Health for women : showing the causes of feebleness and the local diseases arising therefrom with full directions for self-treatment by special exercises

Preface

Many excellent treatises on Pelvic Pathology and Therapeutics are already before the medical profession and the public; yet there are principles involved in these subjects which no previous works discuss or even indicate. I am. not aware of any treatise in ivhich the causes even of the ordinary affections of the pelvic contents are distinctly pointed out, nor of any in ivhich the complete cure of these affections is shown to depend on the removal of their causes. I know of no work ivhich maintains the practicability of correcting the faulty position of the pelvic contents by strengthening their natural supports ; none in which the possibility of removing pelvic hypercemia and its consequences by restoring the natural motions of the dominant parts arc even referred to, much less demonstrated. This work attempts to supply these deficiencies, and to set forth certain principles ivhich medical literature lias overlooked .

0 PREFACE.

It is a source of sincere gratification that in the development and verification of these principles 1 have received the kindly support, and often the hearty co-operation, of the profession. The workings and results of these principles prove, them to be not. merely accessory to, but an integral part of, medical science ; a knowledge of them, therefore, becomes a permanent extension, as well as simplification, of the physician’s resources, insuring more successful and beneficent results in practice.

Women are everywhere suffering from want of acquaintance with the physical laws of their being. 1Y0 age or station is exempt. The need of the services of the physician is, to a large extent, due to inattention to and ignorance of principles easily understood and practiced. To point out these principles, and to show how simple, natural and eminently practical they are, has been my purpose. I therefore commend this treatise to Women, confident of thereby rendering them a genuine service of permanent value. Let no one be discouraged by medical terms, ns a Glossary at the end, gives their meaning.

G. H. T.

Sew 'Cork) im.

DISEASES OF WOMEN.

i.

NEGLECTED FACTS IN UTERINE PATHOLOGY, AND THEIR THERAPEUTIC IMPORTANCE

A conviction of the inadequacy of the current methods of treating diseases incident to tho contents of the female pelvis, and of the importance of recognizing certain cardinal facts and principles which are now usually overlooked both by patients and practitioners, has led to the writing of the following pages.

The chief source of erroneous judgment in this matter is the limited number of known or generally admitted facts. The well-attested facts bearing on the subject are of the utmost importance, but are altogether insufficient to establish sound scientific conclusions. To obtain more facts relating to the subject is therefore a matter of special importance ia Etiology, since

DISEASES OF "WOMEN.

our ideas of this subject practically control our Therapeutics.

Each of the current medical opinions, of which there is a vast variety, undoubtedly contains a grain of truth. These opinions originated in the different appearances the same thing presented from different points of view • each of them represents some but not all of the facts involved in the subject under consideration. It is therefore reasonable to suppose that the more we increase the points of observation, the more important facts shall we elicit, and the nearer shall we approximate absolute truth. Each new observation, whether it discovers new facts or brings into new relief those hitherto unappreciated, affords a broader and surer basis of therapeutic advantage. In this way real and permanent medical progress is made ; while otherwise medical science and practice must remain stationary — tempting targets for whoever wishes to assail them.

I propose to call attention to the subject of Uterine Pathology and Therapeutics from a hitherto neglected point of view, and thus to .introduce the reader to facts that are not generally mentioned in works on these topics. I desire to

VITALITY AND MECHANISM.

call attention especially to the mechanical telaiions of the pelvic organs, and also to the part these relations play both in the pathology and the therapeutics of the pelvic region.

The existence of such relations has received a passing recognition by the Profession, in some of the means employed in Pelvic Therapeutics. But, so far as I am aware, it has failed to apprehend, much less has it set forth, the true pathological and therapeutic significance of the facts involved in these' relations.

The importance of a careful investigation of this field of inquiry is obvious. Were the mechanical elements eliminated from Physiology, there would be very little left that would call for discussion. The great functions of Respiration, Circulation, Motion, Nutrition, and the Evolution of Force, both sensorial and dynamic, — all involve the idea of a change in place of the matter of which the system is composed. Any adequate consideration of these functions includes a variety of facts pertaining to mechanism, both as regards the form and structure of the vital apparatus, and the force which it exhibits.

