - 51

Method of Cure, 68

CHAPTER V. Of the History of Menstruation, - 75

▼Ill

CONTENTS.

CHAPTER VL

Of Deranged Menstruation, » - - .

Sect. I. 1. Of the Tardy Appearance of the Menses,

II. 2. Of the Suppression of the Menses,

Case I.

Case II.

III. 3. Of the Immoderate Flow of the Menses,

IV. 4. Of Dysmenorrhea, or Painful Menstruation,

V. 5. Of the Decline of the Menses,

Chapter VIII

Of the Signs which usually accompany Pregnancy, - Sect. I. 1. Suppression of (he Menses, II. 2. Nausea and Vomiting, - III. 3. Enlargement of the Mammse, LV. 4. Areolae, - - V. 5. Formation of the Milk, - VI. 6. Enlargement of the Abdomen, VII. 7. Increased Size of the Uterus, VIII. 8. Pouting out of the Navel, IX. 9.^-Spitling of Frothy Saliva, X. 10. Sulivation, - XI. 11. Of Quickening, -

Chapter IX

0/"Me General Condition of the System, and the Effects of certain Remedies during Pregnancy, - Bleeding, Purging, -

Emetics, _ _ -

Blisters,

Chapter X

On some of the Diseases of Pregnancy, Sect. I. Of the Febrile Condition of the System during Preg nancy.

CONTENTS. ix

Page

Sect. II. Of Vomiting, - - - - - 191

III. Of Heartburn, ----- 195

IV. Of Salivation, - - - - - 196 V. Of Pain in the Right Side, - - 198

VI. Of Inquietude and Want of Sleep, - - 200

VII. Of Costiveness, 201

CHAPTER XL

Of Hemorrhoids, or Piles, ----- 204

CHAPTER XIII. Of the Displacement of the Uterus, - - - - 214

Sect. I. Prolapsus of the Uterus, • - - ib.

II. Of the Chronic Inversion of the Uterus, - - 227

CHAPTER XIV. Of the Diseases of the Uterus, Ovaria and Tubes, - - 232

Sect. I. Of the Disorders and Diseases of the Uterus, - ib.

II. Of the Diseases of the Ovaries, - - - 233

III. Of the Diseases of the Tubes, - 234

CHAPTER XV. Of the Particular Diseases of the Uterus, - - - 236

Sect. I. Of the Carcinoma Uteri, - - - 238

II. Of the Treatment of Carcinoma Uteri, - - 240

1. Abstracting Blood, - - - - 241

3. Abstemious Diet, - - - - 245

5. Rest, .... - 248 'III.- Of the Polypus of the Uterus, ... 256

Case IV. 264

Case VL - - . 266

X

CONTENTS.

Sect. IV. Mode of applying the Ligf^ejor Polypi,

V. Of the Cauliflower Excrescence, -

VI. Of the Symptoms,

Vllt* %% Caviar 'Essence,

IX. Of Hydatids of the Uterus,

X. Of tlie Irritable Uterus* -

CHAPTER XVI. Of Uterine Hemorrhage, - - - . "

Sect. I. 1.0/ the Connexion of the Ovum with the Uterus,

II. 2. Of the Causes which may tend to destroy tins

III. S. Of the Mode' of Action of certain of the remote

Causes, -

IV. 4. Of the Periods of Pregnancy at which Hemor-

rhage may take place, - First Period, Second Period, - V? Delivery considered as a Mode of arresting Hemorrhage, -

Chapter XVII

Hysteritis, or Inflammation of the Uterus - - Sect. X Species First. 1 . Causes,

2. Symptoms, -

3. Constitutional Symptoms, -

II. Species Second. On the mixed Inflammation of the Uterus, or Accidental Puerperal Fever, Treatment, - • a. Bleeding, - -

b. Purging, - - - - -

c. Fomentations, -

d. Blisters, - _ _ _

e. Sudoriflcs, -

f. Opium,

g. Emetics,

CHAPTER XVIII. Of Puerperal Fever, - History

Predisposing Causes.

