Osteopathy Complete
Elmer D. Barber, D. O.
1898
  
GYNECOLOGY - DISEASES OF WOMEN
 
 
    That our readers may gain a more correct understanding of our method of treating diseases peculiar to women, it will be necessary to refer to the anatomy.
 
 
THE UTERUS

    The uterus is the organ of gestation, receiving the fecundated ovum in its cavity, retaining and supporting it during the development of the fetus, and becoming the principal agent in its expulsion at the time of parturition.  In the virgin state it is pear-shaped, flattened from before backward, and situated in the cavity of the pelvis between the bladder and rectum; it is retained in its position by the round and broad ligament on each side and projecting into the vagina below. Its upper end, or base, is directed upward and forward; its lower end, or apex, downward and backward in line of the axis of the inlet of the pelvis.  The uterus measures about three inches in length, two in breadth at its upper part, and nearly an inch in thickness, and weighs from an ounce to an ounce and one-half.
    The size, weight, and location of the uterus varies at different periods of life and under different circumstances.  In the fetus the uterus is contained in the abdominal cavity, projecting beyond the brim of the pelvis.
    The uterus consists of two parts: the body, with its upper broad extremity, the fundus; and the cervix, or neck, which is partly above the vagina ,and partly in the vagina.
    The division between the body and cervix is indicated externally by a slight constriction, and by the reflexion of the peritoneum from the anterior surface of the uterus on to the bladder, and internally by a narrowing of the canal, called the internal os.
    The body gradually narrows from the fundus to the neck.  Its anterior surface is flattened, more than the posterior, covered by peritoneum throughout, and separated from the bladder by the utero-vesical pouch.  Its posterior surface is convex transversely, covered by peritoneum throughout, and separated from the rectum by some convolutions of the intestine.  Its lateral margins are concave, and give attachment to the Fallopian tube above, the round ligament below and in front, and the ligament of the ovary behind both of these structures.
    The fundus is placed on a line below the level of the brim of the pelvis, being directed forward behind the upper portion of the anterior pelvic wall.
    The cervix is the lower constricted segment of the uterus; around its circumference is attached the upper end of the vagina, which extends upward a greater distance behind than in front.
    The supravaginal portion is not covered by peritoneum in front; a pad of cellular tissue is interposed between it and the bladder.  Behind, the peritoneum is extended over its upper part.  The vaginal portion is the rounded lower end projecting into the vagina.  On its surface is a small aperature, the os uteri, generally circular in shape, but sometimes oval.  The margin of the opening is, in the absence of past parturition or disease, quite smooth.
    Ligaments. - The ligaments of the uterus are eight in number: one anterior; one posterior; two lateral or broad; two sacral-uterine - all these being formed of peritoneum; - and, lastly, two round ligaments.
    Cavity. - The cavity of the uterus is small compared with the size of the organ; that portion of the cavity which corresponds to the body is triangular, flattened from before backward, so that its walls are closely approximated, and its base is directed upward toward the fundus.  At each superior angle is a funnel-shaped cavity, which constitutes the remains of the division of the body of the uterus into two cornua, and at the bottom of each cavity is the minute orifice of the Fallopian tube.  At the inferior angle of the uterine cavity is a small constricted opening, the internal orifice, which leads into the cavity of the cervix.
    Blood Vessels. - The arteries of the uterus are the uterine, from the internal iliac, and the ovarian, from the aorta.  They are remarkable for their tortuous course in the substance of the uterus, and for their frequent anastomoses.  The termination of the ovarian artery meets the termination of the uterine artery, and forms an anastomotic trunk, from which branches are given off to supply the uterus.
The veins are of large size, and correspond with the arteries.  In the impregnated uterus these vessels are termed the uterine sinuses, consisting of the lining membrane of the veins adhering to the walls of the canal channeled through the substance of the uterus.  They terminate in the uterine plexuses.
    Nerves. - The nerves are derived from the inferior hypogastric and ovarian plexuses, and from the third and fourth sacral nerves.
    At puberty the uterus is pyriform in shape, and weighs from eight to ten drachms.  It has descended into the pelvis, the fundus being just below the level of the brim of the pelvic cavity.  The arbor  vitae is distinct, and extends to the upper part of the cavity of the organ.
    During menstruation the uterus is enlarged, and more vesicular, its surfaces rounder; the os externum is rounded, its labia swollen, and the lining membrane of the body thickened, softer, and of a darker color.  At each recurrence of the menstruation a molecular disintegration of the mucous membrane takes place, which leads to its complete removal, only the bases of the glands imbedded in the muscle being left.  At the cessation of menstruation, by a proliferation of the remaining structures, a fresh mucous membrane is formed.
    The uterus being suspended by muscles and ligaments in the cavity of the pelvis, and being subject to so many and such radical changes, it is in no way surprising that ulceration, polypus, cancer, and prolapse of the uterus are so very prevalent.
 
 
DISPLACEMENTS OF THE UTERUS

    The true pathology or proximate condition of these affections is but little understood by the medical profession, as is apparent from the general ill success attending the ordinary treatment.  The term prolapsus is used indiscriminately for all degrees of simple descent or falling of the womb; but some books use the term relaxation, when the descent is only to the middle of the vagina, procidentia when the uterus descends to the labia, and prolapsus when it protrudes externally.  Retroversion is that form of displacement in which the fundus uteri descends toward the sacrum, the os uteri, or mouth of the womb, inclining towards the pubes.  Anteversion, is the reverse of the preceding, the fundus falling forward and the os uteri inclining backward.  In inversion the organ is turned inside out while in a state of prolapse.  In anteversion the body of the uterus is bent forward on the cervix.  Retroflexion denotes the permanent backward dislocation of the fundus uteri, with simultaneous flexion of the uterus over the posterior surface. In some cases the upper part of the vagina protrudes into the lower, constituting what is called prolapse of the vagina.
 
