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free from this disagreeable trouble.

Another symptom which often causes much alarm to the patient is amenorrhœa or deficient or scanty menstruation. This may result from fear, worry, catching cold or to an enlargement of the womb. It also is one of the first symptoms of pregnancy. Sometimes it indicates an impoverished condition of the blood and shows the need of a general building up of the system. This is true especially in young girls who have what is called chlorosis or green sickness. These girls are pale, weak, sometimes having a greenish cast to their complexions. They need good care and nourishing food and plenty of light, outdoor exercise.

In young girls I sometimes find an irritation of the vagina which causes pain. This may be due to the retention of secretions in the vagina. The general idea that only married women have leucorrhœa, or whites, is fallacious. Virgins may have it. The usual cause is catching cold at the menstrual period. Another delusion is that these girls should not take douches for fear they might injure the hymen. This is erroneous, for douches are necessary in the treatment of this condition and, except in very rare cases, a douche can be taken with an especially small douche point without injury to the parts. There normally must be a small opening in the hymen to permit the passage of the menstrual flow. If a small douche point is used no harm will result.

When I talked to you about the structure of the external generative organs, I mentioned the clitoris and explained that sometimes the prepuce or foreskin is bound down, or is too tight, so that the natural secretions are retained under it and produce an irritation; that the operation for the unhooding of the clitoris is very similiar to that of circumcision in the male and is performed for similar causes. Many a woman who has been nervous all her life, owes her condition to a hooded clitoris, which a very simple operation would correct. A hooded clitoris also may have something to do with the immoral life of some girls. The other day I received a letter from an aged physician who, in discussing the tendency to immoral practices, says: "You say in one of your articles, 'What is the remedy? Educate!' Well, perhaps, but if you would let me circumcise the girl early in life, I believe it would be more certain." There is considerable truth in his statement. A hooded clitoris produces a constant irritation which tends to lead to habits of self-abuse and perhaps immorality.

The other common disorder which I named at first is a tumor. Tumors are any unnatural growth. They may form in any part of the body, but just now we will speak only of those affecting the internal female organs. Tumors may form in the cavity of the womb, in its walls or on the outside of it. The common symptoms are an enlargement of the abdomen accompanied usually by pain due to pressure on the nerves. There also may be some hemorrhage at other than the regular menstrual periods.

Sometimes the ovaries are diseased and become enlarged, tender and filled with fluid. Then they are spoken of as cystic tumors or as cysts. The tubes may become inflamed and filled with pus. The most common cause of these pus tubes is one of the black plagues. With all these tumors the treatment usually is to remove the tumor and sometimes the entire organ. In a few cases it is possible that the fluid or other contents of the tumor may be absorbed, if the general health and circulation are improved. In some cases we find what is called a phantom tumor. There really is no tumor, although the symptoms may be such that even reliable physicians are misled. The symptoms are due to a nervous condition. These phantom tumors have given many a quack a reputation for removing tumors without the use of the knife.

A carcinoma or cancer is a malignant tumor, that is, one that tends to grow worse and to reappear if it apparently is removed. The reappearance may be in the same place or in an entirely different portion of the body. Cancer of the uterus is not uncommon in women. It frequently follows neglect of some injury. For example, it will appear on the site of an unrepaired tear. It most commonly comes after the menopause. The change that is undergone at that time seems to stir things up and bring to light any neglected injury. This is another reason why every woman at the menopause should undergo a thorough examination and have any defect repaired, thus avoiding much of the possibility of trouble. A frequent symptom of carcinoma of the uterus is hemorrhage at irregular times after the menopause. Any woman who has such a condition would be wise if she immediately repaired to a physician and determined the cause of the hemorrhage. In the beginning it is possible to remove a cancer, but later it becomes so involved in the surrounding structures that its removal is impossible.

You may think I am trying to increase business for the physicians but in reality my advice, if taken, would lessen their practice. It is another application of "a stitch in time saves nine." In the beginning almost all these diseases can be corrected with very little trouble, while if neglected the process is much slower. The probabilities are that the doctor will have the case later, if not consulted early, but instead of a few office treatments he will have an expensive operation. So, you see, I really am trying to save you doctors' bills when I urge early and thorough examinations. There is a peculiar thing about the human race. A machine will get out of order and the owner will send for an expert machinist to repair it—not attempting to patch it up himself. But when these bodies of ours, the most wonderful and complicated of machines, get out of repair we try to patch them up ourselves or try various remedies recommended by those who know worse than nothing about the physical machinery. Then we think we are saving doctors' bills, when at the same time we are spending twice as much on questionable repairs—patent medicines, which often do more harm than good. Frequently they contain stimulants which produce a mythical improvement but leave the system worse off than before.