In fact, vitality implies mechanism. Even il

DISEASES OF WOMEN.

we reduce our idea of life to its lowest possible terms, by restricting it to tho simplest mode, we shall still find that vital existence is inseparable from mechanical function and activity. The aciion of this mechanical force has hitherto been held of little or no account ; but the existence and influence of this force I propose to make clear. Tho interplay of chemical force with vitality will, by analogy, aid us in understanding what this mechanical force is and how it operates. When vitality ceases in death, chemistry has entire control over the elements thus abandoned, and in proportion to the decline of vitality in the system chemical force asserts its sway. Medicine consists very largely of materials designed to prevent or to counteract the disastrous effects of chemical force within the living body.

So also the force of gravitation is ever present in the system, and ever asserts its power in proportion as vitality declines in any part of the body. ' While the influence of chemistry is exercised over atoms, the power of gravitation is exerted over masses. The part gravitation plays in inducing disease, and tho assistance it can be made to yield in the restoration of health, form a

GRAVITATION.

highly interesting and hitherto neglected subject of inquiry.

It is plain, therefore, that the mechanical relations of the pelvis, and the various forces that are active for good or ill in these relations, should receive thorough investigation. This is specially important in order that pathological causes may bo better understood, and that suitable therapeutic and hygienic conclusions may be derived therefrom. If we neglect this field of inquiry, and the important facts that it may yield, it is obvious that our practical inferences, our conceptions of pathology, and our remedial resources will be alike incomplete.

Such mechanical facts, and the principles involved in them, naturally suggest a new order of remedial resources. These differ greatly from the medical appliances in common use, and this may possibly lead some minds to question their value or to condemn them outright. But improved remedies for painful and often fatal diseases can afford to wait for recognition, certainly as long as those who need them. When it shall be found that these remedies are more direct, more appropriate, of moro rapid and permanent effect, and useful alike in all the multifarious

DISEASES OF WOMEN.

forms of pelvic disorder — resembling in this respect the air and food which are necessary alike for all — both patients and the profession will undoubtedly cordially welcome and adopt them.

Therapeutic measures for which such a basis and such a wide range of application are claimed, wall naturally provoke and should certainly receive the severest questioning. This is heartily invited. Let the facts and principles set forth in these chapters be subjected to the severest tests. I am chiefly anxious to know and state the truth on the subject for the benefit of those who may and those who do suffer. The rejection of erroneous opinions is oftentimes indispensable to the reception of the truth, and so nothing but benefit can come from careful inquiry and the publication of its well-attested results.

Another important advantage should flow from the enlargement of the number of admitted facts bearing on this subject. We shall arrive at a clearer understanding of tho relative value of the remedies to which we have heretofore been restricted, and about which there is much disagreement in the medical world. We shall also ascertain the limitations as well as the uses of the various remedies. Thus we shall be enabled

PATHOLOGY PROuBESSIYE.

to avoid their misapplication, their useless application, and their abuse, from each of which patients now suffer much.

Nor need wc bo deterred from this undertaking by the recent labors and achievements of modem Gynecologists. F or though uterine pathology and therapeutics have been elevated to the dignity of a distinct branch of medical science, this science can hardly bo supposed as yet to have passed through its progressive and to have arrived at its perfected stage. Indeed, the practical advantages yet derived from the cultivation of this specialty are far less than will be found attainable when the facts involved shall have been turned to proper account. Our knowledge of actual and differential local pathology has been greatly improved ; while the causes upon which these states directly depend have been most unaccountably ignored. Our therapeutics havo hence been directed. not to the removal of the causes, but to the palliation of effects. The common results of practice are consequently transient; the actual disease continues while the symptoms fluctuate. "While intent on the multitudinous aspects of disease we fail to comprehend its essential nature as related to ultimate causes.

DISEASES OP WOMEN.

