GENERAL CAUSES OF UTERINE AND PELVIC DISEASES OF WOMEN.
WHY are womb diseases so prevalent? is a question which we are not
infrequently called upon to answer. At first sight this would strike
one as a casual or commonplace remark, but a moment’s reflection makes
it one of vital interest, for a truthful and intelligent reply lays
bare the causes which undermine the health, strength and character of
the mothers of our citizens, and when a disease of this sort becomes
common, it threatens the morality, health and life of our nation.
The causes which operate in producing these diseases of the female
differ widely in their origin; some are due to ordinary imprudence,
while others are deeply rooted in moral depravity and marital abuses
and for this reason I consider it convenient to arrange them into three
distinct classes or groups.
The first class is characterized by comprising those causes which are
for the most part accidental. They are peculiar to confinement and
motherhood, and may be in a great degree controlled or averted by the
skillful and competent accoucheur. They have principally a scientific
interest, and do not fall within the scope of the non-professional
reader.
The second class is entirely beyond anyone’s control. The causes
belonging to this category are innate to the human organism; they
induce those numerous afflictions which here and there sprout up in
previously healthy persons, and are, in all probability, due to some
specific hereditary taint. They are to be attributed to the natural
imperfections of humanity, and are a constant reminder that the body is
simply the transient abode of the soul, or spiritual man, and as such
only perfect in its imperfections. Like the causes of the first class,
these, too, have principally a scientific interest.
The third class of causes of uterine diseases constitutes a very large
group, and has a popular or general interest. For this reason it should
be freely discussed, because the causes of this class are _avoidable_.
They are entirely within the control of the average sensible person,
and for that reason should be known and understood by everyone. These
causes superinduce inflammatory diseases, which are not confined to the
womb alone but take in the entire pelvic _appendages_, the Fallopian
tubes and ovaries. They are the greatest source of revenue to the
doctors, and vary in symptoms in different persons, from a slight
casual reminder of something wrong to harassing pains and physical
suffering; and that these all are brought about through ignorance,
wanton carelessness, or sinful disrespect of nature’s or God’s law, is
the characteristic feature of the causes under investigation.
Exercise in the open air is so essential in strengthening the nervous
and muscular systems that where this is neglected it predisposes
to womb disease. I consider the differently-devised indoor or room
calisthenics or exercises as totally inadequate and no substitute
whatever for healthful outdoor movement, and for the following reason:
that while it irritates the muscular and nerve fibers, it lacks the
stimulating and tonic influence of pure oxygen-laden air, so that the
blood becomes still more deteriorated and overloaded by excessive waste
material, which is not thrown off. If a person exercise at all with a
view of deriving physical benefits, let it always be in the open air.
Like walking, riding, rowing, to which bicycling should be added as one
of the very best of outdoor exercises, the mind can then be engaged at
the same time, though it must not be overstrained. The great obstacle
nowadays arises from a fashionable and morbid desire to cultivate
an appearance of delicacy; if, instead, recreations which required
muscular exertions were more fashionable, the results in developing
strong and hardy women would be astonishing.
No exercise can be profitable which is not interesting to the person
who practices it.
It is not the bodily exertion alone which can profit a person, but
the happy associations, the abandonment of self thought, the mental
relaxation, and the pleasure which accompanies it. With one or two
companions we can have a jolly time, while taking a swimming bath or
floundering in the surf, but alone it soon becomes tiresome. If we
take a stroll with an agreeable companion, we can walk a distance
which, when undertaken alone, would fatigue and tire us completely out,
while, when with an associate or friend, we cover the same distance
refreshed and invigorated, because the mind is entertained while the
body is exercised. This must have been the experience of everyone, and
if it teaches anything worth remembering, it teaches that monotonous
exercises should be avoided and entertaining ones sought and practiced.
Walks over hills in small, friendly groups is one of the best modes
of exercise I know of. And then there remain the many outdoor games.
