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SUPPRESSION OF THE MENSES.

In this disease there is a partial or total obstruction of the menses in women from other causes than pregnancy and old age. The menses should be regular as to the quantity and quality; that this discharge should observe the monthly period, is essential to health. When it is obstructed, nature makes her efforts to obtain for it some other outlet; if these efforts of nature fail, the consequence may be, fever, pulmonic diseases, spasmodic affections, hysteria, epilepsy, mania, apoplexy, green sickness, according to the general habit and disposition of the patient. Any interruption occurring after the menses have once been established in their regular course, except when occasioned by conception, is always to be considered as a case of suppression. A constriction of the extreme vessels, arising from accidental events, such as cold, anxiety of mind, fear, inactivity of body, irregularities of diet, putting on damp clothes, the frequent use of acids and other sedatives, &c., is the cause which evidently produces a suppression of the menses. This shows the necessity for certain cautions and attentions during the discharge. In some few cases it appears as a symptom of other diseases, and particularly of general debility in the system, showing a want of due action of the vessels. When the menses have been suppressed for any considerable length of time, it not unfrequently happens that the blood which should have passed off by the uterus, being determined more copiously and forcibly to other parts, gives rise to hemorrhages; hence it is frequently poured out from the nose, stomach, lungs, and other parts, in such cases. At first, however, febrile or inflammatory symptoms appear, the pulse is hard and frequent, the skin hot, and there is a severe pain in the head, back, and loins. Besides, the patient is likewise much troubled with costiveness, colic pains, and dyspeptic and hysteric symptoms.

PAINFUL AND IMPERFECT MENSTRUATION.

Besides the two deviations from the usual course of nature already mentioned, there sometimes occurs a third, viz. where menstruation, although not wholly suppressed, is nevertheless somewhat difficult, and accompanied with severe pains in the back, loins, and bottom of the belly. This disease is owing to a weak action of the vessels of the uterus, or spasm of its extreme vessels, and is to be obviated by tonics, warm bathing, both local and general, together with the use of anodynes, which should be employed as soon as the symptoms which denote its approach are apparent. This complaint is a common, and generally an extremely harassing, affection. It may occur at every period during the menstruation stage of life; but it appears to be most common between the twentieth and thirtieth years of age, and in subjects of an irritable and sanguineous temperament. In many instances severe pains are experienced in the back, loins, and lower part of the abdomen for five or six hours previous to the appearance of the menses. This, however, soon ceases, and an immediate aggravation of the torturing pain follows. Sometimes the catamenia begin to flow moderately, with little or no previous pains; but in an hour or two, they become suddenly arrested, at the same time that violent pains come on in the hips, side, loins, back, and thighs, with a distressing sensation of forcing or bearing down. Occasionally a very slight menstrual discharge continues uninterruptedly for three or four days, accompanied throughout with extremely severe pains in the abdomen; and in some rare instances the catamenial evacuation, although attended with great suffering, is sufficiently copious and prolonged in its course, and may even exceed the regular duration and quantity of an ordinary healthy menstruation.

Since it is well known that a derangement in the uterine functions must generally proceed from a check of perspiration, astringing the minute ends of the uterine vessels, or in some manner deranging their functions, causing debility, &c., it will appear clear that our first attention must be directed to the skin. Cold appears to be the cause of the disease, and heat seems to remove it; therefore, when these periods of distress occur, let the patient sit over a strong decoction of bitter herbs, such as tansy, hoarhound, wormwood, catnip and hops, while a blanket is thrown round the waist of the patient to confine the steam to the lower parts. After the diseased person has been thus steamed and the feet bathed, let her be put into a bed, warmly covered, and diluent drinks given, such as tansy, thyme, pennyroyal, &c. At the same time let fomentations of the same herbs, enclosed in a flannel bag, be applied to the abdomen, as before directed. This will produce perspiration and afford immediate relief; and when these distressing symptoms are removed, and the patient becomes comfortable, a course of treatment must be adopted to prevent a recurrence of these symptoms, or to produce a natural flow of the catamenial discharge; and similar to that recommended under the preceding complaints. Herbs may be freely drunk.

IMMODERATE FLOW OF THE MENSES.

This alarming complaint may occur under two different states of the constitution. In the one, the woman is of full habit, and often of a ruddy countenance. In the other, she is pale, delicate, and easily fatigued.

