The Abdominal and Pelvic Brain
Byron Robinson, M. D.
PATHOLOGIC PHYSIOLOGY OF THE TRACTUS GENITALIS.
"The Soul knows only Soul, the web of events is the flowering robe
in which she
is clothed." - Emerson.
"Furnish the government with neither a kopek nor a soldier."
- Final appeal of the Russian Douma, dissolved by the czar, July,
For over a decade I have been attempting to make
prominent in gynecologic teaching, pathologic physiology, disordered function,
rather than pathologic anatomy, changed structure. It seems to me
that disorder - functions or pathologic physiology of the tractus genitalis
impresses itself more indelibly on the student's and practitioner's mind
than pathologic anatomy. Besides, in gynecologic practice pathologic
physiology occurs tenfold more frequently in the genital tract than pathologic
anatomy. For the gynecologist pathologic physiology presents innumerable
views of practical interest. Pathologic physiology teaches that the
circulation of an organ is a fundamental factor in comprehending its disease
and administering rational treatment. It takes an inventory of the
volume of blood which streams through the organ as a fundamental factor
in comprehending its diseases and administering rational treatment.
It takes an inventory of the volume of the blood which streams through
the organs at different stages and conditions. We wrote years ago
that the arteries of different viscera were supplied with automatic visceral
ganglia, and we christened the peculiar nerve nodes found in the walls
and adjacent to the uterus, oviducts and ovaries, as "Automatic Menstrual
Ganglia." The automatic menstrual ganglia complicate the blood supply of
the tractus genitalis by changing its volume during the different sexual
phases. In pueritas the blood stream of the tractus genitalis is
quiescent as well as its parenchymatous cells; in pubertas it is developing
as well as proliferating parenchymatous cells. In menstruation the
blood stream is active with active parenchymatous cells. In the puerperium
there is retrogression of blood stream and an involution of parenchymatous
cells. The climacterium is the opposite of pubertas - subsidence,
the decrease of blood volume and parenchymatous cells. Senescence
is a repetition of pueritas - the quiescence of the genitals, their long
night of rest. The circulation of an organ quotes its value in the
animal economy. It rates its function. Observe the enormous
volume of blood passing through the kidney or pregnant uterus in a minute.
To study pathologic physiology of any visceral tract
we must possess clear views as to its physiology. The physiology
of the tractus genitalis is: (1) ovulation; (2) peristalsis; (3) secretion;
(4) absorption; (5) menstruation; (6) gestation; (7) sensation.
(1) On account of the numerous theoretic views
connected with OVULATION and lack of space we will omit the general discussion
on the pathologic physiology of ovulation. it is well known that ovulation
has a wide physiologic range. We do not know the life of an ovum
or corpus luteum. It was once supposed that a corpus luteum was a
sign of pregnancy and the supposition gained legal or judicial position.
We know that this is an error. I have found two corpora lutea on
one ovary of a lamb which had not been pregnant. The internal secretion
of the ovary is important and chiefly manifest by marked symptoms on removal
of both ovaries - neurosis, accumulation of panniculus adiposus, extra
growth of hair, diminished energy and ambition. These symptoms may
occur in women possessing both ovaries, hence, we would conclude that pathologic
physiology of ovarian secretion existed. The sensation of the ovary
occupies a wide zone of pathologic physiology in the mental and physical
being. Forty per cent of women visiting my office remark, "I have
pain in my ovaries." On physical examination we find the following conditions:
First and foremost in the vast majority of women who complain of pain in
the ovaries, palpation of the ovaries elicits no tenderness on pressure.
However, the pain of such women is located bilaterally in the area of the
cutaneous distribution of the ileohypogastric and ileoinguinal nerves.
It is a skin hyperesthesia - a cutaneous neurosis. The bilateral
iliac region of cutaneous hyperesthesia corresponds to the segmentation
or somatic visceral (ovarian) area, and presents a frequent varying zone
of sensory pathologic physiology. In the vast majority of women complaining
of ovarian pain no disease of the ovary can be detected - it is cutaneous
hyperesthesia of the ileoinguinal and ileohypogastric nerves.