CONTENTS. X}

Page

Prophylactics, - - - - * 351

Seat of the Disease, and its proximate Causes, - 353

Period of Attack, and Symptoms, ... 369

Pontagious Nature of Puerperal Fever, - - 380

1. Bleeding, Stage First, - 391 Purging, - - - - 405 Emetics, - - - - - ib.

Blisters, - - ... 408 Fomentations, - - - - 409 Spirit of Turpentine, . ... - ib.

Mercurial Frictions, - - - 410

2. Of the Gangrenous Stage, - - 412

3. Of the Stage of Effusion, - - - 417 General Directions and Rules, - - - 418

CHAPTER XIX. Phlegmasia Dolens, or Milk Leg, - 420

Symptoms and General Character of Phlebitis, - - 434

Case II. 437

Case III. - - - ib.

Case IK - - 438

Method of Cure, ------ 442

Blood-letting and Leeching, - - - - 443

Purging, fyc. ib.

Topical Applications, - - - - - ib.

External Applications, .... 445

Blisters, - - ib.

CHAPTER XX. Of Milk Abscess, ------ 447

Of the Treatment, ------ 451

1. Local Applications, - - - - 452

3. Purging, ----- ib.

4. Puncturing, - - - - - ib.

xii

CONTENTS.

5. Caustic, -

6. Seton,

7. After -Treatment,

CHAPTER XXI. Of Hysteria

Sect. I. Of the predisposing Causes,

II. Of the exciting Causes, -

1, 2. Wind and Tough Phlegm, a. Worms, -

4. Aliments, improper in Quantity or _

5. Schirrhous or other Obstructions in the Sto-

mach, or Intestines, fyc. -

6. Violent Affections of the Mind,

III. Of the Phenomena of Hysteria,

IV. Diagnosis, - Y. Treatment,

Case I. - Case II.

L Of the Paroxysm,

% To prevent the Recurrence of Paroxysms - Explanation of the Plates, - - - . . ~ Index,

ON

THE DISEASES OF FEMALE &

Chapter I. "of The Peculiarities Op The Female System

However powerful the influence of education and modes of life may be upon the human frame, they are not capable of effecting so great a change upon the female constitution, as to deprive it of its distinctive peculiarities. Yet we are aware that much is done by these great agents; and that when they have been employed under equal circumstances, for an equal period, an approximation of physical and moral similarity has been observed; though they have never been able to alter the general character of the female so much, as to leave the slightest doubt to which of the sexes the individual belongs, even independently of sexual peculiarity. r

The intentions of nature in the formation of man, are not, nor cannot be fulfilled, by one sex alone ; both must concur in this great object; and it would be idle to decide, by any process of reasoning, to which is assigned the most important role in this great work. Participation is essential to the end in view; and to each is allotted respective duties; duties which cannot be exchanged or even varied; for they are immutable. To preserve, therefore, the moral antl physical distinctions in his favourite' creatures, and to prevent either neglect or confusion in the performance of the duties assigned to them, the Deity has imposed such distinctness of organization upon the sexes, as defies alienation, or exchange, in the exercise of the functions resulting from it.* °

* Alphore le Roi is of opinion, that most of the causes which degenerate the human family, originate with the female; he says, « With a view more effectually

In this place, however, we have only to detail and that very

briefly, the peculiarities which d^ng"18^*^^^/^^ male i peculiarities, which impose upon her functions ^d diseases ^together her own. For both her particular organization and her temperament are made subservient to the importan = P«rt she is destined to perform : upon her devolves conception ge^Uon delivery, suckling, and all the contingencies connected with these

PrToSwhat evils, then, do not these processes subject the female ! vet, before she experiences them, she is liable to all such, as may arise from sexual functions and organization : and before she can perform one of the ultimate intentions of her creation, she is obnoxious from mere structure to painful, and sometimes to iatal

For to her the period of puberty is oftentimes replete with evils; she is constantly liable to irregularities in her menstrua, and menaced severely by their consequences. She may be visited bv them precociously, and be debilitated by their quantity, or frequency ; or they may be withheld so long, as to involve her health in ruin. Or she may be defective or exuberant in structure; and be obliged to submit, if not to dangerous, yet perhaps to indelicate operations, to compensate for the one or tor the removal of the other. Besides these, she is liable to all the diseases of the male, that do not depend upon sexual distinction ; and thus is multiplied upon her, almost all the evils that can be-

fal two sexes. . . . , ( n\a

The anatomical and physiological peculiarities of the female are both numerous and curious; we shall only, however, succinctly enumerate a few. . , A

One of the most striking differences between the male and female, is the inferiority of her stature. Her whole osseous fabric is more delicate and less extended. The bones of her cranium are thinner, smaller, and more pliant; and the space destined to be filled with the brain, is smaller. ■ , .., - .

