HYGIENIC MEASURES FOR CATARRHAL DISEASES OF THE FEMALE ORGANS.

No treatment for catarrhal inflammations in general and of the pelvic organs in particular is certain and complete without special attention being given to certain laws or rules that are laid down for the preservation and attainment of health, and these comprise one of the collateral departments of medical science which is termed hygiene.

What the skin or integument is to the exterior of the body, the mucous membrane which lines the respiratory passages and other organs is to the interior of the body.

The mucous membrane is only a modification of the skin, and while it differs in its glandular composition in the different organs that it lines, in the main, it retains the common characteristics of the skin or outer covering of the body.

The corium or fibrous layer of the mucous membrane is analogous to the derma of the skin; and it is in fact a continuation of it at the orifices of the body.

The corium of the mucous membrane supports an epithelial layer of cells that are of various forms, differing in the different organs that it lines.

Underneath the corium of the mucous membrane there is the fibrovascular layer, which contains the blood vessels, lymphatics and nerves and embedded in the epithelial cells supported by the corium are the numerous mucous glands or follicles. In some portions of the mucous tract and projecting out of it are little elevations called villi or papillÆ, analogous to the papillÆ of the skin.

These glands and papillÆ exist only at certain parts and are modified according to the function that the organ performs. The mucous glands of the stomach differ from those of the intestines, and those of the mouth from those of the bronchial tubes. The mucous membrane of the womb differs from all the rest, by having no submucous or fibrovascular layer; the mucous glands of the womb are imbedded and extend directly into the muscular tissue of the organ. The secreting glands, which form a special feature of mucous membranes, are abundantly supplied by small capillary blood vessels and nerves, so that any disturbance of the general or systemic circulation or a derangement of the nervous system will at once greatly influence the healthy or normal secretion of the membrane, just exactly as the skin is affected by cold or fright.

In order to appreciate all the causes that operate for either good or evil, we must pause for a moment and consider the sympathy with and the close relation of the mucous membrane to the circulation of the blood and the nervous system. The mucous membrane of the different organs is often made the safety valve through which obnoxious materials or morbid conditions of the blood are eliminated from the system, and for that reason I have long ago discarded the usual harsh measures in the treatment of sudden or acute catarrhs. I have found that, by carefully watching and giving close attention to the details of certain rules of health, catarrhs speedily disappear of their own accord: on the other hand, if irritating local remedies are constantly used, catarrhs continue to grow worse.

This demonstrated fact so very often repeated, impressed upon my mind the importance of hygienic measures for the successful treatment of catarrhal inflammations, whether they are of the respiratory organs or of the female pelvic organs. The most prominent and efficacious measures are to be found in intelligent precautions for preventing colds and inuring the system to changes of temperature by appropriate outdoor exercise.

By far the greater proportion of female complaints are catarrhal inflammations, and these fasten themselves upon all the pelvic organs—on the bladder, vagina, womb and Fallopian tubes.

We generally know how we contract a bronchial catarrh or bronchitis, a nasal catarrh or sore throat; in precisely the same manner do women contract most of their pelvic catarrhs, that is, from a common cold or sudden chilling of the body or part of the body.

Dr. Thomas F. Rumbold, in his work on the “Hygiene and Treatment of Catarrh,” says: “The history of every case of chronic catarrh attests that the complaint commenced with colds in the head and that the disease grew upon the patient almost imperceptibly, the first colds being so trivial in character as to attract but little attention.”

This statement is as true of the great majority of cases of vaginal and uterine catarrh as it is of catarrhs of the air passages, and for this reason the measures and precautions for the prevention of colds must be one of the features in the successful treatment of female complaints.

The particulars of the causation of colds and the hygienic precautions for their prevention are hardly ever given the attention which their importance demands in the treatment for catarrhal complaints of women, so that a great deal of suffering is left unrelieved and a great deal of expensive and useless doctoring is endured. Altogether too much reliance is placed upon a wash or some local application made by the doctor to the affected parts, and, indeed, the mainspring of the catarrhal affection is entirely overlooked or neglected, which is, the susceptibility to the recurrence of fresh colds.