(2) PERISTALSIS (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).
(a) Excessive peristalsis of the tractus genitalis
(uterus and oviducts) may occur at menstruation, during gestation, parturition
by the presence of myomata, during the expulsion of blood coagula, placenta
during congestion. The phenomenon of peristalsis in the uterus and
oviduct differs from the form and distribution of the muscularis.
The myometrium during gestation is in continual peristalsis - uterine unrest.
By placing the hand on the abdomen of a four-month gestating woman one
can feel the uterine muscular waves. The gestating uterus is always
prepared for an abortion, but the cervix, the sentinel on guard, checks
the proceeding. Fright will produce such violent, disordered myometrical
peristalsis as to break through the guarding cervix. Many women during
gestation experience considerable pain (supersensitive uterus) from excessive
uterine peristalsis - it is pathologic physiology. Uterine peristalsis
may be sufficiently excessive to rupture the myometrical wall.
The "after puerperal pains, is excessive peristalsis in an infected myometrium.
Frequently the severe pelvic pain during menstruation is excessive uterine
and oviductal peristalsis due to its extramenstrual blood supply.
It is chiefly the excessive peristalsis at menstruation that forces many
women to assume rest in bed, for, with anatomic rest (maximum quietude
of bones and voluntary muscles) and physiologic rest (maximum quietude
of visceral muscles) the uterine peristalsis will exist at a minimum.
Excessive oviductal peristalsis may produce pain of varying degrees.
In excessive peristalsis the automatic menstrual ganglia are stimulated
by extra quantities of blood or by other irritation.
PELVIC BRAIN (ADULT)
Drawn from my own dissection. A, pelvic brain. In this case
it is a ganglionated plexus possessing a wide meshwork. Also the
pelvic brain is located well on the vagina, and the visceral sacral nerves
(pelvic splanchnics) are markedly elongated; V, vagina; B, bladder; 0,
oviduct; Ut, uterus; Ur, ureter; R, rectum; P L, plexus interiliacus (left);
P R, plexus interiliacus (right); N, sacral ganglia; Ur, ureter; 5 L,
last lumbar nerve; i, ii, iii, iv, sacral nerves; 5, coccygeal nerve.
Observe that the great vesical nerve (P) arises from a loop between the
ii and iii sacral nerves. G S, great sciatic nerve.
(b) Deficient peristalsis of the tractus genitalis
(uterus and oviducts) is not uncommon. Uterine inertia is an example
known to every obstetrician. Deficient uterine peristalsis allows
hemorrhage in the fourth and fifth decades of woman's life. Deficient
peristalsis allows extraglandular secretion (leucorrhea).
(c) Disproportionate peristalsis is disordered,
wild muscular movements in different segments of the uterus or oviduct.
(3) SECRETION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).
(d) Excessive secretion from the genital tract,
pregnant or non-pregnant, has an extensive range and varying quantity.
The excessive secretion zone in the tractus genitalis has an important
bearing in practice. Typical pathologic physiology may be observed
in the pregnant woman from whose uterus may flow several ounces of white
mucus daily - no pathologic anatomy is detectable. Excessive uterine
secretion is a common gynecologic matter. The glands may not be embraced
sufficiently firm by the myometrium. The automatic menstrual ganglia
are diseased, insufficiently supplied by blood or the myometrium is degenerated.
Flaccid uteri secrete excessively. Excessive secretion and its fluid
currents allow insufficient time for localization of the ovum. Excessive
uterine secretion is, from apt bacterial media, liable to become infected.
During excessive secretion physical examination frequently detects no palpable
pathologic anatomy - merely physiology has exceeded its usual bounds.
(e) Deficient secretion of the tractus genitalis
is not so manifest as its opposite. The mucosa of vagina and uterus
present excessive dryness, desiccation, practically as visceral functions
are executed by means of fluids, pathologic physiology is in evidence;
dryness and abrasion of the mucosa, local irritation, chafing, local bacterial
development, dysparunia, dysuria, defective import of spermatozoa and export
of ova ending in sterility. Deficient secretion means that waste-laden
fluids are bathing and irritating the thousands of lymph channels in the
body. Deficient secretion or excessive dryness of the genital mucosa
- pathologic physiology with no perceptible pathologic anatomy - is not
uncommon in gynecologic practice. Oily applications to subjects with
deficient genital secretion may be required for protection of exposed nerve
periphery, as abrasion, fissure, ulcers, and also for relief.
