DISEASES OF WOMEN, AND THE USE OF THE SPECULUM.
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The introduction of the stethoscope and the speculum constitute two important epochs in medical science—the former ascertaining, by the conveyance of sound, disease in the most hidden and inaccessible parts of the human frame, and the latter bringing to view structures which, without such aid, are necessarily veiled from our sight. The speculum consists of an instrument formed of silver or steel, that without pain or inconvenience is passed into the vagina, when, by a simple contrivance, it is made to expand and dilate the vaginal passage, and thereby expose to view the entire canal, together with the uterine aperture. The usefulness of such a method, whereby disease can at once be detected, admits of no dispute. It is physically painless; and if opposed to female diffidence and modesty, its importance and serviceableness should be balanced against the mental distress such a procedure may occasion. On the one hand, without its assistance, the treatment of the disease is at best but conjectural; on the other, by its aid, it is safe and sure—much suspense and suffering is at once put an end to. Experience has proved that many local disturbances, that were believed to have been merely vaginal irritation, have been discovered to depend upon absolute disorganization of the neck and mouth of the womb. Deep-seated ulceration has been detected, and cancerous enlargements; the disease thereby having been exposed, has had the necessary and successful treatment. In Paris, it is considered so valuable that a chair, termed a “speculum chair,” has been invented solely for its use. See engraving on previous page.
The speculum is now in the hands of every respectable medical man, and the class of disorders that hold it in requisition are being better understood, and consequently more successfully combated. In no cases is it more useful than in secretive irregularities, such as in leucorrhœa, gonorrhœa, or syphilitic ulceration. Without further comment, these diseases will be considered.
GONORRHŒA IN THE FEMALE.
This disease is rarely so violent as in man, it being mostly confined to the uterine conduit; in fact, except by the discharge, women are almost unconscious of its existence, mistaking it, when occurring in married life, for leucorrhœa. Occasionally, however, the inflammation is highly acute, and a variety of distressing symptoms ensue. There is considerable excoriation around, and a swelling of the organs, much ardor urinæ, and the same constitutional disturbance as in the other sex.
The medical treatment of both sexes is constitutionally alike; but the female has to depend more upon local treatment than the male. Hence the importance of injections. Now here is another source of difficulty: women are as averse to the use of the syringe as they are to the speculum; and the consequence is, vaginal diseases are generally protracted to double as long as they need be. However, as these hints are likely to be seen only by those who doubtlessly have, and who indisputably ought, to exercise it, namely, influence over the sex in persuading them to submit to what common sense bespeaks as most prudent and expedient, appropriate formulæ for the suggestions just recommended will be found a few pages hence. Frequent ablution, rest, temperate diet—the more farinaceous and mucilaginous the better, avoiding entirely wines, fermented and spirituous liquors, together with mild (Form [63]) aperients and salines, constitute the chief means of cure. Injections are indispensable.
I have already alluded to the difficulty of getting female patients to be their own confessors. If they appoint others, every possible information should be furnished, and fastidiousness by no means should supplant the avowal of real facts. Although gonorrhœa in women is generally less severe than in the male, it is vexingly oftentimes more lasting; which is easily accounted for, owing to the extent of surface diseased: whereas in man it is limited to the narrow urethra, and seldom exceeds an inch or two upward, constituting not one tithe part of the space morbidly affected in the former. See, however, the formulæ.