The injurious effects of taking cold or chilling the body or any part of it, have been the subject of special inquiry in Germany. The mucous membrane and the skin seem the most sensitive to sudden changes from a warm to a colder atmosphere, but observations have already proven that besides the usual catarrhal inflammations, there are other inflammatory conditions that are developed. The kidneys, lungs, and liver have been found to be the seat of inflammations in a series of experiments that were made with rabbits that were removed from a warm to a much colder apartment, and from this may be inferred that these conditions originate similarly in the human subject.

The logical conclusions of these researches have been, that the chilled or cooled blood becomes chemically altered and acts as a direct irritant in the small capillary vessels, and by that means all the phenomena of inflammation of the tissues are excited, and these of course develop wherever the cold may strike or locate.

When we speak of a slight or a bad cold, we cannot form the least idea of the remote effects that the cold may bring about. It may lay the foundation of a nephritis or Bright’s disease of the kidneys, or some other lesion, and that it often gives rise to vaginal and uterine catarrh is as certain as that it gives rise to nasal catarrh or a cold in the head.

An aptitude to take cold grows with each repetition of the attack and the prolonged duration of the acute catarrhal symptoms. And for that reason persons grow into the habit of taking cold upon the slightest exposure or change of temperature. At this stage of catarrh there is an abnormal sensitiveness of the mucous membrane and skin, in which the slightest draught of air or even passing from one room to another occasions an attack of sneezing or a chill and other symptoms that will indispose the patient for several days.

The great majority of individuals have a natural predisposition to certain diseases.

In anatomy the body has been divided into systems. A system is an assemblage of organs composed of the same tissues and intended for similar functions, as the circulatory system, the nervous system, the muscular system, the cutaneous system, etc.; these systems are all liable to particular diseases. In one person the mucous membrane of the respiratory system is the most sensitive part of the body, while in another, and especially in women, it is the mucous membrane of the genito-urinary system. In other words, one person will take a cold and it will settle in the head or on the bronchial tubes, while another from the same exposure will get a catarrhal inflammation of the bladder or womb; this is only explained on the theory of natural predispositions, and, perhaps, hereditary taints.

If a person once knows the weak or vulnerable points, he can outgrow them, by employing such rules of hygiene as experience has taught to be useful. There is much more benefit to be derived in an educational treatment directed to the prevention of disease, for this is also in the nature of a cure, than in a blind obedient faith in the treatment or remedy of a physician who may be ignorant, and generally is, of the laws of health or the science of hygiene.

To promote health and to antagonize disease is greatly within one’s own power, because there is no doubt that most diseases are the result of imprudence that cannot be attributed to ignorance, because persons commit these errors with a full knowledge of their evil effects.

A healthy habitation, that has all the advantages of pure air and sunshine, is an essential feature in regaining health and encouraging a cure. There are hundreds of persons who have been sick and miserable for years, and who have made the rounds of all the doctors they ever heard of, without the least benefit to themselves, because they were never told how to live, and their living rooms are dark and sunless and poorly ventilated.

The even and equable temperature of all the rooms of a house should be kept in constant view, so that sudden and extreme changes of temperature are avoided.

Warming a dwelling artificially should be one of the important features in the construction of a completely-furnished residence. This subject has been neglected, owing to the temperate climate of California, yet the moisture of the air, and the closeness with which dwellings are built in cities, exclude the rays of the sun and make houses too cold for health and comfort. In our climate we become more sensitive to the cold air than those who live in drier regions.

In shaded houses and rooms, especially in damp weather, we need artificial heating as much as they do in colder climates, so that architects should make it a study to introduce a system of heating that will insure an equable temperature throughout the entire building, at a minimum of expense.

The fireplace or open hearth, which has become so popular with us as the pleasantest and healthiest mode of heating and also insuring ventilation, should be discarded for something much better. The fact that the fire is directly beneath the chimney flue explains the fact that eighty-seven per cent of the total heat yielded by coal or coke and ninety-four per cent of that yielded by wood escapes through the chimney. This enormous loss of temperature arises from the current of air necessary for combustion, carrying with it a large quantity of the heat produced which is lost in the atmosphere. This of course is a means of ventilation, but a little reflection will convince almost anyone that it cannot be the most practical, and in this State where coal is very high it is equally expensive. The smoke, soot, and ashes that are inseparable from the open fireplace make it troublesome and dirty, not to say anything of the coal gas, which poisons the atmosphere of a room, and I have often noticed its noxious influence on infants.

