the hygienic system orthopathy chapter 15
AFFECTIONS OF THE FEMALE
Definition: Expulsion of a fetus before it is viable, that is before it is able to live or liable to live. It is termed accidental or spontaneous when it occurs from accident, and induced when brought on purposely.
Symptoms: Hemorrhage and pain ("bearing down pains") are the chief or only symptoms. Hemorrhage is likely to develop suddenly in ordinary health with no previous symptoms of any kind. If the hemorrhage is profuse and accompanied with pain, and the pain subsides, to be followed by slow and irregular bleeding, it is safe to diagnose incomplete abortion.
If the subject develops periodic hemorrhages, these occurring monthly, or every two or three months, with a profuse flow lasting ten days to two weeks, and accompanied with more or less discomfort, not amounting to pain, and there is a history of two or three miscarriages at from the third to fourth month, it is safe to diagnose chronic auto-abortion — the abortion habit.
Such cases will often abort fifteen to forty times in the course of five to seven years, each conception being followed in a short time by expulsion with hemorrhage. The greatest number of such abortions any of our patients have suffered has been twenty-eight.
Etiology: An abortion may be brought on by overwork, strain, fright, sexual overindulgence, and by a greatly weakened or devitalized body. Death of the fetus usually precedes abortion.
Care of the Patient: Rest in bed, with the feet slightly elevated and no food but water so long as there is hemorrhage are all the measures we have employed. In incomplete abortion it is generally thought to be necessary to curet the womb. If this is done a skilled surgeon should be employed for the work.
The abortion habit is followed by normal pregnancies and birth of children at full term when good health is restored. These cases respond very favorably to physical, physiological and sexual rest, followed by a proper diet, exercise and other means of building good health.
Definition: This is occlusion (imperforation) of the vagina.
Symptoms: Suppression or retention of menses, painful menstruation and sterility are the regular symptoms.
Etiology: Acrid leucorrhea causes contraction of the tissues and destruction of their elasticity. A hardened condition, not unlike that seen in the arteries in arteriosclerosis, develops. Starch in-digestion (fermentation) causing a general acidity of the body is the most likely cause of acrid leucorrhea. Stricture of the urethra seen in a few of these cases shows that the urine is also very acid.
Care of the Patient: It is doubtful if complete restoration of normal elasticity can ever be restored to these tissues. The inelasticity is slow in developing and hard to overcome.
The mouth of the vagina should be gently and frequently dilated. Great care must be exercised as these tissues will tear but will not stretch. Extreme cleanliness is essential. Fasting to remove acidity and clean up the catarrh and a proper diet thereafter are essential.
CANCER OF THE UTERUS
Cancers of the womb, usually of the cervix are all too common. They develop most commonly about the menopause and result from chronic inflammation of the neck and mouth of the womb growing out of errors of life.
Symptoms: Hemorrhage, pain and discharge are the most pronounced symptoms of uterine cancer, but care must be made in diagnosing cancer from these symptoms, as they are present in other conditions.
Etiology: The overweight ("well nourished") are most likely to develop cancer. Shock, grief, quick temper, irritableness and jealousy predispose the toxemic to develop cancer. Childlessness and one-child celibacy also predispose. No doubt the wide-spread use of irritating chemicals as contraceptives is partly responsible for much of the recent increase in female cancer of all locations.
Cancer of the neck of the womb (cervix) is almost always preceded by years of inflammation — acute, subacute or chronic — often not great enough to attract attention. Usually there is a history of leucorrhea, often slight, and in other cases there has been marked affections of the uterus which have been treated in the usual ineffectual manner; or, lacerations at childbirth, though "repaired," have not fully healed.
Back of all chronic and subacute inflammation is toxemia resulting from careless and haphazard living. There will be indigestion, gas, foul stools and other evidences of impaired function for years before cancer develops.
Care of the Patient: See Cancer in this volume.