The pernicious systems of training which are observed in some female
seminaries often plant the seeds for future disease. All the school
hours are employed in reading, drawing, music, and other brain work,
while the evenings are devoted to preparing lessons for the following
day. This is very injurious, and should never be permitted.
After school hours the mind should have complete respite from study, so
that the forces can recuperate themselves for the next day.
Nervousness or neurasthenia is often a result of this excessive mental
application. Where the mind is constantly engaged in intellectual
pursuits, the result often is a too rapid development of the brain and
nervous system.
When the thoughts and memory of girls of tender age are too long and
too laboriously engaged, there will be an abnormal development of the
nervous centers; they will grow or develop beyond the muscular or
physical strength, and a morbid impressibility, great feebleness of the
muscular system, and a marked tendency to disease of the pelvic organs,
is established. Parents may refer with pride to the precocious talents,
the refined and cultivated tastes, of their daughters, as qualities to
be admired and appreciated, but without a physical substratum it is
a dreamy delusion. It would be much better for the children if their
parents took more pride in rotund figures and robust constitutions,
for these would ever be a source of joy, while the cultivated talents,
especially at the expense of their health, will not only be of little
practical value to them in after years, but often incapacitate them
for wives and mothers, by making them restless, discontented, and
physically unfit for maternal functions.
There is entirely too much scholastic education imparted to our girls,
and not enough domestic education. I believe that the most favored
should not have too much of one and not enough of the other, because if
parents do not prepare girls for household duties in early life, they
run desperate chances of laying the foundation for a failure in the
remote future.
Children must be constantly reminded that they are in this world to
serve a useful purpose, and that co-equal with every accomplishment is
a utilitarian training.
We take a pride if our boys trade pocketknives, especially when our
own gets the better one of the two, because we appreciate the natural
business trait. He will be no less a good candidate for some of the
learned professions, and, indeed, it has come to this, that material
success in the professions depends as much on shrewd business tact as
it does upon proficiency in professional attainments.
The knowledge or even wisdom of a person is of no earthly use to
himself or the world if he or she do not possess the faculty of letting
the people know of this superior wisdom; and that is why some persons
often become more celebrated and even renowned than others, who are
intellectually their superiors, because the former possess the faculty
and cunning to make people believe in their superiority. By this I
simply desire to impress upon parents not to be over-anxious about
their daughters standing _first_ in their class room, but, rather, to
be very anxious that they attain a healthy and vigorous growth, and
that sufficient practical knowledge of domestic affairs be imparted to
them so that they can creditably fill their mother’s places some day.
This I consider the best legacy.
The time to commence to train mothers is from the moment they are born.
The minds of parents should be disabused of the false delicacy about
this aspect of a girl, and while no one expects daily lectures to be
given to children or young girls upon the responsibilities which await
them, such information should not be studiously avoided. I insist that
this important fact should not be lost sight of, motherhood is the
ultimatum of feminine existence.
Mistaken conceptions of woman’s education, in pinning girls to a life
of close mental application, is often productive of uterine disease, by
lowering the tone of the nervous system; while others who are ambitious
to acquire a professional education in later life, fall by the wayside
as hopeless invalids.
I do not disparage her capacity to study with equal proficiency the
arts and sciences, often with more ardor and closer application, than
her male colleagues, but she is simply striving to accomplish that
which the men can and do willingly accomplish for her, while at the
same time she is neglecting the education of those qualities which are
the sole inheritance of her sex, and which man could not usurp if he
would.
This class of uterine diseases develops in a few years into melancholy,
which closes the windows of the soul to the sunlight of hope, and
gradually drags the sufferer into a decline, that nothing but an entire
change in the habits and thoughts of the patient will ameliorate or
cure.
I would have our girls as independent of our boys as the latter are of
our girls. I would have it understood that each, in their specialty for
which God and nature has ordained them, is as honorable and important
in the social and industrial conditions of mankind as the other. I
would give woman the right, and deem it her privilege, to frankly and
unrestrainedly profess her fondness or desire to marry the man who she
believes would make her a desirable husband, because woman’s intuition
transcends man’s reason.
