SOME CONSEQUENCES OF IGNORANCE AND SILENCE.—PART III.
Prominent medical authorities claim that syphilis was not known in Europe before the discovery of America. Others equally as prominent hold that it has existed for many centuries in Europe, but was confused with other diseases such as leprosy. It makes little difference to the girl or boy today just how long or where it came from; the point we do know is that it is here in our homes and workshops, and we should know what it is like and how to avoid it.
A story is told of a French nobleman whose son was about to leave his home to live in a big city. Said the father to the son: “If you are not afraid of God, fear at least syphilis.” This advice might be applied today, for if boys or girls knew, or could see the appalling results of syphilis, they would surely fear it, for it is humanity's most deadly foe.
Syphilis is an infectious disease, caused by a special microbe which is acquired by contagion or heredity.
It is chronic in course, varied and intermittent in character, and the length of time it remains in the body is indefinite.
It is so widespread that no country in the world is free from it, neither is any organ of the body exempt from its ravages.
Let us take a young man indulging in promiscuous sexual intercourse, who cohabits with a syphilitic woman. He notices nothing wrong for about five weeks, when he becomes aware of a pimple on the sexual organs, to which perhaps he pays little attention. This grows and becomes hard at the base and is ulcerated on the top.
About ten days after the appearance of the ulcer (or chancre) the boy notices that the glands of the groins begin to swell, but as there is little or no pain attached he still pays no attention to all this.
After three, or sometimes four weeks the ulcerated opening heals, but leaves the hard lump under the skin. In two or even three months after the time of infection the first general symptoms appear. His bones ache, he is mentally depressed, slightly feverish at night, and a rash appears upon his body and sore spots in the mouth; and throat. These symptoms usually decide him to consult a doctor, who finds him in the second stage of syphilis. This condition lasts usually about two and one-half years, the rash often lasting a short period, and leaving, but to return again.
The blood within and the ulcers on the body contain the poisons of the disease, and for three or four years the poison can be transmitted by contagion, or by heredity.
The third stage is the most destructive, especially to the nervous system, for this disease is recognized as the greatest factor in organic disturbances of the nervous system.
It not rarely is the cause of cerebral and spinal meningitis, paralysis of the legs, paralysis of one side of the body, and that most helpless and terrible disease, softening of the brain and many other diseases which affect the spinal cord, which are seldom ever cured. The majority of those diseased are left with physical or mental infirmities, rendering them public charges.
There have been cases where the third stage did not develop, and as this stage is not distinctly separated from the second stage by a definite line, it may not take place for months, or even years after the first sore appeared. Again, this stage has been averted by careful treatment in the early stages, and it is here the hope of all afflicted lies.
Every case of syphilis begins with the characteristic pimple or chancre, except inherited syphilis. The chancre always appears where the infection enters, and the glands swell in the same vicinity. For instance, if in using a pipe of a syphilitic, whose mouth contains the sore patches, the victim finds the chancre will appear on his lips, mouth or throat, and the glands of the neck will swell.
It is said that almost 10 per cent. of the infections are contracted innocently, especially in European countries, where kissing and other forms of endearment are much indulged in. In this country it is not so common, but more women than men contract it innocently and in this manner.
In women, too, the first symptoms are not so characteristic as in men. She may pay no attention to the chancre for a month, even if she does feel aches in the bones, she thinks she is run down, or thinks she has malaria; even the rash does not alarm her, and often only repeated miscarriages will be the only symptoms she can remember of the early stages. She may continue for years before the disease reaches the third stage. This is not always so, for in every individual the disease differs in character and duration.
Gonorrhoea and syphilis differ in many ways. For instance, the former shows itself in a week or ten days after infection, where syphilis shows no signs for five or six weeks.
Gonorrhoea is considered a purely sexual disease, because infection takes place only in sexual relations (except where the germ gets into the eyes), while syphilis can be contracted in many other ways, through forks, spoons, glasses or cups, towels, sponges, bathtubs, toilets, pipes, dental and barbers' instruments, and kissing.
Gonorrhoea is considered a social danger because of its effect upon the sexual organs, often rendering them sterile. Syphilis is also a social danger, but it has direct effect upon the offspring, and upon future generations because its effects are visited upon the child.
Sixty to eighty per cent. of the syphilitic offspring die at birth or in early infancy. Someone has well said, “The greatest criminal is he who poisons the germ cells.”
In hereditary syphilis there is more difficulty in gathering facts, for the laws which control it are not so well understood, as yet.
There is no sore or chancre in hereditary syphilis, but other symptoms appear which every physician recognizes and of course attends to at birth.
