Chapter XLVII: Introduction (17)

We cannot too strongly urge in this, as in all other chronic diseases peculiar to women, that the bowels be kept regular. Frequent, but small doses of Dr. Pierce's Pleasant Pellets will prove most beneficial. If the vaginal passage is tender and irritable, an infusion, or tea of slippery-elm bark is very soothing, and may be used freely with a vaginal syringe. Whatever injection is employed, should be preceded by the free use of Castile soap and warm water, to thoroughly cleanse the parts. One part of glycerine to six parts of water is a soothing lotion when there is much tenderness, heat, and pain in the vagina. If there be no great tenderness in the vagina, or if the acute, inflammatory symptoms have yielded to the lotions already suggested, then a tonic and astringent injection should be employed.

For this purpose a wash made by dissolving one of DR. PIERCE'S PURIFYING AND STRENGTHENING LOTION TABLETS, in one pint of hot water is a superior application and will not fail to be of great benefit in controlling the disagreeable drain. If your medicine dealer is not supplied with these, mail 25 cents in one-cent stamps to us and we will forward a box of the Lotion Tablets by return post.

These Lotion Tablets have for many years been used in the treatment of obstinate cases of leucorrhea at the Invalids' Hotel and Surgical Institute, and their efficiency has been alike gratifying to both patient and physician.

If _pruritus_ or severe itching, be also a symptom, the itching will readily yield if the parts be cleansed with Castile or other fine soap and warm water, followed by the application of a compound composed of two ounces of glycerine, one ounce of rose-water, and one drachm of sulphite of soda; or, for the sulphite of soda, two drachms of borax may be substituted. The following lotion is a good one to relieve pruritus: sugar of lead, two drachms; carbolic acid, half a drachm; laudanum, four ounces; glycerine, four ounces; water, four pints; mix. This may be applied to the itching parts, and also injected into the vagina.

HOW TO USE VAGINAL INJECTIONS. We usually recommend the Fountain Syringe illustrated in Fig. 6, as the most convenient instrument for administering vaginal injections. The fountains supplied by us are of soft rubber, and have extra nozzles, with which to make rectal, nasal or ear irrigations. There is also a large, long nozzle for vaginal injections.

It is channeled so is to permit the free clearing away of the secretions as the Douche is employed. The Fountain Syringe can he used without assistance, the flow of fluid is gradual, and with a force that can be varied, by raising or lowering the reservoir, yet is never so great as to be liable to produce injurious effects.

The syringes usually sold with small nozzles or pipes are of little or no value for vaginal injections. In many instances so small a tube will pass readily into the canal of the uterus, and hence there has frequently resulted an injection of a portion of the fluid into the uterus itself, producing severe pain. It is important, therefore, in using the Vaginal Douche to employ only a large tube that has grooves in its surface for the free clearing away of the fluid as it runs from the fountain.

Where it is desired to obtain relief from a congested, inflamed or sensitive and irritable state of the mucous surface, the employment of a large quantity of water as hot as it can be borne, is of the greatest remedial value. It rapidly diminishes the size of the blood vessels, and aids in bringing about a normal circulation in the parts.

As a rule, in taking the Douche with the Fountain Syringe the rubber bag is filled, and suspended from a nail or hook at a height of from two to five feet above the patient, and the fluid passes through the tube by force of gravity, thus requiring no muscular exercise. The force of the stream depends upon the height of the fountain above the outlet nozzle. It is only necessary that the patient should assume a comfortable position where the fluid which comes from the vaginal canal can flow into a water closet, or any convenient vessel.

After a thorough cleansing of the vaginal surfaces of mucus, by means of the warm or hot water, it is sometimes advisable to inject remedial fluids. These injections may readily be made with the fountain or bulb syringe, introducing not less than from two to four ounces. This may be retained sufficiently long to exert its remedial effects upon the mucous surface, which usually takes from five to eight minutes. The hips should be elevated, and the nozzle of the syringe surrounded by a napkin or other similar material, upon which moderate compression can be made so as to retain the fluid in the vagina for the necessary period.

When suffering from any uterine trouble, it is necessary to avoid severe fatigue. The amount and character of exercise should be suited to the condition of the patient; while, most important of all, the strictest abstinence from sexual intercourse should be observed.

To those who are unable readily to obtain the Fountain Syringe above recommended we can send by mail, post-paid, one of these instruments on receipt of $2.00.

A Soft Rubber-bulb, or Pump Syringe (illustrated in Fig. 7), not so good for making vaginal injections, can be sent by us, post-paid, for from 75cts. to $1.50, the price varying with the quality and size.

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STERILITY.

(BARRENNESS.)

Real sentiment and interest center in fecundity, since the desires and happiness of mankind are consummated in marriage and procreation. How dreary would life be without love, companionship, and the family! How precious are the ties that bind our hearts to father, mother, daughter, and son! The love of children is innate in the heart of every true man and woman. Each child born supplements the lives of its parents with new interest, awakens tender concern, and unites their sympathies with its young life.

How dreary is the thought that one may attain a ripe old age with neither son nor daughter to smooth the decline of life, or sorrow for his or her departure! How many women desire a _first-born_ of love, the idol of their waiting hearts, a soul, which shall be begotten within, clothed with their own nature, and yet immortal! It is a natural instinct, this yearning of the heart for offspring; and yet little is said upon this subject, in which so much is experienced. All that is beautiful and lovely in woman, finds its climax in motherhood. What earthly being do we love so devotedly as our mother?

