Chapter 11 - Female Diseases
Introduction to Female Diseases
Inflammation of the Neck of the Womb
Inflammation of the Ovaries
Whites
Absence of the Menses
Profuse Menstruation
Painful Menstruation
Green Sickness
Cessation of the Menses
Hysteria
Polypus of the Womb
Uterine Hydatids
Inflammation of the Womb
Falling of the Womb
Falling Over of the Womb
Tumors of the Womb
Cancer of the Womb
Ovarian Tumors
Inflammation of the Fallopian Tubes
Inflammation of the Vagina
Itching of the External Parts
Tubal Pregnancy
Sterility
Midwifery
Miscarriage
Abortion
Prevention of Pregnancy
Labor
Antiseptic Dressings
Milk Leg
Child Bed Fever
Puerperal Convulsions
Hemorrhage
Nursing Sore Mouth
Broken Breast
Sore Nipples
Sex of Child, How to Regulate Before Birth

11.1 Introduction to Female Diseases

FEMALE DISEASES.

IN addition to the diseases common to both sexes, women are subject to a class of distressing complaints peculiar to themselves, and denominated, in general terms, female diseases. Involving considerations of a delicate nature, these complaints have too generally and too long been shut out from works intended for popular distribution. Hence there is a general ignorance of a class of diseases which are fast unfitting woman for the high duty of continuing the race; and the subjects of these maladies are generally themselves so uninformed of the true nature of their sufferings, that they are neither prepared to seek relief in the proper direction, nor to submit to the remedy if it chance to be proposed.
It is intended here to speak of these disorders, as I have done of all others, in t plain and simple way, to describe them, so far as the present state of medicine permits, just as they are, and to make known the modes of treatment which have been found available for their cure. The sufferings of woman require this; the interests of humanity require it; and the writer is impelled to it, as he thinks, by a just sense of responsibility.
Physicians, in my judgment, are changeable with a great wrong in concealing within their own breasts information upon what are called delicate subjects, information which the good of the world requires should be divulged, and which they ought to pour into the public mind, and make common, and which they would thus popularize, but for their stiff pride and conservatism.
The idea that our knowledge cannot be imparted to the world without injuring the public morals, is simply absurd. We are more afraid of bringing the common people too near to us, of letting down our dignity, and of opening our profound secrets to popular eyes. The result is as it should be, that unsophisticated people are apt to give physicians a wide berth, and to have nothing to do with them unless necessity compels. Let doctors strip off their reserve, and while they remain gentlemen, become likewise companions, imparting their knowledge freely and familiarly to all, and the public confidence, now considerably shaken, will be frankly restored to the profession.
It should be the object of a good physician to know all he can, and to impart his knowledge to as many as possible. Knowledge is not merely power: it is happiness, it is wisdom, it is health, it is virtue; yes, it is always virtue, except in some rare instances, where the worst natures pervert it. No physicians are so much loved as those who are frank, and have no concealments. The day for mysterious nods of the head, and rolling of the eyes, and shrugs of the shoulder, has gone by. Men, and women too (or those of them who are wise), wish to know distinctly what their diseases are, and what is necessary, not to palliate and prolong, but to cure them.

Time when Female Diseases Begin. Female complaints begin to make their appearance at the period of life called puberty, the time when the girl passes from childhood to womanhood. This is the period when menstruation is established, which consists of a discharge from the genital organs, composed of blood and mucus, and which occurs, when regular, every four weeks. Up to this period, the system of reproduction has remained dormant. By the intervention of this mysterious function, the young female becomes a new being. The heart unfolds itself to new emotions; the mind assumes a solidity before unknown, and even the body acquires beauty from a sudden rotundity of form.
This is the period when the great question of female health is very apt to be settled once for all, and for life. The girl who is well trained at this time, generally has a foundation laid for health and character, which is worth more to her than riches. At no time does the mother need so much wisdom and knowledge as now. To establish the health and develop the affections of the daughter at this critical period, is a sacred trust which she can devolve upon no other being; nor can she meet her responsibilities at this time, unless better informed than most mothers are. The general apathy in regard to this maternal duty is deplorable.

