UNCLEANLINESS AS A CAUSE OF DISEASES IN WOMEN.
THE custom of washing and bathing has existed from the earliest times.
Among the Egyptians it was a part of their religious worship. Among
the Jews it formed part of the ceremony of purification prescribed by
Moses. The Greeks considered it a sanitary expedient, and among the
Romans it was instituted for similar purposes. All virtues when carried
to extremes degenerate into folly or vice, so bathing in the days of
the Roman Empire, became immoderate and degenerated into enervating
luxury and unbridled debauchery, in which indiscriminate bathing of
both sexes was one of the demoralizing features.
The bath was usually taken after exercise and before the principal
meal, which rule holds good to-day, as the very best and proper time.
The gorgeous splendor of the _Thermæ_, which was a palatial edifice
constructed by Agrippa, was adorned with beautiful statues and fine
paintings, while luxuriant green foliage of great variety formed
enchanting bowers of fairy splendor. This was thronged by the Roman
citizens for the pleasures of gymnastic exercises and bathing.
In those countries which have adopted the religion of the Arabian
prophet, Mohammed, people bathe as a part of their devotions, and a
religion which has for a part of its ritual the washing of the body,
goes a great way towards cleansing the spirit.
Among the Northern nations the introduction of the bath dates back to
the period of the Crusaders, although _Tacitus_ speaks of the river
bathing of the Germans, which was one of the strengthening methods
employed by the early Saxons. That filth and dirt generate crime and
moral depravity seems to be apparent, where squalid misery has dulled
the sensitiveness to unwholesome surroundings.
Sanitary science has also demonstrated that filth is the most fruitful
source of diseases that are called infectious, because their origin is
due to germs of the lowest forms of vegetable life. The brightest page
in the medical history of the nineteenth century is that which records
the discovery of these micro-organisms as the cause of such diseases
as septicæmia or blood poisoning, pyæmia, diphtheria, tuberculosis or
consumption and others. All forms of fermentation and putrefaction
are due to the presence of some germs, and upon this fact antiseptic
surgery bases its scientific premises.
The germ theory of disease, like every new discovery, which supplants
the accustomed and deeply-rooted theories of the speculative
philosophers, met with opposition, criticism, ridicule and
misconstruction, but the brilliant achievements of Lister and Koch have
established its founders upon a pinnacle of fame, which promises to be
an immortal monument to their genius, and not only in surgery has its
beneficial influence been exerted, but the entire field of medicine has
been enriched by the germ theory, which plays so formidable a part in
the causation of many diseases.
The great boon that medical science will confer upon humanity, in the
future, will not be so much in improved methods of treatment, as in
the means and methods which medical science will devise for preventing
disease. One ounce of prevention will always be worth a pound of cure.
When we look back fifteen or twenty years, we must even now acknowledge
that preventive medicine has accomplished greater results than curative
measures, because the former can be made in the very nature of things
_absolute_, while curative agents are only relative. Puerperal, or
childbed fever, which is an _infectious disease_, was at times a
pestilence, which destroyed women by the score, in maternity hospitals,
or in certain neighborhoods, by the infection being carried by midwives
or accoucheurs from house to house, yet no one had the least suspicion
that it was possible to carry the germs of this disease under the
fingernails of the attendant, or on the clothing or a syringe, or on
some other little instrument, from one patient to another, and, indeed,
there are a great many to-day who are practicing midwifery who are
still ignorant of the importance of refined cleanliness.
But for this ignorance, there is no longer an excuse, because the
infectiousness of this and other diseases is so positively established,
and even the physical characteristics of the micro-organisms have
become familiar to the microscopists. This knowledge of the causation
of puerperal fever has been applied to the employment of preventive
measures, so that this dreadful malady is becoming a rarity,
particularly in countries where scrupulous care and cleanliness are
enforced by governmental rules and regulations. I refer to this
particular _fever_, because it is, to my mind, one of the most
brilliant illustrations of the efficacy of preventive or antiseptic
medicine.