Men and women exhibit but little concern, mere idle curiosity, perhaps, on this subject, unless, perchance, there is no evidence of their own reproductive powers. If, however, these appear to be deficient, then few topics are more deeply interesting or investigated with greater personal solicitude. Such persons will seldom submit their condition to the family physician, for it is a delicate subject, involving personal considerations, and, therefor, they prefer to consult with one who cannot connect their unfortunate situation with any of the incidents which enter into the history of their lives. This is very natural, and sometimes is the only way to keep private matters profoundly secret. Being widely known as specialists, devoting our undivided attention to chronic affections, and having unusual facilities for the investigation and management of such cases, we have been applied to in innumerable instances, to ascertain the causes of barrenness and effect its removal.

It is admitted that the question of a woman's sterility is practically decided in the first three years of married life, for statistics show that less than ten out of a hundred women who do not indicate their fertility in the first three years of wedlock ever bear children. We have treated many who gave no evidence of fertility for a much longer period of married life, and who afterwards gave birth to children. We are unable to state the proper ratio of the number of the married who are childless; much less have we the right to assume that all who decline the responsibilities of motherhood are necessarily barren.

CAUSES. The causes of barrenness may be obliteration of the canal of the neck of the womb, sealing up of its mouth, or inflammation resulting in adhesion of the walls of the vagina, thus obstructing the passage to the uterus. In the latter case, the vagina forms a short, closed sac. In some instances, the vaginal passage cannot be entered in consequence of an imperforate hymen. Again, the cause of barrenness may either be a diseased condition of the ovaries, preventing them from maturing healthy germs, or chronic inflammation of the mucous membrane of the neck of the uterus, which does not render conception impossible, but improbable. It is one of the most common causes of unfruitfulness, because the female seldom, if ever, recovers from it spontaneously. It has been known to exist for twenty or thirty years.

Chronic inflammation of the vagina also gives rise to acrid secretions, which destroy the vitality of the spermatozoa. Suppression of the menses, or any disorder of the uterine functions, may disqualify the female for reproduction. Flexions of the uterus, displacements, congestions, and local debility, may likewise prevent fertility. Sterility may result from impaired ovarian innervation or undue excitement of the nerves, either of which deranges the process of ovulation. Even too frequent indulgence in marital pleasures sometimes defeats conception. Prostitutes who indulge in excessive and promiscuous sexual intercourse, seldom become pregnant. Any thing that enfeebles the functional powers of the system is liable to disqualify the female for reproduction.

TREATMENT. An extensive observation and experience in the treatment of sterility, convinces us that, in the majority of cases, barrenness is due to some form of disease which can be easily remedied. If the passages through the neck of the uterus be closed or contracted, and this is the most frequent cause of sterility, a very delicate surgical operation, which causes little if any pain or inconvenience to the patient, will remove the impediment to fertility. In many of these cases, we have succeeded in removing the contraction and stricture of the neck of the womb by dilatation. When the vaginal walls are so firmly united as to prevent copulation, a surgical operation may be necessary to overcome their adhesion. When the hymen obstructs the vaginal orifice, a similar operation may be necessary to divide it. Vaginismus, which will be treated elsewhere, sometimes causes sterility.

It is proper that we should suggest to the barren, that if sexual intercourse be indulged in only very abstemiously, conception will be more likely to occur than if moderation be not exercised. We may also very properly allude to the fact that there is greater aptitude to fecundation immediately before and soon after the menstrual periods than at other times. In fact, many medical men believe that it is impossible for conception to occur from the twelfth day following menstruation up to within two or three days of the return of the menses.

ELONGATION OF THE NECK OF THE WOMB. An elongated condition of the neck of the womb, illustrated by Fig. 9, is frequently a cause of sterility. If this part is elongated, slim and pointed, as shown in the illustration, it is apt to curve or bend upon itself, thus constricting the passage through it and preventing the transit of seminal fluid into the womb. An eminent author says, "Even a slight degree of elongation, in which the cervix, or neck, has a conical shape, has been observed to be frequently followed by that condition [sterility]." Our own observations, embracing the examination of hundreds of sterile women annually, lead us to believe that this condition is among the common causes of barrenness. But, fortunately, it is one of those most easily overcome.

TREATMENT. If the neck is only slightly elongated, this consists in dividing the slim projecting part, by the use of the _hysterotome_, If it be a more aggravated case, a portion of the womb must be removed. This operation is perfectly safe and simple, and, strange as it may seem to those who are not familiar with operations upon the womb, is not painful. We have never seen any bad results follow it, but have known it to be the means of rendering numerous barren women fruitful.

FLEXIONS AND VERSIONS OF THE WOMB. Flexion of the uterus, in which it is bent upon itself, as illustrated in Fig. 10, produces a bending of the cervical canal, constricting or obliterating it, and thus preventing the passage of spermatozoa through it. Version of the uterus in which its top, or _fundus_, falls either forward against the bladder (anteversion), as illustrated in Fig. 11, or backward against the rectum (retroversion), may close the mouth of the uterus by firmly pressing it against the wall of the vaginal canal, and thus prevent the passage of spermatozoa into the womb. 'The treatment of these several displacements will be considered hereafter. We may here remark, however, that they can be remedied by proper treatment. Our mechanical movements, manipulations, and kneadings are invaluable aids in correcting these displacements.

