Femina, a work for every woman

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Book

COPYRIGHT DEPOSIT

Prefatory Note

The publication of this volume was suggested by the astonishing ignorance displayed and the antiquated ideas entertained upon questions of health and disease by most persons with whom I came in professional contact, even by those who were accomplished in other subjects of a scholastic and scientific nature. The practical importance of the subject naturally led me to the consideration of diseases that are essentially inflammatory, for over seventy-five per cent of all diseases of women are of an inflammatory nature. In this respect the book differs from other works on similar subjects.

In discussing this class of diseases I have aimed to present a treatise simple in style, and easily understood by the casual reader. While I have endeavored to impart strictly scientific information, I have tried to impart it in familiar language, avoiding the use of technical terms as far as possible, and carefully defining them when their use became indispensable.

JOHN A. MILLER, M. D.

BY THE SAME AUTHOR.

MEDICAL EDUCATION IN THE UNITED STATES AND AN OUT- LINE OF THE GERMAN SYSTEM. Essay read before the Alumni Association of the Medical Department of the University of California, March, 1886.

EROSIONS OF THE VAGINAL PORTION OF THE CERVIX, OR ULCERATION OF THE SAME PART. Pacific Medical and Surgical Journal, January, 1887.

RETROVERSIO-FLEXIO AND A NEW INSTRUMENT FOR THE REPOSITION OF THE UTERUS. American Journal of Obstetrics and Diseases of Women and Children, February, 1887.

UTERINE HEMORRHAGE AND LIGATION OF THE UTERINE VESSELS AS A THERAPEUTIC EXPEDIENT. The New York Medical Record, September, 1889.

PHLEGMASIA ALBA DOLENS, OR MILK LEG; ITS PATHOLOGY AND TREATMENT BY MEANS OF COLD WATER COMPRESSES AND ICE BAGS. Pacific Medical Journal, June, 1891.

CONTENTS,

Chapter I. The Reason Why

I see a large field of usefulness which has not been covered by competent authorities. I propose, therefore, to offer a plain, simple statement of the most common causes of physical suffering in women, and a simple and reliable method of home or domestic treatment, to be carried out by the patients themselves, which, in the great majority of cases, is easily applied.

The first nine years of my professional life was an untiring and incessant devotion to the arduous demands of a large family practice, after which I decided to go to Europe, and there prosecute such studies in two German universities as my experience as a practitioner had fully convinced me to be of the greatest practical and scientific importance; hence, I offer no excuse or apology for aught I may say on a subject with which I have taken especial pains to familiarize myself. Having in a measure established my identity, I am more fully prepared to proceed in a more congenial way.

In the realm of thought there is no monopoly, and it is, after all, at the bar of public opinion that a final judgment must decide the merits of my course.

The question is not what to teach, but whom to teach. This may seem, at first sight, an easy matter to determine, but a more careful inquiry will show the complexity.

The platform of a medical college is considered by some the only legitimate place from which a medical man may impart his knowledge, but here the opportunity is limited, notwithstanding the abnormally great number of these institutions. This, however, is not the only reason. Medical colleges are becoming so numerous, that they should be discouraged by all honest and high-minded medical men*, because in this country they are private institutions, with very few exceptions, and subserve sinister purposes, in furthering the interests of their promoters either as advertising schemes or money-making institutions, or both.

Of course they are incorporated under State laws, which make them quasi-public institutions, but the State exercises no authority over them, and their self-constituted professors conduct them to suit their own private ends. They are not limited by law, nor is a required course for their students imperative, so that the public have no guarantee of the fitness or competency of their graduates. There is, also, an unhealthy rivalry among our colleges for students, improper material is taken in, and correspondingly poor material is turned out ; this in turn causes a rivalry among their graduates in making spoil of the sick.

Every self-respecting and competent medical man has an utter contempt for these doctor mills. This will never be different in this country until we follow the plan of European governments, and make medical colleges State institutions, and their professors officers of the State, with liberal salaries.