A reform in this direction would, indeed, elevate the woman to man’s
estate, where she belongs. A little less sentiment and more sense is a
wholesome panacea for some of the abuses of the marital contract.
I fully subscribe to the view that a woman shall at all times receive
the same wages for her mental and physical labor that men receive for
the same work, but I am entirely opposed to that modern tendency and
false social philosophy which is constantly striving to make a man
out of a woman. There is something so grossly absurd and unnatural in
this artificial readjustment of the natural duties of the sexes, in
their industrial and social relations, that it has degenerated in many
instances into fanaticism.
Women are organizing everywhere for the purpose of increasing the
facilities of their sisters in the studies of science and philosophy.
Large sums are offered to the faculties of universities to gain
admission to female students on an equal footing with the male
students, for the purpose of studying some of the already overcrowded
professions. In the main, all this abnormal rivalry does not contribute
a single advantage to either sex.
There was a time in the history of civilized nations, and that
time is not more than twenty or twenty-five years ago, when an
academical education gave an immense advantage to its possessor over
his less-informed contemporary, but this is not true in our time,
because there is now an overproduction of college-bred men. The man
who can decline a Greek noun or conjugate a Latin verb is no longer a
rarity, because the sons of European tradesmen and American farmers
have deserted the pursuits of their progenitors—which, in the case
of the American farmers, is to be deplored—and obtained a collegiate
education, that is no longer the inheritance of the privileged few,
so that in our time and day an academical education has run to seed
among the men. And now the attempt is being made, under the guise of
social progress, to burden our girls with the same wisdom that has
incapacitated many of our boys from making an honest and independent
living. It would be much better for the State if two-thirds of our
universities or high schools were changed into manual training schools
or polytechnical colleges, where the foundations for the industrial
pursuits may be laid, so that labor will be made not only respectable
but intelligent.
We would then hear of educated mechanics or artisans, and scientific
farmers, which, to my mind, requires the same order of intelligence to
excel, that it does in the professions generally qualified as “learned.”
Why crowd our girls, then, into the professions for which they are not
only unsuited by nature, but which are already demoralized by the keen
competition within their ranks? It is, certainly, an open secret, in
the profession to which I have now devoted the best years of my life,
that the methods in vogue to get business have descended to the level
of the “confidence trickster,” and that, no matter what ability or
merit a person may possess, without the natural instincts and elements
of the quack and charlatan he can gain neither a livelihood nor fame.
This theatrical demeanor of the profession, this aping the gaudy
display of European aristocrats by riding in closed coaches, driven by
liveried coachmen, is but the outward symptom of the internal disease
of contention for notoriety and success.
If, instead of all this false and demoralizing philosophy, termed
“woman’s rights”—which is more appropriately designated “woman’s
wrongs”—we turn the thoughts and ambitions of women towards domestic
economy and domestic virtue, which alone should be and ever will be the
_ideal_ of noble womanhood, there will be, then, much less disease,
more happiness, and less discontent. There is enough on God’s earth
for all of his children to eat, wear, and work, if the labor and the
subsistence are fairly and wisely apportioned.
The growing sentiment, which is as vicious as it is absurd, is that a
girl, to be educated or accomplished, must be either a teacher, lawyer,
or doctor, or anything else except an accomplished housekeeper, just
as though it required less talent or ability to raise a child, cook a
wholesome or digestible meal, and cut or sew a garment.
Why, there is much more thought and judgment required in making an
angel mother than in administering or prescribing a dose of medicine
and filing a legal brief, and there is not a lawyer or doctor who has
given sufficient thought to the duties and requirements of maternity
who disputes it for a moment. If our strong-minded women would preach
this doctrine, which would tend to make household duties respectable,
they would be benefactors instead of mischief makers, and then our
comely girls would prefer to cultivate habits of domesticity, which
should and would become as honorable an occupation as that of a
doctoress or lawyeress.