There are objections against warming one or two rooms of a house and leaving the others cold. A warm sitting room, while the halls and bedrooms remain cold and chilly, is a very fruitful source of cold and catarrhs.

There is a vast difference between heating for health, and heating to have warm rooms; in the former, the warm rooms would be incidental to health and comfort, while in the latter you might sacrifice health for warm rooms.

Heating by hot air has serious objections that may be briefly stated as follows: Fresh air passing through or around red hot furnaces, becomes so rarefied that it no longer contains sufficient oxygen for healthful breathing purposes.

The expansion and contraction of the furnace allows the escape of the noxious gases of combustion which become unavoidably mixed with the hot air that is to heat the dwelling, and thus vitiate the air that is to be breathed, and should there be any malaria from defective sewerage in the basement that, too, would be circulated with the heated air.

It seems also to be impossible to distribute hot air equally to all the rooms of a house through long flues, for the hot air is choked off at the registers by the counter currents of cold air from the rooms on the side of the house exposed to the winds, while the protected side is always overheated.

I have practically demonstrated, in my own residence, that hot water is the most simple and efficient means of heating a dwelling for both health and comfort, and for several reasons: There is no danger of overheating, and there is no possibility of vitiating the air, because the temperature of the hot water is always lower than even the boiling point.

With a proper distribution of the heated water through pipes, and radiators of sufficient heating surface, all rooms can be warmed to an equal temperature. Another consideration is the economy in fuel when properly constructed heaters are used, for the water readily absorbs the heat and retains it for hours after the fire has ceased to burn. Unlike steam heating, a moderate fire will warm the house in moderate weather. Hot water heating does not exclude a practical scientific system of ventilation. There is no danger from explosion, nor from fire, the plant is absolutely odorless and noiseless, and requires neither mechanical skill nor close attention to run it. There is no doubt of the durability of a hot water system, for if properly constructed it should last as long as the building, and the cost is less than a number of mantels with the necessary flues.

The most comfortable average temperature for living rooms is from 65 to 70 degrees Fahr., for hospitals and sick rooms a higher temperature is generally required, say from 75 to 80 degrees Fahr.

Dr. Horace Dobell, of London, in his work entitled “Winter Cough,” makes some very practical and useful remarks, when he says: “But before leaving the subject of sudden changes of temperature, I must not forget to speak of sleeping rooms. It is quite astonishing what follies are committed with regard to the temperature of sleeping rooms. On what possible ground people justify the sudden transition from the hot sitting room to a wretched cold bedroom, which may not have had a fire in it for weeks or months, it is impossible to say, but it is quite certain that the absurd neglect of properly warming bedrooms, is a fruitful source of all forms of catarrh. We cannot too much impress this upon our patients.”

There is another source of danger in artificial heating, and that is, in having the air of the house always much warmer than the most favored temperature of the open air. This is a great mistake because it is under these circumstances almost impossible to go from an overheated house or apartment into the open fresh air without catching cold, and for this reason the thermometer should be found in every well-regulated household. Women who are under treatment for female disease should never get into a cold bed, even if there has been fire in the sleeping room during the day. In damp and cold weather there should be greater precaution in this respect. The best bed warmer is one or more earthenware jugs, like the German seltzer water jugs, filled with hot water. Earthenware radiates the heat better and retains the warmth longer than glass, while there is no danger of the heat cracking the jug, as it will glass bottles. One or two of these jugs filled with hot water and put into a bed an hour or so before retiring will bring the temperature up to an agreeable warmth.

Proper clothing is perhaps from a sanitary standpoint of equal importance with that of artificial heating and ventilation. With appropriate clothing, the body can be protected against the inclemency of the weather and the sudden changes of the atmosphere so that no ill effects are experienced from the great changes of temperature to which we are exposed. Women are dressed less warmly than men, although they do not possess the bodily strength to resist cold in the same degree as men. Their garments are not only made of lighter material, but the loose, fluttering manner in which they hang around the limbs does not protect their bodies in the same thorough manner that similar material made after the style of men’s clothing protects men.

This does not imply that women should don men’s clothing, because the present costume or outside apparel of women of civilized countries, is both graceful and modest. A reform, however, in her underclothing is not only desirable but in many cases absolutely necessary to insure permanent relief from catarrhal affections.

All women who are suffering from uterine or pelvic diseases, and who are still wedded to the injurious costume of open drawers and skirts, have an important lesson to learn.