CHAPTER IV CONSTIPATION—HEMORRHOIDS

A regular daily movement of the bowels is necessary to health. Much of the illness in the world might have been avoided if the victims had taken better care of the excretory organs. One of the first questions a physician asks a patient is, "How are your bowels, do they move regularly every day?" In some cases that is the first time the patient has thought of them, and he has to think some time before he can remember just when and how often his bowels did move. Then perhaps he is not sure. In a great many cases it is a routine practice with physicians to give a "good cleaning out," that is, to give a thorough laxative. Many times this is all the treatment required and in other cases it only is combined with a little intestinal antiseptic to further carry out the cleaning process.

The most common cause of constipation is irregularity in going to the toilet. When the desire for defecation comes, we are too busy and postpone it until some more convenient time, which time may be too late. Nature is the best judge as to when the bowels are ready to be emptied. If we do not obey her call, we must take the consequences. When the waste material is ready to be voided, it is in a semi-fluid state, but, if it remains in the intestines too long the water is absorbed and the waste material is left in a hard mass which is expelled with difficulty. Not only that, but the desire to expel it soon passes. Nature, finding we do not respond to her call, ceases to notify us.

If the waste material is allowed to remain in the bowels, not only the water is absorbed but with it some of the poisons from the waste material, which are taken up by the blood and carried to all parts of the system, causing a great deal of trouble and pain. This absorption of toxins (poisons) causes headache, loss of appetite, a sense of depression and a lack of energy.

The pressure of the hard material on the tender tissues of the rectum causes hemorrhoids or piles, by irritating the tissues and causing a congestion. Hemorrhoids are enlarged veins which have been so irritated and filled with extra blood that they have lost their power to contract. These enlarged veins may remain inside the rectum and then are known as internal piles. Sometimes they protrude externally and then are known as external piles. Frequently they become tender and cause a great deal of pain. In some cases one of the little veins becomes so engorged with blood that it bursts and allows the contained blood to escape. This is known as bleeding piles. For mild cases of hemorrhoids (piles) the treatment is to correct the accompanying constipation, then take an enema or injection of warm water morning and evening, using the water as hot as can be borne and allowing it to run in and out the rectum for some time. Following this, an astringent and soothing lotion should be applied.

Constipation may be caused by retroversion of the uterus. If the uterus is tipped backwards it presses on the rectum, preventing the passage of the feces (bowel movement). This pressure also causes hemorrhoids. In this case the treatment is to correct the displacement. In many cases all that is necessary is to take the knee-chest position for a few minutes night and morning.

Always in the treatment of constipation, the first item is to discover the cause. We have noted that the chief cause is irregularity in going to the toilet, therefore, the first measure to be taken in the treatment is regularity in going to the toilet. Choose a convenient hour, usually right after breakfast, and always go to the toilet at that time no matter if there is a desire or not. At first there may be no natural movement but if you persist, your efforts will be rewarded. For the first few days it is well to take an enema of warm, soapy water at this time. Every day take exercise that will strengthen the muscles of the abdomen. Bending forward and touching the toes with the fingers without bending the knees is one valuable exercise. This should be done ten or twelve times morning and evening. A daily brisk walk in the fresh air is another good exercise. Fruit or figs eaten with the meals or a glass of water taken before breakfast and upon retiring often proves very beneficial in relieving a tendency to constipation. There is an old saying, "An apple or two before going to bed, and the doctor will go begging for his bread." This really is a practical idea and more nearly true than many old sayings.

Cathartics or laxatives should not be taken except for an occasional dose or during illness upon the advice of a physician. So common is the practice of taking daily laxatives that it has become a "national curse"! People do not realize that they are slaves to this habit, so they continue to take their daily doses of "teas" or "waters." In many cases a patient will tell his physician that his bowels are "all right," that they move every day. Further questionings reveal the fact that he is

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