Affections of the Female Reproductorium

Definition: Expulsion of a fetus before it is viable, that is before it is able to live or liable to live. It is termed accidental or spontaneous when it occurs from accident, and induced when brought on purposely.

Symptoms: Hemorrhage and pain (“bearing down pains”) are the chief or only symptoms. Hemorrhage is likely to develop suddenly in ordinary health with no previous symptoms of any kind. If the hemorrhage is profuse and accompanied with pain, and the pain subsides, to be followed by slow and irregular bleeding, it is safe to diagnose incomplete abortion.
If the subject develops periodic hemorrhages, these occurring monthly, or every two or three months, with a profuse flow lasting ten days to two weeks, and accompanied with more or less discomfort, not amounting to pain, and there is a history of two or three miscarriages at from the third to fourth month, it is safe to diagnose chronic auto-abortion — the abortion habit.
Such cases will often abort fifteen to forty times in the course of five to seven years, each conception being followed in a short time by expulsion with hemorrhage. The greatest number of such abortions any of our patients have suffered has been twenty-eight.

Etiology: An abortion may be brought on by overwork, strain, fright, sexual overindulgence, and by a greatly weakened or devitalized body. Death of the fetus usually precedes abortion.

Care of the Patient: Rest in bed, with the feet slightly elevated and no food but water so long as there is hemorrhage are all the measures we have employed. In incomplete abortion it is generally thought to be necessary to curet the womb. If this is done a skilled surgeon should be employed for the work.
The abortion habit is followed by normal pregnancies and birth of children at full term when good health is restored. These cases respond very favorably to physical, physiological and sexual rest, followed by a proper diet, exercise and other means of building good health.

ATRESIA

Definition: This is occlusion (imperforation) of the vagina.

Symptoms: Suppression or retention of menses, painful menstruation and sterility are the regular symptoms.

Etiology: Acrid leucorrhea causes contraction of the tissues and destruction of their elasticity. A hardened condition, not unlike that seen in the arteries in arteriosclerosis, develops. Starch in-digestion (fermentation) causing a general acidity of the body is the most likely cause of acrid leucorrhea. Stricture of the urethra seen in a few of these cases shows that the urine is also very acid.

Care of the Patient: It is doubtful if complete restoration of normal elasticity can ever be restored to these tissues. The inelasticity is slow in developing and hard to overcome.
The mouth of the vagina should be gently and frequently dilated. Great care must be exercised as these tissues will tear but will not stretch. Extreme cleanliness is essential. Fasting to remove acidity and clean up the catarrh and a proper diet thereafter are essential.

CANCER OF THE UTERUS

Cancers of the womb, usually of the cervix are all too common. They develop most commonly about the menopause and result from chronic inflammation of the neck and mouth of the womb growing out of errors of life.

Symptoms: Hemorrhage, pain and discharge are the most pronounced symptoms of uterine cancer, but care must be made in diagnosing cancer from these symptoms, as they are present in other conditions.

Etiology: The overweight (“well nourished”) are most likely to develop cancer. Shock, grief, quick temper, irritableness and jealousy predispose the toxemic to develop cancer. Childlessness and one-child celibacy also predispose. No doubt the wide-spread use of irritating chemicals as contraceptives is partly responsible for much of the recent increase in female cancer of all locations.
Cancer of the neck of the womb (cervix) is almost always preceded by years of inflammation — acute, subacute or chronic — often not great enough to attract attention. Usually there is a history of leucorrhea, often slight, and in other cases there has been marked affections of the uterus which have been treated in the usual ineffectual manner; or, lacerations at childbirth, though “repaired,” have not fully healed.
Back of all chronic and subacute inflammation is toxemia resulting from careless and haphazard living. There will be indigestion, gas, foul stools and other evidences of impaired function for years before cancer develops.

Care of the Patient: See Cancer in this volume.

HOODED CLITORIS

Definition: This is a condition caused by a small fold of mucous tissue surrounding the clitoris, often referred to as a foreskin or pre-puce. When it is too tight or too long, the pent-up secretions become sources of irritation and this results in nervous irritability, excessive sexual stimulation and masturbation in girls.

LEUCORRHEA (Whites)

Definition: This is a whitish viscous discharge from the vagina and uterine cavity — a catarrhal discharge. It indicates an inflammatory state of the mucous membrane of the neck or body of the womb or both.

Symptoms: The name “Whites” is somewhat erroneous, since the disc is sometimes yellow or greenish-yellow. If the discharge is thin or watery, or thick and cream-like, we may be quite certain it is from the vagina. If it is ropy, gluey or albuminous like the white of an egg, the discharge probably comes from the neck of the womb or from the womb. If pus is present this denotes suppuration. A profuse discharge indicates that a large surface is involved; a slight discharge indicates only the neck of the womb is involved. The intensity of the constitutional impairment has much to do with the amount of the discharge.

Etiology: When occurring in young, unmarried women it is the result of an exaggerated hyperemia of the reproductive organs resulting from overstimulation. The emotional natures of such young people have been fed by a morbid mind; their reading has been of an erotic nature; their company has been unfitted for them; there has been much petting, often precocious sex development has resulted from over-stimulating foods and drinks and salacious suggestions. All this results in an excess of blood being sent to the reproductive organs so that they are engorged. Often the engorgement is great enough and the mucous membrane is so thickened and the submucous tissues are so engorged that the neck of the uterus is closed and the menstrual flow cannot pass without pain.
The continuous engorgement of the parts and the menstrual-flow exaggeration, added to systemic toxemia, soon develop catarrhal inflammation and, unless the causes are removed, the engorgement will continue and the inflammation will be followed by ulceration.
Leucorrhea is not unlike catarrh of the nose and throat and other mucous tissues of the body and is caused by the same blood and flesh condition that is back of catarrh anywhere else in the body, plus the localizing causes mentioned above. The more imperfect the systemic elimination, the more discharge there will be from the uterus, unless other mucous surfaces are also requisitioned to do vicarious duty. On this stick is grafted all the so-called “diseases” of women treated by gynecologists.