The medical press has a comparatively limited opportunity for imparting information to the public, unless the editor of the secular press happens to make a quotation.

The exclusiveness that has characterized the learned professions generally, and the medical profession particularly, is rapidly passing away. Only half a century ago, the medical lectures in Germany were mostly delivered in the Latin language, and, while we now often suffer, in listening to medical lectures in bad English, the latter may still be the lesser evil. In fact, so great is the deference to public opinion in favor of diffusing knowledge that medical faculties court popular favor by delivering a course of lectures on medical subjects, and consider these the best-drawing card of the institution.

Information that is not sensational nor untruthful cannot fail to do incalculable good to the class for whom it is intended, namely, our wives, mothers, daughters, and sisters, so that they may avoid errors, that entail suffering and disease; information that will teach them how to cure themselves of the commoner and simpler ailments, and thus avoid running to the doctor, who cannot always afford to tell them the truth. Some would not if they could.

The Darwinian theory is of wider application than to mere animal or plant life; it extends itself to the overcrowded professions, and the increasing "struggle for existence" in the ranks of the profession makes men dishonest and greedy for any opportunity to raise a fee, so that patients are being treated for diseases which are created for them by the cunning and dishonesty of their doctors.

A little common sense and a knowledge of the elementary principles of disease would be the best protection against these deceptions; but, as a rule, sick persons are inclined to throw aside all good sense, and give themselves up entirely to their feelings or to their doctor. This is a very wrong thing to do, and opens the door for all manner of impositions.

The general practitioner of thoughtful and studious habits finds that, in the course of years, a diversified reading on the different diseases which in the routine of his w T ork he is called upon to treat makes him a generally wellinformed man, but not a thoroughly exact man, either in theory or in the details of his treatment.

Fifty to sixty years ago the entire field of medicine was comparatively so small that it was easier for a brilliant mind then, to comprehend all that was believed to be known, than it is for the same quality of mind to understand any of the subdivisions of medicine to-day.

Those were the days of doctrines and rules. Little that was absolutely correct or true was then known about disease, otherwise such absurd theories as the " dynamization or spirit-like" influence, causing disease on the one hand, or

Li that the " great source " of chronic diseases was psora, or itch, on the other, as Hahnemann would have them believe, could never have gotten a foothold.

These are the days of scientific deductions from microscopical and physiological research, in laboratories connected with great universities, and the result is, that any of the specialties or subdivisions of medicine is as large and interesting a field as the entire area was some time ago. It thus happens, that some thoughtful persons, after years of general practice, drift almost involuntarily into some one department of medical art and science. To this they become gradually wedded, and in it they grow in knowledge and experience far beyond their previous anticipations. What they read on the subject is better understood, and new ideas are constantly formed, which enlarge the scope of their knowledge. In this manner the writer drifted into the domain of diseases peculiar to women, which was as unhappy on the one hand, as it is interesting on the other, for the phrase "diseases of women" has fallen into disrepute because every superficial, practitioner professes to know all about them, and it often is but another name for criminal abortion.

But for all that, there is a legitimate and scientific specialty of women's diseases. The time-serving specialist must be exposed in every department of medical science. Whether the pretender is labeled, a professor in a college, or labels himself through glaring newspaper advertisements, one is just as much a catch-penny as the other.

The object of educating the laity cannot be reasonably confined to a few medical truths, but the perversion of the truth must also be understood, so that the false can be detected. It is necessary to point out the dangers and frauds which are the unhealthy outgrowths or excrescences of established truths, and there must be no veneering of the wicked and sinful with ambiguous phrases to shield the guilty; the truthful and innocent require no apologist.

The honest observer can pursue no middle way in a work to which he has devoted the best years of a studious life,- and hence he may seem radical in his opinions. While policy often dictates a conservative course, that which conscience and reason dictate to be true is prompted by loftier motives, namely, to subserve the highest purpose of moral integrity.