Definition: This is a condition caused by a small fold of mucous tissue surrounding the clitoris, often referred to as a foreskin or pre-puce. When it is too tight or too long, the pent-up secretions become sources of irritation and this results in nervous irritability, excessive sexual stimulation and masturbation in girls.
Definition: This is a whitish viscous discharge from the vagina and uterine cavity — a catarrhal discharge. It indicates an inflammatory state of the mucous membrane of the neck or body of the womb or both.
Symptoms: The name "Whites" is somewhat erroneous, since the disc is sometimes yellow or greenish-yellow. If the discharge is thin or watery, or thick and cream-like, we may be quite certain it is from the vagina. If it is ropy, gluey or albuminous like the white of an egg, the discharge probably comes from the neck of the womb or from the womb. If pus is present this denotes suppuration. A profuse discharge indicates that a large surface is involved; a slight discharge indicates only the neck of the womb is involved. The intensity of the constitutional impairment has much to do with the amount of the discharge.
Etiology: When occurring in young, unmarried women it is the result of an exaggerated hyperemia of the reproductive organs resulting from overstimulation. The emotional natures of such young people have been fed by a morbid mind; their reading has been of an erotic nature; their company has been unfitted for them; there has been much petting, often precocious sex development has resulted from over-stimulating foods and drinks and salacious suggestions. All this results in an excess of blood being sent to the reproductive organs so that they are engorged. Often the engorgement is great enough and the mucous membrane is so thickened and the submucous tissues are so engorged that the neck of the uterus is closed and the menstrual flow cannot pass without pain.
The continuous engorgement of the parts and the menstrual-flow exaggeration, added to systemic toxemia, soon develop catarrhal inflammation and, unless the causes are removed, the engorgement will continue and the inflammation will be followed by ulceration.
Leucorrhea is not unlike catarrh of the nose and throat and other mucous tissues of the body and is caused by the same blood and flesh condition that is back of catarrh anywhere else in the body, plus the localizing causes mentioned above. The more imperfect the systemic elimination, the more discharge there will be from the uterus, unless other mucous surfaces are also requisitioned to do vicarious duty. On this stick is grafted all the so-called "diseases" of women treated by gynecologists.
Care of the Patient: Since without infection, it is impossible to establish a local affection unless there is a constitutional derangement of toxemia and enervation, care must be directed to the removal of the constitutional impairment. In other words, the habits of life must be corrected — every mental and physical habit that has helped to produce enervation and imperfect elimination must be given up. Fasting and rest will remove toxemia and restore nerve energy, but only a correction of the mode of living can be depended on to prevent rebuilding the catarrhal condition.
Definition: This is the "change of life" through which the female passes at the end of her child-bearing period. It seems to be peculiar to the human female.
Symptoms: The cessation of menstruation and slow atrophy of the breasts are the only normal symptoms. The vaginal mucosa returns to the thin, ill-developed structure of childhood and the secretions are no longer acid.
It is a great bogy in the lives of women, somewhat like teething in children. Practically all the suffering of women between the ages of thirty-five to fifty are attributed to the change.
If a woman is sick or in poor health between the ages of thirty-five and fifty only inexcusable ignorance will consider "change of life" as the cause of her ill-health. The enlightened doctor will look for the cause of her sickness and remove it.
Etiology: The "change" is due to the normal cessation of certain functions of the ovaries and to changes in these.
Hot-flashes and other nervous symptoms, high or low blood pressure, mental symptoms, etc., commonly blamed on the change are of toxic origin, the toxemia resulting from enervation growing out of youthful imprudences, wrong food, etc.
Care of the Patient: To correct all devitalizing habits and build good health will remove the symptoms of ill-health. The "change" per se is not pathological and nothing can be done for it.
Definition: This is inflammation of the womb. If confined to the lining membrane of the womb it is called endometritis; if limited to the neck it is called endocervicitis. It is all one and the same affection.
