EFFECTS OF DRUG-TREATMENT.
And now, to follow out our imaginary case, how is this young lady to be treated? Do not people generally set at work in such cases with hot drinks, hot baths, and, in short, the heating means generally? And what is the result of such treatment? If it be at all persevered in, the individual is rendered more weak. Such treatment may occasionally succeed; but any and every means of debilitating the system must necessarily render it more liable to a similar attack. But it is also to be observed that such treatment generally fails of its object, and thus, in the end, the patient is certain of being made worse for it.
How came this delusion? How does it happen that people are so much afraid of the cooling and tonic means? It is from a wrong understanding of the nature of the case. In the first place, a cold was taken. This is literally true; cold made a more powerful impression upon the system than it could bear at the time without harm. As a secondary effect, inflammation is the result. In all cases of acute, but sudden suppression of the menses, I conceive that there is more or less inflammation of the womb; and wherever there is inflammation, which always consists in increased heat, the natural discharge cannot go on. Now here, where there is a cold, as we say, which means heat and inflammation, should we apply hot things? Certainly not; but rather cold. And yet I would not use cold too much; never more than the individual can safely bear.
This, then, is the plain treatment for acute suppression of the menses: do all that may be in fortifying the general health of the individual.
If at any time there is shivering, or rigors, apply the rubbing wet-sheet, rubbing briskly over it, and then let the patient go and exercise in the open air. Let her bathe, at least daily, in water tepid, cool, or cold, accordingly as she can bear. A tepid-bath, that is, water from 70 to 80° Fah., is always cooling in effect, it being much cooler than the blood, which, in its natural state, is 98° Fah. She should also wear the wet girdle constantly, changing it at least four times in the twenty-four hours. She should walk out daily and often, but not too far at a time. She should, in short, pursue just such a course as we would in any similar case of debility; and, if necessary, take a full course of water-treatment, such as is suited to the particular case.
I am sorry that some of my younger friends of your sex are in the habit of checking the menstrual discharge for some particular object; but if they could know the great hazard they run in doing so, they would not, I hope, do it. Let me say a few words to them on this subject.
Frank mentions the case of a young lady who put her feet several times in cold water during the flow of her menses, because she expected her lover, which quickly arrested them. An inflammation of the womb followed, and she was brought dying into the hospital, at Vienna.
One of his relatives, of fine health and rare beauty, who, after dancing all night with her menses on her, left the ball-room in full perspiration; she would not wait for a carriage, but proceeded home, which was not far off. She was attacked with inflammation of the womb, and died on the fourth day.
Mr. Brown, a writer in the Edinburgh Medical and Surgical Journal, gives the case of a lady of about forty years of age. She had become very much heated by a long walk in hot weather. At the end of her walk, the menses appeared, but which were entirely suppressed by a drink of cold water. This was followed by headache, oppression, and amaurosis of the left eye. In about six months, Mr. Brown succeeded in restoring the menstrual discharge, at which time, also, her sight fortunately returned to her. The eyes are particularly liable to affections of this kind, arising from a sudden stoppage of the catamenial function; and some have been made blind for life in this way. I hope, therefore, that those for whom I write, both young and old of your sex, will hereby learn to be very cautious in regard to checking the monthly discharge. You see how dangerous it is, and how easy, by carelessness or design, it is to cause it. But, beware!
Shall I again speak of the water-treatment? If you bathe habitually every day; if you are careful to avoid overheated rooms, and becoming too fatigued; if you exercise daily in the open air, and keep yourselves actively engaged in some useful employment, you will have little to fear from the evils of which I have been speaking. But, after reading what I have said, if any of you will persist in taking such a course as will tend to the suppression of the catamenia, or, what is worse, if any of you should dare to put a check to this discharge, when it interferes with your pleasure or convenience, the evil must be upon yourselves, and not upon me. But I hope for better things of you, and that no one will be guilty of designedly or wantonly doing that which can only end in harm.
LETTER VI.
OF MENSTRUATION.
Menorrhagia and Dysmenorrhea—Their Nature and Treatment.
In the present letter I propose giving you some thoughts concerning two other forms of disordered menstruation—I refer to menorrhagia—an immoderate flow of the menses, and dysmenorrhea, by which we understand painful or difficult menstruation. There are few subjects connected with health, which deserve more particular attention, or which are of greater interest to you, than these of which I am now to speak.