The chest is more elevated, in consequence of the ribs forming nearlv right angles with the spine ; and these bones themselves, are broader and flatter, than in the male. This disposition of the ribs renders the thorax shorter, though its upper part is larger ; but the sternum and cartilages have less length, and are flatter ; the clavicles are longer and less crooked. The pelvis of the female differs in a number of points from that of the male ; it is

in follow the labyrinth of the human economy, it appears necessary to study that nf he female ; in this we may perceive more certainly and frequently than in that «f the man, the cause and progress of diseases. Moreover, the degeneration of tL soecies always begins in nature with the female; to study the diseases of them is to arrive at the source of all that belong to the human species." Histoire Naturelle de la Grossesse et l'Accouchement, p. viii.

PECULIARITIES OF THE FEMALE SYSTEM.

calculated to subserve one of the most important as well as interesting functions of the body ; namely, the passage of the child during labour: hence, we find all its diameters larger than those of the male ; together with a much greater expansion of the bones which constitute the arch of the pubes, &c.

The general character of the bones, as well as their connexions with each other, differ from those of the male; their angles are less silent ; and consequently their articulations are better concealed.

The muscular system also differs; its mobility is much greater; the whole of the fibres of the female seem to possess a greater tenuity and sensibility; hence, the proneness of the female to spasmodic, and convulsive diseases; hence, the greater susceptibility of impressions from physical and moral causes : hence, the greater quickness of contraction of the muscles ; and hence, less permanency of impressions.

The nervous system has also its peculiar properties ; the nerves themselves are smaller, and of more delicate structure. They are endowed with greater sensibility, and of course are liable to more frequent and stronger impressions from external agents, or moral influences; and thus the nervous, with the muscular system, contribute to render the female liable to spasmodic diseases,

and obnOXioUS tO inordinate stinaubaiion..

But these peculiarities are considered by some, rather an advantage, than an evil. Thus,. Vigarous declares, " Cette sensibilite excessive, loin d'etre un mal, devient un avantage dans leur condition ; car plus les sensations sont grandes, moins elles sont durable, parce que la mollesse et la flaccidite des solids leur faisant opposer moins de resistance, leur reaction est moins forte et cesse bientot."

" 111 n'en est pas de meme dans l'homme;. la rigidite et la force de ses solides exigent plus d'energie et un plus grand degre' d'entensite dans la cause qui agit sur lui » mais aussi l'effect est plus durable, par la grand resistance que sont en etat d'opposer ses organs, resistance qui le fait souvent succomber. Je comparerois volentiers, dans ce cas, la femme a ce frele roseau, qui, incapable de resistance, flechit humblement la tete sous l'effbrt de la tempete, et la releve doucement quand le ealme est revenue; et l'homme a ce chene altier, qui se trouve abuttu, par la seule raison qu'il est fort et capable de resister."*

In the sanguiferous system, we may perhaps recognise the united peculiarities of the muscular and nervous systems; for in that system, we constantly find the circulation carried on with more rapidity, but with less force ; the arteries are smaller, more irritable, and more easily urged into action, and less easily ap-

* Maladies des Femmes. Vol. i., p. 40, peased, after having been inordinately excited. The veins offer less resistance to any given distending force ; hence, they are more strongly marked upon the surface of tire body ; more decidedly full, or permanently distended ; and more disposed to become varicose. The arteries have smaller calibers ; are quicker in their action ; and but rarely ossify.

The cellular system is more abundant; more flexible; and more easily distended. It is better supplied with moisture ; and from the compressibility of its texture, permits the blood vessels to divaricate, and pass unrestrainedly in all directions through it. From its abundance, and especially about the articulations of the great joints, and large foldings of the body, a roundness and beauty is given to parts, which in the male are angular, and perhaps even sometimes unsightly..

