Chapter V: The Respiratory and Circulatory Systems: the Kidneys (2)

If the woman has any great amount of writing to do, she should learn to use a typewriter. In using this machine she not only writes very much more rapidly and easily, but the position of the body is much more erect than that assumed when using the pen, and it is not nearly so fatiguing to the muscles of the hands and arms.

All closely confining sedentary occupations, as writing, sewing, etc., should be frequently interrupted to move about for a few minutes, rest the eyes, and take a few deep breathing exercises before an open window; this is necessary for the eyes as well as for the ventilation of the lungs.

=Ventilation of the Lungs and Breathing Exercises.=—Forced respiration is essential to completely change the air in the lungs, to maintain the elasticity of the lung tissue, and to expand the chest in every direction. Only in this way can a thorough ventilation of the lungs take place; a full supply of oxygen is taken in, which stirs up, disinfects, and cools the stagnant residual air, and forced expiration expels the respiratory excretions. One of the frequent causes of foul breath is lack of ventilation of the lungs, so that the expired air becomes laden with impurities.

In normal breathing the current of air which passes in and out of the lungs travels through the nose, not the mouth. The ingoing air, by exposure to the vascular mucous membrane of the narrow and winding nasal passages, is warmed and moistened, and at the same time the mouth is protected from the desiccating effects of the continual inroad of comparatively dry air.

By means of respiratory exercises the mobility of the chest may be greatly augmented; there is an increased flexibility of the ribs and sternum, as well as loosening of the thoracic joints, which may have become stiff, and these exercises also lead to a development of the respiratory muscles.

In this manner only can the frame work of the chest become thoroughly inflated from within, and thus all parts of the lungs, which run the risk of becoming incapacitated from lack of use, be brought into play.

It is highly important that this thorough ventilation of the lungs should take place at least three times a day—the first thing in the morning, while making the toilet, again about the middle of the day, and at night just before retiring.

To obtain the greatest benefit from these exercises they must be taken without corsets, the clothing must be light and loose, and the body lightly clad. The air in the room must be fresh, and after they have been learned, they can, as a rule, be taken before an open window. In the morning they are best taken just after the cold bath, when, by removing the impurities and filling the lungs with fresh air, and at the same time starting up a good vigorous circulation, they cause one to begin the day with energy and zest.

The respiratory movements are diminished during sleep, and at the same time there is a large accumulation of blood in the splanchnic veins, so that, particularly when there is any tendency to difficulty with the breathing at night, the trouble is greatly lessened by filling the lungs with pure air just before retiring.

It is necessary, first of all, to learn the art of breathing, to be able to dissociate the clavicular, the costal, and the diaphragmatic. By clavicular breathing is meant the raising of the collar-bone and shoulders as high as possible by means of a slow but deep inspiration—this expands the apices of the lungs; costal breathing is the throwing out and expanding the chest to its utmost capacity, and so enlarging the chest in its transverse and anteroposterior diameters; diaphragmatic breathing is the depression of the diaphragm and the protrusion of the abdomen without raising the lower ribs. The last is the most readily learned in the supine position; the bed supports the weight of the body, so that the individual is able to concentrate her entire attention on fixing the bony thorax, depressing the diaphragm, and protruding the abdomen at every inspiration and retracting it to the utmost with every expiration. This, of course, develops and gives tone to the abdominal muscles.

When the woman has conquered these first principles of respiration, she is ready to put them into practice in the standing posture. They should be learned before a mirror, and after that taken before an open window. The hands should be placed on the hips; first elevating the collar-bones and the shoulders to the utmost, while still holding the breath, she expands the chest, always breathing in from above downward, and, lastly, the diaphragm is depressed. With the lungs thus expanded to their utmost capacity, the breath is held as long as possible, then the lungs are emptied by an abrupt and forced expiration.

These exercises should be repeated at first ten times, gradually increasing to thirty times. It is well to take one or two ordinary respirations between the forced ones.