(f) Disproportionate secretion may occur in
the different segments of the genital tract, unequal, excessive, deficient,
(4) ABSORPTION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).
(g) Excessive absorption presents two views,
namely, a dryness of the genital mucosa from excessive absorption of the
mucal fluids. This resembles the conditions arising in deficient
secretion of the genital tract (see e). Again the mucosa of the genital
tract excessively absorbs deleterious substances lying on its mucosa -
septic or toxic. Excessive absorption in the genital tract, pathologic
physiology, resembles excessive absorption and conditions in other localities,
as the absorption of poison ivy, lead, arsenic, among art workers.
The pathologic physiology possesses a wide range, for some experience no
ill-effects while others are severely or even fatally ill from absorption
,of same substance under similar conditions.
| Fig. 120.
This illustration demonstrates the vast amount of nervus vasomotorius it
requires to ensheath the arteries of the uterus.
(h) Deficient absorption in the tractus genitalis
produces an excessive discharge, the decomposition of which lays the foundation
of bacterial multiplication and excoriation of mucosa and skin.
(i) Disproportionate absorption occurs in
the different segments of the tractus genitalis and presents pathologic
physiology. However, lack of space makes it impractical to discuss
(5) SENSATION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).
(j) Excessive sensation in the tractus genitalis
presents a wide zone of pathologic physiology. Vaginismus is the
extreme type of genital hyperesthesia. The introitus vaginae of perhaps
fifty per cent of women is supersensitive. When I was a pupil of
Mr. Lawson Tait he had a patient, a recently married woman, from whom the
husband was suing for divorce as her genital hyperesthesia was so excessive
that coition or examination was intolerable. She had to be anesthetized
to be examined, which was also suggested for impregnation with the hope
that gestation would relieve the condition. Supersensitiveness of
the pudendum is not an uncommon matter in gynecologic practice and without
demonstrative pathologic anatomy. The pathologic physiology of excessive
sensation in the tractus genitalis has a wide range of variation and degree
of intensity. Some subjects may be afflicted with excessive sensation
in the pudendum for many years. The excessive sensitive genitals
may be manifest in the uterus or ovaries. A small number complain
of tenderness and soreness in the internal genitals which cannot be detected
as pathologic anatomy - simply excessive sensation. The gestating
uterus may be so sensitive that it disorders adjacent viscera by reflexes.
The treatment of subjects with excessive genital sensation requires unlimited
time with continuous patience.
(k) Deficient sensation of the tractus genitalis is encountered.
With such subjects practically no organism occurs during coition to which
they are indifferent. Practically little or no treatment is required.
(1) Disproportionate sensation in the genital
tract is irregular, indefinite, disordered sensation arising and disappearing
in its different segments practically without reason or rhyme.
(6) MENSTRUATION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).
I will present this subject through a clinical patient.
Brief remarks on common examples of pathologic physiology in the tractus
genitalis will suffice to illustrate and suggest. As the most apt
subject to illustrate pathologic physiology in the tractus genitalis I
will choose that of menstruation.
To illustrate the value of pathologic physiology and the methods of
teaching it we will place a gynecologic patient before a student to elicit
clinical data in reference to menstruation as landmarks for diagnosis.
A landmark is a point for consideration physiologic, anatomic, pathologic.
To teach gynecology we should instruct by means of disordered function
as a base. Menstruation is the first practical function of the genital
tract. Hence the student asks in menstruation four questions, namely:
(a) How old were you when the monthly flow began? The patient may
answer: eleven (premature), fifteen (normal), or nineteen (delayed) years
of age. This answer presents a wide range of beginning of the menstrual
function. Now, the girl who begins to menstruate at eleven generally
represents pathologic physiology, but not pathologic anatomy. For
example, the girl who begins at eleven (menstratio precox) will in the
majority of cases menstruate profusely and prolonged. She will experience
a late climacterium. An early menstruation indicates a late climacterium.