Symptoms: An acute inflammation of the womb may be attended by chilliness followed by fever. Faintness, nausea and vomiting are frequent. There is a sense of heat and uneasiness in the pelvic region, with sharp pains in the lower back and in the right or left groin, per-haps darting down the thighs. Coughing or pressure upon the pelvis greatly increases the pain. The womb is exceedingly tender and enlarged, the vagina is hot and sensitive, there is leucorrhea, painful menstruation and often uterine hemorrhage. There is constant headache, constant desire to urinate and painful evacuations.
Cervicitis may go on to ulceration of the cervix. There is much nervous irritation, painful, often profuse, menstruation, general irritability and disturbances throughout the system.
Chronic Inflammation of the Womb is more common than acute metritis, though it often follows an acute crisis. It is most common in married women and first makes it presence felt by pain during intercourse. Later there develops a dull pain in the lower part of the abdomen, a bearing down sensation, discomfort in defecation and urination and a mucus discharge.
Etiology: Primarily there is always the same constitutional impairment serving as the basic cause for all chronic pelvic inflammations. Primarily this is a catarrhal condition. Cases follow tears at childbirth, abortion and injury from treatment. Tears will heal if the blood is as it should be. Lasciviousness and frequently repressed sexual excitement may predispose.
Care of the Patient: In acute metritis, physical and physiological rest until complete comfort returns is essential. Fasting and rest in bed are also helpful in chronic metritis. In all cases the whole life must be reordered to overcome enervation and prevent the redevelopment of toxemia.
Definition: A. morbid and seemingly irresistible sexual desire, the excitement of the sexual organs so dominating the thoughts and feelings of the individual that her conduct toward the males she meets is openly forward despite her better judgment.
Symptoms: Overpowering desire which is more or less constant, frequent repetition of the sex act, and evidences of nervous instability are present. In one case known to us the young woman did not permit her husband to sleep at night and sought other male companions during the day.
Etiology: Inflammation or irritation of the vulva or internal parts of the sex organs or nervous affections give rise to inordinate and uncontrollable desires. Menorrhagia may lead to this trouble. Such unfortunate girls are pronounced degenerates and incorrigibles and treated accordingly. Few parents recognize the conduct of such daughters as due to pathology, but believe their conduct is due to viciousness.
Care of the Patient: A slight irritation of the reproductive organs that becomes the exciting cause of nymphomania cannot be remedied by abuse of the girl. If the habit has been established for any time, will is lost and the girl lacks power to do anything except "gratify" her "wants." Operations are often resorted to in these cases. They do no good, but deteriorate the will and the body.
To remove the causes of the irritation and restore the girl to good health and help her regain her control over her body will overcome the nymphomania. Unless the neurotic stress is relieved by removing its cause, no recovery is possible
Definition: This is inflammation of the ovaries and may be either acute or chronic.
Symptoms: The first and most important symptom of acute ovaritis is pain to the right or left of the womb, with a sense of heat, the pain being greatly increased upon pressure, or exertion. The pain, sometimes intermittent, sometimes constant, is of a dull dragging nature. There may be nausea and vomiting with a rise in temperature and rapid pulse. The ovaries become enlarged and hardened and may suppurate (ovarian abscess). If the inflammation is in the right ovary the condition may be mistaken for acute appendicitis.
In chronic ovaritis the pain is more severe before the menstrual period, though it is usually relieved by a free flow. Standing erect or straightening the thigh may greatly increase the pain.
We would caution the reader against the habit of diagnosing every pain in the right or left pelvis as ovarian "disease." There is a lot of carelessness and ignorance displayed in diagnosing and treating affections of women and it has become a professional bad habit to find ovarian "disease" where there is none. The ovaries are so situated and protected from injury that we doubt that they are affected once in a hundred times when they are said to be.