In plethoric habits it is often preceded by headache, giddiness, or difficult breathing, and is afterwards attended with pain in the back and loins, universal heat, and a frequent, strong, and hard pulse. But when it arises from general debility, or in consequence of a laxity of the organ, paleness of the face, chilliness, lassitude of the body, oppressed breathing on the slightest effort, pains in the back on remaining any length of time in an erect posture, and coldness of the extremities, together with a long train of nervous complaints.

A variety of causes may produce this troublesome disease. Some of these are general, such as a state of great weakness, or of too much blood; others are local, such as debility of the uterus, occasioned by tedious labor or frequent miscarriages. It may also be produced by accidental circumstances determining the blood more copiously and forcibly into the uterine vessels, as violent exercise in dancing, much straining at stool from great costiveness, contusion on the belly, excess in venery, or strong passions of the mind, particularly at the menstrual period.

In the management of this disease we have two objects: first, to moderate the discharge and procure present security; and, secondly, to prevent a return.

The first thing to be done when the hemorrhage is sudden or profuse, is instantly to remove the clothing which may occasion the least interruption to the free circulation of the blood, and to put the patient to bed, lightly covered with clothes. So long as this discharge continues, it is of importance to keep her in a recumbent posture, as cool as possible, and perfectly at rest, both in body and mind. Cloths, dipped in cold vinegar and water, and renewed as often as they become warm. These cold applications have a powerful effect in restraining uterine hemorrhage, and ought never to be omitted where the discharge of blood is profuse.

If the patient be of a full habit, attended with severe pain in the head or back, and febrile symptoms, it will be proper to give the antimonial, or febrifuge powders, or mixture.

The state of the belly must be attended to. It can be kept gently open by the cathartic mixture, sulphur, or any mild laxative medicine. Stimulating purgatives or clysters, under such circumstances, are improper, from their tendency to increase the discharge.

When no symptoms indicating an increased action in the vessels of the womb are present, astringent medicines should be employed. And, in cases where the discharges have not continued long, and the strength not much impaired, it is often sufficient to arrest the disease by giving fifteen or twenty drops of elixir vitriol, or six or eight grains of alum dissolved in a glass of cold water every hour; or, what is preferable, alum whey, sweetened to the taste, in doses of a small cupful, as often as the stomach will receive it. But, if the discharge be obstinate, we should have recourse to pills of sugar of lead and opium.

In no instance which has come under my knowledge, where the hemorrhage was in consequence of a laxity of the uterine vessels, have these pills failed in producing the desired effect.

In those cases where the hemorrhage is profuse, or of long continuance, and resists the means already pointed out, it will be proper to inject into the uterus from a gill to half a pint of a strong decoction of oak bark, in which one or two drachms of alum have been dissolved, or as much of the saturated solution of alum in water, in order to constringe and strengthen the vessels of the womb. This may be repeated twice or thrice a day, according to circumstances.

When symptoms of an increased action in the vessels of the womb are observable, the tincture of foxglove, in doses of twenty drops every four hours, constitutes the best remedy.

When there is reason to suppose the hemorrhage proceeds from a scirrhous or ulcerated state of the womb, all that can be done, is to afford temporary relief by giving opium in large doses. Indeed, opiates may be given with advantage in every case where there is considerable pain or anxiety, and the patient much exhausted. Under these circumstances, from one to two teaspoonfuls of laudanum, or from two to four grains of opium, according to the urgency of the case, will be useful not only in giving a check to the discharge, but also in preserving the strength, and abating nervous irritation. In most cases it is preferable to give opium in the form of injections to allay the spasmodic pains of the womb; and, when administered in this way, clysters of thin starch or gruel, in each of which two teaspoonfuls of laudanum are added, should be given every two hours until relief be obtained.

The diet, at the time of excessive discharge, must be light and cool. The drink must always be cold, as ice-water, lemonade, or tamarind beverage. Port wine, in such cases, is too frequently resorted to, which uniformly does harm by increasing the circulation.

To prevent a recurrence of the attack in those who are subject to it, the patient must necessarily avoid the causes by which it has been produced.

When it is evident that the discharge is in consequence of a full habit, it will be proper to reduce the system by living sparingly, by keeping the bowels rather in a laxative state, and by rising early, and taking through the day regular but frequent exercise; and, after the plethora is removed, by strengthening the vessels which have been over-distended, by the use of the cold bath.

In a greater number of cases, however, we meet with a delicate constitution and spare habit, with pale countenance: this state requires the use of sea bathing or the shower bath, and the vessels of the womb are particularly strengthened by pouring cold water daily on the back and loins.