Though one can palpate practically no pathologic anatomy, the tractus genitalis
is prematurely developed at eleven years of age, premature in dimension
(nerves, blood, lymph, parenchyma) and function (menstruation, gestation).
The blood stream to the genitals is prematurely excessive, the automatic
menstrual ganglia are large and prematurely active. Her menstrual
life is accompanied by excessive blood supply and hemorrhage, disordered
function, active parenchymatous cells, prolonged reproductiveness.
It is pathologic physiology, exaggerated function. but practically not
pathologic anatomy. The girl who begins at fifteen is practically
normal during her menstrual life. No pathologic anatomy nor pathologic
physiology is manifest. The girl who begins to menstruate at nineteen
(menstratio retards) is delayed with her menstrual function; late menstrual
appearance means early climacterium; it frequently indicates amenorrhea
and dysmenorrhea. It generally means defective genital blood supply
and limited parenchymatous cellular activity. It is pathologic physiology,
disordered function, limited productiveness, but frequently no palpable
pathologic anatomy exists. It is a fact, however, that in some cases
atrophy or myometritis is palpable pathologic anatomy and should not be
confused with subjects possessing pathologic physiology.
(b) The student asks the patient: Is the monthly
flow regular? The answer may be, regular or irregular. The
patient with irregular menstruation is afflicted with pathologic physiology
but no pathologic anatomy may be detected. It may be stated, however,
that the automatic menstrual ganglia require about eighteen months of vigorous
blood supply to become sufficiently strong and established to act regularly
monthly. The same condition exists in the automatic visceral ganglia
(Auerbach's and Billroth-Meissner's) of the tractus intestinalis of a child.
(c) The student, thirdly, asks the patient:
Is the monthly flow painful? The answer may be, yes or no.
A normal menstruation should be painless. Dysmenorrhea or painful
menstruation is pathologic physiology, disordered function, but frequently
no pathologic anatomy can be detected. At menstruation the blood
volume in the tractus intestinalis rapidly increases, blood pressure is
raised, compressing or traumatizing the nerves to a degree; limited hematoma
may occur in the endometrium, congestion is intense, inciting vigorous
and disordered peristalsis of the uterus and oviducts. In short the
trauma or shock of menstruation of the genital tract irritates it into
a state of pain. It is a state of pathologic physiology, disordered
function, but no pathologic anatomy may be palpable.
TRANSVERSE LONGITUDINAL SECTION OF UTERUS
This illustration presents the endometrium (secretary and absorptive -
glandular - apparatus) ; the myometrium peristaltic or rhymic-muscular-apparatus)
; the perimetrium (secretary, absorptive - lymphatic - gliding apparatus).
The uterus is richly supplied by sensory and motor nerves.
The affliction is functional.
(d) The student finally asks the patient:
How many days does the monthly flow continue? The answer may be,
two to eight days. Two days is deficient (amenorrhea or oligemia);
four days is normal, eight days is excessive (menorrhagia). I have
examined scores of gynecologic patients with over a week's flow, menorrhagia,
but in many of them no pathologic anatomy or change of structure could
be detected. It is typical pathologic, physiology, disordered, unusual
function. The subject is like a watch with an excessively powerful
mainspring. The watch has no detectable pathologic anatomy, no change
of structure. The mainspring, the automatic ganglia, is excessively
active. The organ is working excessively, the watch is gaining time.
The automatic ganglia are prematurely powerful, the watch spring is too
strong. Menorrhagia in many subjects is typical pathologic physiology.
The pathologic anatomy, if it exists, is too subtle for us to detect.
The adult life of the tractus genitalis presents an excellent field for
study and teaching in pathologic physiology. Its several periodic
functions, its changing volume of circulation, the limited life of its
parenchymatous cells and its automatic menstrual ganglia afford a useful
field for study and development of pathologic physiology.
Gestation presents many phases of pathologic physiology.