 
SYMPTOMS

    Prolapse of the uterus is attended with a heavy, disagreeable, or painful dragging-down sensation at the lower part of the abdomen, aching, or weakness about the small of the back, and, when severe, great difficulty or inability in walking.  At first there is increased mucous secretion, which increases by degrees until it acquires the character of an obstinate leucorrhea.
    Retroversion of the uterus is attended with irregular or constipated bowels, and from the pressure of the displaced organ in the rectum behind and urethra in front there is more or less difficulty experienced in expelling the contents of the bowels and bladder.  In this situation the womb often becomes congested, inflammatory, and enlarged, and every attempt at walking is exceedingly painful and exhausting.  In bad cases the patient can only endure a fixed, motionless position in her chair or bed.  There is, too, usually considerable tenderness and tension of the whole abdomen.
    Anteversion is a less frequent occurrence; it is denoted by difficulty in walking, sense of weight or fullness in the pelvis, with many of the symptoms of prolapse, and is attended with much less difficulty in evacuating urine and feces than retroversion.
    Inversion is known  by the organ hanging down externally; it is usually the result of violence in extracting the placenta, but may occur from an adhesion of the placenta or from polypous tumors. In some instances the falling of the uterus or vagina drags the bladder with it, constituting what is called complicated prolapse.  In this case the bladder, being deprived of the expulsory aid of the abdominal muscles is incapable of evacuating its contents without artificial assistance.
    Anteflexion must be accompanied by rigidity at the point of flexion; there are disturbances of bladder functions, and symptoms peculiar to inflammation.  The os is frequently small and the cervix long.  The uterus may also, at the same time, be retroverted.
    Retroflexion never exists without some degree of retroversion.  There is pain in the back constantly; reflex neuroses, excessive, long, and painful menstruation; and conditions due to the extent of retroversion.  The neck is usually near the vulva.
    Genital excrescence consists in polypus or other tumors issuing from the surface of the uterus or vagina; they are of all sizes and various degrees of consistency, from the softness of the sponge to the firmness of leather.
 
 
SPECIAL CAUSES

    Although medical authors and professors of midwifery are continually talking about "relaxation of ligaments" which hold the uterus in position, as the main cause of its displacement, it is quite clear that this relaxation has nothing whatever to do with it; the yielding or elongation of the ligament itself being an effect of the displacement.  The natural supports of the uterus are the vagina and abdominal muscles; if the former is greatly relaxed, the uterus will descend, and the ligaments, being kept constantly on the stretch, will finally elongate more or less; and if the abdominal muscles are greatly debilitated, they do not contract vigorously, so as to keep up equable and uniform compression in all the various positions of the body, and hence the uterus is liable to fall forward or backward, or to incline laterally; and when both are badly relaxed and debilitated, we find both conditions of displacement - falling down and tipping transversely across the pelvis.
    In corroboration of this view of the subject, we may advert to the fact that all the cases of uterine displacement met with in our practice, with the single and rare exception of such as are produced by violence, occur in females who suffer from the very circumstances which are most efficient in inducing muscular relaxation of these parts, as constipation, piles, dyspepsia, nervous debility, mis-menstruation, abortions or miscarriages, preternatural labors, etc.
    It is a well-known fact that all cases of female troubles are accompanied by a weak, lame back, and it is to this point we trace the real cause of almost cases of falling of the womb and other troubles peculiar to women.  Either by an accident or overwork, the muscles of the back, from the first lumbar vertebra to the last sacral, have become strained, causing contraction and a consequent pressure on the nerves which control the organs of generation, thus breaking the nervous current from the brain to these parts, interfering with the circulation and permitting the muscles and the vagina, which hold the organs of generation in place, to relax.  The fact that our treatment usually gives immediate relief, and in most cases a continuation of the treatment effects a permanent cure, is ample proof that in female troubles the principles of Osteopathy are far superior to any other known method.
 
 
TREATMENT FOR DISPLACEMENTS OF THE UTERUS

    1.  Place the patient on the side; beginning at the first lumbar vertebra, with the fingers close to the spine, move the muscles upward and outward, very gently but deep, as low as the last sacral vertebra.  In the sacral region move the muscles very deeply for about two inches on each side, as it is here we find formina which transmit nerves directly to the organ in question.  Treat the opposite side in a similar manner.
    2.  Place the patient on the back; flex the limbs slowly but strongly against the abdomen and hold in this position for a few seconds, moving them gently from side to side.
    The above treatment stimulates the nerves and frees the blood-supply to the weakened muscles and the vagina; relaxation and lack of tone being the true cause of this disease.
    3.  In all cases of constipation the bowels should be flushed and the Constipation Treatment given.
    4.  Insert the finger into the vagina and move the uterus carefully back to its normal position.  It is seldom necessary to use an instrument to perform this operation.
    Treatment should be given every other day, except local treatment, which should be given no oftener than every third or fourth day.  In the majority of cases a decided relief will be the result of the first treatment.
    In a great many instances a slight dislocation will be discovered in the lumbar region - the result of accident or a strain.  In such instances a speedy cure may be effected by reducing the dislocation, in addition to the above treatment.
    See Dislocation of the Lumbar Vertebrae (below).
 
 
DISLOCATION OF THE LUMBAR VERTEBRAE TREATMENT

    Place the patient on the face, the limbs lying perfectly straight, the arms hanging over the sides of the table; in this position the spinous processes of the lumbar vertebrae should be exactly in line and an equal distance should intervene between them; place one finger upon each side of the last dorsal vertebra, move the fingers carefully down the spine, and a slight lateral slip will easily be detected.
    In case the spinous processes are thrown up or down, it is easily discovered by passing the finger slowly downward over the spines.
    In case of a lateral displacement to the right, after manipulating the muscles gently but deeply in the immediate region, place the thumbs upon the spinous process of the vertebra at fault, while an assistant, grasping the limbs, carries them slowly but quite strongly to the left, bringing them with strong extension slowly back to their former position, the operator pressing quite hard upon the spinous process of the vertebra at fault the instant the limbs, under strong extension, are brought back to the median line.  Care must be exercised not to use sufficient strength to cause the patient much pain, the object being to gain a little each treatment until the cure is effected, which usually requires from two to eight weeks’ treatment, given every other day.
    In case of a posterior dislocation the patient should be placed upon the side, the thumbs of the operator upon the spinous process at fault, while the limbs are flexed by an assistant strongly against the abdomen, a strong pressure being exerted by the operator upon the vertebra at fault as the limbs are extended slowly but with strong extension.
 


 
ANTEVERSION
(A forward inclination of the entire uterus.)

CAUSE
    May be due to tight clothing, violent effort, pregnancy, congestion, or dislocation of lumbar vertebra.

SYMPTOMS
    Frequent micturition due to pressure of the uterus on the bladder; may be menorrhagia; other symptoms similar to Metritis, Cellulitis, and Peritonitis; the cervix is far back into the hollow of the sacrum; the fundus approximates the symphisis pubis.

TREATMENT
    See Displacements of the Uterus.
 