There is a gynecological hygiene with which women should become
familiar; it is based on the principle of antiseptic precautions
applied to the daily lives of their sex. The object of this is to keep
the body and reproductive organs that are exposed to contamination
or infection from the outer world in the most refined and scrupulous
cleanliness. The vaginal douche or syringe is as important an auxiliary
to a refined woman’s toilet case as her tooth brush, because the
cleanliness of the genitals is as essential to the preservation of
health and comfort, as the possession of a sweet breath and the
preservation of the teeth. I am therefore convinced of the hygienic
value of familiarizing little children with washing or sponging their
external genitals; in a few years this will have become second nature,
and they are thus protected for all future time from contracting
diseases which have their origin in personal uncleanness. It behooves
mothers to avoid all delicacy on this subject, so that their little
ones may grow up with the sentiment that to the pure in heart all
things are pure. It is false modesty and ignorance which degenerate
into vice and excesses; the scientific truth is always pure and
holy, because it is based on reason, while abnormal delicacy is only
emotional, and is quite likely to shoot into the other extreme, namely,
licentiousness.
As the world grows wiser, the physiology of the reproductive organs
should form a part of its wisdom, and in proportion to this knowledge,
will their functions become questions of sense, instead of sentiment
and nonsense.
The vagina is a membranous canal. It is situated in the cavity of
the pelvis, below and behind the bladder, and in front and above the
rectum. Its direction is curved from before backwards and a little
upwards; its walls are flattened and ordinarily in contact with each
other. Its length is about four inches along its anterior wall, and an
inch or two longer along its posterior wall. In introducing a nozzle
of a syringe it must always be remembered, that the tube is to be
introduced directly backward on a horizontal plane with the body in the
erect posture; by attempting to introduce it directly upwards, you meet
with resistance from the anterior wall of the vagina.
In this cavity the secretion is susceptible of decomposition, owing to
the accessibility of air laden with germs, which excite fermentation.
A day or two after the cessation of the menstrual flow, there still
lingers a little blood in the cavity of the vagina; this becoming
infected with the germs in the vagina, a decomposition is the result,
which is recognized by an offensive smell. The naturally soothing and
harmless secretion is now changed into an acrid, irritating fluid,
which not only may cause an inflammation of the membrane of the
vagina, but also excoriate the skin at the orifice of the canal.
Leucorrhœa, or what is commonly called _whites_, is the most
distressing symptom of this condition. In the course of months or in
some instances a few years, the inflammation spreads from the vagina
to the mouth and lining membrane of the uterus. Inflammation of the
endometrium or lining of the womb will excite another complication,
the so-called ulceration, but more correctly termed _erosion_. Who
will deny the usefulness of any advice that will teach girls or women
to avoid all these diseases? It is all contained in the simple phrase,
_Keep clean_. Young girls must be taught by their mothers or guardians,
not only the necessity of keeping the external genitals clean by daily
ablutions, but a few days after menstruation, upon the slightest
indication of offensiveness, she must resort to the employment of the
vaginal douche or syringe, so as to wash out the seeds of disease,
that are rapidly multiplying themselves, and if allowed to remain will
entail the consequences to which I have already referred.
As an antiseptic wash, there is nothing so simple, efficacious and
healing, as a solution of borax in previously boiled water, that has
been allowed to cool to the proper temperature, which is between 103
and 106 degrees Fahr., one teaspoonful of the powdered article to the
half gallon of water, to be used as a rinsing for each time.
Directions for administering vaginal douches will be given elsewhere.
The proper time of the day for the employment of the wash is always at
bedtime; and once or twice a week is quite often enough in the majority
of instances.
Married women are more exposed to infectious contamination than single
ones, because they are constantly liable to have infectious microbes
introduced into the vagina during the ordinary course of marital
relations. Men, as a rule, are neither cleanly nor careful in their
habits, and approach their wives without any thought of serious
consequences in their sexual relations. I had a married woman under
treatment for an offensive discharge from her vagina which I traced
to her husband, thence to a suppurating wound on his horse, which the
husband had under his treatment. This can happen, of course, only
through carelessness. By getting some of the matter or pus on the
fingers, which incidentally contaminates his person, or not washing
and brushing the finger nails, the husband may directly convey
the infection to his wife, and thus inaugurate, unconsciously, an
inflammation of the vagina, which becomes complicated, as the primary
disease is neglected, leading to inflammation of the womb and ovaries,
and often to abscesses, that compromise not only the health but the
life of the sufferer.
To preclude the possibility of _innocent_ infection, between husband
and wife, there is only one means of prevention, and that is a careful
_toilet_, which thoroughly cleanses the bodies in general and the
genitals in particular.