It has often been said that this is a mechanical age. How true is this even in the furtherance of science ! How true is this of the science of astronomy, which was revolutionized by the construction of good telescopes! Mechanical genius has perfected a lens for Mount Hamilton thirty-six inches in diameter, and one is now in course of construction for Mount Wilson, in Southern California, which is to measure forty inches. Through these means scientists hope to decipher the complexion of remote planets.

Microscopic lenses have been equally perfected, and, by means of achromatic condensers and immersion lenses, great magnifying power can be obtained with perfect distinctness. That this mechanical spirit of the age should also have obtained a foothold in medical art and science, is but natural. Surgical and other mechanical methods have entered so boldly into the field of diseases of women that the writer feels constrained to sound a note of alarm. Great strides have been made in a more perfected technique in abdominal operations, and, by favorable recoveries from grave and severe operations, the field of surgical usefulness became enlarged, but this has degenerated into a license for notoriety and personal aggrandizement of not overscrupulous and selfish surgeons who are over-anxious to ■operate so as to be able to boast of the great number of their capital operations, or laparotomies.

I was enthusiastic in abdominal and pelvic surgery, but not until I entered the field as a specialist in this department of medicine did I see and hear of daily abuses and misuses of this branch of surgery. In many instances it ■degenerated into criminal malpractice. It will be instructive information to cite a few cases which occurred under my observation, and present the actual facts to the reader.

It was in the month of February, in the year 1888, that a business trip to the southern part of the State forced an absence of several weeks upon me. Some two months before this time I had been called to see a young woman, who had then been sick for several months. She informed me that she had been married nine years, and, not having had anychildren, she concluded to see a noted specialist of femalediseases. By this physician she was told that her sterility was owing to a closure or contraction of the mouth of the womb. This was obviously a wrong diagnosis, and for these reasons: she had always menstruated regularly and without pain, which excludes a constriction ; and, secondly,, no physician can honestly call a woman sterile until h& has examined her husband, who, in the majority of instances, is the cause of his wife's sterility, because it is hewho is sterile. This woman and the doctor agreed, however, on a course of treatment, which was to forcibly open, or stretch the mouth and cervical canal of the womb. Thisby itself is neither a dangerous nor a severe operation, if carefully performed, but care in this case was evidently not exercised, because the young woman was taken with severe inflammation, which caused a pelvic abscess.

I found her after two months of suffering. The discharge had become extremely offensive, her body emaciated, and her strength exhausted.

I enlarged the opening of the abscess, placed a largedrainage tube in the cavity, through which it was washed out,, by means of an antiseptic solution of bichloride of mercnry, 1 part to 2,000 parts of water, and, by further giving her simple, nutritious food, she improved rapidly, so that the day before I left the city she was at my office, and told mo that she felt as well as ever, although not thorough^ recovered. I was absent two weeks, and a few days after nry return I incidentally met her husband, who told me that sl week after I had left, his wife felt unwell and called in one of her former doctors, who, by the way, rides a hobbyhorse on surgery. This man found a few pimples on her body, which can be found on almost any healthy person, these, he said, were signs of blood poisoning from her abscess, and that an operation to extirpate the abscess, with one or both of her ovaries, was of urgent necessity to save her life from blood poisoning. The deceived woman was of course frightened into giving her consent to the operation, which was undertaken immediately, and, as luck would have it, she recovered; but she might have easily died, which she undoubtedly would have done had this knifeman got her sooner, or before I had restored to her a splendid physical condition, which withstood the unnecessary butchery to which she was induced to submit.

Some doctors seem to have a perfect mania for cutting operations, just as though the entire science and art of medicine were exhausted in surgery alone. To assume this for an instant is manifestly ridiculous. More lives are annually saved by a scientific application of other methods of cure than the most elaborate and brilliant statistics of surgery can approach. There is science and skill in selecting proper medicines, in the employment of hygiene or the Tules of health, in the practice of obstetrics, and in a variety of other ways to demonstrate the triumphs of the art of healing.