 
ANTEFLEXION
(A bending forward of the uterus, forming an angle at its body.  It may be congenital or acquired.)

CAUSE
    May be due to tight clothing, muscular efforts, tumor, pregnancy, or a partial dislocation of a lumbar vertebra.

SYMPTOMS
    Frequent micturition; dysmenorrhea; leucorrhea; sterility; the cervix lies rather high, the os directly downward and forward.

TREATMENT
    See Displacements of the Uterus.
 


 
RETROVERSION
(A backward inclination of the entire uterus.)

CAUSE
    May be due to tight and heavy clothing, muscular efforts, distended bladder, pregnancy, or partially dislocated vertebra in the lumbar region.

SYMPTOMS
    Gnawing pain in the back; constipation; menorrhagia; leucorrhea; cervix lies near the symphisis pubis, the fundus in the hollow of the sacrum.

TREATMENT
    See Displacements of the Uterus.
 


 
RETROFLEXION
(A bending backward of the uterus, forming an angle at its body.  The most frequent of uterine displacements.)

SYMPTOMS
    Dysmenorrhea; sterility; abortion; cervix lies in its place; the fundus appears as a round tumor in the posterior fornix of the vagina.

TREATMENT
    See Displacements of the Uterus.
 


 
LATEROFLEXION
(A bending of the uterus to the right or left side.  Can be detected by conjoined manipulation.)

CAUSE
    May be due to inflammatory disease, direct pressure, increased weight, or partial dislocations in the lumbar region.

SYMPTOMS
    May simulate fibrous tumors.

TREATMENT
    See Displacements of the Uterus.
 


 
COMPOUND FLEXIONS
(Varieties are: Retro-Anteflexion, Retro-Lateroflexion, Ante-Retroflexion, Ante-Lateroflexion.)

TREATMENT
    See Displacements of the Uterus.
 


 
INVERSION
(Uterus turned inside out.)

CAUSE
    Due to relaxation and inertia of the uterine walls and downward traction or pressure.

SYMPTOMS
    Dragging pain in the pelvis; anemia; hemorrhage; leucorrhea; general malaise; cupping may be felt on abdomen by the hand.
    May be benefited, but is not treated successfully, by Osteopathy.
 


 
PROLAPSUS UTERI
(Falling down of the uterus.)

CAUSE
    Due to distension and eversion of the vagina, and impairment of the sphincter vaginae muscle; also relaxation of the uterine ligaments.  Generally produced by parturition, followed by a lack of tone in the supports.

SYMPTOMS
    Dragging sensation  in the lower abdomen and back; protrusion and excoriation of the parts; gradual descent of the vaginal walls, cervix, and body of the uterus; micturition difficult.
    This disease may be benefited by Treatment for Displacements of the Uterus, but is not treated very successfully by Osteopathy.
 


 
AMENORRHEA
(Absence of menstruation between puberty and the menopause.  May be divided into: Emansio Mensium, where menstruation has never appeared; Suppressio Mensium, where menstruation is suppressed.)

SYMPTOMS
    When caused by phthisis, there is emaciation, cough, and night sweats; when caused by anemia, there is dyspnea and palpitation on exertion; depraved appetite; headache; constipation; hysteria; pallor, and edema.

TREATMENT
    In suppressed menstruation osteopathic treatment, freeing and equalizing the circulation and nerve-wave to the genital organs, is remarkably successful, usually giving immediate relief, and a continuation of the treatment a permanent cure, except in cases where the suppression of the menses is the direct result of tuberculosis.
    1.  Place the patient on the face; beginning at the eighth dorsal vertebra, with the thumbs upon each side of and close to the spinal process, move the muscles upward and outward, gently but very deep, the entire length of the spine.
    2.  Beginning at the first lumbar vertebra, with both hands upon the same side of the spine, the fingers close to the spine, move the muscles slightly upward and strongly outward, with quite a strong pressure, permitting the hands to slip over the flesh as they are drawn outward.  Treat in this manner to the lower part of the sacrum, being very thorough in the lower lumbar and sacral region.
    3.  Place the patient on the back; flex the limbs slowly but strongly against the abdomen, hold in this position a few seconds, and then move them gently from side to side without relaxing the pressure.
    4.  One operator grasping the shoulders, an assistant the feet, give gentle extension of the spine.
    5.  Place the hand lightly over the uterus, and vibrate gently one minute.
    6.  It is very often advisable in cases of Amenorrhea, or suppressed menstruation, to give such portion of our General Treatment as conditions indicate.  It is also always advisable to make careful examination of the spine, endeavoring to detect, if possible any irregularity in the spinous processes in the vertebrae of the lumbar region.  Slight dislocation here, caused by strain or accident, is often the cause of serious troubles See Dislocation of the Lumbar Vertebrae.
 


 
OLIGOMENORRHEA
(Insufficient menstrual flow.)

TREATMENT
    See Amenorrhea.
 


 
MENORRHAGIA
(Excessive and long menstrual flow.)

TREATMENT
    1.  Place the patient upon the table; beginning at the sixth dorsal, with the hands both upon the same side of the spine, move the muscles slightly upward but strongly outward, pressing quite hard as the hands are permitted to slip over the muscles.  Treat in this manner to the lower sacral.  All motions should be very slow and gentle, but as hard a pressure used, as the hands are slipped outward front the spine, as the patient can stand.
    2.  With one thumb upon each side of the first lumbar vertebra, between it and the second, press gently but very strong a few seconds.  Treat each successive vertebra in a similar manner until the lower vertebra is reached, where a little stronger and longer pressure should be given.
    3.  Place the patient on the side; with one hand against the sacrum, the other grasping the crest of the ilium, draw the ilium strongly toward the operator, at the same instant pressing hard upon the sacrum.
    Treatment should be given every other day, in a very careful manner.  One month's treatment correctly given is usually sufficient to effect a cure.
 


 
METRORRHAGIA
(Uterine hemorrhage, independent of the menses.)

CAUSE
    May be caused by obstruction of the general circulation; diseases of the heart, lungs, or liver; low condition of the blood and vessels in a wasting disease; fungous degeneration of the uterine mucous membrane; inversion of the uterus; polypus; carcinoma: ulceration congestion; areolar hyperplasia; hematocele; or retained products of conception.

TREATMENT
    In the treatment of this disease so much depends upon the real cause or combination of causes that the results obtained will depend in a large measure upon the good judgment of the operator, who, after a careful study of his work, should select such treatment as the conditions would indicate.
 