Care of the Patient: Since without infection, it is impossible to establish a local affection unless there is a constitutional derangement of toxemia and enervation, care must be directed to the removal of the constitutional impairment. In other words, the habits of life must be corrected — every mental and physical habit that has helped to produce enervation and imperfect elimination must be given up. Fasting and rest will remove toxemia and restore nerve energy, but only a correction of the mode of living can be depended on to prevent rebuilding the catarrhal condition.

MENOPAUSE (Climacteric)

Definition: This is the “change of life” through which the female passes at the end of her child-bearing period. It seems to be peculiar to the human female.

Symptoms: The cessation of menstruation and slow atrophy of the breasts are the only normal symptoms. The vaginal mucosa returns to the thin, ill-developed structure of childhood and the secretions are no longer acid.
It is a great bogy in the lives of women, somewhat like teething in children. Practically all the suffering of women between the ages of thirty-five to fifty are attributed to the change.
If a woman is sick or in poor health between the ages of thirty-five and fifty only inexcusable ignorance will consider “change of life” as the cause of her ill-health. The enlightened doctor will look for the cause of her sickness and remove it.

Etiology: The “change” is due to the normal cessation of certain functions of the ovaries and to changes in these.
Hot-flashes and other nervous symptoms, high or low blood pressure, mental symptoms, etc., commonly blamed on the change are of toxic origin, the toxemia resulting from enervation growing out of youthful imprudences, wrong food, etc.

Care of the Patient: To correct all devitalizing habits and build good health will remove the symptoms of ill-health. The “change” per se is not pathological and nothing can be done for it.

METRITIS

Definition: This is inflammation of the womb. If confined to the lining membrane of the womb it is called endometritis; if limited to the neck it is called endocervicitis. It is all one and the same affection.

Symptoms: An acute inflammation of the womb may be attended by chilliness followed by fever. Faintness, nausea and vomiting are frequent. There is a sense of heat and uneasiness in the pelvic region, with sharp pains in the lower back and in the right or left groin, per-haps darting down the thighs. Coughing or pressure upon the pelvis greatly increases the pain. The womb is exceedingly tender and enlarged, the vagina is hot and sensitive, there is leucorrhea, painful menstruation and often uterine hemorrhage. There is constant headache, constant desire to urinate and painful evacuations.
Cervicitis may go on to ulceration of the cervix. There is much nervous irritation, painful, often profuse, menstruation, general irritability and disturbances throughout the system.

Chronic Inflammation of the Womb is more common than acute metritis, though it often follows an acute crisis. It is most common in married women and first makes it presence felt by pain during intercourse. Later there develops a dull pain in the lower part of the abdomen, a bearing down sensation, discomfort in defecation and urination and a mucus discharge.

Etiology: Primarily there is always the same constitutional impairment serving as the basic cause for all chronic pelvic inflammations. Primarily this is a catarrhal condition. Cases follow tears at childbirth, abortion and injury from treatment. Tears will heal if the blood is as it should be. Lasciviousness and frequently repressed sexual excitement may predispose.

Care of the Patient: In acute metritis, physical and physiological rest until complete comfort returns is essential. Fasting and rest in bed are also helpful in chronic metritis. In all cases the whole life must be reordered to overcome enervation and prevent the redevelopment of toxemia.

METRORRHEA

Definition: This is a hemorrhage from the uterus usually occurring between the menstrual periods.

Symptoms: Bleeding and pain may be the only symptoms. Often there are symptoms characteristic of cancer, tumors, ulcer, etc.

Etiology: Where fibroid tumor or cancer can be eliminated as “cause,” uterine hemorrhage comes from abortion. If it develops suddenly in ordinary health, with no previous symptoms of any kind, it is safe to say, abortion. If a profuse hemorrhage is accompanied with pain and the pain subsides, to be followed by a slow and irregular bleeding, incomplete abortion may be diagnosed. In a few cases a tear in the neck of the uterus or an ulcer may result in bleeding.

Care of the Patient: Care for as directed under abortion, tumor, cancer, ulcer, etc.

NYMPHOMANIA

Definition: A. morbid and seemingly irresistible sexual desire, the excitement of the sexual organs so dominating the thoughts and feelings of the individual that her conduct toward the males she meets is openly forward despite her better judgment.

Symptoms: Overpowering desire which is more or less constant, frequent repetition of the sex act, and evidences of nervous instability are present. In one case known to us the young woman did not permit her husband to sleep at night and sought other male companions during the day.

Etiology: Inflammation or irritation of the vulva or internal parts of the sex organs or nervous affections give rise to inordinate and uncontrollable desires. Menorrhagia may lead to this trouble. Such unfortunate girls are pronounced degenerates and incorrigibles and treated accordingly. Few parents recognize the conduct of such daughters as due to pathology, but believe their conduct is due to viciousness.

Care of the Patient: A slight irritation of the reproductive organs that becomes the exciting cause of nymphomania cannot be remedied by abuse of the girl. If the habit has been established for any time, will is lost and the girl lacks power to do anything except “gratify” her “wants.” Operations are often resorted to in these cases. They do no good, but deteriorate the will and the body.
To remove the causes of the irritation and restore the girl to good health and help her regain her control over her body will overcome the nymphomania. Unless the neurotic stress is relieved by removing its cause, no recovery is possible.

OVARITIS (Oophoritis)

Definition: This is inflammation of the ovaries and may be either acute or chronic.