It will be found that, as these exercises proceed and the lungs are filled with purer air, the breath can be held for a longer period of time, and that with practice the length of time that the breath can be held is greatly increased; it should be held for half a minute. Public speakers, singers, and divers are all skilful in this respect.

When these simple breathing exercises have been mastered, breathing exercises can be combined with other exercises, which have as their aim the development of the muscles of the chest.

Reading aloud, singing, talking, laughing, are all good exercises for developing the capacity of the lungs.

=The Cure of Chronic Bronchitis by Deep-breathing Exercises.=—The upper part of the body must be nude and the exercises taken before a mirror, so that the woman can watch the movements of the chest and abdomen, see that all the hollows of the chest are filled out during forced inspiration, and that the muscles of the abdomen are properly retracted. For the average woman this last will be the most difficult; in beginning these exercises she will find that it will require all her concentrated energy and will power to cause a retraction of these disused muscles.

Patients with chronic bronchitis do not have the ability to perform forced respiration properly. The respirations are too superficial, and the respiratory movements are not properly performed.

As respiration is ordinarily performed, the partial expansion of the upper part of the chest is accompanied by a contraction of the abdominal muscles, whereby the diaphragm is forced upward, with the result that the lower part of the lungs remains very slightly expanded, whereby the circulation as well as the removal of mucus is imperfectly performed. This lack of forced respiration is a frequent cause of acute bronchitis running into a chronic form.

In chronic bronchitis it is especially in the lower part of the lungs that stagnation of the secretions takes place, and they can only be dislodged from the mucous membrane by forced abdominal expiration and the ascent of the diaphragm. This causes a cough which expels the mucus, and forcible abdominal expiration and cough are the only means of drainage of the lower and deep-seated parts of the lungs. Further, in forced respiration the muscle tissue of the bronchial tubes contracts, which certainly does not take place in ordinary respiration, but, on the contrary, this tissue atrophies.

Other beneficial results from forced respiration are increased oxygenation, improved nutrition, changes of a mechanical nature, ventilation, and disinfection of the lungs, massage of the lungs and pleura, and drainage.

No other method of treatment is so successful in the cure of chronic bronchitis not dependent on disease of the nose and throat. In from two to six weeks of treatment, in which there is a profuse discharge of mucus, it will be found that the bronchial tubes have cleared up, provided that the patient is supplied with an abundant supply of fresh air day and night. Methodically practised, deep breathing is not only the surest cure, but also the safest stimulating expectorant.

=Relation of Colds and Influenza to Pneumonia and Tuberculosis and their Prevention.=—We have already seen that bacilli are not only the cause of acute infections, but also of chronic bronchitis, and that this was especially true of the bacillus of influenza and the pneumococcus of pneumonia.

It is well known that influenza is an infectious disease, which rapidly spreads through the family and the community, but it is not so well known that the so-called “common colds,” ordinary sore throat, and tonsillitis are also highly contagious. The infection is carried from one person to another by direct contagion; the air is being constantly sprayed with the germs of disease in talking, laughing, sneezing, and coughing. In coughing and sneezing it is not sufficient to hold the hand before the mouth—a handkerchief must be used for this purpose.

_Colds_ are among the most frequent of the so-called minor ailments in this country. The causes are the overheating of the houses, the great dryness of the air, badly ventilated houses and public assembly rooms, which render people very susceptible to the great variations in temperature.

_Prophylaxis_, or _the prevention of colds_, combine all those measures which promote the general tone of the system, and may be said to embrace all the elements of personal hygiene. Good digestion and proper nourishment of the body with suitable food; the proper ventilation of houses, all public buildings and conveyances, for in these latter the public are brought into very close contact with their fellow-men.

Local prophylaxis would consist in the toilet of the nose and throat—the removing of adenoids and enlarged tonsils.

The individual must remember that she can reinfect herself; for this reason, an abundant supply of handkerchiefs must be used; they should be placed in a handkerchief bag and washed separately. Packs of cards should be thrown away before they become soiled. Sprays and atomizers must be individual property, and be kept thoroughly cleansed.