 
DYSMENORRHEA
(Painful menstruation.)

TREATMENT
    See Amenorrhea.
 


 
NEURALGIC DYSMENORRHEA
(Usually associated with other forms, and generally with indoor life; anemia; malnutrition, or hysteria.)

SYMPTOMS
    Pain in the uterus at times; at others it is referred to the ovaries; shooting in character; usually begins just before the flow, and may be relieved by free flow.

TREATMENT
    See Amenorrhea.
 


 
OBSTRUCTIVE DYSMENORRHEA

CAUSE
    May result from flexion or version of the uterus, contraction of the cervical canal, vaginal stricture, polypus in the uterus, or obturator hymen.

SYMPTOMS
    Cramp-like pain, with expulsion of blood-clots, which may relieve the pain until further obstruction.

TREATMENT
    See Displacement of the Uterus.
 


 
CONGESTIVE DYSMENORRHEA

CAUSE
    May result from exposure to cold, defective portal circulation ,plethora, metritis, pelvic peritonitis, ovaritis, areolar hyperplasia, fibrous tumor, displacement of the uterus, or mental disturbances.

SYMPTOMS
    Feeling of weight and heat in the back and pelvis just before the flow; elevation of temperature; rapid pulse; flushed face; headache.  Usually relieved by free flow.

TREATMENT
    1.  See Amenorrhea.
    2.  Displacements of the Uterus.
    3.  In the treatment of this disease a great deal depends upon the judgment of the operator in selecting such treatment as conditions indicate, always endeavoring to remove the cause and to free and equalize the circulation and nerve-wave.

MEMBRANOUS DYSMENORRHEA
(Usually associated with chronic endometritis and poor general health.)

SYMPTOMS
    Colicky pains at the menstrual period, with expulsion of organized membranes, either as a whole or in pieces.

TREATMENT
    See Amenorrhea.
 


 
OVARIAN DYSMENORRHEA
(Associated with disease of the ovaries.)

SYMPTOMS
    Pain and tenderness over the ovary between periods, increased by exercise, coitus, and defecation; symptoms are intensified at the menstrual period.

TREATMENT
    1.  See Amenorrhea.
    2.  Place the patient on the back; manipulate the ovaries gently, carefully, and in a very thorough manner.
    3.  Place the hand lightly over the ovary, and vibrate gently one minute.
    4.  Place the patient on the side; with one hand of the operator against the sacrum, the other grasping the patient's knee, draw the limb lowly but quite strongly backward, pressing at the same moment upon the sacrum.  This manipulation stretches the muscles in the immediate region of the ovary.  Treat the opposite ovary in a similar manner.
    Treatment should be given every other day; an immediate change for the better is usually the result of the first few treatments.
 


 
LEUCORRHEA, OR THE  WHITES (UTERINE CATARRH)
(Discharges from the vagina of a whitish or yellowish mucus.)

CAUSE
    May be caused by disordered menstruation, rectal or vesical irritation, endometritis, inversion of the uterus, granular degeneration, fibroids or polypi, and other genital or inflammatory processes.

TREATMENT
    This disease may be the result of so many different causes that a great deal will depend upon the good judgment of the operator in properly locating the cause,  giving suitable treatment.
    This disease usually, however, responds quite readily to the following treatment.
    1.  See Amenorrhea.
    2.  Place the patient on the face; the thumbs of the operator upon each side of and close to the spinous process of the second lumbar vertebra, an assistant raises the limbs slowly, but quite strongly, as high as patient can stand, the operator pressing quite hard, at the same instant, with the thumbs; move the thumbs down to the next vertebra, flex the limbs as before; and repeat until the sacrum is reached.  Place the hand upon the sacrum, pressing very hard as the limbs are raised strongly.  Great care must be exercised not to use sufficient strength to injure the patient.
    Treatment should be given every other day, and will occupy fifteen or twenty minutes.
 


 
UTERINE MALFORMATION
(The principal varieties are: Rudimentary, Bipartitus, Unicornis, Bicornis, Didelphys, Septus, Infantile, Congenital Atrophy, Complete Absence.)

    Not treated successfully by Osteopathy.
 


 
ACUTE METRITIS
(Inflammation of the parenchyma of the uterus, usually associated with endometritis or peritonitis.)

SYMPTOMS
    Similar to those of endometritis, but more severe; elevation of temperature; rapid pulse; pain in pelvis and hypogastrium; uterus enlarged and tender on pressure; nausea; hemorrhage often.

TREATMENT
    1. Place the patient on the face; with the thumbs on each side of the spine, beginning at the upper cervicals, move the muscles upward and outward gently but deep the entire length of the spinal column.
    2.  Place the hands upon the same side of the spine; beginning at the last dorsal vertebra, move the muscles slightly upward, drawing them slowly outward with a strong pressure, permitting the muscles to slip under the hand.  Treat in this manner through the lumbar and sacral regions.  Treat the opposite side in a similar manner.
    3.  Place the patient on the back; the operator grasping the shoulders, as an assistant holds the feet, give gentle extension of the spine.
    4.  Place the hand lightly over the pubes, and vibrate one minute.
    5.  Place the hands upon the sides of the neck, the fingers almost meeting over the upper cervicals; tip the head backward and press quite strongly with the fingers upon the vaso-motor four or five minutes.
    Treatment will require fifteen or twenty minutes, and should be administered each day until recovery.
 


 
CHRONIC METRITIS, AREOLAR HYPERPLASIA, OR DIFFUSE INTERSTITIAL HYPERTROPHY
(Disorder of nutrition affecting the uterus and characterized by inflammation,
hypergenesis, and hyperesthesia.)

SYMPTOMS
    Feeling of weight in the pelvis; pain, radiating to the back and limbs; irritability of the rectum and bladder; the uterus is enlarged, soft, and tender, becoming hard later; menorrhagia; abortion; sterility; reflex neuroses.

TREATMENT
    This disease, in its early stages, responds readily to osteopathic treatment.  In its later stages, however, it is not treated with marked success.
    1.  See Acute Metritis.
    2.  General Treatment.
 


 
ACUTE ENDOMETRITIS
(Inflammation of the lining membrane of the uterus.)

CAUSE
    May be due to cold from exposure during menstruation; vaginitis; excessive venery; or suppressed menstruation.

SYMPTOMS
    Discharge at first watery, later creamy; slight elevation of temperature; dull pain in the back and pelvis; cervix enlarged, soft, and sensitive.

TREATMENT
    See Acute Metritis.
 