Improprieties of dress are to be found in excessive or deficient
clothing, in an improper adjustment, and in an inherent defect of the
undergarments. I will reserve some of my views on these questions, for
the chapter that is devoted to hygienic measures. In the main, the
custom or manner of dressing women in Christian countries does not
deserve that sweeping denunciation that some radical dress reformers
make. I would not, if I could, change the very becoming and graceful
modern female dress, for it possesses the merit of displaying the
beauties of the figure in a modestly delicate manner, and it hides its
defects from the vulgar gaze.
As a rule, there is too much pressure on the abdomen, from the weight
of heavy skirts that are suspended from the hips, and not sufficient
room for the chest to expand, so as to accommodate the respirating
movements of the lungs. In the absence of shoulder bands, to which
the skirts should all be fastened, the much-decried corset has its
redeeming qualities, for it serves the purpose of a yoke or support
for the different undergarments, and when not tightly laced is rather
a benefit than an injury, and if the corset had a shoulder strap
fastened to it over both shoulders so as to keep the garments from
dragging on the hips, there could then be no objection to it whatever.
The corset must always be so loosely worn as to permit the wearer’s
hands to be easily passed between it and the waist. It then becomes a
useful brace to a weakly woman and entirely harmless to a strong or
healthy one. We can imagine how a tightly-fitting corset will cause
mischief by compressing the ribs and abdominal walls, and that this
absurd fettering will prevent the lateral expansion of the chest, and
also injuriously press upon the internal organs, but this is not due
to an inherent property of the corset itself, but to an abuse of it.
One might as well advocate a return to the Roman sandal, on the ground
that some persons are foolish and vain enough to wear shoes altogether
too small for their feet, thereby causing deformities and corns. For
my part, I admire a nice, well-shaped, healthy foot, incased in a
low, broad-heeled, comfortable shoe, even if its size were one or two
numbers larger than a pinched-up, deformed one. But no one would be
enthusiastic enough on the question of healthy feet to have us all wear
sandals again.
Warmth of the lower extremities is a very important point in a female’s
apparel, and of more importance than all the other questions raised
on this subject. The exposures endured by women, from ignorance or
indifference to this fact, is, in my experience, a fruitful source
of disease. The chilling blast which sweeps under the skirts must
be mitigated and the moist vapor arising from a damp and cold earth
neutralized. If the limbs are only protected by thin cotton fabrics,
they are insufficiently clad to avoid the evils above mentioned. It is
of the greatest importance that the limbs of women should be incased in
flannel drawers, and these can be worn underneath the white muslin or
linen ones, and the hose, especially in cold or damp weather, should be
made of woolen material; the soles of the shoes should be sufficiently
heavy so as not to be permeable by the moisture from the ground, and
in wet or rainy weather rubber overshoes are always a necessity. When
the feet and lower limbs are kept warm, the whole body is more or less
protected against cold.
Superfluous or too warm garments are the cause of an endless variety
of diseases. The rule is this, that any garment which by its weight
or thickness excites perspiration when the wearer sits quietly or
exercises moderately, is either superfluous or too thick or heavy, and,
as perspiration relaxes and softens the skin, it makes one susceptible
to take cold. It is reported on good authority that sealskin wraps
cause more deaths among those who wear them than typhoid fever and
for the reason above mentioned. Loosely-woven woolen goods make the
best wraps and the best underwear. If we were called upon to state a
single proposition which we considered of the greatest importance in
preventing disease, we would frankly say that, next to an irregular and
unwholesome diet, excessive clothing is the most mischievous factor in
causing or predisposing to disease.
The same rule applies to bedcovering; if it be so heavy as to make
the sleeper sweat during the night, he is almost sure to take cold
from the sudden change, from a warm, moist bed to the cool room or
comparatively chilled clothing.