Symptoms: The first and most important symptom of acute ovaritis is pain to the right or left of the womb, with a sense of heat, the pain being greatly increased upon pressure, or exertion. The pain, sometimes intermittent, sometimes constant, is of a dull dragging nature. There may be nausea and vomiting with a rise in temperature and rapid pulse. The ovaries become enlarged and hardened and may suppurate (ovarian abscess). If the inflammation is in the right ovary the condition may be mistaken for acute appendicitis.
In chronic ovaritis the pain is more severe before the menstrual period, though it is usually relieved by a free flow. Standing erect or straightening the thigh may greatly increase the pain.
We would caution the reader against the habit of diagnosing every pain in the right or left pelvis as ovarian “disease.” There is a lot of carelessness and ignorance displayed in diagnosing and treating affections of women and it has become a professional bad habit to find ovarian “disease” where there is none. The ovaries are so situated and protected from injury that we doubt that they are affected once in a hundred times when they are said to be.

Etiology: Acute ovaritis is said often to result from gonorrheal infection. If so, this would indicate that the infection has been forced up into the ovaries by maltreatment. It never develops in hygienically treated cases. “Blood-poisoning” after childbirth is also held responsible. Puerperal sepsis results only in mal-treated cases.
Inflammation may arise in overfed, debilitated and toxic subjects. During menstruation the pelvic congestion amounts almost to inflammation. It is thought that sexual excesses and alcohol may produce it. We doubt that it ever results from roughness in coition.
Sexual excitement from petting, lasciviousness, reading erotic novels, voluptuous self-indulgence, overeating, eating stimulating foods, etc., tend to produce chronic inflammation of the ovaries in toxemic subjects. It may also follow acute inflammation of the ovaries.

Care of the Patient: In acute ovaritis an absolute fast is essential. No food but water should pass the lips until full comfort has returned. Rest in bed is fully as important. If pain is very severe a hot pack may be placed over the pelvis.
In chronic ovaritis, rest and fasting are beneficial. Strict continence and avoidance of all sources of erotic stimulation are essential.
In both conditions a complete correction of the whole mode of living is necessary.

PIN-MOUTH WOMB

Definition: This is an unusually small mouth of the womb — either internal or external.

Symptoms: These girls are exceedingly nervous and are said to be neurasthenic, a word as meaningless as “biliousness,” “hysteria” and “hypochondria.” They have much pain in the region of the ovaries, are anemic, dysemic or chlorotic, and always dyspeptic. With rare exceptions they are undernourished, not from lack of food, but from failure of nutrition. The young girls are often troubled with acne of the face, especially around the menstrual periods and more or less pain is experienced in the region of the ovaries during menstruation. If they have no pain, there is always malaise, general excitability, perhaps headache, nausea and a capricious appetite. All of these symptoms or only a few may be present in a given case. Many will appear to be in near health while others will be badly “run down.”

Etiology: The small mouth may be congenital or a result of delayed or arrested development. Imperfect drainage with retention of menstrual and other secretions result and these decompose causing systemic infection when absorbed.

Care of the Patient: Months of care are often required to bring a pronounced case back to full health, but all such cases can recover health if they can be induced to follow instructions long enough for their bodies to undergo a complete physiological readjustment. Radical operations for the removal of the womb or ovaries are crimes in these cases. Dilatation of the neck of the womb may be essential in a few cases, but most cases will get well by adopting a general health-building regimen and sticking to it.

PRURITIS

This is itching and is treated under Affections of the Skin. Intense itching of the external genitals, often accompanied with vulvitis is often seen.

SALPINGITIS

Definition: This is inflammation of the fallopian tubes. It is not an uncommon condition. It may be acute or chronic.

Symptoms: Acute salpingitis may be a very serious affection, especially in its purulent form, causing violent illness. The tubes become swollen, tender and very painful, and the sufferer is forced to take to her bed. The temperature rises, the pulse is rapid, the abdomen is bloated and there is frequent urination. There are marked restlessness and weakness.
If pus forms, and this often happens, we have pyosalpinx or pus-tube. In this case both ends of the tube close up and it becomes distended with its contents, perhaps swelling to alarming proportions for instance, to the size of a child’s head, while the pus can find no outlet. If the pus is discharged internally into the abdomen a fatal peritonitis develops.
Chronic salpingitis is of a catarrhal nature and is marked by pain, which, though it may vary in intensity, is almost constant and is increased by exertion, coition and defecation. The pain is usually intense during menstruation and for a few days before. The menstrual flow is usually profuse and of uncommon duration.
If the inflammation results in closing up, by adhesions, of both tubes, sterility is the result.

Etiology: The mucous membrane lining the tubes is continuous with that of the inner lining of the womb which is, in turn, continuous with that of the vagina. Inflammation of the vagina or womb may extend from these to the tubes and through these even to the ovaries and peritoneum.
The more severe forms of salpingitis result from gonorrhea or from puerperal sepsis following childbirth, or it may be an extension of metritis following abortion. It can develop only in enervated and toxemic subjects — those of low resistance.
Chronic salpingitis results from the extension of catarrh from the womb and is due to the ordinary causes of catarrh.