Tho truth of these statements is substantiated by such considerations as follow. The number of females who require the services of the physician in affections of (lie pelvic contents increases rather than diminishes, as is evident from tho increase of specialists devoted to this branch of practice, the supply being proportioned to the demand. The length of time required for treatment, often extending through months and even years, is a convincing evidence of its insufficiency. Tho persistence of annoying symptoms, after ordinary remedial treatment has been discontinued, and the frequent reappearance of old symptoms after they were supposed to bo permanently subdued, are conclusive proofs of the same fact. The frequent change of physicians, and resort to new and sometimes questionable remedies, indicate that neither the causo nor tho effects of disease are satisfactorily reached. Tho fearful increase among females of a great variety of nervous disorders, especially those of an emotional nature, popularly as well as professionally connected with the organs under consideration, strongly intimates that the nervous system endures continuous though indefinable suffering physician’s duties.

from causes dependent on tho condition of this important centre of nervous sympathies.

In the light of the above statements, an important fact is clearly apparent. If it be a function of the physician to develop and diffuse a knowledge of the causes of diseases of this class, the failure to fulfill this duty is signal and complete. In some futuro time such a service may bo regarded, as it certainly is, tho liighest and most important of his calling. Preven.ivc knowl- ' edge aud preventive measures aro hero of much more consequence than in the instances of infectious diseases, in which the law provides salutary regulations, because the cases aro more numerous, and the aggregate of suffering greater.

The development, popularization, and diffusion of facts bearing on this subject must inevitablyresult in tho diminution of these affections, if not in their entire prevention, as serious and prolonged diseases. It is to these comprehensive and unquestionably important ends that my efforts in the present work aro directed.

II. The Pelvic Contents Have No Exceptional Ten- Dency To Disease

It seems to be the prevailing impression that tbe contents of the female pelvis are peculiarly liable to disease ; in short, that a tendency to disease inheres in thcso parts, and is liable to development at any unexpected moment. The causes of such disease being constitutional or hereditary, the victims of it are therefore quite free from all responsibility in the matter. And there are physicians who appear to countenance this impression ; at least, they do not protest against it, and them silence is construed into testimony in its favor.

This idea must bo vigorously combatted and effectually repressed before any real advance can be made in uterine therapeutics. In order to render the sufferer anything more than the fnost superficial and temporary benefit, her active cooperation is absolutely essential. Certainly no one

PELVIC DISEASE PKEVENTED.

will be likely to contend effectually against a malady which is regarded as in any degree inevitable.

But that diseases of the contents of the pelvis are not inevitable is evident from the fact that the brute creation enjoys entire immunity from them. Brutes are subject to various other diseases, which often prove fatal ; but there is no instance on record of any but the human female suffering from diseases of this class. This remarkable fact indicates that the cause of the disease in the latter case is not constitutional, and that women are not necessarily its victims. But it indicates that women should use the knowledge they have abundant capacity and opportunity for acquiring in such a manner as to prevent these diseases and exempt themselves from the sufferings to which they are peculiarly liable. If the animal has an advantage in position, woman has a greater in reason, which is a more powerful protector and guide than any brute organ or instinct of which we now have knowledge. It is only necessary for her to use reason for her own protection and well-being, to enjoy a complete immunity from these painful diseases, which sometimes lead to fatal results.

DISEASES OF WOMEN.

The position of the generative intestine in women, being chiefly underneath the mass of dir gestivo organs, has sometimes been regarded as peculiarly unfavorable to health. There are considerations, however, that entirely remove this idea, and which indicato that, on tho contrary, the location of tho pelvic contents is peculiarly favorable to health, shoving, moreover, that the purpose of nature to preserve tho species, even, if necessary, at the expense of the individual, is well displayed in the disposition of these organs. Such considerations as tho following appear to justify this statement :

The pelvic organs are enclosed in a bony encasement, stronger and more capable of resistance than any other portion of the body, consequently these organs are better protected than tho brain, tho spinal cord, or the chest, and are less liable to injury from accidental and external causes than any other part of tho system.

