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.