A system of practical medicine. By American authors. Vol. 4

by Unknown

The SYMPTOMS are well marked—at first, local, as severe backache, increased heat and pressure in the pelvic region, discomfort passing on to pain, even uterine colic. If the impression be severe enough to affect the general system, there will be febrile action more or less intense, and various nervous symptoms, spasmodic or convulsive.

The therapeutics of amenorrhoea must be directed in accordance with the conditions which cause it. But the strictly scientific method cannot be followed at the outset. This method presupposes a direct examination of the organs as the first step. For obvious reasons this must be deferred until special symptoms show its necessity. For treatment the cases may be classified, in some instances according to the schedule, but more frequently according to the cause or leading features, and very generally without reference to whether there is absence merely or suppression of the function.

In amenorrhoea from atresia the measures of relief will be purely surgical; the treatment, therefore, does not fall within the scope of this article.

The physician is frequently consulted in cases where menstruation has occurred once or twice, perhaps at long intervals, and not appearing regularly the fears of friends are excited. This is the normal course of establishment in a large proportion of cases. Time and assurance and regimen are alone needed, provided there is no evidence of deteriorated health. Absence of the function alone does not demand treatment—a fact which should be kept steadily in mind.

In a still larger class of cases the amenorrhoea depends upon, and is the direct result of, some pronounced cachectic condition, as chlorosis, scrofula, or a more or less active tubercular disease of the lungs. The treatment of this class resolves itself into that of the disease causing the derangement, and the reader is referred to the articles on the corresponding subjects.

The cases requiring more direct consideration therapeutically are those closely allied to the preceding, in which delay in appearance depends upon want of development of the body or general feebleness of constitution, or those in which absence follows and continues unduly after some severe disease. In all these cases the treatment is to be indirect rather than direct. The absent function is to be restored by improving nutrition, by increasing bodily vigor, and by using every means to establish the general health on a firm basis. Measures for this purpose should be addressed to every particular of the habits, occupation, and surroundings of the patient. They do not differ from those of a general tonic course, but in some particulars a special influence may be exerted upon the function at fault. The clothing should be warm, especially about the pelvis and lower extremities, due care of the feet being impressed in proportion to the universal neglect shown by girls and women in regard to these important parts of the person. The diet should be of plain, wholesome, substantial food, and in many cases one of the lighter wines may be added to the principal meal of the day with decided advantage. Gymnastics may be prescribed, but outdoor life should be urged, with horseback riding as the very best mode of exercise for promoting the flow. A change of air and scene exerts a well-known and powerful influence in improving nutrition and modifying vital actions. It should be rather from the city to the country for these cases. Special advantages may be derived from a residence at the seaside on account of the beneficial effects of surf-bathing. A scientifically-conducted hydropathic establishment is very desirable for its regular hours, well-ordered diet, and treatment by baths and douches. Or a watering-place may be preferred where a chalybeate water may exert a special influence in addition to those of moderate indulgence in the gayety and amusement of such a place.

Inquiry as to school-life and educational work should never be omitted. The general mode of education of girls is faulty in the extreme. No attention is paid to the great change of puberty, which amounts to a revolution in the economy, and instead of aiding the vital forces drawn upon for effecting this change, they are still further depressed by sedentary life in close rooms or strongly urged in another direction. No two leading organs of the body can be pushed in development at the same time with impunity. There is no exception here: either the brain and nervous system or the sexual organs will suffer. In this direction is often found a potent cause of all the forms of uterine derangement—a fact which cannot have escaped the observation of every physician. The writer has always urged an entire break in the school-life of girls of at least one year's duration at the time when signs of puberty begin to manifest themselves; and this period is too short rather than too long.

Tonics should supplement these regiminal measures. They may be hæmatic, stomachic, and nervous—either or all. There is a chain of diseased actions, and it may be attacked at any of its links. Iron stands at the head of the list. It is not only an hæmatic tonic, and in proper conditions a promoter of digestion, but decidedly promotes pelvic congestion, and has therefore an emmenagogue action. The forms at command are so numerous as to meet the requirements of any case or to satisfy any fancy. The standard preparations, as a rule, deserve the preference over more modern ones, in which efficacy is often sacrificed to elegance. Among the best are those which contain the remedy in a nascent state, as the compound mixture or the compound pills of iron of the Pharmacopoeia. Dialyzed iron, the tincture of the chloride, and the pyrophosphate are reliable, while the addition of manganese, as in the syrup of the iodide of iron and manganese, is believed by some to increase the efficacy. With iron may be combined nux vomica or strychnia and quinia. In large sections of our country malaria is a constantly-acting depressant of vital force, and the latter medicine may be given for a time with a free hand, and may be followed by or combined with arsenic to great advantage.

Constipation is almost universally present in women. It deserves especial consideration in treating all disorders of the sexual organs. When attention to habits and appropriate laxative food, as fruits, oatmeal, Indian meal, cracked wheat, and salads, do not suffice, resort must be had to enemata or drugs. Aloes has always had a reputation of special virtue in amenorrhoea which is doubtless well founded. In pill form it may be combined with any or all the other medicines. Pills of aloin, one-fifth or one-third of a grain, have the advantage of very small bulk.

Before considering more direct measures for establishing menstruation it may be well to recall to mind the two elements of the function—ovulation and the uterine flow. The first, the prime factor, we can not influence by any medicines nor by any mode of treatment except, perhaps, by electricity. Observation of animals shows that mere proximity of the male influences it plainly, but this only indicates a line along which we cannot prescribe. An opinion may, however, be asked in regard to the propriety or advisability of marriage for a woman who has never menstruated. In such case no advice should be given until after a thorough local examination, and its tenor will then be in accord with the condition of the organs. With such atresia or absence of organs as not to permit sexual intercourse marriage should be positively negatived. In such cases as those of partially-developed or absent uterus the facts should be laid before the parties interested and the decision referred to them. In the former class of cases some hopes of improvement may be entertained.