The pelvic contents are also less liable to suffer from causes connected with digestion than most other parts of the system. Placed quite outside tho digestive tract, these organs can never be directly affected by irregularities in that process, like the stomach and bowels. The

POSITION OF 0 EGANS.

relation of the pelvic to the digestive organs is more remote than that of the muscles and nerves, since they need constant support for the discharge of their functions. Even acute attacks of the digestive organs are seldom communicated to the generative intestine.

The perturbations of climate and temperature sometimes occasion, if they do not excite, various diseases; but they hardly have any considerable influence on the pelvic organs.

The overtasking of the voluntary powers are sometimes thought to affect the pelvic contents unfavorably. A closer analysis of cases, however, has generally shown that this cause, when it has appeared to operate unfavorably, acts indirectly, and through deficiency of nervous and muscular power, the nerves and muscles being the first sufferers from over-exertion. It is quite another class ■>f women than the workers who suffer most from pelvic affections. The reason for this important but indisputable fact will hereafter be made plain. The numerous secondary affections arising in acute diseases, it is now well known, fall upon every other portion of the body more than upon the one we are considering.

We have left, as the cause of disease of these

DISEASES OF WOMEN.

organs, the abuse of their own functions. But these abuses affect the nervous system rather than the pelvic organs themselves, and are treated accordingly. The exceptions constitute a separate class of special diseases, which the present work does not propose to consider, and which are outside of the scope of the Gynecologists. Those aberrations of functions, deformities and diseases of the uterus and its appendages for which physicians are daily consulted by the most conscientious and moral women in the community, both married and single, are not regarded by patients or physicians as attributable to abuse of the sexual functions, and are not prescribed for as having such oiigin. Harlots, and women subject to ungovemed and immoral excesses, are said to be nearly exempt from diseases of this class.

It has been asserted by some authors, that the periodical function of women, which is absent in the lower order of animals, produces a strong tendency to disease of the generative organs. It is thought by some persons that this monthly afflux constitutes congestion, which, under frequently recurring and unforeseen circumstances, merges into disease. A little reflection will show

NO TENDENCY TO DISEASE.

the untenableness of this presumption. This function is as natural as the action of the brain or the muscles. All organs, during their activity, receive alike a large accession of blood. This is a necessary concomitant of any functional act. But brain and muscles do not, as the consequence of their functional activity, have a necessary tendency to disease. Health, and not disease, is the consequence. Disease can only result from a prolonged and excessive activity which constitutes abuse, and generally when from other causes the organs are unfitted for work.

Nature, however, kindly provides against any possible predisposition to disease of these organs from this source in an exceptional manner, as is shown in the method of disposing of the blood of functional activity. In case of every other function, this fluid passes freely on its natural course ; in case of this function it is at once excluded from the system. This fact would appear to provide against the probability of disease arising from the cause assigned.

From these considerations it is evident that other causes than those already referred to must be sought for the diseases from which women suffer so frequently and so much. These causes

DISEASES OF WOMEN.

suffering is inexplicable ; ancl their willingness to resign themselves to the care of physicians for affections more easily avoided than contracted, and them unwillingness to study the legitimate means and methods of directing those delicate processes of their systems, which they, of all others, ought best to understand, are certainly unreasonable and astonishing.

But suffering tends to work out favorable results in legitimate succession. The first impulse of the sufferer is to seek relief. This is the stage of blind credulity. The victim willi 1 1 g ! y subjects herself to such other suffering or sacrifice as those in whom she reposes confidence prescribe. If her efforts to obtain relief in one direction fail, she seeks it elsewhere, losing strength and faith 'with each successive trial. Aftei lepeated failures she begins to inquire, “ Wherefore ? Is this apparent tendency to pelvic disorder real and unavoidable? Can the

PBESSING INQUIRIES.

causes of this prostrating disease be discovered and eradicated ? Has not human nature intelligence enough to learn the natural history of this derangement, and sufficient force of will to prevent, if not to cure it ? In short, is not this a case where a knowledge of cause and efiwct is attainable, and where the effect is removable. by eradicating its cause ?” Such questions intelligent females are beginning to ask with a seriousness and urgency that indicate a determination to have them intelligently answered.

