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 pudendæ, 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 visceral tract. 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 H.O. One of the best stimulants of renal epithelium is sodium chloride (one-half to one-quarter physiologic salt solution). 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.

half normal salt solution effectively stimulates the peristalsis and epithelium of the tractus intestinalis inducing secretions which liquify feces, preventing constipation.

(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 tract with consequent increase of peristalsis, absorption and secretion in both I used 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 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 fourteen-quart 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 105° in the beginning and increased one degree at each administration until it is as hot as it can be borne (115° to 120°).

(5) The duration of the douche should be ten minutes for each gallon.

(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 serves 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 teaspoonful 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 number 11).

(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 it 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 acid.

(2) The duration of preparation of vaginal tampon should be to lie in the boroglyceride solution forty-eight hours before using.

(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 (lymhatics, 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.

(5) The methods of introduction consists in placing three to five vaginal tampons (with, or better, without a speculum) in the vaginal fornices in the direction of least resistance.

(5a) Disinfectants in a vaginal tampon is 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, diagonis, and mechanical support.

(7) The diagnosis is aided by the use of a tampon by collecting and preserving the uterine discharge (as pus, blood, debris).

(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 (mucous, 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.

(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, endosalpingitis, myosalpingitis, 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.

IV.-HABITAT.

The value of fresh air was never realized so much as at present. Fresh cold air cures pulmonary and other tuberculosis. 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