It will be advisable to use a generous nutritive diet, with wine, and to have recourse to some of the tonic medicines, as advised under the head of obstructed menses, to strengthen the system generally. At the same time the bowels must be attended to, and invigorating exercise taken daily; whilst on the other hand, fatigue, and especially exposure to relaxing heat, must be carefully avoided.

DECLINE OF THE MENSES.

The nearer a woman approaches her forty-fifth year , will be the risk of some irregularity in the menses; and as this period is more frequently the one at which any latent disease of the uterus shows itself, it is always looked forward to with much anxiety by women. Indeed, so replete is this time with horrors to many, that we may very justly suspect apprehension to be the cause of some of the distressing symptoms, which sometimes accompany this interesting process of the human uterus.

Delicate women, and especially those who have lived idly, have this period of life arrive earlier than those of a contrary constitution, and opposite habits. We have already noticed, in our section on Suppression, that this change sometimes takes place at a very early period of life, and this without leaving any injurious consequences behind it; and, on the other hand, we find many cases on record, where this discharge had continued with regularity to a much longer period than the ordinary one. Gardien mentions a case which fell under his own notice, where this evacuation continued with great exactness, until beyond the seventy-fifth year; others, still more uncommon, are mentioned by various writers.

This change is sometimes effected so silently, that the woman scarcely notices her altered condition; at others, its approach is so gradual, as not to attract observation, until the diminished quantity gives warning that it is about to take its leave for ever; while, again, the irregularity, both in period and quantity, may be such, as justly to give alarm, as well as to produce the most serious danger.

But, as a general rule, it may be observed, that when the woman arrives at about her forty-fifth year, she finds her menses to become irregular, both in the quantity of fluid evacuated, and in the periods they observe; being sometimes in advance, and at others, not appearing until long after the accustomed time. The woman also finds some alteration has taken place in her general health; she becomes pale, debilitated, and nervous; arising, however, for the most part, from the too frequent returns of this discharge, or its too great abundance.

At this time, also, the woman sometimes becomes the victim of a strange illusion, should the menses not have returned for several periods; for she now supposes herself to be pregnant, as her abdomen enlarges, as do the mammae; her appetite becomes capricious, or she has strange longings, &c., the whole of the rational signs of this condition being present, in her imagination, even to the motion of the child. This delusion is most common to women who marry late in life, and who are very desirous of offspring. Now the breasts lose their intumescency; the morning sickness vanishes; the swelling of the abdomen subsides; the imagined stirrings of the foetus cease, or the sensation becomes so unequivocal as to satisfy that it arises from the movement of wind; and, to put everything beyond hope, the menses return in overwhelming quantity. It is highly proper, that practitioners, and especially the younger part of them, should be put upon their guard in respect to this condition of the patient, and not too easily yield credence to all her wishes may dictate, or absolutely to treat as an impossibility, a circumstance of which there is occasionally an example.

It seems that the apprehensions of this period of life have arisen mainly from the notions entertained of the final cause of the menses; namely, that it gives vent to peccant humours. But females should be made to know, that all this is purely the theory of the vulgar; as the menstrual blood is formed from the general mass; and, consequently, if that be pure, the other will be; therefore, the idea is altogether ill-founded. But unfortunately, whenever this discharge is less abundant than usual, the most serious fears are entertained, that there will be a retention of a portion, which will cause disease, either in the uterus itself, or in some other part of the body; hence, a diminished menstruous secretion is always more alarming to the female, than an unusual flow. But it may be well to remark, that there is a great difference between the cessation of this discharge, and the suppression of it. In the one instance, it is an event which nature has designed should take place, and is effected altogether by arrangements of the system itself; and, of course, one of its natural processes: in a word, as much so as its commencement; but the suppression, from some morbid agency, is in direct opposition to the intentions of nature, and will, of course, be followed by some baleful consequence, if it continue beyond a certain period.

From this it will follow, that a milk and vegetable diet, together with pure water as a drink; regular exercise, not carried to fatigue; keeping the bowels well open, by well-selected food, as the fruits of the season in proper quantities: the bran bread if necessary; but not by medicine, unless absolutely required; governing the temper; restraining the passions, as well mental as animal, will largely contribute to the safety and comfort of this period. All that we have just recommended, is calculated to place the system in a condition by which it shall preserve its various forces; have its irritability diminished; its sensibility moderated; and pretty certainly prevent that condition of the blood-vessels, most decidedly unfriendly to the general health at this time, called plethora. And, though last, not least in fair estimation, is an attention to cleanliness. The external organs should be washed with lukewarm water at least twice a day, and the whole body once a week, by going into a lukewarm bath. In using the bath, care should be taken to come out of it as soon as the purposes of cleanliness are answered.