Imprudence during menstruation. A heedless disregard, ignorance, or
carelessness of the precautions above referred to is, during the
catamenial days, quite sure to lay the foundation for disease. Every
practitioner has met with a great number of cases where the disease
originated during menstruation from some indiscretion, and it ran
on for years, until a condition of affairs was developed which was
well-nigh incurable.
The female organism is particularly sensitive about this time and much
easier affected than at any other.
During this period the ovaries and uterus are intensely congested, and
the Fallopian tubes which connect the former with the latter share this
condition, and if a cold should suddenly check or interfere with the
natural functions of these organs, it might result in inflammation of
the ovaries or in a catarrh of the tubes and womb. Any one of these
conditions is painful and often troublesome to cure, but when all these
organs are complicated in the diseased process, which we frequently
find to be the case, it may entail serious consequences.
Dysmenorrhea, or painful menstruation, will be a prominent symptom,
if any of the above organs have suffered from imprudence, during this
period, and I have known of cases which gave me no end of trouble
before they were restored to health.
Measurements of the healthy uterus. In a grown person the average
length is three inches, two inches in breadth and an inch in thickness.
It weighs from an ounce to an ounce and a half. The size of the uterus
is an important guide to the physician in establishing the presence or
absence of certain diseases.
In the child-bearing period measurements and weight change, because
the organ grows correspondingly large to accommodate the growth of the
child.
Growth of the uterus from the moment of conception is one of the most
interesting physiological studies. All its tissues, muscles, nerves,
vessels, and lymphatics are increased in bulk and multiplied in number.
The human ovum is an extremely minute microscopic cell, from one
two-hundred-and-fortieth to one one-hundred-and-twentieth of an inch in
diameter. This grows so rapidly that at the end of nine months we often
have the average nine-pound baby. The growth of the muscular fibers of
the womb is truly remarkable. They grow eleven times longer and twice
to four times thicker, so that the growth of the womb keeps pace with
that of the child.
Changes immediately after confinement. Women as a rule, and their
husbands also, are wofully ignorant of the condition of the womb just
after confinement, and at this point it will be opportune to impart the
necessary information illustrating that it is one of the most critical
periods of the entire process, because the pelvic organs are again very
sensitive, somewhat akin to the menstrual condition, namely, one of
engorgement, or congestion.
After the child is in the world, the uterus usually contracts to about
the size of a cocoanut; its measurements and weight as compared with
what it was before pregnancy have materially increased.
The diameter is now about four inches, and its weight a little over two
pounds. If we now stop to reflect that its weight was formerly an ounce
to an ounce and a half, to which size and weight it must again return,
we can readily appreciate the important changes that must take place
to accomplish this object. The scientific world has only learned how
this is effected within the last thirty years. It was a very important
discovery. The superfluous or excessive tissues are converted into
fat—the process is called _fatty degeneration_—and as fat the tissues
are absorbed into the blood and disposed of, and thus gradually is the
superabundant substance removed, until its measurements are as they
were formerly and its weight as it was before.
Involution is the name given to this process by medical writers.
It signifies a rolling back of the size and substance of the womb
to where it was before pregnancy. It is the physiological activity
in the tissues of the organ to restore it to its former size and
healthfulness. The time usually required for nature to accomplish this
remodeling varies in different individuals from six weeks to three
months.
Subinvolution is a term employed to designate a partial or complete
cessation of this restorative action. The prefix _sub_ means always
_under_; in this case the same thing is meant, _under-involution_ or
_incomplete_ involution.
When, in six weeks to three months after confinement, the womb has not
returned to its previous healthy size, weight and state, or if the
enlargement of the womb incident to pregnancy lasts longer than already
specified, we have the disease termed subinvolution. It generally
becomes complicated with inflammation of either the cavity of the womb
or of its entire substance, and often the inflammation extends to all
the other organs and tissues in the pelvis.