 
CHRONIC CORPOREAL ENDOMETRITIS
(May follow acute attacks or begin as chronic.)

CAUSE
    May be due to retention of secundine products after parturition.

SYMPTOMS
    Pain in the back and pelvic region; dysmenorrhea; menorrhagia; leucorrhea; abortion; and sterility; cervix usually tender and slightly enlarged.

TREATMENT
    See Acute Metritis, applying such additional treatment as conditions indicate.
 


 
ENDOCERVICITIS
(Chronic inflammation of the lining of the cervix.)

CAUSE
    May be due to extension upward of vaginitis, or downward of corporeal endometritis; uterine flexions; enfeebled constitution, etc.

SYMPTOMS
    Pain in the back and loins; leucorrhea; menorrhagia; sterility; reflex neuroses.

TREATMENT
    1.  General Treatment, which should be given in a very careful manner.
    2.  Give such additional treatment as the conditions indicate.
 


 
CERVICAL HYPERTROPHY
(Enlargement of cervix.)

SYMPTOMS
    Sense of weight in the pelvis; leucorrhea; os near the vulva, or may protrude.

TREATMENT
    In its early stages this disease responds very readily and is easily cured by osteopathic treatment.   After the hypertrophy has become pronounced, it cannot be benefited by Osteopathy.
    1.  See Amenorrhea.
    2.  Give conjoined manipulations.
 


 
CERVICAL STENOSIS
(Constriction of the cervix.  May be congenital or acquired.)

SYMPTOMS
    Dysmenorrhea and sterility.

TREATMENT
    See Amenorrhea.
 


 
CERVICAL LACERATION
(Tearing of the cervix, due to parturition or abortion.)

SYMPTOMS
    Feeling of weight in the pelvis; neuralgia; menorrhagia; leucorrhea; sterility; reflex neuroses.
    Not treated successfully by Osteopathy.
 


 
UTERINE ATROPHY
(Wasting of the uterus; natural condition after menopause.)

CAUSE
    May be caused by removal of ovaries or tubes.

SYMPTOMS
    Amenorrhea; sterility; reflex neuroses.

TREATMENT
    May be benefited by General Treatment, but not successfully treated by Osteopathy.
 


 
UTERINE FIBROID TUMOR
(Tumor composed of fibro-muscular tissue, situated usually in the body of the uterus.)

SYMPTOMS
    Dysmenorrhea; menorrhagia, followed by metrorrhagia; pain, due to pressure on pelvic nerves, causing neuralgia and numbness; constipation; leucorrhea.

TREATMENT
    1.  Place the patient on the side; move the muscles upward and outward gently but very deeply the entire length of the spinal column.  Treat the opposite side in a similar manner.
    2.  Place the patient on the back; flex the limbs, strongly against the chest, one at a time, giving strong abduction of the knee and adduction of the foot as the limb is extended.
    3.  Place the patient on the face; the operator placing the thumbs upon each side of the spine, and close to the second lumbar vertebra, an assistant raises the limbs slowly but quite strongly as far as the patient can stand; move the thumbs down to the next vertebra and raise the limbs as before; and repeat until the sacrum is reached.
    In all cases where constipation is manifest, see Constipation.
    4.  Manipulate the tumor as thoroughly as possible.
    5.  Place the hand lightly over the tumor, and give thorough vibration two minutes.
    Treatment should be given every other day, and will require about twenty minutes.
 


 
UTERINE POLYPUS
(Tumor covered by the mucous membrane of the uterus, and attached to that organ by a stem.  May be Fibrous, Mucous, Placental, Glandular, or Cellular.)

SYMPTOMS
    Hemorrhages from the mucous membrane; pain; leucorrhea; sterility; anemia; malaise.

TREATMENT
    See Uterine Fibroid Tumor.
 


 
UTERINE CARCINOMA
(Cancer of the uterus, usually in the cervix.)

SYMPTOMS
    Pain; hemorrhage; offensive discharge; impaired nutrition.
    No cure in Osteopathy.
 


 
UTERINE SARCOMA
(A growth of modified embryonic connective tissue, usually in the body of the uterus.)

SYMPTOMS
    Pain; hemorrhage; watery discharge; impaired nutrition.  Most frequent between the ages of forty and fifty.

TREATMENT
    See Uterine Fibroid Tumor.
 


 
SALPINGITIS
(Inflammation of the mucous membrane of the Fallopian tube, usually arising from extension of endometritis.)

SYMPTOMS
    Dragging and burning pain in the region of the tube, especially when walking or standing; dysmenorrhea: peritonitis; tenderness in the lateral vaginal fornix on pressure.

TREATMENT
    1.  Place the patient on the face; with the hands both on the same side of and close to the first lumbar vertebra, pressing rather hard, move the muscles slightly upward and strongly outward from the spine, permitting the muscles to slip beneath the hand.  Treat in this manner through the lumbar and sacral region.  Treat the opposite side in a similar manner.
    2.  Place the left hand upon the center of the sacrum; passing the right arm under the limbs, raise the limbs slowly but as high as the patient can stand, pressing at the same instant upon the sacrum.
    3.  Place the patient on the back; the hand of the over the Fallopian tube, give gentle vibration one minute.  Treat the opposite tube in a similar manner.
    This treatment should be given each day, and will occupy about ten minutes.
 


 
OVARITIS
(Inflammation of the ovary.  May be acute or chronic.)

CAUSE
    Generally due to salpingitis, sepsis during parturition, or cold during menstruation.

SYMPTOMS
    Acute form usually accompanies salpingitis or peritonitis.  Sharp pain in the ovarian region, radiating to the back; may be pain in micturition and defecation; reflex neuroses. In chronic form symptoms are less marked.

TREATMENT
    See Salpingitis.
 


 
OVARIAN HEMORRHAGE

CAUSE
    Due to obstructed circulation, tumor, cold during menstruation, diseases of the heart, lungs, etc.

SYMPTOMS
    Ovary enlarged and sensitive to pressure; throbbing pain over the ovary; menorrhagia.

TREATMENT
    See Salpingitis.
 


 
OVARIAN PROLAPSUS
(Falling down of the ovary.)

CAUSE
    May be due to congestion of the organ or displacement of the uterus.

SYMPTOMS
    Similar to Ovaritis.  Ovarian compression; painful defecation, and dyspareunia.