The cutaneous system diners much from that of the male ; lor it of itself, almost becomes an object of beauty. Its texture is infinitely finer, more highly polished, and more decidedly transparent. It permits the veins to ramify gracefully through its structure; to be distinctly seen, and thus forming a fine contrast with the white ground on which they repose. It shows, from its fineness, to the greatest possible advantage, the arterial terminations which so beautifully assemble upon the cheeks. Its sensibility is much greater; and J is sy mpathloB, if not more extensive, are certainly more vivid, than in the male. It is also much more distensible .;* especially that portion of it which covers the abdomen ; and makes, by this means, an important provision for the period of gestation. The capillary system, also appears to be more developed in the female than in the male system. Thus the great aptitude of the system of the former, to diseases 'attended vvith paleness of the skin, oedema, dropsy, and hemorrhages, and thus involving affections of both the serous and the mucous surfaces.

The lymphatic system of the female does not differ widely as regards conformation, from that system in the male: it absorbs and transmits perhaps with more rapidity, its appropriate fluids; yet, there is no other known peculiarity in it, except the lymphatic vessels are more numerous; and when they have a certain predominance, they constitute a temperament ; and then, unfortunately for the possessor, it but too certainly and too frequently, becomes the seat of terrible, and oftentimes incurable disease.

The peculiarities which we have thus briefly pointed out, necessarily render the female constitution one of a marked, and distinct character. The assemblage of the differences which constitute it, renders it, in general terms, one in which the solids are less dense and resisting: for these are found to be more relaxed and flabby than in the male, owing, probably, to the predominance of the cellular and nervous systems. The lymphatic system is

PECULIARITIES OF THE FEMALE SYSTEM.

more extensive than the sanguineous; which it is supposed, gives to the female a greater quantity of fluids than to the male.

To the operation of several of the peculiarities above enumerated, is attributed the supposed predominant temperament of the female constitution; namely,., the sanguineous temperament, so much insisted on by Rousel, and. agreed to by Vigarous.

In attributing, the sanguineous temperament, as the predominant one of the female, we. only mean to express it as occurring as a general rule; for we are aware, that there are many exceptions to be found; for, among them, as with the male, every temperament may be seen. It has, however, been given so generally; that some object must attach to its frequency; and perhaps the opinion of Vigarous, is as plausible as any. He says, " destinees, comme elles le sont (females) a passer de revolutions en revolutions, a eprouver des transitions brusques dans leur maiere d'etre, la nature a du. former les femmes d'une trempe molle, pour les mettre en etat de. resister aux orages auxquels elle sont exposees," p. 39, vol.j.

Besides the systems just enumerated as belonging to the human .system, many are disposed to give to the female another, namely, the uterine system; and which they endow with an extent of influence that belongs to no other.

It has been handed down to us from time immemorial, that the uterus exerts a paramount power over every other system; and governs them with a. sway no less whimsical than potent. . That it creates, exalts, or modifies disease, in every portion of the body; hence, the aphorism of Hippocrates, " morborum omnium qui muliebres vocantur uteri in causa sint." That it not only forms, or governs the moral character of the female, but regulates the physical movements of her body; hence, the declaration of Van Helmont : " propter solum uterum, est mulier id quod est."

By many, the uterus has been declared.ao .possess a separate and peculiar life; that it has its own mode of existence; and is totally independent of the laws, which govern the other portions of the system. Aretaeus compared.it to "an animal confined within another animal ;. that , it travelled without restraint from any portion of the body to another; that it would take possession of any sense;, or occupy any viscera, whether situated at the right or the left side of the body;, but that its movements were rather towards the inferior portions of it. It was like a wandering being;, that it relished agreeable odours, and would move itself towards the place from which they appeared to emanate; but would remove itself , in sadness, from places which had disagreeable smells," &c*

Sydenham, Cullen, Good, and very* many others, have given

*<Chamboa. 2* to this organ, power to produce, or modify disease. To venture an opinion, that would very much differ from the sentiments of the great men just named, would have the appearance of fastidiousness at least, if not of rashness. But, as we have never witnessed any decided instance of this exclusive influence ot the uterus in the production or modification of disease, we teel ourselves justified in entering our protest against its possessing such unlimited sway. In doing this, however, let us make ourselves as clearly understood as the nature of the thing will permit.

