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.

Leucorrhoea, 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 gonorrhoeal 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.