It is lamentable that the public is content with such low aims in matters relating to health. Even many physicians are content to afford their patients immediate but questionable comfort, without sufficiently studying ultimate effects. The natural consequence is that causes are suffered to remain unabated, while effects are experimented upon and the system is tampered with. The disease should be fully explained to the invalid, so that she cai\ comprehend its origin and workings ; for without her intelligent co-operation the successful treatment of her case is almost impossible.

III. Initial And Derivative Forms Of Pelvic Disease

Chronic diseases of tlie pelvic viscera differ from other chronic diseases chiefly in location.

We should divest ourselves of any notion of intrinsic peculiarities arising from other sources. All disease, wherever located, when reduced to its last analysis, is the consequence of imperfect vital action. There is some impediment, known or unknown, to the complete expression of the vital power ; and imperfectly vitalized products, or non-vitalized material, invade the system, and exhibit their presence and their effects by local disorder.

The great obstacle to the correct understanding of disease, and consequently tho chief impediment to its removal, is tho too exclusive attention paid to particular modes of its expression. There is insufficient breadth of observation and of generalization. It is too often forgotten that the manifesiaiion of disease, whatever it may be, can never exist unsupported ; that there is neces-

PROGRESSIVE FORMS.

sarily something back of it, often unrecognized because unsought, but generally detected -when earnestly looked, for. The symptoms are merely the utterances of this something , which we should seek to ascertain and remove. We commit grave mistakes in considering the symptoms as the disease, and restricting remedial attention to them.

Another consideration should be here presented. Disease in general, and that of the pelvis in particular, is progressive in its character, not only in its degrees, but also in its forms. It not only passes through various stages of development, but is liable to become developed in different directions from tho same apparent beginning. Tho different characters thus assumed do not necessarily require a corresponding difference in remedial treatment, provided this treatment be in the initial stage. The commencing stago is necessary to the very existence of disease.

Modern Gynecology lias devised the means for thorough investigation of the pelvis, and has made great advances in the determination of actual and differential diseased states. Treatment is, theoretically, applied with reference to the facts thus elicited. But these facilities in arriving at facts have not by any means produced unanimity of

DISEASES OF WOMEN.

opinion among Gynecologists, cither in regard to essential facts or necessary treatment. This is because different physicians look for, and therefore find, different conditions. This statement does not imply that anything is really unrecognized by the competent physician, but that superior consequence is attached to special points of pathology, which therefore secure exclusive therapeutic attention.

For example, leucorrhoea, having its scat in inflammation of the glands of the uterus and its connections, is thought by some physicians to be the principal cause of uterine maladies, and they direct treatment for the suppression of this symptom. With others, displacement is regarded as the general cause of all uterine affections, however varying the symptoms. Supporters are, with these, the indispensable remedy. Ovarian inflammation is regarded by other physicians as competent to account for most of the symptoms referred by the patient to the pelvis.

Others still, following Dr. Bennett, insist that it is inflammation of the neck of the uterus which accounts for the symptoms observed ; the remedies are consequently exclusively addressed to this easily accessible part. I confess myself

MEDICAL OPINIONS.

to Have been an early and faithful follower of Bennett ; but the gradual development of the facts and principles presented herein convinced me of the incompleteness and insufficiency of that author’s views regarding both pathology and practice. Chronic Metritis is by many looked upon as a more reasonable explanation of both the rational and the physical evidences of pelvic disease than is inflammation of any special tissue or part of the organ.

There is still a respectable minority of physicians who continue to regard all pelvic symptoms, whether physical or rational, as so many evidences of deteriorated general health, and therefore prescribe remedies chiefly with reference to this fact.

Much stress has of late been laid on minute points of pathology, as therapeutic aids, by leading Gynecologists. To designate these differences in the location of points of greatest apparent deviation from health, we find employed such terms as these : cellulitis, endometritis,

parametritis, perimetritis, tracheal itis, endotrachealitis, &c. The knowledge of these distinctions is evidence of the searching nature of modern inquiry, and illustrates the perfection

DISEASES OP WOMEN.

attained in our means of diagnosis. Their influence must, however, be confined to narrow limits, or they prove damaging to our practice. The too close observance of these special and minute distinctions has these effects :

To circumscribe the physician’s inquiries to a local point ;

To limit the remedial means to such as may be locally applied ;

To ignore the existence of causes upon which the declared manifestation directly depends ;

To presume that the effects of topical remedies are confined to the point of application.