DISEASE OF THE OVARIES. Sterility may be due to disease of the ovaries. Chronic inflammation of the ovaries may result from uterine disorders or peritonitis, and is commonly attended with a sense of fullness and tenderness, and pain in the ovarian region. These symptoms are more apparent upon slight pressure, or during menstruation. This disease is curable, although it may require considerable time to perfectly restore the health. When this chronic affection is the result of other derangements, the indications are to restore health in the contiguous organs, and to relieve excessive congestion and nervous excitement in the ovaries. The patient should be very quiet during the menstrual period and avoid severe exercise or fatiguing occupations, not only at those periods, but during the intervals. All measures calculated to improve the general health should be adopted. Use injections of warm water, medicated with borax, soda, and glycerine, in the vagina every night and morning. The surface of the body should be kept clean by the daily employment of hand-baths, followed by brisk friction. The bowels, if constipated, should be regulated as suggested for constipation. The system should be strengthened by Dr. Pierce's Favorite Prescription, and, if the blood be disordered, no better alterative can be found for domestic use than Dr. Pierce's Golden Medical Discovery. If the patient does not in a few months improve under this treatment, the case should be placed under the immediate care of some physician well qualified by education and experience to critically examine and successfully treat this affection.

CHRONIC INFLAMMATION AND ULCERATION OF THE UTERUS, A CAUSE OF STERILITY. When enumerating the causes of barrenness we mentioned that chronic inflammation of the mucous membrane of the mouth and neck of the womb was the most common affection that defeats conception. Of all diseases of female organs, this is, without doubt, the most common, and, since it does not at first produce great inconvenience or immediately endanger life, it does not excite the attention which its importance demands. It is overlooked, and, when the attention is directed to the existence of this long-neglected disease it appears so trivial that it is not regarded as being the real cause of infertility in the patient.

When this disease has existed for a long time, the very structure of the parts involved becomes changed. The glands of the cervical membrane secrete a glairy mucus, resembling the white, or albuminous part of an egg. The secretion is thick and ropy, and fills the entire mouth and neck of the uterus, thus preventing the entrance of the spermatozoa. The mucous membrane becomes thickened, the inflammation extends to the deeper structures, and, on examination through the speculum, we find the mouth of the uterus inflamed, hardened, and enlarged, as represented in Fig. 22, Colored Plate IV, or in Fig. 23 of same plate. Fig. 25, Plate IV, shows the mucous follicles just as they are found all along the neck of the womb, in a state of inflammation and enlargement, and filled with a fluid resembling honey, giving rise to ulceration and a thick discharge, as illustrated in Fig. 23, Colored Plate IV.

Feebleness of the constitution, impoverishment of the blood, a scrofulous diathesis, want of exercise, uncleanliness, tight lacing, disappointment, excessive excitement of the passions, the use of pessaries for displacement of the uterus, overwork, and taking cold, all predispose the cervical membrane to chronic ulceration.

The inflammation may be so mild, and the discharge so trifling in quantity, as scarcely to attract attention. But after it obtains a firmer hold, and, in most cases, it is aggravated by exposure or neglect, the patient experiences dragging sensations about the pelvis, and pain in back and loins, accompanied with a bearing-down sensation and numbness or pain extending to the thighs.

The discharge is thick, starch-like, and generally irritating. The patient becomes irascible, capricious, querulous, and sometimes moody and hysterical. She is easily discouraged, her appetite and digestion become impaired, and she grows thin and does not look or act as when in health.

TREATMENT. In offering a few hints for the domestic management of these abnormal conditions, we would at the same time remark, that, while health may be regained by skillful treatment, recovery will be gradual. We especially wish to guard the patient against entertaining too strong expectations of a speedy recovery. Although she may employ the best treatment known, yet from three to five months may elapse before a perfect cure can be effected. In persons of scrofulous diathesis, in whom the recuperative forces are weakened, it is very difficult to effect a radical cure. It is equally true, however, that under domestic management alone, thousands have been restored to perfect health and fruitfulness.

Hygienic management consists in toning the functions of the skin by daily bathing the surface of the body, and quickening the circulation by brisk friction. The patient should rise early in the morning, and exercise in the fresh and invigorating air. Those who sleep in warm rooms, or spend much of their time in bed, will continue to have congestion of the uterus, and habitual discharges from this enfeebled organ. The patient should take daily walks, increasing the length of the excursion from time to time, but not to the extent of producing fatigue. The bowels, if constipated, should be regulated. Strengthen the system by using Dr. Pierce's Favorite Prescription, to each bottle of which add two drachms of citrate or pyrophosphate of iron. The mouth and neck of the uterus should be thoroughly cleansed by the use of the syringe, as suggested for the treatment of leucorrhea. The use of the solution of Dr. Pierce's Purifying and Strengthening Lotion Tablets there advised will also be beneficial, if thoroughly applied.

A most valuable course of local treatment, which may be adopted by any intelligent lady without the aid of a physician, and one that will result in the greatest benefit when there is morbid sensibility, congestion, inflammation, or ulceration about the mouth or neck of the womb, consists in applying to those parts a roll of medicated cotton or soft sponge, allowing it to remain there for twelve hours at a time. A piece of fine, soft, compressible sponge, as large as a hen's egg, or a roll of cotton batting of two-thirds that size, is thoroughly saturated with pure glycerine. Securely fasten to it a stout cord a few inches long. The vagina and affected parts having been thoroughly cleansed with warm water and Castile soap, as advised in the treatment of leucorrhea, the sponge or cotton should be passed up the vagina with the finger, and pressed rather firmly against the mouth and neck of the womb, which, being enlarged, and, consequently falling below its natural position, will generally be low down in the vagina, and so hardened as to be unmistakably distinguished from the surrounding parts by the sense of touch. The glycerine, having a very strong affinity for water, will absorb large quantities of the _serum_, which has been effused into the affected tissues in consequence of their congestion and inflammation, and thus reduce the inflammation and enlargement. This is the cause of the profuse, watery discharge which follows the application. In twelve hours after the sponge or cotton has been applied, it should be removed by means of the attached thread, one end of which has been purposely left hanging out of the vagina. Then thoroughly cleanse the vagina with warm water, use the solution of Dr. Pierce's Lotion Tablets as suggested for the treatment of leucorrhea, and repeat the glycerine application the following day or every other day.