False Delicacy. The refined delicacy which withdraws these subjects from the public gaze is commendable, for it cast$ a beautiful charm over society; but when carried so far as to cast a veil even over the eyes of mothers, it is quite unnatural, and leads to the worst results; for in the bad management of girls at this critical period is laid the foundation of so many of the diseases which shatter the constitution of so many women. For this bad management, it is not mothers alone who axe to be blamed. The neglect of the medical profession to furnish the necessary information should come in for its full share of reproach.

The Establishment of the Menses. Nature always comes slowly and by degrees to the inauguration or establishment of any of her great functions. It is so in regard to menstruation, or, as it is variously called, ̉the menses," the courses," ̉the change," etc. For some time before the flow be there are certain symptoms, or premonitions, which to the eye of the physician plainly enough foretell the impending change. To the mother these signs would be equally intelligible, were she as well informed as she should be. It is plainly her duty to be intelligent enough to assist nature in the establishment of this important function. But how often, either from ignorance or from false ideas of delicacy, does she fail to interfere, and allow the daughter to be taken by surprise, and perhaps frightened and thrown into convulsions!
From inquiries made of about one thousand women, a distinguished English physician found that about one quarter were unprepared for the appearance of the menses. Some of the girls were frightened and went into hysterical fits; others thought they were wounded, and washed with cold water. The flow was stopped in several cases, and in some never restored; while the health of all in whom it was interrupted was seriously impaired. ~

Symptoms of the First Menstruation. A variety of symptoms precede and foretell the first menstruation. Headache, dizziness, sluggishness of thought, and disposition to sleep; these occurring in a girl, may be taken as hints that the 11 change " is at hand. If to these be added pains in the back and lower limbs, the intimations will be still more significant.
At this time a girl loses a relish for the society of children; she is apt to acquire a taste for solitude; her temper becomes wayward and fretful; her eyes acquire a peculiar luster; she becomes a sort of mystery to her friends and herself; not her physical frame only, her whole character is changed. She is about stepping into a new life. Her emotions, thoughts, anticipations, retrospections, are all new to her, and her outward manifestations are new to her friends. An intelligent mother will not fail now to prepare her mind for the important event close at hand.

The age when this change takes place depends very much upon a variety of circumstances. It occurs much earlier in warm than in cold climates. It is hastened by high living; by the whirl and bustle and excitement of city life; by reading novels which are full of love incidents; by attending balls, theatres, and parties; and by mingling much in the society of gentlemen.

Early Menstruation not Desirable. It is a law, both in animal and vegetable life, that the later the period at which maturity is reached, the greater the solidity of the body, and the longer it lives. Girls who menstruate early do so because the body is weakened by climate or luxury, and the nervous system unduly developed by excitement; while those who come late to womanhood have firmer constitutions, enjoy better health, and live longer. Those mothers, therefore, commit great errors, who are anxious and administer 11 forcing medicines," because their daughters do not menstruate at fourteen or fifteen. If girls are suffering from no special ill health, no anxiety need be felt if , the custom of women " do not come to them till the age of eighteen, or even twenty. The delay should excite thankfulness rather than regret. It shows that the constitution has not in it the seeds of early dissolution; that it is fortifying itself against future disease.
Girls who come thus tardily to maturity are much more 11 regular" in after life. They bear children with fewer accidents, and are afflicted much less with female diseases. The duty of mothers is plain: it is to bring their daughters forward as late as possible, by refusing their early admission to society, by withdrawing from them all exciting reading, by prohibiting their early attendance at parties and theatrical entertainments, by prescribing for them the most unstimulatingy diet, and by requiring a large amount of exercise in the open air.
A wide investigation has shown that the first menstruation occurs, in hot climates, at the average age of thirteen years and nineteen hundredths ; in temperate regions, at fourteen years and seventy. four hundredths ; in cold latitudes, at sixteen years and fifty three hundredths. Under the hot house culture of modern society, and especially among the wealthy classes, where indolence, luxury, and excitement unite to weaken the constitution, this change is constantly occurring at a more tender age.