There is the typical pathologic physiology, namely, emesis, albuminuria,
hypertrophy of left ventricle, pigmentation, capricious appetite, constipation,
increase of panicular adiposus, the peculiar gait, venous engorgement (edema),
excessive glandular secretion, osteomalacia. The vomiting of pregnancy
may present a vast zone from slight regurgitation of food to profound anemia
due to limited nourishment - where pathologic physiology alone tells the
tale. The normal physiologic nerve relations between the tractus
genitalis (uterus) and tractus intestinalis (stomach) have become disordered.
No pathologic anatomy is demonstrable. Constipation (pathologic physiology)
is liable to arise during gestation because the normal physiologic blood
supply of the tractus intestinalis is robbed to supply the increasing demand
of the gestating genital tract. The albuminuria of pregnancy is doubtless
partially due to pressure of the expanding uterus on the ureters and veins,
obstructing venous and urinal flow. The normal physiologic relations
between the tractus urinaria and the gestating tractus genitalis have become
projected into the field of pathologic physiology. Pathologic anatomy
is not in evidence except as ureteral dilatations secondary matter.
A comprehensive view of pathologic physiology aids in diagnosis and treatment.
It will impress the practitioners with the utility of visceral drainage,
the administration of ample fluids at regular intervals to relieve the
system of waste-laden blood-irritating substances. Pathologic physiology
teaches us to restore function and frequently pathologic anatomy will take
care of itself.
PELVIC BRAIN IN RELATION TO THE NERVUS VASOMOTORIUS
General view of the nervus vasomotorius (sympathetic). B. Pelvic
brain. H. Interilia nerve disc. 1 and 2. Abdominal brain.
TREATMENT OF PATHOLOGIC PHYSIOLOGY OF THE TRACTUS GENITALIS.
Since pathologic physiology is the zone between physiology
and pathologic anatomy, it should be amenable to treatment. A diagnosis
by exclusion should be made. It must be remembered that in the physiology
the entire six abdominal visceral tracts are balanced harmonious, functionating
without friction - no reflexes dashing hither and yon disturbing the exquisitively
poised visceral physiology. In the treatment of pathologic physiology
of the tractus genitalis it should be remembered that the genitals are
not vital for life, but that the richly nerve-supplied genitals dominate
the mental and physical existence of woman. In the treatment of pathologic
physiology there are the subjects of periodic hyperemia, congestion, hemorrhages,
excessive glandular secretions, disturbed sensation (hyperesthesia).
First and foremost in the treatment of pathologic physiology of the tractus
genitalis, the adjacent visceral tracts must be regulated to normal states
as to drainage, but especially as to the physiologic condition of blood.
Frequently by producing daily evacuation of the digestive tract and increasing
the renal secretion by ample fluids the pathologic physiology of the genital
tract improves. The genitals should be examined for adherent prepuce,
pudendal fissure, pruritus pudendoe, or other point of irritation.
The other five abdominal visceral tracts (urinarius, intestinalis, vascularis,
lymphaticus, nervosus) should be examined for points of visceral irritation.
The frequent splanchnoptotic condition must be studied and remedied.
I. VISCERAL DRAINAGE.
For many years I have applied a treatment to such
subjects which I term visceral drainage. Visceral drainage signifies
that visceral tracts are placed at maximum elimination. The waste
product of food and tissue are vigorously sewered before new ones are imposed.
The most important principle in internal medication is ample drainage for
every visceraltract. The residual products of food and tissue should
have a maximum drainage in health. I suggest that ample visceral
drainage may be executed by means of: (A) Fluids; (B) Food.
(A) Visceral Drainage by Fluids.
The most effective diuretic is water. One of
the best laxatives is H20. One of the best stimulants of renal epithelium
is sodium chloride (one-half to one-quarter physiologic salt solution).