If there is no irritation or tenderness of the vagina, add one drachm of tincture of iodine to each ounce of the glycerine, alternating the use of this with that of pure glycerine; or, the iodine and glycerine may be used every third day, and the glycerine alone on the two intervening days. As the iodine will color the finger somewhat, it is well to know that this unpleasant effect may be almost or entirely avoided by coating that member with lard, sweet oil, or vaseline. The stain may be readily removed with a solution of iodide of potassium. The use of Dr. Pierce's Antiseptic and Healing Suppositories as advised on an other page under the head of Ulceration of the Uterus will aid greatly in effecting a cure.

If your medicine dealer does not have these Suppositories in stock, mail 25 cents in stamps to Dr. R.V. Pierce, Buffalo, N.Y., and a box will be sent you by return post.

It is well to alternate Dr. Pierce's Golden Medical Discovery with Dr. Pierce's Favorite Prescription, taking of each three times a day. By persevering in this course of treatment, nine-tenths of those who are thus afflicted will improve and be fully restored to health, fruitfulness and happiness. If barrenness continue, the case should be unreservedly submitted, either in person or by letter, to a physician skilled in the diagnosis and treatment of these affections.

From the foregoing remarks, the reader will perceive that there are a variety of diseased conditions, any one of which may produce sterility. It is equally true that nearly all these conditions may be easily cured by proper medical or surgical treatment. A frequent cause of barrenness is stricture of the neck of the uterus. No medicine that a woman can take or have applied will remove this unnatural condition. Fortunately, however, the means to be employed cause no pain, are perfectly safe, and the time required to effect a cure is short, rarely over twenty or thirty days.

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DISPLACEMENTS OF THE WOMB.

The relative positions of the womb and surrounding organs, when in a state of health, are well illustrated by Fig. 1, page 680. The womb is supported in its place by resting upon the vaginal walls, and by a broad ligament on either side, as well as by other connective tissues. By general debility of the system, the supports of the womb, like the other tissues of the body, become weakened and inadequate to perfectly perform their duty, thus permitting various displacements of that organ.

PROLAPSUS, OR FALLING OF THE UTERUS, is a common form of displacement. It has been erroneously regarded as a local uterine disease, requiring only local treatment instead of being considered as a symptom of general derangement, and, therefore, requiring constitutional treatment. Hence, variously devised supporters have been invented to retain the womb in position after its replacement. It is a law of physiology, that the muscular system is strengthened by use, and that want of exercise weakens it. The blacksmith's arm is strengthened and developed by daily exercise. Support his arm in a sling, and the muscles will be greatly weakened and wasted. So when artificial supports are used to retain the womb in position, thereby relieving the supporting ligaments and tissues of their normal function, the _natural_ supports of the uterus are still further weakened, and the prolapsus will be worse than before when the artificial support is removed. Besides, all these mechanical contrivances are irritating to the tissues of the womb and vagina, and frequently produce congestion, inflammation, and even ulceration, thus rendering the patient's condition much worse than before their employment. These worse than useless appliances should never be resorted to for the temporary relief which they sometimes afford. Constitutional treatment together with appropriate applications is the only effectual method of remedying this morbid condition.

SYMPTOMS. When the displacement is sufficient to cause any serious disturbance, the prominent symptoms are a sensation of dragging and weight in the region of the womb, pain in the back and loins, inability to lift weights, great fatigue from walking, leucorrhea, a frequent desire to urinate, irritation of the lower bowel, and derangement of the stomach. The womb may protrude from the vaginal orifice; in very rare cases, wholly protrudes, and may be inverted.

CAUSES. As we have already stated, general debility favors prolapsus of the womb, but various general and local circumstances and conditions also favor its occurrence. Wearing heavy garments supported only by the hips, compressing the waist and abdomen with tight clothing, thus forcing the abdominal organs down upon the womb, are fruitful causes of this affection. Excesses in sexual intercourse give rise to leucorrhea, producing a relaxed condition of the vagina, upon which the womb rests, and, in this way, one of its supports is weakened. Enlargement of the uterus from congestion, and inflammation or tumors also favor prolapsus. Abortion may leave the womb enlarged, its supports weakened, and result in this displacement.

FLEXIONS AND VERSIONS. Instead of sliding down into the vagina, as in prolapsus, the uterus is liable to fall or be forced into other unnatural positions. When the uterus is bent upon itself, it is called _flexion_. If the bending is backward, it is called _retroflexion_; if forward, _anteflexion._ Fig. 12, represents the former condition, the uterus being flexed backward so that the fundus, or upper part of the womb, is pressed against the rectum, while the neck of the uterus remains in its natural position. This is a common form of displacement, and generally occurs between the ages of fourteen and fifty.

