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.