Hence I administer eight ounces of half normal salt solution to a patient
six times a day, two hours apart. (Note. - Sodium chloride is contraindicated
in parenchymatous nephritis.) Forty-eight ounces of half normal salt solution
daily efficiently increases the drain of the kidney. It maintains
in mechanical suspension the insoluble uric acid; it stimulates other matters;
it aids the sodium, potassium, or ammonium salts to form combination with
the uric acid, producing soluble urates. The half normal salt solution
effectively stimulates - the peristalsis and epithelium of the tractus
intestinalis, inducing secretions which liquefy feces, preventing constipation.
ARTERIES OF PUERPERAL UTERUS
Illustrates the arteries of a puerperal uterus 5 days post postum.
It is a half-tone - a so-called bromine photograph. It well illustrates
the enormous amount of nerves it would require to ensheath the numerous
arteries of the uterus. The uterus was injected with red lead and
starch and X-rayed. It represents excellently the author's circle.
(B) Visceral Drainage by Foods.
The great functions of the visceral tract - peristalsis,
absorption, secretion, sensation - are produced and maintained by fluids
and foods. To drain the tractus genitalis and adjacent visceral tracts
which should be excited to peristalsis, foods which leave an indigestible
residue only are appropriate. All visceral tracts must be stimulated
to maximum peristalsis, secretion and absorption in order to aid that of
the tractus genitalis. Rational foods must contain appropriate salts
whose bases may form combinations which are soluble, as sodium, potassium
and ammonium combined with uric acid and urates to form soluble urates.
The proper foods are cereals, vegetables, albuminates (milk, eggs), mixed
foods. Meats should be limited as they enhance excessive uric acid
formation. In order to stimulate the epithelium (sensation) of the
digestive and urinary tracts with consequent increase of peristalsis, absorption
and secretion in both I used a part or multiple of an alkaline tablet of
the following composition: Cascara sagrada (1/40 grain), aloes (1/3 grain),
sodium carbonate (1 grain), potassium carbonate (1/3 grain), magnesium
sulphate (2 grains). The tablet is used as follows: One-sixth to
one tablet (or more, as required to move the bowels freely, once daily)
is placed on the tongue before meals and followed by eight ounces of water
(better hot). Also 10 A. M. to 3 P. M., and at bedtime one-sixth
to one tablet is placed on the tongue and followed by a glassful of any
fluid. In the combined treatment one-third of the sodium chloride
tablet (containing eleven grains) and one-sixth to three alkaline tablets
are placed on the tongue together every two hours, followed by a glass
of fluid. The eight ounces of fluid may be milk, buttermilk, eggnog
- nourishing fluid. This method of treatment furnishes alkaline bases
(sodium, potassium and ammonium) to combine with the free uric acid in
the urine, producing perfectly soluble alkaline urates and materially diminishing
the insoluble free uric acid in the urine. Besides, the alkaline
laxative tablet increases the peristalsis, absorption and secretion of
the intestinal tract, stimulating the sensation of the mucosa-aiding evacuation.
I have termed the sodium chloride and alkaline laxative method the visceral
drainage treatment. The alkaline and sodium chloride tablets take
the place of the so-called mineral waters. I continue this dietetic
treatment for weeks, months, and the results are remarkably successful,
especially in the pathologic physiology of the visceral tracts. The
urine becomes clarified like spring water and increases in quantity.
The tractus intestinalis becomes freely evacuated, regularly, daily.
The caliber of the tractus vascularis becomes a powerful fluid volume to
carry oxygen and food to tissue, while the effete matter and waste products
are rapidly swept into the sewer channels. The blood is relieved
of waste-laden and irritating material. The tractus cutis eliminates
freely and the skin becomes normal. The appetite increases.
The sleep improves. The patient becomes hopeful, natural energy returns.
The sewers of the body are drained and flushed to a maximum.
II. VAGINAL DOUCHE.
(1) The kind of instrument to employ is a fountain
syringe of fourteenquart capacity. The simplest and most economic
vaginal syringe is a fourteen-quart wooden pail, the kind generally used
in transporting candy or tobacco.
(2) The location of the syringe should be
four feet above the patient.
(3) The quantity of fluid administered in
the beginning should be two quarts for patients unaccustomed to its use
and four quarts to those accustomed to its use. The quantity should
be increased a pint at each administration to fourteen quarts.