Under proper treatment the danger of the father transmitting the disease to the child should cease in from two to five years, while the danger of the mother transmitting it to her offspring does not end at any definite time, for there have been mothers known to give birth to syphilitic offspring years after all disappearance of their own symptoms.
The strongest features of the disease transmitted to the offspring are the deformities which it imparts to the bones of the head as well as of the body.
It is said on good authority that if a patient, at the end of five years, has been two years without symptoms or treatment, he may be guaranteed for marriage. Though he can never be wholly guaranteed from relapses in his own person. These, however, are considered noninfectious.
The cure of the disease depends upon the individual's environment, constitution and his habits, chiefly as regards alcohol and tobacco.
Alcohol is considered the commonest and most active enemy of the patient's recovery. Men addicted to the use of alcohol are the most difficult to cure.
There seems to be no doubt that if the disease receives the proper treatment there is every hope for the individual to live a normal life. Fouriner, a French authority, says:
“Personally I could cite several hundred observations concerning syphilitic subjects who, after undergoing thorough treatment, have married and became fathers of healthy, good-looking children.” The question, then, to receive some attention is what means are available for the treatment of both syphilis and gonorrhoea.
Dr. Prince A. Morrow says: “Prompt curative treatment is not only in the interests of the patients themselves, but especially in the interests of the others they might infect. But everywhere we are confronted with this situation: There are no special hospitals for this class of diseases; few general hospitals receive them in the early, curable stage; still fewer have special venereal wards; even the dispensary services are not organized with special adaption to the needs of venereal cases; few have night classes, so that working people who go to the dispensary must lose half a day, which often means the sacrifice of their employment. As a consequence they resort to quacks or the use of nostrums (secret or quack medicines). They are not cured, but go on spreading the seeds of contagion.”
This is the condition as far as hospitals are concerned in the matter of venereal diseases. And in relation to private practice the average person's position is still more deplorable. Take, for example, the story of a girl who came under my care some years ago, after having suffered three years with the disease. She had been refused attendance in public hospitals in three different cities while she was working her way to New York. At different times she consulted physicians, only to learn that to be cured she must be treated regularly, and to be so treated would require money. Different estimates were quoted from $150 to $500 for treatment. As the amount of money left over after she had paid her expenses each week was never over $2, the possibility of a cure looked hopeless. She concluded to purchase patent medicines whenever she could, but her condition became worse, until she was picked up by a charitable organization, who cared for her until she died. When I saw her all her hair, eyebrows and eyelashes were gone, her nose and upper lip were almost entirely eaten away, most of her teeth were gone—in fact, to try to describe her condition would be almost impossible.
This is only one case, but there are thousands of syphilitics who are wandering around unable to pay the prices which the physician asks to treat this disease. The same can be said of gonorrhoea, and the same physician who clamors against the prices of the so-called quack, forgets that the price he asks of the public is exorbitant in the extreme. So the only course for the individual to take, if he cannot pay the price, is to remain a menace to society. The physician assumes no responsibility toward society to find out if the patient is under treatment elsewhere; the patient can do as he pleases with his disease when he closes the doctor's door. This, then is the situation as regards society's attitude toward the venereal subject: Society seems to take a different attitude towards other contagious and infectious diseases, such as measles, chicken pox, diphtheria, etc. In these diseases, a physician has some responsibility toward society; he must report each case as it comes to his attention, to the Board of Health, who in turn assume some responsibility by isolating the disease.
If this is necessary in these comparatively simple diseases, how much more important should it be to register and isolate patients suffering from the venereal diseases.
CHAPTER VII.
MENOPAUSE OR CHANGE OF LIFE
In the previous chapter on Puberty, it was stated that the menstrual function began in the average girl at fifteen years of age and continued until the forty-fifth or fiftieth year.
At this later age it ceases, together with her sexual or child-bearing capabilities and is known as the Menopause or Change of Life.
This constitutes a period from the beginning of irregularities in the appearance of the menstrual flow, until it has actually ceased, which period usually lasts two and one-half to three years.
Thousands of women know nothing of the period which, like puberty, they must pass through, but are entirely ignorant of the process.
It is usual for them to look toward this age with dread and foreboding; where a little knowledge of the nature of the process would enable them to enter upon this period physically prepared, which would insure their safe arrival through this dreaded and much-feared period.
The greatest change occurring in the woman at this time is that which goes on in the ovaries. They cease to do their work and ovulation stops.
The first indication that the woman has, that this is likely to occur, is by the ceasing of the menses or monthlies.
Ovulation, however, very often continues for several months, even a year after menstruation has entirely ceased.
The glandular tissues of the uterus, tubes and ovaries degenerate, which is said to account for the Menopause, and that of the ovaries occurs later than the tubes and uterus, which explains the continuance of ovulation after the menses have stopped.