TREATMENT
    1.  In case of Displacement of the Uterus.
    2.  Careful but thorough manipulation of the ovaries, with a view to relaxing the muscles in the immediate region and freeing the circulation to the ovaries.
    3. Place the hand lightly over the ovary, and vibrate one minute.
    4.  Place the patient on the side; one hand of the operator against the sacrum, with the other grasp the knee of the patient, drawing the limbs slowly but quite strongly backward; hold in this position a few seconds.  Treat the opposite side in a similar manner.
    Treatment should be given every other day, and will occupy fifteen or twenty minutes.
 


 
OVARIAN TUMOR
(May be Fibromata, Sarcomata, Carcinomata, or Cysts.)

SYMPTOMS
    Dull pain over iliac fossa, with sense of fullness or throbbing; dragging pains; dysuria; rectal disorders; fatigue after exertion; localized peritonitis; no leucorrhea or menorrhagia; uterus not enlarged.

TREATMENT
    See Ovarian Prolapsus.
 


 
PAROVARIAN CYST
(Cyst in the broad ligaments of the uterus, developed from the parovarium.)

SYMPTOMS
    Difficult to distinguish from ovarian cyst, except by tapping.

TREATMENT
    1.  See Ovarian Prolapsus.
    2.  Manipulate, as thoroughly as possible, the cyst; also vibrate over it one minute.
 


 
SIMPLE CATARRHAL VAGINITIS
(Inflammation of the mucous membrane of the vagina.)

CAUSE
    Due generally to poor health, irritating discharges from the cervix, retention of secretions, etc.

SYMPTOMS
    In acute form, sense of heat and burning in the vagina; pelvic pain; frequent desire to micturate; excoriation of the parts above the vulva; in chronic form, itching and leucorrhea.

TREATMENT
    1.  Place the patient on the side; beginning at the upper cervicals, move the muscles upward and outward slowly, gently, but very deep, the entire length of the spinal column, being very careful, but thorough, in all regions where any tenderness or abnormal temperature is manifest.
    2.  Place one hand under the chin, the other under the occipital bone, and pull slowly but strongly until the body moves.
    3.  Give gentle extension of the neck, rotating the head from side to side.
    4.  Flex the limbs, one at a time, slowly but strongly against the abdomen, giving strong abduction of the knee and extending with a light jerk.
    5.  Pass the finger carefully into the vagina, manipulating the mucous membrane and muscles gently, but as thoroughly as possible.
    6.  Place the patient on the face; the operator placing one hand upon the center of the sacrum, and passing the other beneath the limbs of the patient, raise the limbs slowly but strongly, pressing, at the same instant quite hard upon the sacrum.  Care must be exercised not to use sufficient strength to injure the patient.
    Treatment will occupy about twenty minutes; an immediate change should be noticed for the better, and a continuation of the treatment, given every other day, will usually effect a cure.
 


 
GRANULAR VAGINITIS
(Inflammation and hypertrophy of the mucous follicles imbedded between the rugae of the vagina)

CAUSE
    Result of pregnancy, or simple or specific vaginitis.

SYMPTOMS
    Similar to Simple and Specific Vaginitis, with pruritus vulvae, lichenous eruptions about the pubes.

TREATMENT
    See Simple Catarrhal Vaginitis.
 


 
SPECIFIC VAGINITIS
(Inflammation of the vagina, vulva, and urethra, arising from specific contagion.)

SYMPTOMS
    Similar to simple vaginitis; heat and burning in the vagina; heat and sense of weight in the perineum; scalding in micturition, which is frequent; profuse leucorrhea, purulent and offensive in character.

TREATMENT
    See Simple Catarrhal Vacinitis.
 


 
ULCERATIVE VAGINITIS
(Present, to some extent, in most women over sixty years of age.)

SYMPTOMS
    Scaling of squamous epithelium in spots, and if spots are raw and in apposition, there may be adhesion; usually slight leucorrhea, which irritates the vulva, causing pruritus.

TREATMENT
    See Simple Catarrhal Vaginitis.
 


 
DIPHTHERITIC VAGINITIS
(Dependent upon constitutional diphtheria.)

SYMPTOMS
    Similar to constitutional diphtheria, with membrane resembling that usually found in the throat.  May appear first in the vagina.

TREATMENT
    See Simple Catarrbal Vaginitis.
 


 
ACUTE CATARRHAL VULVITIS
(Inflammation of the mucous membrane lining the vulva.)

CAUSE
    May be due to uncleanliness, discharges from the cervix or vagina, injury or friction from exercise, parasites, foreign bodies, excessive venery, or eruptive disorders.

SYMPTOMS
    Local pain and burning; parts congested; edematous, and covered with a glairy mucus; excoriating discharges; and general malaise.

TREATMENT
    See Simple Catarrhal Vaginitis.
 


 
CHRONIC CATARRHAL VULVITIS
(Found most frequently in scrofulous children.)

SYMPTOMS
    Intense itching of the parts; discomfort in micturition and walking; stained linen.

TREATMENT
    See Simple Catarrhal Vaginitis.
 


 
PHLEGMONOUS VULVITIS
(Suppurative inflammation of the vulva.)

CAUSE
    May be due to irritating discharges, boil or abscess, traumatism, or eruption of the skin.

SYMPTOMS
    Pain and heat, increased by standing or walking; congestion; induration; swelling; and suppuration.

TREATMENT
    See Simple Catarrhal Vaginitis.
 


 
DIPHTHERITIC VULVITIS
(Dependent upon constitutional diphtheria.)

SYMPTOMS
    Membrane resembles that usually found in the throat.  May first appear in the vulva.  Symptoms same as Constitutional Diphtheria.

TREATMENT
    See Simple Catarrhal Vaginitis.
 


 
FOLLICULAR VULVITIS
(Inflammation of the mucous and sebaceous glands and hair follicles of the vulva.)

CAUSE
    May be caused by uncleanliness, vaginitis, pregnancy, or eruptions of the skin.

SYMPTOMS
    Burning and itching in the vulva, with increased granular secretions; urethra may be inflamed at the vulva extremity; vaginismus; mucous membrane very red in spots; sebaceous ducts and hair-follicles appear as little, round, red papillae with a drop of pus appearing in their apices.

TREATMENT
    1.  See Simple Catarrhal Vaginitis.
    2.  Very thorough and careful manipulation of' the muscles in the immediate region of the vulva.
 


 
GANGRENOUS VULVITIS
(Inflammation of the vulva, with mortification of the tissues, dependent upon a depraved condition of the blood, and may develop in puerperal fever,
scarlatina, measles, or continued fever.)