Etiology: Acute ovaritis is said often to result from gonorrheal infection. If so, this would indicate that the infection has been forced up into the ovaries by maltreatment. It never develops in hygienically treated cases. "Blood-poisoning" after childbirth is also held responsible. Puerperal sepsis results only in mal-treated cases.
Inflammation may arise in overfed, debilitated and toxic subjects. During menstruation the pelvic congestion amounts almost to inflammation. It is thought that sexual excesses and alcohol may produce it. We doubt that it ever results from roughness in coition.
Sexual excitement from petting, lasciviousness, reading erotic novels, voluptuous self-indulgence, overeating, eating stimulating foods, etc., tend to produce chronic inflammation of the ovaries in toxemic subjects. It may also follow acute inflammation of the ovaries.
Care of the Patient: In acute ovaritis an absolute fast is essential. No food but water should pass the lips until full comfort has returned. Rest in bed is fully as important. If pain is very severe a hot pack may be placed over the pelvis.
In chronic ovaritis, rest and fasting are beneficial. Strict continence and avoidance of all sources of erotic stimulation are essential.
In both conditions a complete correction of the whole mode of living is necessary.
Definition: This is inflammation of the fallopian tubes. It is not an uncommon condition. It may be acute or chronic.
Symptoms: Acute salpingitis may be a very serious affection, especially in its purulent form, causing violent illness. The tubes become swollen, tender and very painful, and the sufferer is forced to take to her bed. The temperature rises, the pulse is rapid, the abdomen is bloated and there is frequent urination. There are marked restlessness and weakness.
If pus forms, and this often happens, we have pyosalpinx or pus-tube. In this case both ends of the tube close up and it becomes distended with its contents, perhaps swelling to alarming proportions for instance, to the size of a child's head, while the pus can find no outlet. If the pus is discharged internally into the abdomen a fatal peritonitis develops.
Chronic salpingitis is of a catarrhal nature and is marked by pain, which, though it may vary in intensity, is almost constant and is increased by exertion, coition and defecation. The pain is usually intense during menstruation and for a few days before. The menstrual flow is usually profuse and of uncommon duration.
If the inflammation results in closing up, by adhesions, of both tubes, sterility is the result.
Etiology: The mucous membrane lining the tubes is continuous with that of the inner lining of the womb which is, in turn, continuous with that of the vagina. Inflammation of the vagina or womb may extend from these to the tubes and through these even to the ovaries and peritoneum.
The more severe forms of salpingitis result from gonorrhea or from puerperal sepsis following childbirth, or it may be an extension of metritis following abortion. It can develop only in enervated and toxemic subjects — those of low resistance.
Chronic salpingitis results from the extension of catarrh from the womb and is due to the ordinary causes of catarrh.
Care of the Patient: Physical and physiological rest is imperative in the acute stage and helpful in the chronic form. Indeed these are all that are needed during the acute state unless the tubes become pent-up and fail to drain when surgical drainage may be necessary. We have had drainage to occur and complete recovery to follow during a fast in cases that have been told that only an operation can save life. However, if drainage does not occur, the surgeon will be necessary.
Tilden says: "It is doubtful if any form of pelvic abscess will end in death if left entirely alone. The danger in all abdominal and pelvic abscesses is medical and surgical interference. Rough examinations complicate by breaking the pus sac and forcing an extension of the disease into territory that nature has protected by walls of adhesions. Operations following such examinations always show how very necessary the operations were; but if the surgeon's fingers had not been forced through the abscess walls, rupture would not have taken place. If left alone and not interfered with, in due time the pus would have found a safe exit."
Pelvic and abdominal operations outrage one of the most important surgical principles, namely: "always open an abscess at a point where drainage will be perfect." Opening the abdomen in salpingitis, pelvic abscess, appendicitis, etc., forces the surgeon to secure drainage against gravitation. If left alone, ovarian, tubal, cellular and appendicular abscesses tend to open in the line of least resistance and secure drainage with, not against, gravity. Pelvic abscesses will open and drain through the womb, vagina, or rectum if permitted. If rough handling and bimanual examinations cause the pus to find its way into the bladder or the peritoneal cavity the results are chargeable to "medical science," not to nature.
