Hippocrates has truly said, “Uterus sexcentarum œrumnarum mulieri auctor merito dicatur.” Great and important changes ensue at puberty amongst the two sexes, especially the female, affecting their future health. In both, the organs of generation are then evolved, and the sexes first capable of procreation. The semen in males about this period, begins to be strained through the generative organs, the beard to sprout, and the countenance to assume a more masculine appearance. That periodical discharge of red blood from the female womb, called Menses, the index of womanhood, begins in this island to gleet monthly, about the age of 14, 15, or 16: but its first eruption and final cessation, as well as its periodical returns, are sometimes extremely variable; from 11 to 20 years of age; and its final ebb between 30 and 50; generally, however, between 40 and 50. In warm climates, the menstrual commencement is earlier, and more profuse. This discharge is not suddenly in a full stream, but continues oozing from 3 to 5 days, and even longer; the whole quantity in healthy women amounting to 4 or 6, and in others, to even 12 ounces: but the first efforts to menstruation are commonly scanty and irregular. The quantity of blood evacuated, the duration, the intervals, periodical returns and effects, are various; and are diversified by climates, seasons, constitutions, mode of life, habit, and by numerous other accidental circumstances. In different women the menstrual intervals are from 2 to 6 weeks, or longer; but when strictly regular, or the woman not pregnant, every lunar month. The first periods of menstruation, and the final cessation by age, are two very important epochs in female life, on which much of their succeeding health and longevity will hinge. But, without entailing diseases, many women are liable to some menstrual irregularity, with respect to the periods, duration, and quantity.
Morbid and Irregular Menstruation,
under the different heads of scantiness, chlorosis, or morbus virginius, retention, partial obstruction, and total suppression. The menstrual eruption is generally and naturally preceded by heat of the loins, and weight about the uterine region, frequently with pain and cholick, lassitude, headach, dulness of vision, disturbed sleep, inappetency, and nausea, pain and load about the breast: all which, with many other troublesome symptoms, usually disappear on the establishment of this salutary and critical evacuation. But where the menses do not flow at puberty, or afterwards become obstructed or suppressed, a numerous train of morbid symptoms and fatal diseases often ensue; such as inappetency, indigestion, colick, palpitation of the heart, difficulty and labour in respiration, pulmonary consumption, hectic, dropsy, fluor albus, low spirits, fainting, hystericks, insanity, apoplexy, general bad health, barrenness. Indeed, those women who have passed the stage of puberty some years without menstruation, are generally barren.—The Chlorosis appears about puberty, sometimes indeed earlier; and is more frequent amongst indolent and luxurious females. The complexion is pale, sallow, of a green sickly tinge; the lips pale, with aversion to motion, with debility, muscular flaccidity, inappetency, indigestion, craving for unusual and unnatural food, flatulence, palpitation of the heart, laborious and quick respiration on exercise or ascending any eminence; pain and weight about the loins, night sweats, hectic and emaciation, œdematous ancles, crude urine, usually obstructed menses, unusual bad health, and derangement of the animal, vital, and natural functions. It is seldom immediately dangerous to life, but often lays the foundation of some of those diseases above enumerated.
The predisposing and occasional causes of scanty menstruation, obstruction, and suppression, and of chlorosis, may be comprehended under the following: general bad health, debility, and unsound constitutions; partial weakness of the uterine vessels; too great resistance and rigidity of the uterine vessels; want of sufficient momentum in the sanguineous circulation; scarcity of florid blood; not sufficient motion nor exercise of the body; sanguine plethora; sizy blood; spasmodic constriction of the uterine vessels; sudden passions of mind, especially the depressing passions; cold wet feet; cold liquors and various cooling luxuries drank or eat at the menstrual period; crude watery diet; worms; celibacy; love; salacity stifled; lax fibre; severe parturition, and local diseases inherent in the womb and vagina.
Uterine Relaxation,
including excessive menstruation, fluor albus, leucorrhœa. There is a great similarity in all their causes. We here treat of menstrual excess in the unimpregnated state; reserving for pregnancy that uterine hemorrhage, vulgarly denominated Flooding. Menstruation may be morbid from frequency in the returns, from duration, and from quantity. It has already been said, that the quantity of the menstrual flux, the recurrence, and the duration, vary in different women: the immoderate discharge is determined not altogether by the absolute quantity, but by the effects: such as languor, debility, pale countenance, weak pulse, palpitation of the heart; depression of spirits, pain in the back and loins, inappetency, coldness of the skin and of the lower extremities; in the evening œdematous ancles. Excessive menstruation may either be sudden and within a few days, or chronic and persevering a long time beyond the natural period. There is also erroneous menstruation from various parts of the body; of which many extraordinary and monstrous examples may be seen in the records of medicine. Menstruation in excess, especially if chronic, is often accompanied with fluor albus; and may terminate in consumption and dropsy, and in many of the diseases enumerated, under obstruction and suppression.
The Fluor Albus often succeeds or accompanies excessive menstruation. It is a dripping discharge from the womb and vagina, and from the same vessels which exude the menses, sometimes pale and serous, or often variously intermixed with yellow, green, and red tinges; sometimes fetid and acrid, and either constant or irregularly intermittent. At the commencement, the usual concomitant symptoms ascribed to this disease, such as pain and weakness in the back and loins, indigestion, &c. only occur when the discharge is excessive, or long continued. It is then attended with a pale sickly colour and countenance, dejection of spirits, palpitation of the heart, lassitude and debility, pain in the stomach, loss of appetite, indigestion, flatulence, acrid and turbid urine, hectic. But notwithstanding the heat and acrimony of the excretion in many instances, especially when chronic and inveterate, yet it may easily be distinguished from venereal gonorrhœa. Women of various ages after puberty, married and unmarried, some even after the final menstrual cessation, are obnoxious to this gleet, which is not infectious. The fatal termination may be in some of the different diseases consequent of obstructed and excessive menstruation; such as barrenness, diseases of the womb; colick, piles, strangury, hystericks, low spirits, consumption, dropsy.
The predisposing and occasional causes of excessive menstruation and of fluor albus, are, many of the general causes of hemorrhages, already enumerated; plethora, sedentary, luxurious life, stimulating and nutritious diet; too long indulgence in warm soft beds; warm chambers; suppression of usual and habitual evacuations; weakness and laxity of the uterine vessels from abortion, violent evulsion of the placenta, or other injuries during parturition; difficult and lingering, and also frequent parturition; general relaxation, and delicate constitution; weak nerves; violent exercise, especially in hot climates and weather; excessive heat of the season or climate; moist watery climate; violent efforts of the body or muscles, or straining of the body and loins; external injuries, or falls near the uterine region; excess of venery and salacity, manustupration; spirituous liquors and drunkenness, intemperance, immoderate use of tea, and other warm fluids; immoderate use of warm baths or stoves; neglect of cleanliness and abstersion; passions of mind, frights; impeded perspiration; excess of serum in the blood; scorbutic habit and acrimony: purulent translation to and deposition upon the womb from other parts of the body; polypi, fungus, scirrhus, cancer, ulcers in the womb or vagina; procidentia uteri et vaginæ, emmenagogue medicines.