(4) The temperature of the douche should be
105o in the beginning and increased one degree at each administration until
it is as hot as it can be borne (115o to 120o).
(5) The duration of the douche should be ten
minutes for each gallon.
HISTOLOGY OF PELVIC BRAIN
A, drawn from the pelvic brain of a girl seventeen years of age.
The ganglion cells are completely developed. B, drawn from the pelvic
brain of a three months' normal gestation. The ganglion cells are
completely developed. Observe the enormous mass of connective tissue
present. C, child 11/2 years old. A nerve process courses
within the ganglion. Few and small ganglion cells incompletely developed.
D, girl 11/2 years old. A nerve process branches and reunites itself
with the intercellular substance. E, girl 6 years old. The
ganglion cells are presenting development. (Redrawn after Doctor Sabura
(6) The time to administer the douche is in
the evening immediately before retiring and in the morning (after which
the patient should lie horizontally for forty-five minutes).
(7) The position of the patient should be
lying on the back.
(8) As to method of administering the douche
the patient should lie on a sufficiently inclined plane to allow the returning
fluid to drain into a vessel (pail, pan). The ironing board, wash-tub
or board resting on the bath-tub serve convenient purposes. The douche
should not be administered in the bed (unless ordered), standing or sitting
postures or on the water-closet.
(9) As to ingredients a handful of sodium
chloride and a teapoonful of alum should be added to each gallon, the sodium
chloride to dissolve the mucus and pus, to act as an antiseptic and to
prevent reaction, while the alum is to astringe, check waste secretions
and harden tissue.
(10) The vaginal tube employed in administering
the douche should be sterilized, boiled, and every patient should possess
her own vaginal tube. The most useful vaginal tube is the largest
that can be conveniently introduced or the one that distends the vaginal
forces so that the hot fluids will bathe the greatest surface area of the
proximal or upper end of the vagina.
(11) The utility of a vaginal douche is: (a)
It contracts tissue (muscle, elastic and connective); (b) it contracts
vessels (lymphatics, veins and arteries); (c) it absorbs exudates; (d)
it checks secretion; (e) it stimulates; (f) it relieves pain; (g) it cleanses;
(h) it checks hemorrhage; (i) it curtails inflammation; (j) it drains the
tractus genitalis. The utility of the vaginal douche depends on the
quantity of fluid, the degree of temperature, its composition, the position
of the patient during administration, and on systematic methods of use.
(12) Disinfectants in a vaginal douche are
secondary in value to solvents of mucus, pus, leucocytes.
(13) The objects to accomplish by a douche
are: (a) The dissolving of the elements in the discharge, as mucus, pus
and leucocytes; (b) the mechanical removal of morbid secretions, accumulations
and foreign bodies; (c) antisepsis; (d) diagnosis (and it includes
(14) The requirements of a douche; (a) It
should be nonirritating; (b) it should be a clear solution; (c) it should
possess solvent powers of pus, and especially mucus; (d) it should be continued
for months; (e) omit the douche for four days during menstruation.
(15) A vaginal douche, administered according
to the above directions, will prove to be of therapeutic value in the treatment
of pelvic disease, a prophylactic agent and a comfort to the patient.
(16) The vaginal douche is contraindicated
in subjects with oviductal gestation or acute pyosalpinx, as it is liable
to induce rupture of the oviductal wall, abortion or leakage of pus through
the abdominal oviductal sphincter.
III. VAGINAL TAMPON.
(1) The composition of the vaginal tampon consists
of a roll of medicated cotton (hen-egg size), tied to a twelve-inch string,
placed in a solution of sixteen ounces of glycerine and two ounces of boracic
TRACTUS VASCULARIS AND TRACTUS NERVOSUS OF THE TRACTUS GENITALIS
Illustrates the tractus nervosus of the genital tract, pregnant 5 months.
The utero-ovarian vascular circle (circle of author) is ensheathed by
a rich nodular, fenestrated, anastomosing nerve plexus.