Definition: Small growths either mucoid or fibroid which develop in the womb and neck of the womb.
Symptoms: Profuse leucorrhea and hemorrhage, or too profuse menstruation are the usual symptoms. If large (size of all egg) they cause more or less "bearing down" pain.
Etiology: As in the nose and rectum, these growths develop out of long continued chronic catarrhal inflammation of the mucous lining of the womb or its neck. The inflammation grows out of toxemia and is chronic because toxemia is chronic.
Care of the Patient: When long enough to protrude from the mouth of the womb they may be twisted or cut away, a simple operation that causes no pain and inconvenience and does not require going to the hospital. But it should be recognized that this removal will be followed by more growths if cause is not removed.
Uterine polypi may be absorbed by fasting and will not recur thereafter if the patient does not return to her former faulty living.
Many physicians make a big fuss over these growths and tell their patients they must go to the hospital. The needless fear and worry thus created enervates, producing nervousness, high pulse and other troubles. Worry and fear kill by overcoming resistance and inhibiting blood-making.
Definition: This is a catarrhal inflammation of the vagina.
Symptoms: A feeling of heat and fullness is accompanied by pain in the vagina and uterus, a dragging feeling, in the loin, and leucorrhea ranging all the way from a thin watering to a thick catarrhal or whitish-of-egg-like discharge. If the latter, it indicates inflammation of the neck or body of the womb, or both. When the leucorrhea becomes purulent, the discharge is yellowish, or brownish, or bloody.
Etiology: Physical uncleanliness stands at the top as a cause of affections of women. Careless eating, bathing, and clothing, coupled with overworked emotions, lasciviousness, and sexual excitement from any cause evolve a state of the blood and nervous systems that makes the development of local inflammation easy. Resistance is low so that injuries at childbirth, abortion, etc., inflame and ulcerate instead of healing in a normal manner. Vaginitis is frequently developed in the eruptive "diseases," from the same toxemic cause,
Care of the Patient: Local cleanliness is most important. We do not favor the use of douches, however. Fasting and rest result in speedy decline of the inflammation and cessation of the discharge by relieving the body of its toxic overload. Thereafter a hygienic plan of living will maintain health.
"DISORDERS OF MENSTRUATION"
Menstruation is a term applied to the monthly loss of blood suffered by most non-pregnant women between puberty and the menopause. Menstruation does not begin in all girls at the same age, it is said to be "to one's advantage to postpone ovulation (with which menstruation is correlated) by natural life, freedom from excitement and stimulating influences, and plenty of outdoor exercise," as the loss of blood handicaps woman.
While it is generally thought that "normal menstruation means health" it is our thought, based upon experience, that menstruation is, itself, an evidence of pathology. We believe that except for the general and local laxity of tissues, there would be no loss of blood. We hold that all pelvic symptoms, whether considered normal or abnormal, are evidences of deteriorated general health. Geddes and Thomson, in their Evolution of Sex concede a moderate, though quite vague, amount of pathological development in the case of menstruation, saying: "Though thus clearly a normal physiological process, it yet evidently lies on the borders of pathological change, as is evidenced not only by the pain which so frequently accompanies it, and the local and constitutional disorders which so frequently arise in this connection but by the general systemic disturbance and local histological changes of which the discharge is merely the outward expression and result.
Menstruation is not universal among womankind, is seasonal among some tribes, is not essential to health and fecundity and constitutes a marked drain upon the resources of the female organism. It is not seen among the lower animals. It is our thought that the loss of blood is coetaneous with the other symptoms of abnormality that so frequently accompany the hemorrhage. In other words, the first "disorder of menstruation" is menstruation. We base this conclusion, not alone upon the above facts, but upon the many instances in which we have seen the restoration of a high degree of vigorous health result in a cessation of menstruation.