Our next concern is with the derangement of the discharge at or about the period of cessation: this will consist, 1st, in a diminution of the proper quantity; and, 2dly, in an excess of it. As regards the first, we have already said enough when treating of the suppression of the menses; and, with respect to the second, it must be treated according to the rules prescribed for the management of hemorrhage from the uterus from any other cause, that is, first, to diminish the quantity discharging; secondly, to prevent an excessive return.

CONCEPTION; OR, PREGNANCY.

CONCEPTION.

In order to procreate the human species, there is a periodical discharge of blood from the vagina of every female, termed the catamenia, or menses. The secretion of this fluid commences at that period of life termed puberty, which occurs at different ages, according to the climate. In some latitudes it commences as early as eight or ten, and in others not until fifteen. As soon as conception or pregnancy commences, this discharge ceases, and goes to support the foetus, or the child.

The manner in which conception takes place has ever been a fruitful subject of inquiry, but we are unable to account for this change precisely. It is, however, pretty evident that the semen of the male is introduced into the uterus, while the semen of the female is discharged from the ovaria by means of the Fallopian tubes, the fimbricated extremity of which closely embraces that organ.

These tubes, by a kind of peristaltic motion similar to the intestines, convey the semen of the female into the uterus, where it unites with the semen of the male; and it is these united fluids which constitute the rudiment of the foetus, and which often give to the child the appearance and dispositions of their parents. Sometimes one trait is inherited, sometimes another; at other times a new compound or character is formed , which does not partake of the nature of either of the former.

OF THE MODE BY WHICH PREGNANCY MAY BE DETERMINED.

There are certain signs which a female is taught to regard as essential evidences of pregnancy and it is supposed by most, if not by all women, that their presence is absolutely necessary to the existence of this state. In reference to one or two of these signs, this is far from the fact; for they are not unfrequently absent, although pregnancy exist, and the remainder may be present, although pregnancy be absent. Many a female, I am confident, has, from this very circumstance, experienced much difficulty in attaining certainty as to her state, and suffered months of anxiety and doubt. This has arisen from a want of those clear notions, and that precise information, which a question so important demands.

The first symptom of pregnancy is the omission of that monthly return, which, in female phraseology, would be described as "ceasing to be unwell;" and it may be adopted as a general rule, that, in a healthy woman, whose menstruation has been established, and continued regular, and who is not nursing, "Conception is followed by a suppression of the menstrual discharge at the next return of its period." Thus, a female may have been pregnant a week or two already; but she is not aware of it till that period of the month arrives when she is accustomed to menstruate, and then, when she expects to be unwell, she finds that she is not so.

Now this symptom, as a general rule, admits of four exceptions:--

First. A young female shall never have menstruated, and yet conceive.

Secondly. A mother shall conceive while she is nursing, and not menstruating.

Thirdly. A female shall conceive, and yet be unwell during the first three, four, or more months of pregnancy.

Fourthly, and lastly. Occasional conception takes place late in life, after menstruation has apparently ceased for ever.

Although pregnancy under such circumstances is not of frequent occurrence, still it does now and then take place. A knowledge of the fact may therefore prove useful.

I have large opportunities of investigating this, as well as the several points touched upon in this chapter. On an average, between forty and fifty poor women call upon me every month, with midwifery letters for attendance in their confinement: and the result of my inquiries upon the present question has led me to believe, that more than one third of these women have conceived at least once while nursing, and very many of them oftener.

Many other cases illustrative of this fact I might assert, but these suffice to prove the exception.

It has been asserted, as an objection, that this discharge is not truly menstruation; but the discussion of that question does not concern us here. We have only to consider, whether there does not frequently, during pregnancy, take place a discharge, so closely resembling menstruation in its periods, quantity, duration, and appearance, that neither the female herself nor her medical adviser shall be able to detect any difference between them; and of this I have no doubt.

In this case then, the female was unwell in two pregnancies till the period of quickening; and in the other for four months, when miscarriage took place from accident.

The following case proves how important it is that this fact should be generally known; for up to a very late period, some medical men have even denied the possibility of this occurrence.

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