Menorrhagia, from two Greek words signifying the menses and to break out, implies, according to common acceptation, either an immoderate flow of the menses, or uterine hemorrhage, which is often a very different thing. It is generally characterized by pains in the loins, small of the back, and abdomen, similar to those of labor. There is always a preternatural flux of either blood or menstrual fluid from the vagina in what is termed menorrhagia.
Dr. Cullen reckoned six varieties of this disease.
1. Menorrhagia rubra, or bloody menorrhagia, from women neither with child nor in childbirth.
2. Menorrhagia alba, or white menorrhagia, which is, in other words, leucorrhea, fluor albus, or the whites.
3. Menorrhagia vitorium, arising from some local disease.
4. Menorrhagia lochialis, or lochial menorrhagia, from women after childbirth.
5. Menorrhagia abortus, or menorrhagia with abortion.
6. Menorrhagia nabothi, when there is a serous or watery discharge from the vagina in pregnant women.
I think it a better mode to treat of menorrhagia according to the original signification of the term, namely, an immoderate flow of the menses. I admit it must, from the nature of the case, be often difficult—indeed impossible—to determine whether a case belongs really to menorrhagia proper, or to hemorrhage from the womb. But the true indications of treatment would be the same in either case, so that a mistake in diagnosis would be of no manner of account in practice. I shall, then, speak of menorrhagia as a separate and distinct disease. I shall use the term simply as meaning an immoderate flow of the menses. Leucorrhea, hemorrhages, abortions, and the lochial discharge, will be spoken of separately. But I admit it must, after all, be a question, whether in all cases of immoderate flow of the menses, there is not actually hemorrhage. It is held by some, that the fluid, or discharge, in menstruation, is never capable of forming clots; in short, that it is in no sense common blood. But we know that in a great number of cases clots are formed. If it is, therefore, true, as some assert, that the menstrual fluid proper never coagulates, then, in all these cases to which I have referred, there must be hemorrhage. I am of the opinion, that the menstrual fluid is capable, in some cases at least, of coagulating like common blood. For all practical purposes then, it will be sufficient to understand by the term menorrhagia, all immoderate menstruation that does not actually amount to a plain and palpable hemorrhage.
Who are the persons that are most subject to menorrhagia? “Women who live indolently and indulge in stimulating articles; who use little or no exercise; who keep late hours; who dance inordinately; who are intemperate; who have borne many children; who have been subject to febrile affections; who have much leucorrhea; who are too prodigal of the joys of wedlock; who are advancing toward the non-menstrual period; who yield too readily to passions or emotions of the mind, are those,” says a distinguished author, “most subject to menorrhagia; to which may also be added, those women whose physical labors are too great, as well as those who have too little labor, are also subject to this disease.”
Menorrhagia, like amenorrhea, indicates a deteriorated state of the general health. A really healthy person can never have the disease, except, possibly, under some peculiar circumstance, for a single time. Real healthy persons, who have no natural impediments, always menstruate regularly.
Treatment.—The general indications of treatment will be inferred from the character of the disease. Do every thing that may be to fortify and invigorate the general health. Every thing that tends to this important object, acts indirectly to effect a cure. This is the only rational mode.
Daily and habitual bathing in water, tepid, cool, or cold, according to the patient’s strength, is a means of wonderful advantage in this disease. The fibers of the system are too lax, so to say; the vessels open too readily, and thus an unnatural discharge takes place. Imagine that you have walked a long way in a hot day: you find the veins of the hands and feet swollen, heated, and enlarged. The tonicity of their coats has become lessened. If a vein were opened under such circumstances, the flowing of blood would be much more free than ordinarily. Now if we wash these parts in which the veins are too much enlarged, we find that the water immediately strengthens them. The unnatural amount of blood is driven back, the vessels again assume their normal condition. Here we find an evidence of the tonic effects of cold water. Tepid water is also tonic, to a greater or less degree, because always cooling. It is on this tonic principle that water acts so favorably in excessive menstruation.
It is to be observed that in menorrhagia there is much less pain than in the opposite state, namely, deficient menstruation.