Definition: This is excessive flow — flooding — at menstruation, or prolonged menstruation.
Symptoms: The characteristic symptom is the excessive loss of blood, sometimes amounting to hemorrhage, and the prolonged flow, lasting from seven or eight days to two weeks. Indeed we occasionally meet with a case that flows from one period to the next. These girls have quick pulse, and often a tumultuous heart palpitation. They are nervous, irritable and hard to control. They are easily excited and easily turn against their parents who do not understand the source of their nervous storms.
Anemia frequently results from the loss of blood. Pains in the back, headache, acne, especially of the face, and weakness are common symptoms.
Etiology: Sex neurosis growing out of overstimulation of the sex function by overeating, eating stimulating foods, erotic imaginings and lack of exercise are the chief causes. Overstimulating foods produce violent emotions and sexual excitement. When eating and thinking are of a character to produce irritation and engorgement or congestion of the reproductive organs, this high state of irritation and blood pressure not only produces uncontrollable desire, but a hyper-sensitive state of the reproductive organs and necessitates loss of blood to relieve the engorged organs. If the blood is not lost the girl is likely to become the victim of some man or else the hyperemia will be organized into fibroid growths.
CANCER OF THE BREAST
As elsewhere, this is an end-point in a pathological evolution with simple beginnings. It starts as a lump, usually painless and in the majority of cases develops in women past forty. Occasionally it is seen in earlier years. It can best be felt by pressing the breast flat upon the ribs with the palm of the hand. These growths often grow outside and become large, ugly, suppurating fungoid masses.
No woman should allow the discovery of a lump in her breast to frighten her as but few lumps are cancerous. Dr. Richard C. Cabot says: "Many non-cancerous lumps in younger women are now removed by surgeons, because the best-informed opinion holds that about ten per cent of them later become cancerous." They need never become cancerous and they need not be removed. It is wiser to remove their causes.
When enlarged glands, and indurations of any kind in the breast are not removed by correcting the general health and the local affections that furnish reflex irritations; but bad habits of living are continued until nerve energy is much reduced and elimination fails to such an extent that nutrition is brought to a low ebb, then any induration of tissue or gland in the breasts may become malignant. If deranging habits of body and mind are discontinued before cancer develops, there is no danger of it developing.
Lumps in the breasts with which so many women are troubled, if they remain enlarged, are certain evidence of ovarian and uterine impairment. We do not mean that there are necessarily any organic changes in these organs, but a hypersensitive condition, due to the causes of catarrh and inflammation. There exists a close relationship between the breasts and the reproductive organs and for this reason ovarian and uterine affections must be carefully studied in all affections of the breasts.
Care of the Patient: Prevention is the only safe and sure cure for cancer of any part of the body. Cure of cancer of the breast is doubtful in all save a few cases, for the same conditions are to be met here that are met and corrected in cancer elsewhere in the body. When removal of the breast is not followed by a return of the growth, it is safe to conclude that it was not cancer. See chapter on Cancer in this volume.
Definition: "Pernicious" vomiting during pregnancy. Some medical authorities consider vomiting in pregnancy to be normal, attributing it to normal biological processes, and view with suspicion the healthy woman who does not vomit. This view is opposed by all the facts. These are: (1) the lower animals do not vomit when pregnant; (2) pregnant women among so-called savage tribes are never so afflicted; (3) the condition is seen in less than fifty per cent of civilized women; (4) it is always associated with pathology and ceases when health is restored.
Morning Sickness, which is nausea and vomiting in early pregnancy, occurring chiefly in the morning, though often regarded as a natural outcome of pregnancy, is only a mild form of hyperemesis gravidarum, and is equally abnormal. Really healthy women do not have morning sickness.