(2) The duration of preparation of vaginal tampon
should be to lie in the boroglyceride solution forty-eight hours before
(3) The utility of the vaginal tampon is:
(a) It is hygroscopic; (b) it serves as a mechanical support; (c) it contracts
tissue (muscle, elastic, connective); (d) it contracts vessels, (lymphatics,
veins and arteries); (e) it hastens absorption of exudates; (f) it checks
secretions; (g) it stimulates; (h) it curtails inflammation; (i) it drains
the pelvic organs; (j) it cleanses; (k) it dissolves mucus, pus and leucocytes.
The utility of a vaginal tampon depends on its composition, the quantity
employed, the duration of its application and on systematic method of use.
(4) The methods of introduction consist in
placing three to five vaginal tampons (with or, better, without a speculum)
in the vaginal fornices in the direction of least resistance.
PELVIC BRAIN (1, 2.)
Dissected from a subject about 37 years old.
(5) Disinfectants in a vaginal tampon are secondary
to its other qualities, especially that of hygroscopy.
(6) The object to accomplish by a vaginal
tampon is: Maximum hygroscopy, dissolving the elements in the discharge,
as mucus, pus, leucocytes, the mechanical removal of morbid secretions,
accumulation and foreign bodies, diagnosis, and mechanical support.
(7) The diagnosis is aided by the use of a
tampon by collecting and preserving the uterine discharge (as pus, blood,
(8) The requirements of a vaginal tampon are:
(a) It should be nonirritating; (b) it should possess hygroscopic power;
(c) it should be a solvent of discharges (mucus, pus, leucocytes, blood);
(d) it should aid in the dissolving of the mechanical removal of morbid
secretions, accumulations, and foreign bodies; (e) it should be aseptic
(not necessarily antiseptic); (f) it should not indelibly stain the clothing
(this is objection to its use as, for example, ichthyol); (g) it should
be reasonably economic.
(9) The frequency of application of the boroglyceride
vaginal tampons should be in general, twice weekly; more frequent employment
may cause irritation.
This illustration demonstrates how the ureters, bladder and vagina are
distorted and consequently how the accompanying sympathetic nerves are
(10) The time to apply the tampon is at night
during maximum anatomic and physiologic rest.
(11) The duration the tampon may remain usefully
in position is ten to twenty-four hours.
(12) There are no special contraindications
to the application of the vaginal tampon (in pelvic disease).
(13) The boroglyceride vaginal tampon may
be beneficially applied in: (a) inflammatory pelvic disease (vaginitis,
endometritis, myometritis, endosal pingitis, myosalpin-itis, pelvic peritonitis,
proctitis, cystitis); (b) sacropubic hernia (support for the uterus, cystocele
and rectocele); (c) in genital ptosis it depletes the lymphatics and veins.
(14) A vaginal tampon applied according to
the above directions will prove to be of therapeutic value in the treatment
of pelvic disease, a prophylactic agent and a comfort to the patient.
I . HABITAT
The value of fresh air was never realized so much
as at present. Fresh cold air cures pulmonary and other tuberculoses.
The success of the sanitarium is the continued use of fresh (cold) air.
The subject should sleep with fresh cold air passing through an open window
space of three by three feet. It appears to be demonstrated that
cold fresh air is more beneficial than warm fresh air. It is common
talk among people that one winter in the mountain is worth two summers
for the consumptive. The curative and beneficial effect of cold fresh
air continually, day and night, for the family must be preached in season
and out of season by physicians. The windows should be open all night.
Fresh cold air is one of the best therapeutic agents in pathologic physiology
of the tractus genitalis.
Exercise is an essential for health. Muscles exercise
a dominating control over circulation (blood and lymph). The abdominal
muscles influence the caliber of the splanchnic vessels. They exercise
an essential influence over the peristalsis, secretion, absorption of the tractus
intestinalis, urinarius, vascularis and genitalis. The muscles massage
the viscera, enhancing their function and the rate of circulation. In
the uterus, the most typical example, it is prominently marked how the myometrium
controls the blood currents like living ligatures. The habitat that furnishes
opportunity for abundant fresh air and ample exercise is the one that affords
the essential chances for recovery of pathologic physiology in the tractus genitalis.