With the exception of deep-seated chest colds, in the early stages a cold may often be nipped in the bud by a few hours of hard sudorific work in the open air. In half a day the nasal ducts and respiratory system will throw off irritating matter that would take much longer time if the patient remained indoors and relied on the action of drugs alone.

_Treatment._—Other methods of treatment are a hot tub-bath on retiring, an active but not too severe cathartic, as two grains of calomel, taken just before going to bed, and, if the individual is chilly, a hot lemonade should be taken at the same time. Both the cathartic and the free perspiration will aid in relieving the internal congestion and thus aid in its abortion. A cold sponge should be taken the following morning to tone up the system. Turkish baths are also useful in breaking up colds; again, the precaution must be taken to avoid chilling on leaving the bath.

The following tablet is a very simple and very efficacious remedy for breaking up a cold in the early stages: Take of powdered camphor ¼ gr.; of the sulphate of quinin ¼ gr.; and of the fluidextract of belladonna root ⅛ minim. This should be well mixed, and made up into one tablet or a capsule. One tablet is taken every half-hour, until four doses have been taken; after that one tablet every three hours, until the running of the nose has ceased, which generally occurs within twenty-four hours. If there is not marked improvement at the end of this time, or if there is any fever, a physician should be consulted at once.

Quinin, when given alone to abort colds, must be given in sufficiently large doses to produce cinchonism, the subjective symptom of which is a slight deafness or ringing of the ears. The natural tendency of cold is to cause inflammation of the middle ear, and since the use of quinin in large doses causes a congestion, and so predisposes to inflammation of the middle ear, its use should be avoided.

The great amount of illness and mortality from pneumonia during and following epidemics of influenza is too familiar to the public to need more than mentioning. The patient is so rapidly and extremely prostrated by the attack of influenza as to be susceptible to the ready action of the pneumococcus, which, as we have seen, is ever present, and the extension of the inflammation from the fine bronchial tubes to the air-cells of the lungs rapidly takes place. In the exhausted condition of the patient she is not able to resist this invasion, the heart is already weakened, and death frequently rapidly ensues as the immediate result of heart failure.

=The Prevention of Tuberculosis.=—The tubercle bacillus is practically ubiquitous, and the prevalence of tuberculosis is universal. Hence it is imperative to raise the resistance of the individual in every way possible, as well as to limit the spread of the infection. This means the employment of all the resources of public and personal hygiene, public and private sanitation, and the education of the public in how the disease is disseminated, and how its spread may be prevented; also the teaching of the individual, her duty to the family and society, as well as to herself, in order not to spread the contagion.

Tuberculosis attacks the crippled and poorly developed lung just as surely as it shuns the one which is fully expanded and in constant and active service. Numerous observations have established the existence of a constant ratio between tuberculosis of the lungs and deficient chest expansion.

_Diet._—The doctrine has been growing among the laity that the child’s likes and dislikes should determine what food it should eat. Thus a finical taste is cultivated and a lack of proper nourishment follows, and it is this finical diet class of people which forms a large percentage of tuberculous invalids. It has long been recognized that a proper diet and the tolerance of it is of the utmost importance in the treatment of tuberculous patients, but from the foregoing it would appear that a proper diet throughout life is also of the utmost importance in the prevention of disease; a sufficiency, not only as to quantity, but also as regards variety.

It is the patient who can eat everything who stands a good chance of getting well. So, too, it is the individual whose diet for years has been perverse, who could not eat meat, to whom eggs were distasteful, who could not stand milk, who was infected with the vegetarian fad, or the two-meal-a-day fad, who stands a fair chance of falling a victim to tuberculosis, through a lowered tone of the system, because it offers but a feeble resistance to a powerful and insidious enemy. And the mode of the preparation of the food is an equally important factor. It has been shown that the poor cooking among the lower classes is a powerful predisposing cause to intemperance and tuberculosis.