Care of the Patient: Physical and physiological rest is imperative in the acute stage and helpful in the chronic form. Indeed these are all that are needed during the acute state unless the tubes become pent-up and fail to drain when surgical drainage may be necessary. We have had drainage to occur and complete recovery to follow during a fast in cases that have been told that only an operation can save life. However, if drainage does not occur, the surgeon will be necessary.
Tilden says: “It is doubtful if any form of pelvic abscess will end in death if left entirely alone. The danger in all abdominal and pelvic abscesses is medical and surgical interference. Rough examinations complicate by breaking the pus sac and forcing an extension of the disease into territory that nature has protected by walls of adhesions. Operations following such examinations always show how very necessary the operations were; but if the surgeon’s fingers had not been forced through the abscess walls, rupture would not have taken place. If left alone and not interfered with, in due time the pus would have found a safe exit.”
Pelvic and abdominal operations outrage one of the most important surgical principles, namely: “always open an abscess at a point where drainage will be perfect.” Opening the abdomen in salpingitis, pelvic abscess, appendicitis, etc., forces the surgeon to secure drainage against gravitation. If left alone, ovarian, tubal, cellular and appendicular abscesses tend to open in the line of least resistance and secure drainage with, not against, gravity. Pelvic abscesses will open and drain through the womb, vagina, or rectum if permitted. If rough handling and bimanual examinations cause the pus to find its way into the bladder or the peritoneal cavity the results are chargeable to “medical science,” not to nature.

UTERINE FIBROID

Definition: This is a fibrous tumor of the uterus.

Symptoms: Three forms of uterine fibroid are described as follow:

Submucous fibroid develops inside the womb and is accompanied with hemorrhage. If located close to the neck it causes contractions of the uterus — “bearing down” pains. In the course of time this tumor will be forced out of the womb like polypi. If the tumor is located in the fundus it may grow to the size of a large orange with no other symptom than profuse hemorrhage.

Interstitial fibroid develops within the walls of the womb, but when it gets very large, its development will be more on the outside. Though there is less likelihood of hemorrhage in this than in tile preceding form, it may be accompanied by hemorrhages in its early stages.

Subperitoneal fibroid develops on the outside of the womb, under its peritoneal covering. Because it is not restrained by pressure and is not relieved by menorrhagia, this variety attains the greatest size. It may grow to such great size that it will cause discomfort from its weight and press on the bowels and bladder disturbing the functions of these.
Little or no pain accompanies fibroid tumors and most of the symptoms said to be caused by them are toxic symptoms and clear up when toxemia is removed.

Etiology: Tumors are built by irritation and chronic hyperemia. See chapter on Tumors.

Care of the Patient: Fasting will cause speedy autolysis of small tumors and a general health-building regimen will prevent their recurrence. We agree with Tilden that “surgery for the relief of fibroid tumor is the physician’s apology for not knowing how to treat the disease.”

UTERINE POLYPI

Definition: Small growths either mucoid or fibroid which develop in the womb and neck of the womb.

Symptoms: Profuse leucorrhea and hemorrhage, or too profuse menstruation are the usual symptoms. If large (size of all egg) they cause more or less “bearing down” pain.

Etiology: As in the nose and rectum, these growths develop out of long continued chronic catarrhal inflammation of the mucous lining of the womb or its neck. The inflammation grows out of toxemia and is chronic because toxemia is chronic.

Care of the Patient: When long enough to protrude from the mouth of the womb they may be twisted or cut away, a simple operation that causes no pain and inconvenience and does not require going to the hospital. But it should be recognized that this removal will be followed by more growths if cause is not removed.
Uterine polypi may be absorbed by fasting and will not recur thereafter if the patient does not return to her former faulty living.
Many physicians make a big fuss over these growths and tell their patients they must go to the hospital. The needless fear and worry thus created enervates, producing nervousness, high pulse and other troubles. Worry and fear kill by overcoming resistance and inhibiting blood-making.

VAGINITIS

Definition: This is a catarrhal inflammation of the vagina.

Symptoms: A feeling of heat and fullness is accompanied by pain in the vagina and uterus, a dragging feeling, in the loin, and leucorrhea ranging all the way from a thin watering to a thick catarrhal or whitish-of-egg-like discharge. If the latter, it indicates inflammation of the neck or body of the womb, or both. When the leucorrhea becomes purulent, the discharge is yellowish, or brownish, or bloody.

Etiology: Physical uncleanliness stands at the top as a cause of affections of women. Careless eating, bathing, and clothing, coupled with overworked emotions, lasciviousness, and sexual excitement from any cause evolve a state of the blood and nervous systems that makes the development of local inflammation easy. Resistance is low so that injuries at childbirth, abortion, etc., inflame and ulcerate instead of healing in a normal manner. Vaginitis is frequently developed in the eruptive “diseases,” from the same toxemic cause,

Care of the Patient: Local cleanliness is most important. We do not favor the use of douches, however. Fasting and rest result in speedy decline of the inflammation and cessation of the discharge by relieving the body of its toxic overload. Thereafter a hygienic plan of living will maintain health.

VAGINISMUS

Definition: This is painful spasm of the vagina seen chiefly in intercourse.

Symptoms: There is tightness (spasm) of the vaginal orifice, pain and conscious or subconscious tensing of the thighs and buttocks when intercourse is attempted.

Etiology: A few cases are due to inflammation of the local parts; hyperesthesia of the vulva. Most cases are due to fear of pain or fear of intercourse. No normal woman who desires coition will experience this spasm.

Care of the Patient: If there is inflammation, local cleanliness and toxic elimination will soon remedy this. If the spasm is due to emotional causes, fear, dread and resentment must be overcome.

AMENORRHEA

Definition: This is absence of menstruation. Two forms are recognized as follow:

Primary: in those cases in which it has never appeared. Many of these women enjoy excellent health, rear a family of children and live long, useful lives.

Secondary: in those cases in which it has been established and is later absent or suppressed.