SYMPTOMS
    A patch or vesicle of grayish, reddish, or blackish hue which ulcerates and becomes depressed in swollen and indurated tissues - red in color; gangrene at once sets in; vital forces break down.

TREATMENT
    See Simple Catarrhal Vaginitis.
    If taken in very early stage, relief is often given.  If not taken, however, in its earliest stages, this disease is not treated osteopathically with any marked success.
 


 
CYST OF VULVO-VAGINAL GLAND
(May be multiple.)

CAUSE
    Formed by distension of the gland, caused by occlusion, of the duct, probably due to inflammation.

TREATMENT
    1.  Manipulate the muscles in the immediate region of the gland, gently but very thoroughly, with a view of removing the occlusion of the duct.
    2. Knead and manipulate the cyst in a careful but thorough manner.
 


 
ABSCESS OF THE VULVO-VAGINAL GLAND

CAUSE
    May be produced by the same cause as vulvitis.

SYMPTOMS
    Pain heat, redness, especially near the orifice of the gland; tender on pressure; at first hard, later fluctuating.

TREATMENT
    1.  Place the patient on the side; beginning at the first lumbar vertebra, move the muscles upward and outward, to the lower extremity of the sacrum, gently but very deep.  Treat the opposite side in a similar manner.
    2.  Place the patient on the face; the operator placing one hand upon the center of the sacrum, passing the disengaged arm beneath the limbs, raise the limbs slowly but rather strongly, pressing hard at the same instant upon the sacrum.  Great care must be exercised not to use sufficient strength to injure the patient.
    3.  Pass the finger into the vagina, manipulating the parts in such a manner as to free the ducts and circulation to the gland.  Also manipulate the abscess gently, but as thoroughly as possible.
    Treatment should be given every other day, and will occupy about fifteen minutes.
 


 
VULVAR ECZEMA
(More common in women near the menopause.)

CAUSE
    Generally caused by irritating discharges from the cervix or vagina.

SYMPTOMS
    In acute form, parts become red and edematous; vesicles appear, break, and discharge a tenacious fluid; severe burning and itching.  In chronic form, parts become thickened and scaly.

TREATMENT
    See Simple Catarrhal Vaginitis.
 


 
VULVAR ERYSIPELAS
(Erysipelas of the vulva is accompanied by graver symptoms than when appearing in other
parts of the body.)

TREATMENT
    See Simple Catarrhal Vaginitis.
 


 
VULVAR ERYTHEMA
(Superficial redness of the skin about the vulva.)

CAUSE
    Caused by uncleanliness, irritating discharges, exercise, etc.

SYMPTOMS
    Parts become sensitive, red, excoriated. and painful.
 
TREATMENT
    If due to irritating discharges, see Simple Catarrhal Vaginitis.  If caused by uncleanliness, the treatment would be apparent.
 


 
VULVAR HYPERESTHESIA
(Excessive sensibility of the mucous membrane of the vulva.)

CAUSE
    May be due to menopause, hysteria, etc.

SYMPTOMS
    Hyperesthesia about the labia minora and vestibule; no inflammation or pruritus.

TREATMENT
    If due to menopause, see Menopause.
    If due to hysteria, see Hysteria.
    If due to other causes, the operator should endeavor to apply such treatment as conditions indicate.
 


 
PRURITUS VULVAE
(Irritation of the nerves supplying the vulva, with intense itching.)

CAUSE
    Due to irritating discharges, parasites, eruption, etc.

SYMPTOMS
    Intense itching at intervals, later constant; sometimes leads to nervous depression.

TREATMENT
    See Simple Catarrhal Vaginitis.
 


 
VAGINISMUS
(Excessive sensibility of the hymen and vulva outlet, with spasmodic contraction of the
sphincter vaginae muscle.)

CAUSE
    Due to dense hymen, narrow vagina, or disturbance of sexual functions.

    Not treated successfully by Osteopathy.
 


 
ACUTE PELVIC PERITONITIS
(Inflammation of the peritoneum covering the female pelvic viscera.)

CAUSE
    May be due to inflammation of the uterus, ovaries, or tubes, parturition, or abortion.

SYMPTOMS
    Pain and tenderness in the lower abdomen; patient lies on back, with knees elevated; pulse small and rapid; temperature may be 1040 to 1050; nausea and vomiting; tympanites; constipation; often metrorrhagia.

TREATMENT
    1.  Place the patient on the side; beginning at the first lumbar vertebra, move the muscles upward and outward, gently but deeply, to the lower part of the sacrum.  Treat the opposite side in a similar manner.
    2.  Flex the limbs slowly but quite strongly against the chest; hold a few seconds in this position.
    3.  Place one hand against the sacrum, with the other draw the limb of the patient slowly backward while pressing hard on the sacrum.  Treat the opposite side in a similar manner.
    4.  The patient lying on the back; the operator places his hand lightly over the pubes, vibrating gently two minutes.
    The above treatment starts the circulation through the pelvic region, thereby reducing the inflammation.
    5.  Place the hands upon the sides of the neck, the fingers almost meeting over the upper cervicals; tip the head backward, pressing rather hard with the fingers at the same instant; hold in this position three or four minutes.  See Vaso-motor.
    This treatment will occupy about fifteen minutes, and should be given each day until recovery.
 


 
CHRONIC PELVIC PERITONITIS
(May follow acute attacks, or may not.)

SYMPTOMS
    Dull pain in the pelvis; usually vesical and rectal irritation; leucorrhea and menorrhagia.

TREATMENT
    See Acute Pelvic Peritonitis.
    Treatment should be given every other day.
 


 
PELVIC CELLULITIS
(Inflammation of cellular tissue of the pelvic peritoneum.)

CAUSE
    Due to parturition, abortion, or operation.

SYMPTOMS
    Rigor; elevation of temperature to 1030 to 1050; pulse full and rapid; occasional nausea; no vomiting; may be formation of pus above pubes.

TREATMENT
    See Acute Pelvic Peritonitis.
 


 
VESICO-VAGINAL FISTULA
(Communication between the bladder and vagina.)

CAUSE
    Usually caused by tedious labor.

SYMPTOMS
    Urinous odor about person; involuntary escape of urine; irritation; and excoriation about the vulva.
    No cure in Osteopathy.
 


 
RECTO-VAGINAL FISTULA
(Communication between the rectum and vagina.)

CAUSE
    Usually caused by long-continued pressure during labor.