A warm and complete covering for the lower extremities and pelvic organs is paramount to any medicine or treatment that can be given.

It is during the menstrual period that the pelvic organs are more susceptible to congestion and inflammation from exposures than at any other time, and from the manner in which women dress, it is surprising that there is not more sickness among them than there really is. Wide and open cotton drawers, and skirts hanging loosely around their limbs, with cotton hose, are no protection against drafts and sudden changes, so that it often happens that the extremities are chilled and cold, which is in itself sufficient to cause uterine diseases. When this exposure continues, with some already existing disease, it will neutralize the best-directed efforts to accomplish a cure.

It is said of the celebrated Boerhave, that among his effects there was a carefully-sealed prescription, which contained the secret for preserving health and vigor to a ripe old age. In his last will and testament it was provided that the prescription should be sold to the highest bidder at public auction. A physician who was anxious to procure the recipe of this renowned Dutch doctor, bought it for a very high price. On breaking the seal and anxiously unfolding the paper, he found these words: “Keep the head cool, the extremities warm, and the abdomen free.” The buyer was greatly chagrined at the simplicity of the supposed panacea, but, if the profession and the public only appreciated the real worth of the advice, there would be much less sickness.

This strikes at most of the evils in dress that pave the way for diseases of women. It comprises the evil effects of tight lacing and compressing the abdominal organs by improper support for the skirts. A corset should never be worn so tight that the hand cannot be passed through the waist line. In the absence of a waist or shoulder straps for the support of the skirts from the shoulders, shoulder straps should be fastened directly to the corset, so as to relieve the hips and abdomen from the weight of the clothing.

The corset waist is not only a perfect substitute for a corset, in supporting the bosom and preserving the form so as to give a handsome figure, but it supports the skirts without restricting the circulation and respiration, or compressing the abdominal organs. In buying or making a waist or bodice, particular attention must be paid to the shoulder bands, so that these bands are short enough to give the waist or bodice support from the shoulders. If, then, the skirts are buttoned to the waist, the weight is taken from the hips, where it injuriously depresses the abdominal organs, and falls on the shoulders, where it cannot do any harm. There is a good deal of humbuggery about these new devices, and those who make it a business to sell them, never take the pains, or are incompetent, to properly fit the waist. If one only bears in mind that, if the waist does not support the skirts from the shoulders, there is nothing gained over wearing an old-style corset, imposition is impossible.

The dressing for the feet should be warm and comfortable. Women who go to balls and parties should always wear overshoes in going to and coming from an entertainment. Thin and light shoes must be avoided in cold and damp weather; in fact, there is nothing that women should be more careful about than too light and low shoes which do not keep the feet warm. For comfort and keeping the feet warm, there is nothing like a loosely-fitting leather shoe, with wide and thick soles, and a low, flat, English heel. It is also the best “corn remedy” I know of.

When the weather is wet and cold, rubber overshoes should be worn, and these should be removed when entering the house. Women who have a tendency to cold feet, will find the cork or felt soles worn inside of the shoes, a great source of warmth and comfort. The coldest stratum of air is invariably on the floor of the room, and there is, perhaps, no easier or more unsuspected way to take a cold than to exchange a pair of high, warm shoes that fit closely around the ankles, for a pair of light, low slippers. If you desire to rest your feet in a pair of light slippers, then add a pair of heavy woolen socks over the stockings, this will greatly lessen the chances of taking cold.

Women who are suffering from pelvic or womb diseases, and who are anxious to get well, and those who are troubled with painful menstruation, and menstrual irregularities, should wear woolen hose. Thin cotton, silk-mixed, or silk hose are not sufficiently warm, nor do they retain the natural heat of the body like woolen stockings.

Those who have once accustomed themselves to woolen hose, should not discard them in the summer months for cotton, linen or silk goods, and this is to be particularly observed on this coast, but the hose should be exchanged for thinner and lighter goods of the same material, corresponding to the demands of the season. It would not be wise or prudent to wear the same quality and amount of clothing in warm weather as in cold; otherwise the excessive clothing in the summer months will induce perspiration on the slightest exertion, and thus the system becomes most susceptible to cold when the weather changes or becomes cooler.