SYMPTOMS. The prominent symptoms of retroflexion of the uterus are a sense of weight in the region of the rectum, difficulty in evacuating the bowels, and, sometimes a retention of the feces. There may be suppression of the urine and the menses may be diminished in quantity. If retroflexion is due to a chronic enlargement of the uterus, caused by abortion or parturition, the patient suffers from an immoderate menstrual flow.

CAUSES. The principal causes of retroflexion are congestion, enlargement and tumors of the uterus. Congestion is liable to occur in women possessing an extremely active temperament, as well as in those of sedentary and indolent habits. Retroflexion is a common displacement in both married and unmarried women; it is a secondary affection, and, when it is caused by congestion, the menses are painful and reduced in quantity, and there is pain in the back and a sense of weight in the region of the rectum. In some instances, there is a reflex irritation of the mammary glands, and a consequent secretion of milk. There may also be nausea and vomiting, which often lead to the erroneous opinion that the patient is pregnant.

_Anteflexion_ of the uterus denotes a bending forward of the body and fundus of the uterus, while the neck remains in its natural position.

In versions of the uterus, neither the body nor the neck of the womb is bent upon itself, but the whole organ is completely turned backward or forward.

_Retroversion_ of the uterus, illustrated by Fig. 13, signifies a change in the position of the womb, so that the upper, or fundal portion of the organ drops back toward the concavity of the sacrum, while the neck preserves a straight line in the opposite direction. The fundus presses forcibly against the rectum, while the upper part of the vagina bends abruptly and forms an acute angle near the mouth of the uterus.

SYMPTOMS. Retroversion is indicated by bearing-down pains in the loins and difficulty in evacuating the bowels. The feces may accumulate in the rectum, because they cannot pass this obstruction.

CAUSES. Jumping, falling, or undue pressure from the contents of the abdomen, may suddenly cause retroversion of the uterus. Sometimes retroversion results from obstinate constipation.

_Anteversion_. This term designates another unnatural position of the uterus, in which the fundus, or upper part of the organ, falls forward, as illustrated by Fig. 14, while the neck points towards the hollow of the sacrum. This position of the womb is the reverse of that of retroversion. In its natural position, the fundus of the uterus is slightly inclined forward, and any pressure, or forward traction, is liable to cause it to fall still further in that direction.

SYMPTOMS. One of the most common symptoms of anteversion is a frequent desire to urinate, in consequence of the pressure of the uterus upon the bladder. The free flow of the menses is sometimes obstructed.

CAUSES. The causes are tight lacing, prolapse of the abdominal organs, weakness of the supporting ligaments, and enervating habits.

TREATMENT. In treating all the various displacements of the uterus, the prominent indication is to tone up the general system, for by so doing we also strengthen the uterine supports.

Digestion should be improved, the blood enriched, and nutrition increased, so that the muscles and ligaments which retain the womb in position may become firm and strong. The womb will thus be gradually drawn into position by their normal action and firmly supported. It is a great mistake, made by physicians as well as patients, to consider a displacement of the uterus a _local_ disease, requiring only local treatment. A restoration of the general health will result in the cure of these displacements, the uterus will regain its tone and muscular power, and the local derangement, with its attendant pain and morbid symptoms, will disappear.

It is true that displacements of the womb may be associated with inflammation and ulcers, which require local treatment, as elsewhere suggested; but simple displacement of the uterus may be remedied by pursuing the following course of sanitary and medical treatment. Sleep on a hard bed, rise early, bathe, and take a short walk before breakfast. Dress the body warmly and allow sufficient space for the easy and full expansion of the lungs. Eat moderately three meals a day, of those articles which are nutritious and readily digested. Keep the bowels regular by the use of proper food. If they are constipated, use Dr. Pierce's Pellets to keep them open and regular. Avoid retaining the standing position too long at a time, especially when the symptoms are aggravated by it. Many energetic women disregard their increasing pains, and keep upon their feet as long as possible. Such a course is extremely injurious and should be avoided.

As a general restorative and uterine tonic, nothing surpasses Dr. Pierce's Favorite Prescription, which is sold by druggists and accompanied with full directions for use. If leucorrhea is an attendant symptom, the treatment suggested for that condition should be employed. The use of Dr. Pierce's Antiseptic and Healing Suppositories, applying one every third night After having first cleansed the vagina and neck of the womb thoroughly by the use of warm water and soap as an injection, will prove of great benefit in giving strength to the supports of the womb and its appendages.

By persevering in the rational treatment which we have suggested for the various displacements of the womb, nearly all who suffer from such derangements may be fully restored to health. The patient should not expect _speedy_ relief. Considerable time will be necessary to bring the general system up to a perfect standard of health, and, until this is accomplished, no great improvement in the distressing symptoms can be expected. Mechanical movements are especially effective in this class of cases. We have successfully treated many obstinate cases in which the displacements were very serious.

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ULCERATION OF THE UTERUS.

Ulceration is the process by which ulcers, or sores, are produced. It is characterized by the secretion of pus or some fetid discharge, and is continued as a local disease through the operation of constitutional causes. Ulcers are generally symptoms of other morbid conditions.

Ulcers may form in the _mouth_ or _neck_ of the uterus, and, omitting cancerous ulcers and those of a syphilitic character, which are considered elsewhere, may be classified as _Granular_ and _Follicular_.

GRANULAR ULCER. This variety of ulcerative degeneration is the most frequent, and may exist for some time without exciting any suspicion in the mind of the patient that she is afflicted with any such morbid condition. There is local inflammation, and the mouth of the uterus is uneven, rough, and granular. If an examination be made with the speculum, the mouth of the uterus is often found in the condition represented in Fig. 22, Colored Plate IV.