Etiology: Primary amenorrhea may be said to result from two causes — namely: (1) imperfect or arrested development, as evidenced by failure of the breasts to develop, lack of normal fullness and roundness of the body, and in a few cases, absence of ovaries and womb, or even of the vagina; (2) such excellent health and superior tone of the tissues that no blood is lost. Secondary (retained or suppressed) amenorrhea is seen in advanced tuberculosis, marked anemia, certain nervous and mental states in which cases there is also a failure of ovulation, and in spasm or obstruction of the Cervix. If the decline in health is accompanied by distressing symptoms each month when the flow is expected this is called suppression.
Tilden says of this: “when menstruation ceases, and pregnancy or advanced tuberculosis can be eliminated as a cause, no special concern should be attached; but when tuberculosis is present, amenorrhea indicates conservatism, and that the body needs building; but this symptom per se should receive little attention. If this symptom occurs in other chronic wasting disease, the health impairment, whatever it is, must be corrected; when the health appears normal no treatment is necessary. To attempt to establish the menstrual flow is not wise. All that should be done should be in line with establishing a better general state of health.”

DYSMENORRHEA

Definition: This is painful or difficult menstruation.

Symptoms: Two-thirds to three-fourths of girls suffer more or less. The average menstrual period lasts four to five days and the amount of pain suffered ranges all the way from slight discomfort to complete disability during this period. The nature of the pain varies with different women. Those of nervous tendencies are likely to suffer keenly, the pain often being of a neuralgic character. Others complain of cramps. If there is much inflammation the pain may centralize in the back. A rare form of painful menstruation called membranous dysmenorrhea is characterized by contractions not unlike “labor pains,” the expulsive efforts throwing off shreds of membrane. The bearing-down pains may last three or four days and may be mistaken for a miscarriage.

Etiology: Normal function is painless or pleasurable, never uncomfortable or distressing. No pain should accompany the ovulation cycle at any stage in females. Painful menstruation means chronic toxemia and its resulting chronic catarrh. In such girls the normally increased flow of blood to the sex organs at this time is so intensified that it amounts to congestion. Out of these monthly congestions, inflammation develops, giving rise to leucorrhea and painful menstruation. The leucorrhea appears a day or two before menstruation and lasts for a few days after. The pain results from the overengorged or congested state of the ovaries and mucous membrane of the womb. The mucous membrane, the submucous tissues and muscular structure of the womb gradually become thickened, infiltrated and hardened and the caliber of the canal of the neck of the womb is lessened. Wrong feeding and wrong care of the body is back of the toxic and catarrhal state that produce this condition.

IRREGULAR MENSTRUATION

Only about half of our girls menstruate regularly. A third menstruate every twenty-five to twenty-eight days, the remaining fifth either do not menstruate or menstruate every forty to sixty days, a few of them every two weeks and an occasional one, once or twice a year.

MENORRHAGIA

Definition: This is excessive flow — flooding — at menstruation, or prolonged menstruation.

Symptoms: The characteristic symptom is the excessive loss of blood, sometimes amounting to hemorrhage, and the prolonged flow, lasting from seven or eight days to two weeks. Indeed we occasionally meet with a case that flows from one period to the next. These girls have quick pulse, and often a tumultuous heart palpitation. They are nervous, irritable and hard to control. They are easily excited and easily turn against their parents who do not understand the source of their nervous storms.
Anemia frequently results from the loss of blood. Pains in the back, headache, acne, especially of the face, and weakness are common symptoms.

Etiology: Sex neurosis growing out of overstimulation of the sex function by overeating, eating stimulating foods, erotic imaginings and lack of exercise are the chief causes. Overstimulating foods produce violent emotions and sexual excitement. When eating and thinking are of a character to produce irritation and engorgement or congestion of the reproductive organs, this high state of irritation and blood pressure not only produces uncontrollable desire, but a hyper-sensitive state of the reproductive organs and necessitates loss of blood to relieve the engorged organs. If the blood is not lost the girl is likely to become the victim of some man or else the hyperemia will be organized into fibroid growths.

VICARIOUS MENSTRUATION

Definition: This is a term applied to bleeding from the nose, stomach, bowels, arm pits, nipples, or other organs at menstruation time, without, perhaps any flow from the vagina.
It is our view that it is not vicarious menstruation at all, but a loss of blood through greatly weakened tissue due to the marked rise in blood pressure at this time.
At any rate, when good health is restored the so-called vicarious menstruation ceases.

Care of the Patient: When we recognize all menstrual “disorders” as symptoms of constitutional impairment, correct care suggests itself. Correct the general health is the real remedy. To give drugs to relieve pain; to attempt to force menstruation; to scrape the uterus or to operate is unnecessary, inexcusable and harmful, and not successful.
The effects of overeating, eating overstimulating foods, of violent emotions and sexual excitement, of lack of exercise and of a generally health-impairing mode of life are not to be overcome until these causes are corrected. All bad habits of mind and body must be corrected. A program of right living will do the rest.
If anemia, catarrh, indigestion, or other pathology is present, mental, physical and physiological rest will help these women back to health.

ABSCESS OF THE BREAST

Abscess in the breast sometimes results from injuries — blows, pressure, etc. — but generally it is the consequence of bad management or mal-treatment during the periods of gestation, childbirth and nursing.

Symptoms: it commonly develops in four or five weeks after parturition; suppuration follows in about ten days more, often begin-fling in several distinct parts and forming many separate sinuses, all of which, however, communicate. It opens at one or several points.

Etiology: Trail writes: “This distressing affection is a standing disgrace to the doctor, the nurse, the patient, and all parties concerned. It is produced by the most foolish stuffing, and slopping, and stimulating, and heating and drugging.”

Care of the Patient: Rest — physical, physiological and mental —until the inflammation and pain have subsided and the abscess has drained, followed by a fruit and vegetable diet and good general hygiene constitute all the care needed except local cleanliness.