First.— We have ever found the unoccupied uterus to be one of great passiveness when in a state of perfect health; and that so long as it preserved this condition, it manifested no agency in the production of disease, or in modifying it, when present. Thus, fever, inflammation, either-local or general, or spasm, has never appeared to us to derive advantage, or suffer inconvenience, from the influence of this organ.

Seconds—That when in a state of disease, we have found several parts of the body sympathize with the uterus; as the stomach, the head, the breast, &c; but precisely the same thing may be said of other parts of the body ; yet, for neither of these is such influence claimed, as is bestowed upon the uterus. Thus, the brain, the stomach, the kidneys, the liver, &c. when in a diseased state, will have particular parts, deranged, by a sympathetic influence; yet it has never been asserted, that either of these parts had at any other time, or under any other circumstance but disease, an agency in producing or modifying the affections of other portions of the body.

Third. — While the uterus is performing one of its. functional duties, namely, forming the menstrual fluid ; when it is known to be in a state of excitement, and, decidedly engorged with blood ; a time when it would most likely exert an influence, if it really possessed any ; we never find this organ exerting a power over other parts, so long as.the functional processes carried on healthily ; and during this period, we have hitherto not been able to detect the slightest influence over any disease, that may have been present in the system ; nor has it ever made us vary a prescription, or modify a treatment.

Fourth. — That when the menstruous function is performed with pain and difficulty, other portions of the system are found to suffer from sympathy; but in no greater degree, than these very parts have been known to suffer, when some other organ was the seat of irritation. In dysmenorrhea, we have known the back and stomach suffer severely, the first from pretty intense pain, and the second by severe vomiting; but we have seen the same consequences attend an irritated kidney, or an inflamed neck of the bladder.

Fifth. — That when this organ is labouring under severe dis-

PECULIARITIES OF THE FEMALE SYSTEM.

ease ; as inflammation, scirrhus, or cancer ; where all its ordinaryfunctions are either deranged, perverted, or suspended, and this for a long period together, we do not find, that it involves the system in any severer penalties than any other equally important viscus would, under similar circumstances.

Sixth. — That when its functional processes are irregularly and imperfectly performed; or are altogether suspended; if the general health suffer from this cause, it is not because the uterus has any superior power to effect this, but because a link is broken (and we are willing to admit it to be an important link,) whereby the chain of healthy functions is maintained. A similar condition of any of the other viscera would be followed by the same consequences.

Seventh.— That when the uterus is impregnated, various other portions of the system are deranged, in consequence of their strong sympathy with this organ; but even here, the complaints are not sui generis; for every one of them can be, and have been very often similated from other causes.* The whole phenomena of impregnation are so well understood as not to require reciting; but has not almost every body witnessed. the, whole train of these morbid sympathies to arise from very different causes?

We would then ask, what evidence is there, that the uterus possesses such unlimited sway over the healthy or diseased movements of almost every other portion of. the body? Does not this error proceed from the influence of authority, and a supineness and indifference to rational inquiry or correct observation? Should the names of Hippocrates, Galen, Aretaeus, Van Helmont, and a hundred others of greater or less authority, be permitted so to satisfy the judgment, or so paralyze exertion, as to prevent all investigation?

The discoveries of Gall and Spurzheim on the influence of the cerebral system upon other portions of the body, render it much more probable, that the various morbid phenomena attributed to the influence of the uterus, depend upon certain excitements in the cerebellum ; and that the several facts recorded as belonging to the genital system of the female, are themselves but evidences of the influence of.cerebral irritation. In the male, at least, this point is pretty well settled — as it has been found by Larrey and others, that certain wounds or injuries of the cerebellum, entail impotence. It is, thereforefmuch more rational to look for some

* Ip this assertion, we do not mean to include that beautiful and magic-like play of sympathies, which is established for the future welfare of the expected being; namely, the swelling of the mammee, and the secretion of milk. These parts have a mutual, and an associated sympathy, which they with great fidelity maintain as long as they are capable of performing their appropriate functions. The nature and extent of these intercommunions are too well known to need a particular mention.