Figs 15 and 16 represent two different forms of specula. The one represented by Fig. 15 consists of a tube of glass coated with quicksilver and covered with India rubber, which is thoroughly varnished. That represented by Fig. 18 is made of metal and plated. By using one of these instruments, the condition of the mouth of the womb can be distinctly seen.

FOLLICULAR ULCER. When the mucous follicles of the neck of the uterus are inflamed they enlarge and become filled with a fluid having the color and consistency of honey, presenting the appearance illustrated by Fig. 25, Colored Plato IV. This secretion, because of the presence of the Inflammation, is not discharged. The follicles, therefore, continue to enlarge until they burst, and we then see in their place the red, elevated, angry-looking eminence, which is called a _follicular ulcer_.

SYMPTOMS. The severity of the symptoms depends upon the character of the ulceration. It may be simple or associated with purulent leucorrhea and hemorrhage. If ulceration be slight and local, few symptoms will be present; but if it be associated with uterine debility, congestion and inflammation of the mucous membrane of the uterus, the discharge will be profuse, and there will be fixed pain in the back and loins, a bearing-down sensation, and great difficulty in walking. The discharge is weakening, as it impoverishes the blood, and thus reduces the strength.

CAUSES. Ulceration may be induced by any thing that excites inflammation of the lining membrane of the mouth and neck of the uterus. The use of pessaries, excessive sexual indulgence, injuries occasioned by giving birth to children, congestions, enlargements and displacements, may all operate as causes.

TREATMENT. We cannot too strongly condemn the practice so popular at the present time with physicians generally, of indiscriminately burning all uterine ulcers with strong caustics, such as nitrate of silver, chromate of potassium, and other similar escharotics, regardless of the condition of the general system. Ulcers of the womb must be healed in the same manner as those upon any other part of the body. It is an irrational practice to repeatedly cauterize them, expecting thereby to promote healing, while the system is vitiated and the vitality far below the standard of health. Enrich the blood, tone up the system, keep the ulcers cleansed by the frequent use of lotions, and they will generally heal. Caustics often aggravate the irritability and interfere with the healing processes of nature. Ladies should not unnecessarily submit to the exposure of their persons. If they perseveringly employ the treatment which we shall suggest, other local treatment will _very rarely_ be found necessary. This modern warfare which physicians are waging upon the unoffending womb is a most irrational practice. Our grandmothers got along very well without exposing themselves to the humiliation and tortures of this new-born empiricism. We do not wish to be understood as undervaluing or denying the necessity, in rare cases, of examinations of the uterus, or as being unappreciative of the aid afforded in such investigations by the speculum, and the beneficial effects of local applications made directly to the womb through that instrument. What we affirm is, that such examinations and applications are, in the practice of most modern physicians, made unnecessarily frequent, resulting many times in lasting injury to the patient.

GENERAL MEANS. As has already been indicated, constitutional treatment should be principally relied upon to cure ulceration of the neck of the womb. Put the system in perfect order and the local ulceration cannot fail to heal. If you have a sore or ulcer upon the leg you very naturally reason that there is a fault in the system at large or in the blood. You do not apply caustics to the sore, but you go to work to restore the blood and system to a normal or healthy condition and as soon as this is accomplished the open and rebellious sore, or ulcer, heals of its own accord. All you have to do locally, to stimulate the ulcer to heal, is to keep it well cleansed by the use of Castile soap and warm water. Just so with ulceration of the womb. Thoroughly cleanse the vagina and neck of the womb once a day by the use of warm water and a little soap, applying this _thoroughly_, as directed on page 704, under the head of treatment for leucorrhea, and using a solution of Dr. Pierce's Purifying and Strengthening Lotion Tablets as there directed. After thus thoroughly cleansing and purifying the parts, a piece of soft sponge as large as a hen's egg, to which a bit of cord or strong thread is attached to facilitate removing it, may be thoroughly wet in pure glycerine and introduced into the vagina, pressed against the mouth of the womb, and allowed to remain there for twelve hours, when it should be gently removed by pulling on the attached string. The cleansing lotion of soap and warm water should be used daily and followed by the glycerine application.

Every third night instead of the glycerine tampon apply one of Dr. Pierce's Antiseptic and Healing Suppositories, pressing it well up against the mouth of the womb, and letting it remain there to slowly dissolve. This will give far better curative results than the application of nitrate of silver or other caustics so generally used by physicians. Besides it has the great advantage of being entirely harmless in any condition of the parts to which it is applied. These Suppositories are powerfully antiseptic, destroying all offensive odors and have a soothing and at the same time tonic or strengthening effect upon the neck of the womb and the vagina.

In cases where there is prolapsus or falling of the womb, or Anteversion or Retroversion, or other displacements the use of the Antiseptic and Healing Suppositories will be found to be of great benefit in giving strength to the supports of the womb and its appendages.

If your dealer is not supplied with the Suppositories, inclose 25 cents in one-cent stamps to us at Buffalo, N.Y., and a package will be sent you, post-paid.

We are fully aware that this thorough and _systematic_ course of treatment is slightly troublesome in its application, but what system of treatment that can promise similar success is not?

This course of treatment must be _rigidly_ adhered to for several weeks before we can expect a complete cure of the ulcers and the arrest of the consequent leucorrheal discharge.