Symptoms: Starting usually early in pregnancy the condition is marked by persistent nausea and vomiting. Vomiting follows the taking of food or water and often there is effort to vomit when the stomach is empty. There is weakness, loss of flesh and, if water is not retained, dehydration of the tissues causing great thirst. Cases are seen where the vomiting continues through the whole of pregnancy and abortion is performed to prevent the woman from dying of dehydration and starvation.
Etiology: Many suspected causes are listed by the ex-spurts. To us, the most significant thing connected with the phenomenon is that it never develops in healthy women. In not a single woman that we have guided into a state of superior health before pregnancy, has any nausea or vomiting developed.
One of the most frequent causes of "sick-stomach" is chronic inflammation of the neck of the womb — cervicitis. This produces the so-called neurotic type of hyperemesis gravidarum. Deranged digestion, from imprudent eating, is the cause of many cases. We hold that vomiting in pregnancy serves a useful purpose, that it is not an effort of the body to commit suicide; but that it is part, of the effort of the body to readjust itself and set itself in order. The more toxemic subjects have the most vomiting.
Prognosis: The condition is "self-limited." Practically all cases get well in a few days, no matter how treated.
Care of the Patient: The woman should go to bed and fast until all nausea and tendency to vomit have ceased. All the water may be taken that is desired. This may be hot or cold, as relished. It often happens that warm water can be retained while cold water cannot, or vice versa. In some cases water can be retained only if taken slowly in small sips. No forced drinking is advisable.
After vomiting and nausea have ended, moderate, eating with plenty of green vegetables and fresh fruits will carry the mother through her pregnancy in health and comfort.
Definition: This is a septic infection and is identical with wound infection seen in surgery. It is known also as puerperal septicemia, metria, and child-bed fever.
Symptoms: It is common for the first symptoms to occur on the second or third day after labor, rarely do they appear later than the third day, because granulation of the obstetric wounds have by that time begun and a barrier to infection is formed. The crisis sometimes begins with a chill, but is said to usually start insidiously. A rapid pulse (100 to 140), fever (102° to 104°F.), and fetid lochia are the most conspicuous early symptoms.
Complications: Endometritis, salpingitis, ovaritis, metritis, parametritis, pelvic peritonitis, phlegmous lymphangitis, phlebitis, cystitis, utero-pyelitis, pneumonia, pleurisy, pericarditis, endocarditis, nephritis, arthritis, acute ptomaine poisoning, putrid intoxication, pyemia, and other "diseases" are common complications of this infection. When these affections develop, the symptoms characteristic of them will be added to the above.
Etiology: No better example of the unity of infection can be offered than the many "diseases" in all parts of the body that may result from the spread of infection, in puerperal fever. There is no difference in the so-called "specific" inflammations of the different organs of the body. If there is any fundamental difference in the infecting agent, the resulting so-called "disease" gives no sign of it. The constitutional effects are the same; the differences in "two diseases" — two infections — are supplied by the differences in the structures and functions involved.
Puerperal fever may result from infection from suppurating wounds, gonorrhea, erysipelas, diphtheria, scarlet fever, typhoid fever, cadaveric and other dead or decomposing animal matter, froth suppuration in the genital tract, or from decomposing lochia of the mother. Does the woman infected by erysipelas or diphtheria develop these "diseases"? No. She develops septic poisoning — septicemia. If infection is from a wound or from gonorrhea, she still develops septicemia. Instead of gonorrhea, or erysipe1as, or diphtheria, etc., the woman will develop what is called puerperal fever.
Infection is the same whether generated in a wound, abscess, pent-up duct, ulcerated lung, cancer, or elsewhere. When tissues melt down, in necrosis or decay, they generate a cadaveric poison, a toxic alkaloid, which is the infectious material in all cases. The toxic element in all infections is sepsis.
All secretions, excretions, and exudations are non-toxic until they become toxic through decomposition. In penetrating wounds, if drainage is imperfect and the exudate becomes pent-up it will under-go decomposition and become septic. If obstruction is complete so that absorption is forced, general infection — septic poisoning — will follow so rapidly that often the patient is beyond hope of recovery in twenty-four hours.