Influenza is a frequent and important agent in bringing to light latent tuberculosis, and must be classed as an important exciting if not predisposing cause. Low, damp climates predispose to the infection by lowering the vitality. Tuberculosis is more prevalent in cities than in rural communities, due to the manner of housing and the character of the occupation.

_Summary of the Present Views of Infection._—The doctrine of inherited and acquired susceptibility still holds sway; next, that all infants are susceptible, and that susceptibility lessens with increase in age; that adults are comparatively insusceptible when free from general and local lowered resistance and repeated and prolonged exposure.

As to the source of infection, the consensus of opinion and ascertained facts point to the sputum as of overwhelming importance; cow’s milk is an important factor; the food may be infected directly by coughing, or the dirt and dust from the floor and hands; the fingers and many other objects that find their way into the child’s mouth are sources of danger. To adults, both dust and moist droplets are more often the source of infection than infected food.

_Expectoration._—Careless expectoration is the chief source of infection. Laws should be passed and enforced prohibiting the expectoration on pavements, stairways, in all public conveyances, and all public places.

The danger of infection from tuberculous house servants has not been sufficiently appreciated. A chronic cough in the case of a servant should be at once investigated by the family physician. Servants should be taught the necessity for washing the hands before touching the food or cooking utensils. The condition of their rooms, clothing, bathing, and other personal habits should be closely investigated, and personal cleanliness should be demanded as a _sine qua non_ for obtaining or keeping a situation.

Since it is a well-known fact that tuberculosis can be acquired from the occupation of houses and rooms formerly occupied by tuberculosis patients, it has been suggested that a clean bill of health should be demanded of the owner of the house before renting it; that is, a certificate from the Board of Health, that no case of infection has existed in the house, or that it has been properly disinfected since that time. If such a movement became popular, landlords would be obliged to furnish these bills of health in self-defense. Since the Boards of Health demand the reporting of all cases of tuberculosis, this scheme is by no means impracticable or Utopian.

The tubercle bacillus is not destroyed by any degree of cold, but both light and sunlight are distinctly injurious to these bacteria. The lowest fatal temperature to the tubercle bacillus is 131° F. of moist heat, acting for a period of six hours. The thermal death-point of tubercle bacilli in milk is of great practical importance, and many experiments have been made which have determined that a temperature of from 140° to 167° F., was sufficient if continued for one hour. If it is desired to pasteurize the milk, it should be placed in a closed bottle or stirred and heated for at least twenty minutes at a temperature of 149° F.

_Disinfection._—The use of formaldehyd gas has practically displaced the use of sulphur for the fumigation of rooms, as well as for the disinfection of furniture and clothing. For this purpose a moist vapor used in a sealed room is essential.

At least 8 ounces of the commercial 40 per cent. formalin should be used for each 1000 cubic feet of air content. The most efficient method is that used by Biggs, of New York, which is as follows: For an ordinary room, 1000 cubic feet, 1 pound of lime, 8 fluidounces of formalin, and from 2½ to 3 fluidounces of commercial sulphuric acid are required. All openings but the door are sealed. The formalin is poured into an empty water-pitcher, 4 ounces of water are added, and then the sulphuric acid is poured slowly in. The lime is placed in a china or earthenware wash-basin on the floor upon newspapers; all water is removed from the room. All drawers and cupboards opened; the mattresses stood on end; and the mixture poured quickly upon the lime, when the door is sealed. The sulphuric acid may be packed in a tin bucket containing the lime, and, with the formalin in a separate bottle, may be used by any person of ordinary intelligence. The room should remain closed from twelve to eighteen hours. It must not be lost sight of that after disinfection by means of formalin a thorough cleansing is imperative. A room which has been thoroughly cleaned and carbolized is safer than a room which has been disinfected with formalin and not properly cleaned.

After death or removal the entire place should be renovated. Besides disinfection and scrubbing the painted woodwork with a solution of hot soda water, the walls should be repainted or repapered, and the woodwork repainted.