CANCER OF THE BREAST

As elsewhere, this is an end-point in a pathological evolution with simple beginnings. It starts as a lump, usually painless and in the majority of cases develops in women past forty. Occasionally it is seen in earlier years. It can best be felt by pressing the breast flat upon the ribs with the palm of the hand. These growths often grow outside and become large, ugly, suppurating fungoid masses.
No woman should allow the discovery of a lump in her breast to frighten her as but few lumps are cancerous. Dr. Richard C. Cabot says: “Many non-cancerous lumps in younger women are now removed by surgeons, because the best-informed opinion holds that about ten per cent of them later become cancerous.” They need never become cancerous and they need not be removed. It is wiser to remove their causes.
When enlarged glands, and indurations of any kind in the breast are not removed by correcting the general health and the local affections that furnish reflex irritations; but bad habits of living are continued until nerve energy is much reduced and elimination fails to such an extent that nutrition is brought to a low ebb, then any induration of tissue or gland in the breasts may become malignant. If deranging habits of body and mind are discontinued before cancer develops, there is no danger of it developing.
Lumps in the breasts with which so many women are troubled, if they remain enlarged, are certain evidence of ovarian and uterine impairment. We do not mean that there are necessarily any organic changes in these organs, but a hypersensitive condition, due to the causes of catarrh and inflammation. There exists a close relationship between the breasts and the reproductive organs and for this reason ovarian and uterine affections must be carefully studied in all affections of the breasts.

Care of the Patient: Prevention is the only safe and sure cure for cancer of any part of the body. Cure of cancer of the breast is doubtful in all save a few cases, for the same conditions are to be met here that are met and corrected in cancer elsewhere in the body. When removal of the breast is not followed by a return of the growth, it is safe to conclude that it was not cancer. See chapter on Cancer in this volume.

DELAYED DEVELOPMENT OF THE BREASTS

In many young women there is very little development of the mammary glands. This delayed development is supposed to represent retarded puberty. Marriage and childbearing usually result in full development of the breasts in these cases.

LUMPS IN THE BREASTS

These are commonly scare-headed into cancer. They belong to a syndrome. These glandular enlargements are secondary to inflammation or sepsis of the womb. The womb inflammation is part of a general systemic impairment. It is quite common for the breasts to be sensitive during menstruation. Many women complain of swelling and tenderness during this period, with sometimes a feverish state of the breasts.

Etiology: Inflammation of the breasts develops in toxemic mothers largely as a result of puerperal sepsis. Injury to the breasts may account for a few cases. Injury will not result in suppuration if the mother is not toxemic.

Care of the Patient: Enlarged glands in the breast are due to impaired general health and reflex irritation from affections of the ovaries and womb and disappear when the general health is improved. It is very difficult to convince the victim of one operation that she does not need another. They are full of fear and they doubt the efficacy of anything save the knife.
Surgical removal of these lumps or of the whole breast is criminal. They will disappear not to recur when the general health is improved and drainage of the womb re-established. We have seen them as large as billiard balls disappear completely in three days. We have had many to disappear in a week to two weeks. Some of these had been diagnosed as cancer and removal advised. The rapidity with which they clear up during a fast disproves the diagnosis.

MASTITIS

Definition: This is inflammation of the mammary gland or breast. It occurs in five to six per cent of nursing women, is more common in blondes than in brunettes and develops more often after first than subsequent labors.

Symptoms: Acute. Heat, swelling, redness, local pains, increased temperature and pulse rate, and severe general disturbances indicate inflammation of the breast. It is seen chiefly in nursing mothers and commonly results in suppuration and abscess formation. As the pus accumulates the abscess tends to point on the surface and. drain through the skin.
Four forms are described as follow:

Subcutaneous Mastitis: This is the ordinary symptom of inflammation of connective tissue leading to ulcer or abscess. It is usually single.

Glandular (or parenchymatous) Mastitis: This is in the majority of cases a lymphangitis. It is characterized by more pain and more constitutional symptoms than the subcutaneous. It is ushered in by a chill, is often multiple and the gland is hardened.

Subglandular Mastitis (Paramastitis): In this form there is suppuration, persistently high temperature, deep-seated pain, the gland is not hardened and floats on the underlying fluid.
Two or all three of the above forms may co-exist.

Chronic Cystic Mastitis frequently follows the so-called painful breast, the pain being most intense just before and during menstruation. The pain and tenderness are usually in the upper and outer quadrant of the breast, where the tissue feels flat and of increased density. The formation of cysts follows long periods of intermittent irritation, pain and inflammation of the breasts. The increased connective tissue (adenosis) seen in “painful breasts” may grow to the point where it constitutes definite, small nodules or small, snotty masses, usually distributed at the periphery of one or both breasts. The usual end-condition, if allowed to continue, is multiple, small cysts, cysts which result from the cystic papilloma or non-encapsulated adenomatous area of the earlier lumps.
The increase of connective tissue tends to go on to complete fibrosis of the whole lump and the cessation of all secretory activity. If cause is cleared away in painful breasts or in early adenosis, no fibrosis occurs, and complete recovery follows.

Etiology: Poor general health — enervation and toxemia — plus infection, sometimes through the nipples, but more often from uterine sepsis or intestinal sepsis results in these conditions. Milk stasis is thought to cause a few cases, but this seems to be possible only in those of very low health with injury to the milk ducts.

Care of the Patient: Nursing must be discontinued at once. All food but water must be abstained from so long as there is pain, inflammation and fever. Care should be exercised not to injure the tissues of the breast which should be carefully cleansed regularly. In most cases the abscess will open and drain spontaneously; in rare cases this may require to be drained surgically.

PAGETS “DISEASE”

Definition: This is inflammation of the nipple of a malignant type.