The rash and unnecessary resort to the knife has brought surgery into general distrust, so that some patients would rather die, or wait until they are almost dead, before they allow an operation to be performed on them, in cases where surgery is, indeed, the only possible method of cure.

A lady recently called at my office for a consultation. I found her uterus and other pelvic organs in a perfectly healthy condition, although she suffered pain there. This was due to neuralgia from a generally exhausted and debilitated condition. I was not a little surprised to learn, from her own lips, that she had been treated for womb disease, and was about to undergo an operation for a tear hx the mouth of her womb. This was manifestly absurd, because no laceration existed at all, and if there had it might not have been necessary, because it is quite natural for women who have borne children to have the scars of old lacerations on the mouths of their wombs, and they are not any the worse for them.

It is important for mothers to know something about themselves and of the common diseases to which they areliable, for then they will not be so easily persuaded to permit the use of caustics, or the cutting, stitching, or scrapingof their wombs, which is quite likely to excite complicated inflammations, more serious in their results than the diseases for which these operations were performed. I know of what I write, and there is no one who can successfully deny it.

Dr. William Goodell, who stands as high in the department of diseases of women as any American, had an article in one of the medical journals on "The Abuses of Uterine Treatment." He says: " From a large experience I humbly offer to the reader the following watchwords as broad helpsto diagnosis: 1. Always bear in mind what another haspithily said, that ' woman has some organs outside of the pelvis.' 2. Each neurotic case will usually have a tale of fret or grief, of cark and care, of wear and tear. 3. Scant or delayed or suppressed menstruation is far more frequently the result of nerve exhaustion than of uterine disease. 4_ Anteflexion of the womb, per se, is not a pathological condition. It is so when associated with sterility or painful menstruation, and only then does it need treatment. 5. An irritable bladder is more a nerve symptom than a uterine one. 6. In a large number of cases of supposed or actual uterine disease, which display marked gastric disturbance, if I the tongue be clean the essential disease will be found to be neurotic, and it must be treated so. 7. Almost every supposed uterine case, characterized by excess of ■ sensibility"

and by lack of will-power, is essentially a neurosis. 8. In the vast majority of cases in which the woman takes to her bed, and stays there indefinitely, from some supposed uterine lesion, she is bedridden from her brain and not from her womb. I will go further, and assert that this will be the rule even when the womb is displaced, or it is disordered by a lesion or disease, that is not in itself exacting or dangerous to life. Finally, uterine or womb symptoms are not always present in cases of uterine disease, nor, when present and even urgent, do they necessarily come from uterine disease, for they may be merely nerve counterfeits of uterine disease."

There is not a physician of any extended experience in the land who, if he be true to his better judgment, will not indorse every word of Professor Goodell's propositions. But the chances are they will never accomplish the good for which they were intended if the mothers, wives, and daughters are not permitted " a little peep " behind the curtain, and learn for themselves. For those who are wealthy and have plenty of money, doctoring may be a luxury or an amusement, but there the line must be drawn for the benefit of the deserving poor, with whom any treatment is a hardship. Stupidity of the masses is one of the causes of the abuse of surgical treatments, for they always look upon a surgical or bloody operation as one of the greatest achievements of modern medical art. Then there is the cupidity of the professional classes, who trade upon this popular error and delusion, and charge correspondingly large fees, which, as a rule, are exorbitant, particularly when the working classes are the sufferers.

A little cutting or stitching is much more quickly done, and the patient may be dismissed as cured, or left under the impression " that everything was done that could have been done," than a conservative medical or hygienic treatment, which involves more thought, labor, and patience, qualities which are not as eagerly cultivated as the art

HOME TREATMENT.

to wring out a good fee by a little surgery, with less labor and skill.