Rugs, bedding, pillows, and clothing should be disinfected by hanging up in the room while it is undergoing disinfection. Books and all articles of small value should be burned. All soiled linen should be boiled.

=The Kidneys and their Function.=—The kidneys are the secretory organs of the urine; they are two in number, and are the largest tubular glands in the body. They are deeply seated in the lumbar region, lying one on each side of the vertebral column; the kidneys extend from the eleventh rib nearly to the crest of the pelvis. They are usually embedded in a considerable quantity of fat, which is the chief factor in holding them in position, aided to some extent by the large blood-vessels with which they are connected. The kidneys are oblong bodies and measure about 4 inches in length, 2½ inches in breadth, and over 1 inch in thickness. Their weight is about 4½ ounces.

As an excretory organ the kidney probably stands second to the alimentary canal; it surpasses in importance the skin, whose total excretion of water it equals. The abnormal substances appearing in the urine are often not the products of disease of the kidneys, but of some other organ or system.

The kidneys excrete and put the finishing touches upon the urinary fluid; they act at the end of the metabolic course, both as active and as passive agents. While to some extent the kidneys are mechanical contrivances, mere filters, so to speak, they are to a far greater degree active, specific glands. The renal epithelium has the power of synthesis, and builds up complex substances that are not apparent as such in the blood or lymph, as well as the power of analysis or breaking down of substances. These changes are due to the formation in the tubular cell of an enzyme, which we call histozyme. The kidney is the end link in the vascular chain, and the daily performance of healthy kidneys is no doubt a combination of the mechanical and the vital processes.

_The Secretion of the Urine._—In a perfectly normal being the problems of waste and repair are balanced to a nicety. As we know, the tissues of the body are bathed in lymph containing in solution the compounds that are necessary for their nourishment—proteids, carbohydrates, fats, salts, and gases. Waste follows in direct proportion to the activity of the tissues. The worn-out, effete material first finds its way into the lymph, and from it into the blood-stream, to be later eliminated from the economy, else deleterious results will follow their retention in the body. It is by the selective action of the cells of the various glands of the body that these useless substances are removed from the blood, and converted into such forms as can be readily excreted. In the main, the products to be removed are urea and the allied nitrogenous bodies—carbon dioxid, salts, and water. These organs are of vital importance, since nearly all of the waste-products containing nitrogen are eliminated in the urine.

The most easily understood function of the kidneys is the excretion of the urinary water; this varies in amount with the rapidity of flow through the renal vessels and to some extent on the blood-pressure.

The separation of the solid substances of the urine form the next function of the kidneys, and these substances fall into two groups—inherently useful materials, which are in excess or which have served their purpose, and substances which are inherently harmful. The latter class embrace many end-products of metabolism, which we are accustomed to consider as normal constituents of the urine.

The analytic study of the urine is of great value to the physician and surgeon, because of the knowledge which it gives concerning the processes of metabolism occurring within the body. The nature and amounts of the various end-products of metabolism are carefully investigated as they occur in the urine, whether they be normal or pathologic.

_The Urine._—The normal human urine recently passed is a clear liquid, of a straw color, with an average specific gravity of 1020, the specific gravity indicating the amount of solids contained in the urine. It is acid in reaction. The quantity for twenty-four hours is 50 ounces, or about 3 pints, depending on the amount of water ingested. During sleep the amount secreted is less than at other times. The amount of urine is decreased after profuse sweating, diarrhea, thirst, diminution in the blood-pressure, and after severe hemorrhage. When the body temperature is considerably higher than normal, the amount of urine is again diminished in quantity.

Urea forms nearly one-half of the solids in normal urine and nearly one-half of the urea is nitrogen. It is the principal representative of the waste of the nitrogenous tissues. The chief source of urea is from the metabolism of the muscles; the ingestion of a large amount of proteid food stimulates metabolism. The quantity of urea passed in the twenty-four hours is about 500 grains.