How Female Diseases are Induced. All living things have their origin in germs. The germ from which the higher animals spring, man included, is an ovum or egg. Every animal and every vegetable is provided with an organ for the production of germs. In woman, this organ is called an ovary. There are two ovaries, about half an inch in length, one lying on each side of the womb, to which they are attached by ligaments or cords. The ovarian bodies contain vast numbers of vesicles, or cells, or eggs, which are the true germs of human life, and the only sources from which it can spring.
Between the ages of fourteen and forty~ five (speaking in general terms), every healthy woman matures and deposits an ovum once in twenty eight days. This vesicle, some time before the monthly flow, begins to germinate and swell, and after a time, like a grain of wheat in the earth, it bursts its covering and springs forth. It then passes through what is called the Fallopian tube into the womb, whence it is cast off.
During the swelling and bursting of this vesicle or germ, the vessels of the ovaries and womb, and particularly of the membrane lining the womb and its neck, are so crowded with blood as to produce in the parts a state of congestion. If the parts be examined with a speculum at this time, they will be found red, sensitive, and almost inflamed. So great is this congestion, that the woman often complains of pain in the ovaries and the womb, and a general sense of heat, aching, and dragging down in the lower part of the bowels. The pain often extends to the back, the groins, and the thighs.

This Condition Repeated Every Month. When we consider that this state of things is repeated every four weeks, and that the congested or crowded state of the vessels begins some days before the monthly flow, and lasts, in all, some ten days, making about one third part of every month, we need not wonder that inflammation so often supervenes, with all its attendant ill health and suffering.

Increased by Various Causes. If we reflect, further, that this congestion is increased, among the wealthy, by high living, and among all classes, by over stimulation of the nervous system, and by the lascivious morals of the age, we see stronger reasons for expecting what is really occurring a continually increasing amount of suffering from female diseases.
And when we know, still further, that American females are careless of their health; that they often attend balls and theatres at the very time of suffering from this monthly visitation; that they frequently wet their feet, and otherwise expose themselves to colds, we cannot feel surprise, even when we learn that from one half to three fourths of all women in cities, and quite a large proportion of them in the country, have inflammation of the ovaries, or of the womb, or of the neck of the womb, or suffer some of the forms of displacement of this latter organ.

Child Bearing. The inflammatory state of the uterine organs is often induced by injuries received in child bearing, and by excessive indulgence in sexual pleasures.

Weakness of the Sexual System. The womb, moreover, like any other organ, may be naturally frail, and easily affected by disease. This weakness of the sexual system is indicated by the difficulty with which menstruation is established, and the presence of the whites, both before and after each monthly flow. Women in whom the generative organs are weak, are much more liable to inflammation of the womb, and to all complaints peculiar to the sex.

Description of the Sexual Organs. Before describing the particular diseases to which the female generative organs are liable, it is proper to give the reader a brief description of the chief of these organs.
The Womb itself, in its healthy, natural state, is about two inches long, and one inch broad weighing a little more than an ounce, and is in shape like a pear. It is lined with a mere rudimentary mucous membrane.
The Neck of the Womb has a cavity distinct from that of the body of the organ, and is lined with a mucous membrane well supplied with follicles or glands.
The Fallopian Tubes open, one from each side of the base, or largest end of the womb, and extend outward to the ovaries.
The Ovaries are glandular bodies lying one on each side of the base of the womb. They are more particularly explained else. where. Fig. 136 gives some idea of these organs. A, is the body of the womb; B, the neck of the womb; C, C, the vagina; D, one of the ovaries; F, F, the Fallopian tubes; E, E, the fimbriated extremities; G, the small ligament attaching the fimbriated extremity to the ovary.