Elastic garters to maintain the tops of the stockings in position should be avoided. Rubber bands make a continuous compression on the vessels and nerves, although almost every woman claims that she does not wear her garters tight, yet at night when she removes the elastics there are deep furrows marking the constriction of the garters. The spring-wire garters are just as injurious, for they also exert a continuous pressure.

The veins of the legs are, for the most part, superficial, and this steady and gradual compression is very injurious to the venous circulation, so that the blood is prevented from returning from the limbs as readily as it should; this induces cold feet, and when the circulation is already weak, it often imparts a feeling of heaviness to the limbs, for which women doctor but without getting any relief. The only proper support for the hose is elastic straps that are supported from the waist; they are now so well known and for sale in every dry goods store that a description of them is unnecessary.

To keep the legs and body warm is not a question of quality or quantity of skirts or wraps. If the limbs under them are not separately enveloped and are only covered with thin cotton or silk hose and open cotton drawers, women are continuously exposed to the cold, damp emanations from the ground and to the drafts caused by the motion of the skirts, and blasts of wind.

The most intelligent suggestions for Dress Reform are those that are directed towards reducing the weight or displacing the heavy, stiff, and unwieldy skirts and clothing the extremities of the female in divided garments, so that they are no longer exposed to the dangers of cold and drafts. The divided skirt is in the direct line of a modest and desirable improvement of woman’s dress, and it is growing in popularity among the most intelligent of reading and thinking women. If the specialists of female diseases were to study the interests of their patients with the same ardor that they study the methods how best to fill their offices with patients, on whom they perform useless and dangerous operations, they would be of some actual benefit to our wives, mothers, and sisters, and our women could be dressed as gracefully as at present with less than half the underclothes to pack around with them.

I am decidedly opposed to anything approaching in style or shape the bloomer costume; the present style of outside dress cannot possibly be improved for a comely garment, but it is underneath this that an entire change should be speedily effected. The divided skirt is cut like drawers that have a width of thirty to forty inches of goods in each leg. I believe that the width of each leg should not be more than twenty-five to thirty inches; this makes the skirt warmer and lighter. This is not attached to a band to fasten around the waist, but to a yoke, which should be buttoned to the bodice waist, suspending the skirt from the shoulders. The material will be a matter of individual taste; the two qualities that should be always looked for are softness and warmth, and for that reason Jersey flannel and ladies’ cloth are the most suitable material; in summer or warm climates, pongee or wash silks may be substituted.

The skirt is cut on the bias to fit the hips, where it is fulled in and attached to a yoke instead of a band and in the back it laps about two or three inches. The advantage of the divided skirt is that it protects the limbs and body against drafts and cold emanations, and takes the place of all underskirts and petticoats. This skirt alone, however, would be insufficient to accomplish all that is desired by way of guarding against exposures; for this reason there is also a so-called Union suit worn under the divided skirt to complete the covering of the limbs.

Union suits, as the name implies, unite a pair of closely-fitting drawers with an undershirt. There is no particular advantage in uniting the underdrawers with the undershirt, but there is certainly no disadvantage. The principal object that is to be attained is not in unionizing drawers and shirts, but wearing such closely fitting undergarments that the extremities are permanently protected, and in having them so lapped or closed that the abdomen and pelvic organs are securely protected against cold.

Equestrian tights are made on the same principle and for a similar purpose as union suits, namely, to properly and surely cover the limbs and in a measure displace the great load of petticoats that women usually wear. They come in drawers and also in combination suits with the undershirts; a choice may be left to individual taste. There are different brands of these goods on sale in all the dry goods stores of our large cities, the prices being regulated by material and quality of the goods from which they are made. The woolen goods are preferable for practical purposes.

Women who do not like the woven closely-fitting drawers can take their choice between the latter and home-made flannel drawers, the French flannel for the lighter and the English bully for heavier and warmer clothing will be found to be the most serviceable materials; patterns for making up closed or button drawers may be had at the leading pattern stores of any city.

Women who cannot grow up to an appreciation of the divided skirt should by all means wear equestrian tights or buttoned flannel drawers, under cotton or linen ones; this will enable them to throw off one or two petticoats or skirts because the drawers will safely substitute the skirts and be much lighter. Some women dread the absence of skirts on account of appearing too scant; a little extra fullness and drapery to the dress make the absence of skirts not noticeable. If this were not quite so, there appears no satisfactory reason why a woman should feel embarrassed to modestly display the contour of her form any less than a man.