The uric-acid constituent is very small, and in the human urine scarcely reaches 0.03 per cent. of the solids. Lack of exercise leads to an increased formation of uric acid by a lessening of the oxidation of the tissues. In gout the amount of uric acid excreted is abnormally small, because it accumulates in the blood and tissues. The brick-dust deposit sometimes seen in the urine is composed chiefly of the urate of sodium. The average daily amount of uric acid passed in the human urine is about 7 grains. The excretion of uric acid may be increased by drinking copious drafts of water.

_Toxicity of the Urine._—After the removal of both kidneys the animal dies of uremia; that is, there is an accumulation of urinary products in the blood. The removal of one kidney is not necessarily fatal, and women have so lived very comfortably for many years. A human being excretes enough poisonous material by the kidneys in two days to cause death.

_The Urinary Excretory Apparatus._—After the urine has been secreted by the kidneys it must be carried away from the body, so that the economy may not suffer from the resorption of the contained toxic principles. The excretory apparatus comprises the ureters, the bladder, and the urethra.

The ureters are two cylindric tubes of the diameter of a goose-quill and about 15 inches long. They make their exit from the inner border of the kidney, and pass downward and inward toward the median line, to empty into the base of the bladder by a slit-like orifice.

The bladder is the reservoir for the urine. It is a musculomembranous sac, situated in the pelvis, and in the female it is in front of the uterus and above the vagina. It normally contains one pint. It should be emptied four times a day. If it is allowed to go longer than this, it becomes overdistended, and is apt to displace the uterus backward, and the bladder-walls themselves become weakened.

=The Physiology of the Female Generative Organs.=—The internal and essential organs of generation are the uterus, ovaries, and the Fallopian tubes. These organs have to do with the process of ovulation, menstruation, and reproduction.

_The Ovaries._—These are two small bodies of an almond shape, and lie one on either side of the uterus. The bulk of the organ consists of connective tissue, in which lie embedded the Graafian follicles, or ovisacs, in which the ova are contained.

During the child-bearing period, or from about the age of fifteen to forty-five years, the development of the Graafian follicles and the discharge of the ova are continually taking place. The liberation of the ova usually takes place at definite times, which, in general, coincide with the menstrual epochs, one or more ova being set free at each period, but this is by no means invariable.

_The Uterus._—The virgin uterus is a small, hollow, muscular organ, somewhat pear shaped, whose cavity is about 1½ inches deep. The uterus is situated in the middle of the pelvic cavity, between the bladder and the lower bowel. It is held in position by broad elastic bands, which go to different sides of the pelvis; it is also in part supported by the structures below and above it; but so loosely is the uterus held that it is easily pushed about, as, for instance, by a full bladder or a packed bowel, and persistently allowing the bladder to become overful, and failure to have a daily evacuation of the bowels, are prolific sources of displacements of the womb.

_Respiratory Movements of the Uterus._—When no constrictions are placed about the waist, the uterus moves freely up and down with every respiration. So distinctly, and with such regularity, do these movements occur that an operator, by watching the movements of the uterus, can tell the effect that the anesthetic is having on the patient’s breathing. These so-called respiratory movements play a very important rôle in the circulation of the uterus, and in the return of the venous blood to the heart.

Anything which interferes with these movements, as the wearing of corsets or of tight bands about the waist, prevents the free return of the venous blood. The uterus becomes congested, and through the constant abnormal weight of the organ itself, as well as by the pressing down upon it from above of the superincumbent organs, the uterus is pushed down below its normal position, the ligaments whose duty it is to hold it up become relaxed, and the unhappy woman suffers all the agonies that are attendant on the “falling of the womb.” For this reason the disorder is frequently met with in women who have never borne children as well as in those who have.