Symptoms: Inflammation, pain, suppuration and a retracted nipple are the characteristic symptoms. Otherwise the patient may consider herself to be in good health.

Etiology: Injury may start up a local inflammation in a toxemic subject that refuses to heal, or the inflammation may develop from toxemia and intestinal sepsis without local injury.

Prognosis: This is good if Hygienic care is instituted early.

Care of the Patient: Although considered cancerous, we have had no difficulty in guiding these cases back to good health. Local cleanliness and a fast to eliminate toxemia, followed by a fruit and green vegetable diet, soon reestablish good health.

RETRACTED NIPPLES

Retracted nipples result from injury in childhood or from malformation. All pressure should be removed from the breasts and, if necessary, a cupping-glass should be used daily to pull out the nipple. Fat girls frequently appear to have no nipples. The nipples may be short and the great amount of fatty tissue swamps them. These may be cupped enough to elongate them.

DIFFICULT URINATION

Lacerations of the vaginal wall, perineum, rectum, bladder and urethra at childbirth cause difficult urination. The injuries and pressure from displacements are both involved in rendering urination difficult. The break-down of the vaginal wall permits the rectum to protrude into the vagina causing a tumor called rectocele; or if the bladder prolapses in the same way this forms cystocele. These two conditions are hernias and may cause much urinary trouble and constipation. See Hernia in Vol. IV of this series.

ECLAMPSIA

Definition: A term sometimes applied to a convulsive paroxysm experienced by women in labor, prior to labor, or in the puerperal state, due to a uremic condition. It results from overloading the kidneys from overeating and wrong eating and should be cared for as described under uremia. Tilden says: “If those with weak kidneys are cared for properly from the beginning of pregnancy, there will be no danger of convulsions.”

HYPEREMESIS GRAVIDARUM

Definition: “Pernicious” vomiting during pregnancy. Some medical authorities consider vomiting in pregnancy to be normal, attributing it to normal biological processes, and view with suspicion the healthy woman who does not vomit. This view is opposed by all the facts. These are: (1) the lower animals do not vomit when pregnant; (2) pregnant women among so-called savage tribes are never so afflicted; (3) the condition is seen in less than fifty per cent of civilized women; (4) it is always associated with pathology and ceases when health is restored.

Morning Sickness, which is nausea and vomiting in early pregnancy, occurring chiefly in the morning, though often regarded as a natural outcome of pregnancy, is only a mild form of hyperemesis gravidarum, and is equally abnormal. Really healthy women do not have morning sickness.

Symptoms: Starting usually early in pregnancy the condition is marked by persistent nausea and vomiting. Vomiting follows the taking of food or water and often there is effort to vomit when the stomach is empty. There is weakness, loss of flesh and, if water is not retained, dehydration of the tissues causing great thirst. Cases are seen where the vomiting continues through the whole of pregnancy and abortion is performed to prevent the woman from dying of dehydration and starvation.

Etiology: Many suspected causes are listed by the ex-spurts. To us, the most significant thing connected with the phenomenon is that it never develops in healthy women. In not a single woman that we have guided into a state of superior health before pregnancy, has any nausea or vomiting developed.
One of the most frequent causes of “sick-stomach” is chronic inflammation of the neck of the womb — cervicitis. This produces the so-called neurotic type of hyperemesis gravidarum. Deranged digestion, from imprudent eating, is the cause of many cases. We hold that vomiting in pregnancy serves a useful purpose, that it is not an effort of the body to commit suicide; but that it is part, of the effort of the body to readjust itself and set itself in order. The more toxemic subjects have the most vomiting.

Prognosis: The condition is “self-limited.” Practically all cases get well in a few days, no matter how treated.

Care of the Patient: The woman should go to bed and fast until all nausea and tendency to vomit have ceased. All the water may be taken that is desired. This may be hot or cold, as relished. It often happens that warm water can be retained while cold water cannot, or vice versa. In some cases water can be retained only if taken slowly in small sips. No forced drinking is advisable.
After vomiting and nausea have ended, moderate, eating with plenty of green vegetables and fresh fruits will carry the mother through her pregnancy in health and comfort.

INCONTINENCE OF URINE

Definition: This is inability to hold urine.

Symptoms: Two forms are noted: (1) where there is no desire to urinate; but the patient finds her clothing wet after coughing, sneezing, or making exertion; (2) frequent uncontrollable desire to urinate with inability to hold the urine.

Etiology: These symptoms may result from a very simple, or from a grave, condition. Usually displacement of the abdominal and pelvic organs is the cause. Other cases are due to irritation of the bladder or its neck, perhaps from an acid urine from imprudent eating.

Care of the Patient: The care is only palliative during pregnancy as little can be done to correct the displacement during pregnancy.
The bladder irritation may be overcome by careful eating. A general health-building program will help all cases.

MILK FEVER

This is a term given to a slight feverishness sometimes attending the establishment of the secretion of milk. The simultaneousness of the two phenomena is merely coincidental. The fever is due to toxemia or to gastro-intestinal autointoxication. The care should be the same as for any slight feverish condition.

PUERPERAL FEVER

Definition: This is a septic infection and is identical with wound infection seen in surgery. It is known also as puerperal septicemia, metria, and child-bed fever.

Symptoms: It is common for the first symptoms to occur on the second or third day after labor, rarely do they appear later than the third day, because granulation of the obstetric wounds have by that time begun and a barrier to infection is formed. The crisis sometimes begins with a chill, but is said to usually start insidiously. A rapid pulse (100 to 140), fever (102° to 104°F.), and fetid lochia are the most conspicuous early symptoms.