THE SHEET ANCHOR OF HOPE. Do not fail to bear in mind that no difference how good the lotions and other local applications may be, your _chief_ reliance in all cases of ulceration of the womb, as well as in those of simple leucorrhea, must be upon _thorough constitutional_ treatment. To this end Dr. Pierce's Golden Medical Discovery should be taken three times a day in doses of from one to one-and-a-half teaspoonfuls one hour before each meal, and in the middle of the forenoon, in the middle of the afternoon, and just before retiring for the night, a like amount of Dr. Pierce's Favorite Prescription should be taken. The use of these blood cleansing and invigorating tonic medicines should be kept up _persistently_ for several weeks; for you must not expect a perfect cure too soon in a malady that has become chronic and seated. The disease does not become established hastily, but is slow in its inception and progress, and will only gradually and slowly yield to the best of treatment, which we believe we have already pointed out. Followed _earnestly, faithfully_ and _persistently_, the use of the means which we have suggested will rarely, if ever, fail.

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URINARY FISTULA.

A fistula, or false passage, is sometimes formed between the bladder and the vagina, between the bladder and the uterus, or between the urethra and the vagina. This passage allows the urine to escape through it into the vagina, and is a source of great annoyance and suffering. This affection is most commonly due to sloughing, caused by severe and long-continued pressure upon the parts during child-labor. It is also sometimes produced by the unskillful use of forceps and other instruments employed by midwives. Syphilitic and other ulcerations may so destroy the tissues as to form a urinary fistula.

TREATMENT. The treatment is purely surgical, and consists in paring the edges of the opening so as to make them raw, bringing them together and holding the parts thus by means of stitches until they heal. By the aid of a speculum, properly curved scissors, needles with long handles, fine silver wire, and a few other instruments and appliances, the skillful surgeon can close a urinary fistula with almost as much ease as he can close a wound on the surface of the body.

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DISORDERS INCIDENT TO PREGNANCY.

While some women pass through the whole period of pregnancy without inconvenience, others suffer from various sympathetic disturbances, as "morning sickness," impaired appetite, constipation, diarrhea, headache, "heart-burn," fainting fits, difficult breathing, and sometimes convulsions. A strong nervous sympathy exists between the uterus and every part of the system and this sympathy is greatly intensified by pregnancy, causing the distressing symptoms above mentioned.

TREATMENT. By proper treatment, most of these evils can be obviated and the patient made comfortable. By the moderate use of such a nervine and uterine tonic as Dr. Pierce's Favorite Prescription, this nervous irritability may be controlled or subdued, and the disagreeable symptoms thus avoided.

While the female is pregnant, she should avoid all compression of the waist and abdomen. For this reason tight clothing, stays, or corsets must be discarded. She should also carefully regulate her diet, selecting that which is most nutritious and easily digested.

The nausea which occurs in the morning may generally be avoided by partaking of a little light food and a cup of tea or coffee before leaving the bed. If vomiting occurs, and the ejected matter be very acid, carbonate of magnesia, taken in tablespoonful doses, or some alkali with aromatics, or pulverized charcoal, which can be obtained at any drug store, will afford relief. If constipation or diarrhea be experienced, small doses of Dr. Pierce's Pellets should be employed--one or two only at a time. Want of appetite, headache, or a tendency to convulsions, can be generally overcome by a persistent use of Dr. Pierce's Favorite Prescription, which should be taken in teaspoonful doses three or four times each day. Indeed, this valuable medicine not only relieves the distressing symptoms which frequently attend the pregnant state, but also prepares the system for the ordeal of parturition (delivery). One or two bottles of this nervine and tonic used previous to confinement, will, in many cases, save hours of terrible suffering, besides regulating the system, and thus insuring a speedy recovery. We have received the heartfelt thanks of hundreds of grateful mothers for the inestimable benefit thus conferred. The Favorite Prescription is perfectly safe and harmless to use _at all times_ and under all circumstances in the doses above prescribed.

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OVARIAN AND UTERINE TUMORS.

We have space only to give a brief outline of the characteristics and treatment of the most frequent classes of tumors which affect the ovaries and uterus.

OVARIAN TUMORS generally consist of one or more cysts or sacs, developed within the ovary, and filled with a fluid, or semi-fluid matter, which is formed in their interior. The cysts vary in size, in some instances being not larger than a pea, while in others they are capable of containing many quarts of fluid. In one case operated upon at the Invalids' Hotel and Surgical Institute, thirty-five pints of fluid were taken from three cysts.

The effect of ovarian tumors on the duration of life is shown by the statistics of Stafford Lee. Of 123 cases, nearly a third died within a year, more than one-half within two years from the first development of reliable symptoms, while only seventeen lived for nine years or upwards.

FIBROID TUMORS of the uterus are composed of fibrous tissue, identical in structure with that of the uterine walls. They are met with in all sizes, from that of a small shot to that of a mass capable of filling the entire cavity of the abdomen. Cases are on record in which these tumors have attained the weight of seventy pounds.

The manner in which fibroid tumors terminate life is generally by prostration and debility produced by pressure on, and consequently, interference with, the function of some one or more of the organs essential to life; or by anæmia and debility, produced by the severe hemorrhages, which the intra-uterine or sub-mucous form not infrequently induces.

POLYPI OR POLYPOID TUMORS of the uterus are of three kinds, cystic, mucous and fibrous. They vary greatly in size, sometimes being as large as a tea-cup; and their point of attachment may be extensive or consist only of a small pedicle. The cystic and mucous varieties may spring from any portion of the mucous surface of the uterus, but they are more frequently met with growing from the mucous membrane lining the cervical canal, and pendent from the mouth of the womb, as represented in Fig. 21 and in Fig. 26, Colored Plate IV; while the fibrous variety generally grows from the sub-mucous tissue at or near the fundus, or upper portion, of the uterus.