In a few women the Menopause is accompanied by very little or almost no discomfort at all, just a sudden stopping of the monthlies announces to them that this period has come.
The majority, however, do not pass through this time so easily, but suffer for the entire period with one affliction or another.
Among those symptoms most common are flushings or flashes, which are mostly confined to head, face and neck, are increased by heat and motion and followed by profuse sweating, giddiness, backache, headache, sleeplessness, disturbances of digestion like diarrhoea or constipation, blueness, depression of spirits, shortness of breath, palpitation and nervous irritability.
But the most alarming symptom of the Menopause is hemorrhage. This is too often considered lightly and classed with the minor symptoms of this period.
Whenever there is excessive bleeding, there is surely a cause and calls for special and immediate attention. It may be caused by an inflamed condition of the lining of the uterus (womb), ulceration, general diseases of the heart, lungs and kidneys can also be the cause of excessive bleeding at this period. Some authorities claim that it also has its cause in early or profuse menstruation, too frequent and difficult labors, abortions and alcoholic drinking, but the most common cause of hemmorhage at this time is cancer. It is a fact that cancer in women, from the age of 40 to 50 is more common that at any other age.
Perhaps it is not generally known that cancer is now known to begin as a local disease, and if taken in time it can be removed so completely that a radical cure follows. No wonder then, that hemmorhage should be an alarming symptom, for if care is not taken and the dreaded disease, cancer, is allowed to take root, the results are too generally known to dwell upon. At the first signs of hemorrhages or excessive flow, a woman should place herself under the care of a gynecologist (specialist in the diseases of woman), just as a pregnant woman is under the care of a physician until she is entirely free from the dangers of childbirth.
Women have heretofore looked to this period with dread, on account of the consequences which neglect has caused. It need not be dreaded for assuring word comes from prominent physicians who have made this special period a study, that the natural symptoms of the Menopause do not portend loss of life, reason or health. It is a period as natural to the woman as menstruation and with little care, these symptoms or ailments will cease in a few years, leaving the woman to enjoy years of good health.
When the period is delayed beyond the fiftieth year, it calls for the same attention as excessive flow. These are two important signs of disease, and should receive immediate care. The period is, however, often brought about at an earlier age than is normal, by mental or physical shock, illness, operations, etc.
The age at which it occurs often differs with climate, race and according to Kisch, social relations, who claims, that the sexual function is “generally abolished earlier in the laboring classes, who are compelled to work hard and have many cares,” and further states that a vigorous vitality causes prolongation of the menstrual process.
In the average woman it does not cease at once, but has two or three periods of cessation, returns again for an irregular period and continues in this irregularity for the entire time of two and one-half to three years. It is important to know that the changes which are going on in the organs of the woman are exactly opposite from those which occur at puberty.
At puberty the organs are increasing with life, vigor, and vitality, while at the Menopause they are receding or going backward.
The generative organs gradually but surely shrink or atrophy after menstruation stops. The uterus becomes small. The vagina, whose walls were formerly corrugated or wrinkled, now become smooth. The orifice or opening of the vagina, becomes shrunken, unless it has been previously enlarged by child-bearing. The whole process tends to show that the child-bearing period is at an end, which in fact has caused much mental anxiety and disturbance among women to the extent of melancholy and insanity.
It seems a very small things to give to every woman, going through this disagreeable period of life—a complete change of climate and rest, until the change has become established. Certainly she has served society to the best of her knowledge, often “entering into the valley of the shadow of death”; many times fearlessly, to give the best of herself to the race. It is a small thing to give in return.
Tilt believes that unmarried women suffer less at this period than married women, and says: “As at puberty, from the ignorance in which it is still thought right to leave young women, so at the change of life, women often suffer from ignorance of what may occur, or from exaggerated notions of the perils which await them.”
All that is needed is to keep guard on one's self—watch the diet and bowels. A light vegetable diet seems best at this time unless very actively engaged in physical exercise, then meat once a day. Keep free from foods difficult to digest, cheese, fried foods, hot bread, etc., drink plenty of water and eat fruit to keep the bowels open; slight exercise in the open air, rest, sleep and freedom from mental anxiety are the simple rules which are generally prescribed for women at this time.
Tilt says: “The best way to avoid the danger of this critical time is to meet its approach with a healthy constitution.” And again says, “All complaints remain chronic because there is not stamina enough to carry them through their stages.”
It is the opinion of the foremost medical men that if women at the first sign of irregularities, consult a gynecologist, it would be the means of saving thousands of lives every year, and would prepare women to enter upon the post-climatic period in health and happiness.