Complications: Endometritis, salpingitis, ovaritis, metritis, parametritis, pelvic peritonitis, phlegmous lymphangitis, phlebitis, cystitis, utero-pyelitis, pneumonia, pleurisy, pericarditis, endocarditis, nephritis, arthritis, acute ptomaine poisoning, putrid intoxication, pyemia, and other “diseases” are common complications of this infection. When these affections develop, the symptoms characteristic of them will be added to the above.

Etiology: No better example of the unity of infection can be offered than the many “diseases” in all parts of the body that may result from the spread of infection, in puerperal fever. There is no difference in the so-called “specific” inflammations of the different organs of the body. If there is any fundamental difference in the infecting agent, the resulting so-called “disease” gives no sign of it. The constitutional effects are the same; the differences in “two diseases” — two infections — are supplied by the differences in the structures and functions involved.
Puerperal fever may result from infection from suppurating wounds, gonorrhea, erysipelas, diphtheria, scarlet fever, typhoid fever, cadaveric and other dead or decomposing animal matter, froth suppuration in the genital tract, or from decomposing lochia of the mother. Does the woman infected by erysipelas or diphtheria develop these “diseases”? No. She develops septic poisoning — septicemia. If infection is from a wound or from gonorrhea, she still develops septicemia. Instead of gonorrhea, or erysipe1as, or diphtheria, etc., the woman will develop what is called puerperal fever.
Infection is the same whether generated in a wound, abscess, pent-up duct, ulcerated lung, cancer, or elsewhere. When tissues melt down, in necrosis or decay, they generate a cadaveric poison, a toxic alkaloid, which is the infectious material in all cases. The toxic element in all infections is sepsis.
All secretions, excretions, and exudations are non-toxic until they become toxic through decomposition. In penetrating wounds, if drainage is imperfect and the exudate becomes pent-up it will under-go decomposition and become septic. If obstruction is complete so that absorption is forced, general infection — septic poisoning — will follow so rapidly that often the patient is beyond hope of recovery in twenty-four hours.
Septic infection is virulent in proportion to the amount absorbed. If the position of the womb is such that drainage cannot take place, the pent-up normal discharge becomes putrescent and there follows immediately, symptoms of septicemia. If the true state of affairs is not recognized and drainage established, death follows in two days. If there is imperfect drainage, the discharge may not be held long enough to cause degeneration-changes to produce local infection, resulting in chronic inflammation and suppuration of different parts of the sex organs.

Prognosis: This is good in women of average resistance if proper care is instituted at the first sign of trouble. Tilden says: “It is well to think of all infection following childbirth as septic infection, or even peritonitis, and treat every case with the same care and attention that would be given a real child-bed fever; for, indeed, a little carelessness, mismanagement or bungling treatment may convert a slight infection into a general and fatal type.”

Care of the Patient: Cleanliness is the most important requisite. If fever develops soon after childbirth (or abortion) and pain and tenderness are experienced, we may be reasonably sure that there is retention of debris and that cleanliness has been neglected.
Intra-uterine douches of “hot,” boiled water given every three hours will loosen up and expel the debris and wash away the septic fluids and gases. At least two quarts, or even four quarts, may be used at each douche. The douches must be given at three hour intervals until the temperature and pulse are normal.
Absolutely no food is to be given until all acute symptoms have been non-existent for at least twenty-four hours. Perfect quiet, plenty of fresh air, and heat to the feet, complete the care. Drugs cannot help, but will enervate the patient and lower resistance.
Curetment may empty the womb if infection has not taken place, but if infection has already occurred, curetment, even with a dull curet, may tear down nature’s barriers and probably cause death.

SUBINVOLUTION

Definition: Incomplete involution of the uterus. The return of the womb to its original size after childbirth is called involution. The process usually requires about six weeks. If the process is arrested or interfered with and the contraction is incomplete the condition is called subinvolution.

Symptoms: These are few and indefinite. There may be more or less occasional bleeding, continuing perhaps for a few weeks. The actual condition can be ascertained by feeling the fundus of the womb through the wall of the abdomen, above the level of the pubic bones.

Etiology: It is not a condition that ever develops in any normal or healthy woman. It is associated with retention of parts of the placenta, displacement of the uterus, adhesions, fibroid tumors, and premature resumption of intercourse.

Care of the Patient: All sexual excitement and sexual indulgence should be avoided. The cause — tumor, adhesion, retained placental fragments, etc. — should be ascertained and care directed accordingly.

SWELLING OF THE FEET

This is a symptom of heart or kidney impairment and should be cared for as described under affections of these organs. It is a dropsical condition and often extends up the ankles and legs.

VARICOSE VEINS
These were discussed under affections of the circulatory system, but a few words about their development during pregnancy will be appropriate here.
The veins of the legs often swell to great size, often to half the size of a man’s wrist and the leg or legs from the feet to the body not infrequently swell to double their natural sizes. The veins appear knotted and frequently break and in extreme cases varicose ulcers form on the shins or above the ankles. If the swelling is great there is great suffering.
Enervation is the cause. Added to enervation is the practice of “eating for two” which produces indigestion, gas pressure, and auto-infection. The greater the enervation the less digestive power and the more indigestion. Contrary to prevailing professional opinion, the body is not a machine that can care for a given amount of food under any and all circumstances.
The miserable, lazy makeshift of putting a bandage or rubber stocking on the leg can do nothing more than palliate the condition. To remove the veins, instead of being a “radical cure,” is a shameful, inexcusable crime against the patient. It is followed by enlargement of other veins.
The only cure is: “remove the cause.” What is the cause? A mode of living that builds enervation and toxemia. All nerve-leaks must be corrected. All causes of enervation must be looked after. The general health must be built up by proper feeding and care of the body. The amount of food eaten should be cut down to the ability to digest and assimilate. In severe cases eating should be discontinued until full relief is experienced.