Another fruitful source of disease of women, in this country and to
an alarming extent in Europe, to which the elder Martin of Berlin
called the attention of the profession over thirty years ago, is the
specific or gonorrhœal infection of wives by their unfaithful husbands.
The number of poor women whose health has been irretrievably ruined,
by their husbands having had illicit relations with lewd, diseased
women, is only known to those who have made this class of diseases a
special object of inquiry. I have nothing to do with the moral aspect
of this question, but only with the physical suffering that such men
inflict upon their innocent wives and the mothers of their children,
for the brief indulgence of libidinous pleasure. To think that any
man would take the chances of making his wife a suffering and perhaps
incurable invalid, just for the purpose of gratifying temporary animal
passions, is to place him beneath the brute creation, which has not the
intelligence to reason on the fearful consequences. No man who has
been guilty of illicit relations should return to his wife until seven
days have elapsed, and even not then until he has repeatedly washed
himself by means of a syringe with some cleansing or disinfecting
fluid, like borax water, or, what is preferable, a weak solution of the
bichloride of mercury.
The wife and mother who entertains the slightest suspicion, must insist
upon these precautions, and then not neglect to thoroughly wash and
cleanse herself in the manner previously referred to. It is the height
of hypocrisy to be mealy mouthed on this subject; the wives and mothers
who are fortunate to have husbands beyond suspicion, should learn
that some of their sisters have dangers to encounter and heartaches
to suffer, with which their own lives are not marred, but perhaps the
lives of their daughters may be; for the unhappy woman who becomes the
wife of the blear-eyed sensualist, there is only one relief, and that
is education in these subjects.
I know of no disease in which a correct and early diagnosis or
recognition is of greater importance to avoid the frightful consequence
and serious complications, than this one. It begins with a mild vaginal
catarrh, which, when it is as yet locally confined to the vagina, can
be easily cured. In course of time it spreads itself along the vaginal
tract to the cavity of the womb. When it gets there, the treatment
becomes more complicated, and for this reason; in order to reach the
disease now, the cavity of the womb must be dilated, and this is an
operation which the average physician can only accomplish in a bungling
and imperfect manner. But even in this stage of the disease, in the
hands of a skillful physician, the course of the disease can be checked
and the patient readily cured. When the disease gets beyond the womb,
when it invades the Fallopian tubes and the ovaries, the picture has
entirely changed.
The organs affected are then inaccessible to local treatment, so that
the disease invariably continues until the organs are more or less
destroyed by inflammation, which results in the tissues breaking down
into an abscess. In this stage of the disease it has become quite
the fashion to operate in this class of cases, offering as an excuse
a sure and speedy cure. Here I would interpose a word of warning to
sufferers belonging to this class, not to be too willing to comply
with surgical methods, because I know from careful observations, that
promises of this nature end often in disappointment and death, while an
intelligent conservative treatment can only disappoint but never kill,
and with patience and perseverance in the application of electricity
and hygienic rules of health, a cure is almost certain. The sick in
body and mind are often beguiled into operations of a very serious
nature, which are entirely unnecessary, because better results can be
accomplished by other methods of cure, in which the possibility of a
fatal termination is excluded.
Some women feel tired and languid from morning until night; they
feel as tired in the morning when they get up as they were in the
evening when they retired. If we tell them that it is entirely due
to negligence of their own persons in not using vaginal washings
regularly, they will undoubtedly feel surprised. In the great majority
of these cases, this is owing to putrefactive changes going on in the
cavity of the vagina. In the process of fermentative decomposition,
the so-called _ptomaines_ are developed; these are chemical poisons,
which are absorbed into the blood, and by their depressing influences
on the nervous system are the cause of the weakness and tired feeling.
There are no remedies which, when taken into the stomach, will do the
slightest good for this condition, and it is a waste of both time and
money to expect relief from drugs.
This can easily be remedied by cleanliness, so that the secretions are
not long enough retained in the vagina, to decompose and develop these
ptomaine poisons.