Indiscretion in getting up too soon may cause this state of affairs.
Taking cold and excessive exertion should be guarded against.
A mother who has just been delivered must gradually feel her way as to
how much and what she may or can do without jeopardizing her recovery.
Pains in the pelvis, back, and thighs, or a heavy, dragging sensation
after getting up, indicate a subinvolution. These symptoms should
be attended to, because the longer they last the more obstinate the
disease becomes.
Lying on the back after confinement for ten or twelve days is not only
injurious but an unnecessary hardship for every mother. It is one of
the most fruitful causes of an abnormal position or falling back of the
womb, and very often this excites diseases which greatly complicate the
improper location of the organ.
Retroversion and retroflexion of the womb will be considered more
minutely later on. It is generally caused by this common error of
nurses and physicians, who allow the delivered woman to lie and
often insist on her lying on the back. Thus the womb gradually sinks
backwards, instead of falling forwards, where it belongs: see Plate IV.
Women will not generally feel that anything is wrong until some time
after they are up and around. The first few weeks or months after
confinement, persons are inclined to attribute their weakness, pains in
the back or thighs, and other disagreeable sensations, to the natural
consequences of what they have gone through. But after weeks roll
into months, and their former strength and health do not return, then
they seek the advice of a doctor, who will disclose to them the cause
of their suffering. This can be avoided every time by changing the
positions of lying, from one side to the other, and from the back to
the stomach for a change; then naturally the womb will gradually resume
its normal position, which is inclined forward and rests with its body
over and on the bladder. All of these displacements should receive
early and prompt attention.
Antiseptic precautions. Only a few years ago this phrase was entirely
unknown. It originated with the modern antiseptic treatment of wounds,
and from the domain of surgery it has been transplanted into the
department of obstetrics, in which the application of antiseptic
principles has achieved the most brilliant triumphs. From this
conception has sprung the germ theory of disease, which is now, beyond
doubt, an established fact.
I never can forget my first case of _childbed fever_. It is only
fourteen years ago, and then there was as yet no one who could give a
scientifically truthful interpretation of the disease. My patient was
a young mother, who was being rapidly consumed by a fever, but beyond
that science had not unlocked the causes lurking in the organism,
which had doomed the young woman, on the threshold of motherhood, to a
premature grave.
Thousands of lives were yearly destroyed by _puerperal fever_. Volumes
of literature had been written on the subject, but as yet no one had
deciphered its origin.
Now the whole scene has shifted; we know that the fever is essentially
a blood poison, a septic infection of the patient, precisely similar
to a wound infection anywhere else on the body. The act of parturition
causes wounds or abrasions; these, then, place the woman in imminent
danger of infection of every sort, and it is this infection which it
is now possible to avoid. There is the greatest precaution necessary
on her part and on the part of her attendants, that she be not
contaminated by suspicious-looking finger nails, or dirty hands, or
soiled linen, or unhealthy and unclean surroundings.
The German Government has a compulsory law for a system of antiseptic
precautions, which is incumbent upon all who attend lying-in women.
The importance of a rule to guide midwives and others in carrying out
strictly antiseptic measures was recognized in that country some ten
years ago, and the statistics show a remarkable diminution of diseases
peculiar to the childbed period. The sources of these infectious
micro-organisms are very different. They may be derived from the body
of another person, sick or having died from an infectious disease, from
suppurating wounds and even from the secretions of healthy lying-in
patients. The patient or person herself may have improperly bathed or
neglected cleanliness and ablutions, but the greatest danger arises
from the neglected and unclean hands and sleeves of the midwives and
physicians, and from the instruments usually employed under these
circumstances, like forceps, catheters, or the nozzle of a syringe. The
law above referred to requires all these instruments to be thoroughly
scalded, washed, and brushed every time they have been used, and by
such a complete system of disinfection, the chances of infection are
reduced to the minimum. I hope some day our legislators will be wise
enough to give us similar laws.