The most prominent symptoms of polypoid growths are hemorrhage, which is almost invariably present, leucorrhea, pain, backache, and a sense of weight and dragging in the pelvis.

The best method of treatment, and, in fact, the only effectual one, is removal with the _écraseur_, polypus forceps, or galvano-cautery. The operation is usually attended with little or no pain.

FOR MORE THAN TWENTY-FIVE YEARS the physicians of the Invalids' Hotel and Surgical Institute, have been successfully treating tumors by means of electricity. More recently, the medical profession has quite generally adopted electrical applications in response to the advice of Apostoli, of Paris. The plan used however is crude. It does not compare in results with the successful and safe procedure that our surgeons have invented and pursued.

Electrical treatment will destroy the life of ovarian and fibroid tumors if applied early and after the improved methods so long used at our Institution. The destructive effect of electricity is modified by the introduction of certain electro-chemical applications so that it attacks and kills only the cells of the tumor.

THE VERY LARGE OVARIAN TUMORS, however, are not amenable to treatment by this process. The walls of their cysts become so thin and weak, while the pressure of the fluid from within is so great, that sudden and spontaneous rupture is liable to occur at any time and produce death. Removal by a cutting operation is necessary in such cases. Fortunately this procedure, as skillfully modified and perfected by experience, has, in the hands of our surgeons, proven free from the dangers and hazard common to Ovariotomy. This is due to skillful operation and to the fact that in our Institution the sanitary arrangements are as perfect as it is possible to make them. Everything is at hand in the way of instruments and appliances likely to be required, and the entire procedure is conducted upon the principles of perfect cleanliness and antisepsis, which obviate the risk of inflammation and blood-poisoning.

Furthermore, our nurses have had such fine training and such a vast experience in their attendance upon such cases, that wants are anticipated, and details, that would escape those not so well qualified, are looked after so thoughtfully and vigilantly that the convalescence is rapid, as well as being in every way comfortable and safe. Under such conditions

OUR SURGEONS HAVE COMPLETED A LONG LIST OF REMOVALS OF OVARIAN TUMORS WITHOUT A SINGLE DEATH!

We are, therefore, _warranted_ in stating that

THE DANGERS DUE TO THE PRESENCE OF THESE TUMORS ARE FAR GREATER THAN THE SLIGHT RISKS OF REMOVAL BY THE SKILLFUL METHODS EMPLOYED BY OUR SURGEONS.

Owing to a change made in the anæsthetic used, the painful and persistent vomiting that often follows abdominal operations is prevented. This does away with the greatest of all the dangers attendant upon the operation of Ovariotomy, and favors speedy recovery. Food, as administered in the form of artificially digested and concentrated nourishment, is readily retained. The strength is thus rapidly restored, and the healing process hastened.

It is generally supposed that the size of the opening made through the abdominal walls is large, proportionate to the size of these tumors. This is an error. Even in the largest cystic tumors where the development is immense, a small incision only, is made--simply sufficient to bring the walls of the tumor in view and admit, perhaps, two or three fingers. The tumor is then rapidly emptied of its contents by means of a powerful suction apparatus. Adhesions, if any exist, are then carefully removed, and hemorrhage therefrom prevented; after which the large sac of the tumor, which when collapsed is like a thin bag, is readily drawn out through the small opening in the abdomen and removed. The small pedicle or cord-like mass of vessels that supplies the tumor, are then carefully treated after a plan invented by, and peculiar to, ourselves, which effectually prevents any bleeding, and, at the same time, does not leave any irritating substance, such as burned and charred flesh, rubber, silk, or any other unabsorbable material, within the abdomen. The parts are left unbruised and without any poisonous germs in contact.

Our surgeons have met with phenomenal success in removing Ovarian Tumors, by the operation of Ovariotomy. Thus far, in a career extending over a long period of time and embracing the removal of a long list of these morbid growths, they have not had a single fatal case.

The following cases illustrate our method of treatment in a few of the many cases that have been under our care. Each case is typical of a class:

CASE I A married woman, aged 38. Had never given birth to a child. About four years before coming under our observation, she discovered a small bunch, as she expressed it, in the left ovarian region, which gradually increased in size until, when she consulted us, it caused considerable pain in the region of the liver from pressure, and interfered with respiration. Her general health was becoming much impaired. She stated that she had consulted a prominent gynecologist in this city, who had told her that the attachments of the tumor were so extensive that ovariotomy (removal with the knife) was out of the question, and that, therefore, he could only give her palliative treatment. This unfavorable prognosis only added mental anguish and despair to her physical suffering. On examination, we found a large multilocular cystic tumor, represented by Fig. 17, with very thick walls, extending from the left ovarian region obliquely upwards and to the right, so that it pressed more upon the short ribs on the right side than it did upon the left, but which filled the entire cavity of the abdomen. The attachments, as the doctor whom she had previously consulted had stated, were so extensive that its removal with the knife could not be thought of. We were not disposed, however, to give the case up as hopeless. We told her that we would do what we could for her, but as to what the result of our treatment would be, we could not definitely say. She placed her case in our hands, and we resorted to the above described treatment. She was treated two and three times per week for more than two months, at the end of which time, the tumor had decreased in size fully two-thirds. It has ever since remained stationary, and has given her no trouble or inconvenience whatever. It is now seven years since we treated her.