This latter is a dangerous error, and cannot but produce untold mischief. It is strange that, in these days of the free use of the hypodermic syringe, through which to produce effects on the general system, this error should have been overlooked.

The differing views entertained by well-informed physicians regarding the chief seat of the difficulty in pelvic affections are not so conflicting and inharmonious as would at first appear. They are detached, fragmentary, and incomplete, rather than antagonistic. They represent different aspects and consequences of the same thing — ■

EXCLUSIVE IDEAS.

.85 various outcroppings of the same subterranean strata. Trace these points of prominence a single step backward, and remove the technical

rubbish, and we disclose the same solid foundation. The superficially differing pathological states are then found to have a common origin and starting-point.

The non-professional reader of medical works will be struck with a glaring deficiency in the accounts of uterine affections ; very little, often nothing, is said regarding their origin. Writers appear content to describe conditions and remedies ; they do not fully explain why and how these conditions aiise. They refer to overexercise, to mounting staffs, to menstruation, to the matrimonial state, and various others as exciting causes. These, however, are but intermediate and secondary. This is apparent from the fact that the great mass of females are constantly exposed to all these and other causes, without detriment. This implies the presence of some other condition ; or rather, that the real cause lies in some other fact, which those referred to are capable of rendering operative. We are the more confident that this latter is the correct statement from the consideration that the

DISEASES OF WOMEN.

conditions above mentioned are not in themselves unwholesome, but quite the contrary.

The study of disease will doubtless be more satisfactory if its beginnings be regarded with more scrutiny, and its initial processes be more thoroughly understood. It is not enough that we become familiar with its accumulated effects. We need to watch the point of departure from the full expression of vitality, in order to seize upon its causative influences.

The operations of life constitute in the organism a circuit of mutually dependent processes. We may profitably commence their examination at any point of this circuit, but the most natural and convenient one is the point where inanimate matter becomes living substance, the instrument of bodily force. Here we find the necessary conditions to be the presence of suitable material brought by the capillary blood-vessels. Vital parts are always in immediate relations with these vessels; the materials vitality employs are thus brought — those it rejects are thus disposed of. It hence follows that these vessels have intimate connection with the occurrence of disease, and are immediately responsible for vital conditions.

COMMENCING DISEASE.

Tbe paramount use of this connection is the conveying of material; in other words, the motion of the fluids bearing the incipient vital substance. The minute instruments of force which, aggregated, form muscle and nerve are organized from material thus derived. These organized structures express their functional power, that is, yield their force, through the agency of oxygen, which arrives through the same channels to the point of use.

We must bear in mind that disease and imperfect and perverted nutrition mean much the same thing. They indicate stages of the same process. The initial stage must be connected . with the transformation of non-organized matter to its organic forms. The capillary blood-vessels furnish the conditions whereby these changes are effected. These vessels, therefore, bear most intimate relations to vitality, whose diseased expression may have two opposite forms — Ancemici and Hypercemia.

The first of these terms indicates- that nutritive supply is insufficient for local needs ; it becomes so through deficiency of material, or through deficiency of the causes which carry forward the blood. The deficiency of power and function

DISEASES OF WOMEN.

which characterize anaemia, can hardly be regarded as a local disease, but a general one. The local region would not suffer if the causes derived from the system at large were in complete order. The local symptoms hence betray negative characteristics.

The indications of treatment are very evident. This should consist in increasing the nutritive capacity and action of the system at large. The introduction of more oxygen by respiration requires more food ; the blood is enriched. The pelvic region, under these influences, recovers its functional tone, as soon at least as the general system. The condition of the menstrual function may be regarded as affording, in general,, very reliable indications of the existence and degree of anaemia.

The superior value of exercises to correct pathological states derived from this source is attested by all classes of physicians. The only question which has arisen is regarding the means of rendering this agent available.