There is not only too much mischievous doctoring, but there is too much of every kind, whether good, bad, or indifferent. The trouble is there are too many in the ranks of the medical profession ; and this is not only true of this country, but is raising a cry of warning in Europe. The struggle for existence is a natural law, and nature is immutable. I do not mean to say, that it is a humane law, or that competition is a virtue; in fact, I believe quite the reverse. But much that is natural from a physical standpoint might not be so from a moral or spiritual plane ; thus the two natures are distinct.

It is reasonable to suppose that, if the natural crop of diseases falls short of supplying the demands of those who hunger for an opportunity to treat disease, and it lies within their power to create disease, they will certainly do so. The deficiency must be supplied, or one of two things must be done by the doctor: he must either starve, or go to work at something else. This may be cruel logic, but I know that these are the actual facts.

Now let me ask how many persons who have some sort of a diploma will be self-sacrificing enough or sufficiently unselfish to prefer to starve or honestly work for a living, if they can avoid either, by defrauding someone out of a fee , for pretending to cure some manufactured disease ? It seems almost a waste of time to argue such a self-evident proposition. I have known physicians of high standing who treated women for womb diseases which never had a real existence, and surgeons of large incomes to remove the female breast for a "supposed cancer;" and, that being the case, what would you expect from a less fortunate brother practitioner who is eking out a miserable existence ?

How many a case of simple sore throat or tonsilitis is being paraded as a case of diphtheria. Why, I know of doctors who built up their reputations in that way. It is

<jiiitc an easy matter, to call an ordinary, simple case of bronchitis, pneumonia. Harmless swellings, no matter of what sort, are treated and palmed off every day as cancers. The quack cancer doctor is almost ubiquitous. Some would much rather part with the village parson, or their regular old town doctor, than to part with the cancer doctor. Diseases that are conjured up in the minds of susceptible or hypochondriac persons have for them a real existence, because if a person believes he has a certain disease, it becomes a reality, as far as his own state of mind is concerned, and as far as the treatment is concerned to him who created the delusion, it is much more desirable than if the disease were real, because you can cure an imaginary disease, which may be impossible when a real one comes under treatment. This is another method of making a reputation for extraordinary cures that really never occurred.

When I contemplated writing a book, which I hoped to make a vade mecum for those who felt interested in the subject, I felt that it would be a duty which I should reluctantly perform, for it would be a criticism on the status of the medical profession of this country. I was convinced that whatever I said that would lower the tone of the profession in the estimation of my countrymen would naturally reflect on me as unfavorably as upon any other member, for I never claimed to be anything else but an American physician, and, as such, I have an ambition to elevate the rank and file to honor and respectability.

There is also a motive that underlies a work of this nature which should appear justifiable to the author. It is absolutely necessary that side-lights should be thrown into dark corners and recesses that are usually screened from public notice. If there is a growing deterioration in methods of proficiency and morals, the public should know it, for who is the greater villain, he who trifles with human life through officious ignorance and venturous operations, or the midnight assassin, who, under cover of darkness, waylays his unwary victim? The title "doctor," from the Latin. doceo, " I teach/' has a halo of learning that it derives from the original significance that was attached to it when it was first sanctioned at Bologna University, about the middle of the twelfth century, where it first passed into the faculty of divinity. It was afterwards introduced into the universities of Northern Europe, and remained ever since a degree of distinction in theology, law, philosophy, and medicine. In the German universities doctor implies also a license to teach within the university, as a privat-docent.

When we now consider that no person can matriculate in a German university who has not graduated from the gymnasium or high school, it is clear that, under the above conditions, the title " doctor " guarantees that the possessor is an educated person, not only of the high school, but added thereto is the accomplishment in the specialty of which he holds the doctor degree.