_The Functions of the Uterus._—The function of the uterus is to provide a favorable place for the reception of the product of conception, where it may be protected and nourished during the period of its development. The purpose of menstruation is to keep the uterus in suitable condition for the reception of this product of conception at any time. It is now known that the menstrual flow is not the whole of menstruation, and that the changes going on in the uterus are almost as continuous as the process of digestion.

_Average Duration of the Menstrual Flow._—The average duration of the menstrual flow is five days, although the variations are considerable in healthy women. A flow lasting any place from two to six days is perfectly consistent with health, but a flow continuing less than two days or more than six days generally indicates a local or general disease.

_Character of the Menstrual Flow._—For the first few hours, or perhaps for the first day, the flow is usually slight in quantity and light in color; on the second and third day the flow reaches its height, and is profuse and dark in color, but it should never be clotted; after this it generally ceases. The amount of the flow varies from 5 to 10 ounces. If less than 5 or 6, or more than 18 napkins, are pretty well saturated through, the amount may be considered abnormal.

_Premonitory Symptoms of the Flow._—The premonitory symptoms of the monthly flow should not be so marked as to cause the individual any discomfort. The first indication of the return of the period should be the flow. There is generally a feeling of abdominal fulness, with some lassitude and sometimes slight headache. The temperature is lower and the pulse is slower than at other times. This lowered tone of the system is an additional reason for increased care against exposure in wet or cold weather.

=Hygiene of Menstruation.=—During the menstrual period all _cold_ baths must be strictly prohibited, whether tub-baths or cold sponges. The reason for this is that the application of cold to the surface causes a driving in of the blood from the exterior of the body to the internal organs, and, at the time of the menstrual periods, there is already a congested condition of the pelvic organs, and it must be remembered that congestion is the first stage of inflammation.

Hot or warm sponge baths may be taken throughout the period, and the vulva should be bathed with warm water twice a day throughout the entire period of the flow, as this not only removes the clotted blood before it decomposes and becomes the source of irritation, but also removes other irritating matters, and prevents the nervousness that is caused by local irritation.

Another question which is still _sub judice_ is the necessity for and the frequency with which vaginal douches should be taken; all physicians are agreed that a vaginal douche, taken immediately after the menstrual period, is beneficial, as it removes all of the débris of the flow, which is sometimes very irritating.

_Exercise._—A moderate amount of exercise should be taken every day; this is needed now quite as much as at any other time, and only good can result from it, and no harm comes of a woman going out in the rain or the cold weather. As has been shown, the menstrual process is going on for a large part of the time, and the flow is only the external appearance, but during the time of the flow the woman must be unusually careful not to get her feet wet or sit down with damp clothing on. Violent exercise of all kinds is to be prohibited at this time, as dancing, bicycling, gymnastics, and walks of over three miles. The reason for this is very obvious: the uterus has now reached the height of its turgescence, and is heavier than at any other time, hence the danger that displacements or a very profuse flow would be caused by any kind of violent exercise.

_Treatment._—If the woman has been so unfortunate as to have been caught out in a heavy rain, so that her clothes have been wet through, or if in the cold weather she should come into the house thoroughly chilled, the best thing to do is to take off her wet things as quickly as possible; be well rubbed down with hot rough towels; drink a cup of hot tea, and go to bed at once, with a hot-water bag placed over the abdomen or under the small of the back. She should remain in bed until the next morning, to the end that the circulation may regain its equilibrium as quickly as possible by the immediate relief of the pelvic congestion.

If this exposure should have caused the sudden cessation of the flow, a hot mustard foot-bath should be taken. One tablespoonful of ground mustard is used to the gallon of water, as hot as it can be borne; the pail should be made as nearly full as possible, without running over, and a blanket wrapped about the pail and woman, so as to cause a profuse perspiration; this should be kept up for ten minutes; as the water cools off, hot water may be added.

Profuse menstruation, painful menstruation, and scanty, very slight, or irregular flow are all abnormal conditions that are due to some abnormal or pathologic causes, and a good gynecologist should be at once consulted, so that not only suffering may be prevented, but that serious consequences to the general health may be averted.