Inflammation of the Neck of the Womb. Inflammation of the body of the womb is a comparatively rare disease, but inflammation of the neck of this organ is so common that in nearly nineteen out of twenty cases, when females seek relief for whites, for painful menstruation, for stoppage of the menses, or even for what they suppose to be a falling of the womb, a careful examination will show that this pendant portion of the womb is in a state of marked inflammation, or of absolute ulceration. The whites, if they continue without intermission from one menstrual flow to another, are almost always the result of one of these conditions of the uterine neck.
It would surprise most persons out of the medical profession, and many physicians, to know how large a proportion of the more grave diseases which inflict such terrible suffering upon woman, and so completely shatter her constitution, are dependent for their existence upon a simple local inflammation, either in the neck of the uterus, or in one or both of the ovaries. Many a female has for years suffered agonies, greater than those of death itself, arising, as she supposed, from a complication of ills which invade every part of the system, while the whole of her troubles arose, in fact, from an inflammation of the neck of the womb merely.

Difficulties of Studying Uterine Diseases. The social relations of the sexes, and the great delicacy of the matters to be investigated, for a long time prevented direct examination and investigation, so that little knowledge was gained, and as little benefit confirmed.

Woman, always distinguished for her modesty, could not be expected to invite investigations which were not proffered, whatever the extremity of her sufferings; and man, scrupulously sensitive lest he should make himself an intruder by stepping within delicate enclosures, have both, in times past, mistaken their duty by misinterpreting the demands of the highest delicacy.

Needful Examination not Indelicate. Rightly viewed, no inquiries or examinations are indelicate which are necessary to a fun understanding of the nature of disease, and which are made with the sole purpose of rendering its cure possible. I agree with Dr. Meigs, the elder, that the delicacy or indelicacy of examining the persons of females for the purpose of exploring disease, depends on the motive with which it is done. To pure minded persons, it is never, I think, a source of impurity. On the contrary, the self restraint, the honorable feeling, and the nice sense of delicacy which it calls into exercise, often heighten the tone of a man's virtue, and certainly increase a true woman's respect for it. Unfortunately, there is now and then a gross minded man in the profession, who, in these investigations, will violate the most sacred of all trusts committed to his hands; but such monsters few in number soon find their level, and are shunned as the most vile of the race.
It is now so well understood that these investigations do not lead to immoralities, that the most highly educated, intelligent, refined, and virtuous females almost invariably raise the fewest objections to such examinations as a physician of character may propose.

Methods of Investigating Female Diseases. The symptoms of these complaints will be spoken of in their proper place, as the several diseases come under a brief review. I merely wish to allude here to the methods of physical exploration which modern practice has called to its aid.

The Touch. These methods consist, first, of what is called the touch, which is made either externally upon the bowels, or internally, with the index finger, through the vagina, or passage, from the external genital organs to the neck of the womb.

The Speculum. In the second place, of ocular inspection of the vagina and neck of the uterus, through an instrument called the speculum. By this instrument, the eye, as well as the finger, is made to assist in learning the real condition of the parts.
The finger informs us whether there is any deviation from nature in the bulk, the firmness, the smoothness, or the sensibility of the parts; while the sight, through the speculum, affords absolute certainty as to whether the parts are suffering from inflammation, ulceration, abrasion, or eruption.

There are a variety of specula in use by modern physicians, but all are essentially of two kinds; first, a so called Sims' Speculum (Fig. 137), the end of which, when inserted into the vagina and pulled upon, allows the air to enter and balloons out the vagina so that the parts can be readily seen. This speculum necessitates what is known as Sims' position, i.e. the woman's hips resting on the edge of the bed or table, knees flexed, and chest resting on bed with left arm out from behind her.

The second variety of speculum is what is known as the duck bill pattern (Fig. 138). By a separation of the two blades, the neck of the womb slips in between them. The speculum is then fastened with a thumb screw, leaving the hands of the physician free. This speculum is used with the woman on her back, and feet resting on the bed or table, with knees flexed.
We also give an illustration of an older kind, which is still used to some extent. The end is, so shaped as to catch the neck of the womb, and then by drawing the instrument forward slightly, the diseased surface is presented for as perfect inspection as if located externally (Fig. 139).



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