What may a "doctor degree" mean in this country? The title of an illiterate and utterly incompetent person, who was by natural environment and occupation a teamster, saloon keeper, barber, tailor, or patent-medicine vender, etc.

If a woman, she may be retraced to an ignorant nurse, midwife, or quacksalver, the conceited wife of a man who indulges her in the freak of " learning to be a doctor," for she had demonstrated her genius for the profession by successfully treating a case of measles, which started the doctor's bee a-buzzing in her bonnet, until she passed through a medical college; last, but not least, are the winsome daughters of the millionaire or successful business man, who imagine themselves too smart to make useful housewives and good mothers.

There is not a medical college in this State, and there are few, if any, in the United States, that would not eagerly take in all of this material, and guarantee to them beforehand, that they can graduate as medicinsc doctor in twelve months to three years, a five months' course being considered a year.

The above comparison is a disgraceful commentary on the degree of doctor in this country, and the public should learn to know the difference.

" The United States and Its Doctors " is the title of an editorial in the July number of the New York Medical Record, and it says : " There is certainly no more curious social phenomenon than that of the extraordinary popularity of the medical profession in this country as a means of securing a livelihood.

" This subject is one that is often dwelt upon, but we doubt if many even yet realize the grotesque misproportion which medicine in the United States holds to other breadwinning occupations. Here are some of the naked facts in the matter : —

"France has 38,000,000 of population, 11,995 doctors, while it graduates 624 medical students in one year. Germany has 45,000,000 of population, about 30,000 doctors, and graduates 935 students in one year. The United States has about 60,000,000 of population, 100,000 doctors, 13,- 091 medical students, and graduates 3,740 students in one year.

" Germany, which has relatively less than half as many doctors as America, is already groaning over its surplus. When one compares France with this country, the excess of medical men here seems most astonishing.

"A comparison of the United States with Europeon countries, in whatever way it is made, leads one to think that there is something almost alarming in our medical productiveness."

In connection with the above comparison, in which it is shown that Germany has proportionately less than half as many doctors, as the United States, it will be interesting to learn the views of the German profession. The Berlin correspondent of the Medical Press writes that the " Deutcher iErztebund," Society of German physicians, felt it to be their duty to warn the guardians of young men studying in the gymnasiums or high schools, against entering the medical profession, the state of overcrowding being so great as to insure disastrous consequences. In glancing over the above figures, there is one very important point which is greatly in favor of the German profession and militates against the Americans. It is the enormous patent-medicine trade and quacking that is done through it in the United States ; on the whole, this has been calculated to amount to at least fifty per cent of all the doctoring that is done ; that means, that where one hundred doctors now practice for a living, fifty more could make a similar living, were it not for the patent and quack medicine trade, which, in some of the German States, is almost prohibited, and in others I know it is entirely inhibited.

When the Society of German physicians warns the German people that an overcrowding " insures disastrous consequences," what does it mean ?

This is a question which, we presume, was answered in Germany, and it is certainly worth our while that we should answer it here, and in this we have decidedly the advantage, because in that country the answer was entirely based upon what was anticipated, while in this we can answer from what we have already realized, namely, disastrous consequences to honor and to integrity on the one side, and to health and security against imposition on the other. To this I have already referred. Everyone competent of judging, and who has lived in that country, knows from study and observation that the arrangements and conveniences there for treating the sick are in a much higher state of perfection than with us. Hospitals and physicians are as accessible to all classes as the most humane and philanthropic heart can desire, and now we learn that if this wholesome state of affairs shall continue with less than half the proportion of doctors that we have here, there must be no further increase of physicians, or it would insure disaster. This statement and warning a close and careful observer clearly appreciates. The writer was personally acquainted with a large number of German practitioners while in that country, and knows as an actual fact that while their fees were and are much smaller than anything ever paid in this country, they had not overmuch to do, and were only leisurely employed. This applies to some of the greatest and world-renowned medical professors, as well as to the ordinary general practitioners.