Septic infection is virulent in proportion to the amount absorbed. If the position of the womb is such that drainage cannot take place, the pent-up normal discharge becomes putrescent and there follows immediately, symptoms of septicemia. If the true state of affairs is not recognized and drainage established, death follows in two days. If there is imperfect drainage, the discharge may not be held long enough to cause degeneration-changes to produce local infection, resulting in chronic inflammation and suppuration of different parts of the sex organs.
Prognosis: This is good in women of average resistance if proper care is instituted at the first sign of trouble. Tilden says: "It is well to think of all infection following childbirth as septic infection, or even peritonitis, and treat every case with the same care and attention that would be given a real child-bed fever; for, indeed, a little carelessness, mismanagement or bungling treatment may convert a slight infection into a general and fatal type."
Care of the Patient: Cleanliness is the most important requisite. If fever develops soon after childbirth (or abortion) and pain and tenderness are experienced, we may be reasonably sure that there is retention of debris and that cleanliness has been neglected.
Intra-uterine douches of "hot," boiled water given every three hours will loosen up and expel the debris and wash away the septic fluids and gases. At least two quarts, or even four quarts, may be used at each douche. The douches must be given at three hour intervals until the temperature and pulse are normal.
Absolutely no food is to be given until all acute symptoms have been non-existent for at least twenty-four hours. Perfect quiet, plenty of fresh air, and heat to the feet, complete the care. Drugs cannot help, but will enervate the patient and lower resistance.
Curetment may empty the womb if infection has not taken place, but if infection has already occurred, curetment, even with a dull curet, may tear down nature's barriers and probably cause death.
Definition: Incomplete involution of the uterus. The return of the womb to its original size after childbirth is called involution. The process usually requires about six weeks. If the process is arrested or interfered with and the contraction is incomplete the condition is called subinvolution.
Symptoms: These are few and indefinite. There may be more or less occasional bleeding, continuing perhaps for a few weeks. The actual condition can be ascertained by feeling the fundus of the womb through the wall of the abdomen, above the level of the pubic bones.
Etiology: It is not a condition that ever develops in any normal or healthy woman. It is associated with retention of parts of the placenta, displacement of the uterus, adhesions, fibroid tumors, and premature resumption of intercourse.
Care of the Patient: All sexual excitement and sexual indulgence should be avoided. The cause — tumor, adhesion, retained placental fragments, etc. — should be ascertained and care directed accordingly.
SWELLING OF THE FEET
This is a symptom of heart or kidney impairment and should be cared for as described under affections of these organs. It is a dropsical condition and often extends up the ankles and legs.
These were discussed under affections of the circulatory system, but a few words about their development during pregnancy will be appropriate here.
The veins of the legs often swell to great size, often to half the size of a man's wrist and the leg or legs from the feet to the body not infrequently swell to double their natural sizes. The veins appear knotted and frequently break and in extreme cases varicose ulcers form on the shins or above the ankles. If the swelling is great there is great suffering.
Enervation is the cause. Added to enervation is the practice of "eating for two" which produces indigestion, gas pressure, and auto-infection. The greater the enervation the less digestive power and the more indigestion. Contrary to prevailing professional opinion, the body is not a machine that can care for a given amount of food under any and all circumstances.
The miserable, lazy makeshift of putting a bandage or rubber stocking on the leg can do nothing more than palliate the condition. To remove the veins, instead of being a "radical cure," is a shameful, inexcusable crime against the patient. It is followed by enlargement of other veins.
The only cure is: "remove the cause." What is the cause? A mode of living that builds enervation and toxemia. All nerve-leaks must be corrected. All causes of enervation must be looked after. The general health must be built up by proper feeding and care of the body. The amount of food eaten should be cut down to the ability to digest and assimilate. In severe cases eating should be discontinued until full relief is experienced.