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.
Symptoms.
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.
Causes.
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.
Treatment.
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.[[5]]
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.[[6]]
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. (See Abortion and Flooding.)
Regimen.
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.
Prevention.
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.