SYMPTOMS
    Discharge of offensive gas or fecal matter by the vagina.
    No cure in Osteopathy.
 


 
COCCYGODYNIA
(Painful affection of the muscles and nerves of the coccyx.  Most frequently occurs after child-birth.)

CAUSE
    May be caused by a fall, kick, or blow, etc.

SYMPTOMS
    Pain in the coccygeal region, increased by motion or pressure on the coccyx, and on rising after sitting.
 
TREATMENT
    This disease is usually the result of dislocation of the coccyx, and can be quickly, easily, and permanently cured by reduction of the dislocation.
    See Dislocation of the Coccyx.
 


 
URETHRAL CARUNCLE
(Small red fleshy growth at the mouth of the urethra.)

SYMPTOMS
    Frequent and painful micturition; dysuria increases; pain on walking, pressure, or friction; bleeds easily; may be single or multiple.

TREATMENT
    1.  Place the patient on the side; beginning at the first lumbar vertebra, move the muscles upward and outward, gently but deep, through the lumbar and sacral regions.  Treat the opposite side in a similar manner.
    2.  Flex the limbs strongly against the chest; hold in this position a few seconds, giving strong abduction to the knee and adduction to the foot as the limb is extended.
    3.   Manipulate the muscles in the immediate region of the growth carefully but very deeply, with a view of freeing the venous circulation in the immediate region, an obstruction of which is the true cause of this trouble.
    4.  Manipulate the caruncle very gently but as thoroughly as possible.
    Treatment will occupy about ten minutes, and should be given every third day.
 


 
PROLAPSUS URETHRAE
(Prolapsus of the mucous membrane of the urethra at the meatus urinarius.)

CAUSE
    May be due to frequent child-bearing or vesical and rectal irritation.

SYMPTOMS
    Protrusion at first pink in color, later red, and may become excoriated and sensitive; frequent micturition, becoming painful, and tenesmus.

TREATMENT
    1.  Careful but very thorough General Treatment to stimulate and equalize the circulation and nerve-wave.
    2.  If due to rectal or vesical irritation, such additional treatment should be applied as conditions indicate.
 


 
PROLAPSUS VAGINAE
(Falling down of the vaginal walls toward the vulva.  Has been known to occur in virgins, and may be associated with vaginal hernia and prolapsus uteri.)

CAUSE
    May be due to frequent parturition, atrophy of the walls excessive weight, violent effort, vaginitis, etc.

SYMPTOMS
    Sense of discomfort in the vagina, with tendency to bearing down, as if to expel something; feeling of heat, fullness, and throbbing at the vulva; presence of a tumor between the labia, which touch will show to contain no liquid.

TREATMENT
    1.  See Simple Catarrhal Vaginitis.
    2.  See Displacements of the Uterus.
 


 
VAGINAL HERNIA
(May be Vesico-vaginal, Recto-vaginal, Entero-vaginal.)

    Cystocele consists of descent of the bladder toward the vulva, so as to impinge upon the vaginal canal.
    Rectocele occurs similar to eystocele, the posterior wall of the vagina ceasing to give support to the anterior wall of the rectum.
    Enterocele consists in descent of the small intestine into the pelvis, encroaching upon the vaginal canal.
    No cure in Osteopathy.
 


 
ATRESIA VAGINAE
(Occlusion of the vagina.)

CAUSE
    Generally congenital from maldevelopment.

SYMPTOMS
    Accumulation of menstrual blood; no blood appearing at menstrual period; may produce rupture of hymen or vagina, and cause septicemia.
    Not treated successfully by Osteopathy.
 


 
PUDENDAL HERNIA
(Protrusion of the intestines, omentum, ovary, or bladder through the inguinal canal
into the labia majora.)

CAUSE
    Caused by a blow fall coughing, or violent exertion.

SYMPTOMS
    If intestine gives impulse on coughing; if ovary gives ovarian sensation on pressure; also size and tenderness. increased during menstruation.
    Not treated successfully by Osteopathy.
 


 
PUDENDAL HEMATOCELE
(Effusion of blood into the tissues of the vulvo-vaginal region, usually into one labium or areolar tissue surrounding the vagina.)

CAUSE
    May be caused by muscular efforts, blows, rupturing the labia, or by punctures.

SYMPTOMS
    Pain and throbbing; swelling first soft, later hard; if effusion reaches urethra, there is obstruction to micturition.

TREATMENT
    See Simple Catarrhal Vaginitis, applying the treatment with a view of equalizing the circulation to the parts involved, manipulating the vagina in such a manner as to stretch the muscles and free the circulation, thereby checking the effusion of blood.
 


 
PUDENDAL HEMORRHAGE
(Hemorrhage from the vulva.)

CAUSE
    Same as Pudendal Hematocele.

TREATMENT
    See Pudendal Hematocele.
 


 
PELVIC HEMATOCELE
(Effusion of blood into cavity of the pelvic peritoneum.)

CAUSE
    May be due to ruptured extra-uterine fetation sac or tubal abortion.

SYMPTOMS
    Sudden sharp pain; symptoms of shock and hemorrhage; face pallid; pulse rapid and feeble; temperature subnormal; cold perspiration; may be nausea and vomiting; symptoms of peritonitis; tumor bulging down in posterior fornix of vagina.
    Not treated successfully by Osteopathy.
 


 
MENOPAUSE, OR CHANGE  OF LIFE
(Final cessation of the menses.)

SYMPTOMS
    While the change is in progress there is commonly more or less functional disturbance of the general health, the nervous system especially manifesting various changes, such as vertigo, syncope, headache, flushes of heat, urinary troubles, pains in the back extending down the thighs with creeping sensations, heat in the lower part of the abdomen, occasional swelling of the lower extremities, itching of the private parts, mental irritability and restlessness culminating seriously sometimes, especially in patients of a decided nervous character.  Sometimes menstruation ceases abruptly.        The monthly period may be arrested by cold, fright, or some illness; earlier in life the suppression would have been followed by a return of menstruation after removal of the cause, but now Nature adopts this opportunity to terminate the function.  Gradual termination is, however, more frequent and is attended with less disturbance of health.  In gradual extinction one period is missed and then there is a return, a longer time elapses and there is an excessive flow; this continues for a time, the returns being fewer and farther apart, until they cease altogether.
    At this critical period there is not infrequently an enlargement of the abdomen, which, though it may occur earlier in life, is due to causes peculiar to this.

TREATMENT

    A General Treatment every other day will equalize the circulation and give wonderful relief.