During and after confinement is another important time for the
employment of vaginal washes. The _lochial discharge_, which is one
of the ordinary accompaniments of the newly-delivered woman, is a
discharge from the uterus, which continues for several days, growing
less and less, for a few weeks, when, in a normally healthy state
of affairs, it should cease entirely. The lochia is the oozing from
the mouths of the blood-vessels of the womb where the placenta or
afterbirth was attached, together with the passing off of the old
lining membrane of the womb, while the organ is returning to its
original condition. At first the discharge is bloody, and it may
retain this character for two or more days after delivery; then the
color is changed, partaking more or less of a watery nature and
presenting a yellowish hue; it then becomes whitish and ultimately
ceases altogether. After the first four or five days the lochial
discharge often becomes very offensive; this is a sign of putrescence
or decomposition, and the only remedy in this, as in all other similar
instances, is to wash the vagina thoroughly with borax water, or with a
preparation for which a prescription will be given further on.
In every case of delivery, the mouth of the womb is more or less torn
or lacerated; this is unavoidable, and it is generally harmless. One
of the surgical humbugs is to sew or stitch, or attempt to stitch,
these little harmless tears together, not of course for the good it
will do the patient, because she is more likely to be injured by this
meddlesome surgery, but to make a business and a fee. The common
practice of these and kindred surgical expedients is one of the crying
evils of an overcrowded profession which is trying to keep itself
employed at all hazards.
The vagina also receives more or less injury during an ordinary
confinement; if the midwife or the doctor is too meddlesome or in too
big a hurry to get through, he will use the forceps, which simply
means, to pull the child out and through the vagina, before nature has
had time to dilate or stretch the parts sufficiently, to allow the
child to pass through the maternal organs without injuring them. As a
result of this brutal haste, frightful lacerations are incurred, which
require immediate attention, but small lacerations heal without any
further treatment than to keep clean.
After every confinement there is considerable sore or raw surface,
with which the offensive discharge comes in contact, to become readily
absorbed or taken up into the system, giving rise to fevers or
inflammations of the womb and other pelvic organs. If one has a wound
on any part of the body, the first thought would, or rather should, be
to keep it clean; exactly the same treatment is required for wounds of
the womb and vagina.
When the discharge becomes offensive, it also becomes dangerous and
poisonous, and the only and proper thing to do is to thoroughly
wash out the entire vaginal cavity until all offensive smell
has disappeared. The only sure sign that anyone can have of the
completeness and thoroughness of the vaginal washings, is that there is
no longer any fetid or offensive smell perceptible.
It requires no particularly trained nurse or expert to administer a
cleansing vaginal injection, yet it is more likely to be done in a
bungling, inefficient manner than in a proper workmanlike manner;
for this reason, it would be well to remember a few of the necessary
details of carrying out the douching. In the first place, the room in
which the vaginal douche is administered must be comfortably warm, so
as to preclude the possibility of chilling the patient; the windows or
any other opening liable to cause draft must be closed. The nozzle of
the syringe, whether it be a fountain or a family syringe, must have
been thoroughly brushed and cleansed with soap water, before and after
each use; if the instrument is old, or has been used for questionable
purposes, or, perchance, made the rounds of the neighborhood, it had
better be thrown into the ash barrel, and an entirely new syringe,
the “Alpha,” be employed, which, by its sure and continuous stream, I
consider the most suitable female syringe. The bulb of a syringe must
be compressed in the palm of the hand slowly and deliberately.
The position of the patient is of considerable importance; a vessel is
placed under her, which is carefully adjusted, so as not to tip too
far backwards, otherwise it will overflow and drench the bed or the
patient’s clothing. Beneath the small of her back a few extra pillows
are placed, and thus she comfortably reclines on her back, while the
attendant manages the disinfecting wash and syringe, placed in a basin
between her thighs. Half a gallon of the fluid is usually sufficient.
The temperature of the wash is very important and may range between 103
and 106 degrees Fahrenheit.
The recumbent position is only intended for women who are confined to
their beds; others, who are around and about on their feet, can sit
comfortably over a chamber, on the edge of a low chair, having the
vessel underneath them, and the wash of course in a separate basin.
In the course of my experience I have been called to mothers, five to
eight days after delivery, who were in a raging fever, presumably from
the ptomaines which had developed in the vagina and poisoned the blood.
After a few vaginal injections, sometimes after the first, the fever
subsided entirely. These remarkable results we owe to the _antiseptic_
treatment of disease, and when it once becomes generally known that
this is only another word for cleanliness, infectious diseases will
grow correspondingly less, and the cure for those that exist will be
less experimental and more reliable.