PECULIARITIES OF THE FEMALE SYSTEM-.

disturbance of the brain or nervous system, as long since suggested by Willis, for the origin of hysteria, &c, than to any direct influence of the uterine system.

Do not let it be understood, from what we have just said, that we undervalue the importance of the uterus as an organ; for as an organ we are free to admit, that it has high destinies to fulfil ; we only wish to insist, that it has no exclusive, or concurrent power, to produce, modify, exalt, or diminish, any disease or affection of the body, beyond several other viscera; and, perhaps, less than some. The stomach, decidedly, and, perhaps, the liver, have a more marked influence, either in a state of health, or of disease, over the animal economy, than the uterus.

Nor are we to be supposed to countenance the opinions advanced by Mr. Fogo,* some few years since, in a paper entitled, " On the degree of importance which should be attached to the functions of the uterus, in regard to health." He declares it as his opinion, that the uterus is"~of so little consequence to the animal economy, that it might be spared from the body, without the system suffering by its removal. He calls it " a simple, passive, accommodating organ ;" and, on this account, can have but little influence or control upon the functions of the body. If the value of an organ be tested by such estimates, to what a low value would the brain or the stomach be reduced !

The stomach may, especially, be called " a simple, passive, accommodating organ ;" possessing, perhaps, in a greater degree, these qualities, than even the uterus itself. In the first place, its structure is less complicated than the uterus ; it is- equally passive, when permitted to be so ; and it is doubtless, as " accommodating ;" as the efforts of the gourmand have frequently proved. Yet Mr. Fogo, himself, would not hesitate to admit, that this " simple, passive, accommodating organ," cannot well be spared, because it possesses these qualities.

In a word, we are of opinion, that the uterus ranks in the first order of the viscera ;r that its. health is every way important to the general health of the system ; but that it does not exert any particular power over other portions of the body, more than any other important viscus . would, under the same circumstances; namely, of disease. That its influence is greatest, while performing, or. giving evidence of its best state of health ; namely, during gestation. .

* See an answer to Mr. Fogo's paper, in " Essays connected with Midwifery," by William P. Dewees, M. D., &c.

DISEASES OF THE EXTERNAL AND INTERNAL ORGANS.

Chapter II. Of The Diseases Of The External And Internal Organs

The structure of the external organs is such as to render them liable to a variety of complaints that always excite alarm, however free they may be from danger. Indeed, any disease of these parts creates a great deal of apprehension, especially in the married, or the pregnant woman. Women, especially the married, are often kept in a state of great anxiety, when labouring under any affection of these parts, until they can be assured it is not one of a particular kind, and that it will not be attended with danger. On this account, it is of consequence to the young practitioner, that he be acquainted with their general diseases, both in the unimpregnated, and in the impregnated state of the uterus.

It may be observed, as a general rule, with respect to the economy of these parts, that, from their great vascularity and sensibility, inflammation runs on very rapidly to suppuration, and is accompanied with much pain. Indeed, we have seen severe inflammation of the labia terminate very rapidly in gangrene, though much exertion had been made to prevent it. It may, also, be observed, that suppuration of the libia.is attended with more than a usual degree of foetor ; owing, most probably, to their very cellular structure; this tissue is found to die more easily when much accumulated, than when in more spare proportions. We may also add, that parts thus organized, granulate more slowly after suppuration, than many other portions of the body, from the same cause.

From the looseness of the texture of some of these parts, especially the nymphce and labia, they become sometimes very much enlarged, from very slight irritation; and when there has been a neglect of proper cleanliness, the natural secretions become acrid from stagnation, and produce itching, which, though slight at first, very much increases by the indulgence of scratching; and if this be persisted in, the parts become inflamed, and sometimes swell inordinately, but does no mischief ordinarily, if not too long persevered in. This happens especially with those who have a dread of water after the catemenial discharge; and who neglect to wash themselves after these purgations. On this account, it is important that the parts should be daily washed with warm water particularly during the flow, and immediately after the menses have ceased ; or if the woman be subject to fluor albus.

22 DISEASES OF THE NYMPHS.

The prejudices of some women on the subject of washing, should be removed, by the'practitioner making it a point to recommend its frequent use, when consulted on these diseases.