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Os

LIBRARY
I

PEACTICAL MEDICINE
PUBLISHED BY ORDER OF THE

MASSACHUSETTS MEDICAL SOCIETY,

FOR THE USE OF ITS FELLOWS.

CONTAINING

ASHWELL ON DISEASES PECULIAR TO WOMEN.

VOL. XIIL

-^o

BOSTON:
PRESS OF
T. R.

MARVIN,

24

CONGRESS STREET.

1843.

PRACTICAL TREATISE

DISEASES PECULIAR TO WOMEN,

ILLUSTRATED BY CASES,
DERIVED FROM HOSPITAL AND PRIVATE PRACTICE.

SAMUEL ASHWELL,
Obstetric Physician

M.

and Lecturer

to

Guy's Hospital, London.

BOSTON:
PRESS OF
T. R.

MARVIN,
1

24

CONGRESS STREET.

843-.

PREFACE.

It

is

now

nearly twenty years since the important branch

fol-

of Medical Science which constitutes the subject of the

lowing pages,
attention.
pital,

first

occupied

my

earnest and almost constant

this

During a great part of

its

period, Guy's

Hospri-

with

extensive

Lying-in Charity, and

practice
in

my own

vate

and

consultation

female

diseases,

have

afforded
titioners.

me
I

opportunities falling to the lot of but few prac-

do not,

however, on

this

account urge any

this kind,

exclusive claim to the publication of a

work of

nor

do

ask for

its

opinions and practice any exclusive and undue

still I

deference.

But

trust that the truth

in

of the principles,

and the treatment recommended

it

the book, will obtain for

professional brethren.

the sanction and confidence of

I

my

may

also add, that the

disposition to
I

publish has been

strengthened by an opinion
practitioners

have long entertained, that

who

hold important public appointments, are

bound, so

far as their sources of authentic information

can be
stock

made

subservient, to improve and increase the

It

common
really

of professional knowledge.

may,

too, be
its

urged
is

in favor

of
;

my
for,

attempt, that some production of

kind

wanted

while

we

possess
is

many

valuable single essays on female

diseases, there

scarcely one complete

and really practical

work.

VI

PREFACE.
I

commenced
It

this

treatise
it

many

years ago, and but for

its

difficulty

and extent,

would long ere now have been comit is

pleted.
to

must be remembered, that

to

strictly

devoted

pathology and treatment, not

anatomical
sciences

detail

and

physiological research.

The

latter

will

therefore

be introduced

for the sole

purpose of illustrating disease and

;

the influence of remedies

further .they

would be
that their

irrelevant.

Numerous cases are narrated, in order may show whether the histories of the
ble
issue,

symptoms

various diseases are

accurately given, and that from their successful or unfavorathe

danger of the malady and the worth of the

demonstrated.
for

treatment
practical

may be
men, and

These motives
volume.
to

will,

with

them

have written,

sufficiently apolo-

gize for the increased

size of the

Perhaps

it

may

be also urged, that cases add greatly

the interest of an

elementary work, tending

to

relieve the dulness from

which

a constant repetition of principles, without such

portraits, is

nearly inseparable.

The book will contain little which is not the product of my own practice and observation and if I have not quoted
;

largely from the works of others,

it

has not arisen from any

excellence, nor from any

want of a due appreciation of

their

unwillingness to acknowledge obligation, but because every

practical

book ought mainly

for

to rest

on what

its

author knows

and has proved

such
is

himself to be true and valuable.

Where
is

the case, a writer naturally uses a phraseology of his

own
to

the dress in which he appears before the public

seen
is,

belong, not to another, but to himself;

and there

in

consequence, a consistency of arrangement

throughout
perusal, that

and character
be seen on

the
I

whole.

Nevertheless,
to

it

will

have not forgotten

I

mention the names of

those from

whom

have derived valuable assistance.

Many

formulae of remedies are

appended
it

to

the

various

chapters, and this has been done, because

harmonized with
myself
;

the practical

plan that

had prescribed

to

and be-

PREFACE.
cause there
are

Vll

young

practitioners without

sufficient

the-

rapeutical knowledge, and older

men

with too

many demands

on

their time,

nicely to

test

the

value, and accurately to

determine the doses and other important conditions on which

the efficient use of remedies so

much depends.
treatise
it

My
so

aim has been,

to

produce a

on female diseases,
a
safe

true, simple,

and practical, that

to the

may form
curative

and

efficient

guide
least

elucidation and
intricate,

treatment of

many

at

of these

rapidly-progressing,

and

dangerous maladies.
will be a sufficient

If success attend
for the labor

the effort, that alone

reward
in a

of the work.

I
;

have
with

endeavored

to write

plain
;

and perspicuous style

and
in reference to

scrupulous accuracy as to facts

opinions

and treatment, nothing

worth of which
1

is

recommended, of the probability or

am

not myself convinced.

The
sion,

first

part of

my

undertaking
it

is

now

before the profes-

and

in

reference to

may
"

say, in the

words of the

great and lamented Dr. Gooch,

to execute his

When

an author attempts
is

own view

of a subject, he

the last person in

the world to judge whether he

has succeeded or failed.

impossible for him to see
in

When
it

he has finished his book,

it is

in

the

same
;

point of view, and

the
if

same

light, as

the
its

public will

and as he himself would,

it

he could, forget

thoughts and phrases, and read

with a fresh and impartial

mind

he

may show
is

it

to

a judicious and

well-informed
:

friend, but this

a poor

thermometer of public opinion

to this
I

the

only one

is

publication, and

must

trust the fate of

my

volume."
pleasure

In conclusion, I acknowledge with

sistance

valuable as-

afforded

to

me by Mr. Tweedie, Mr.

Lever, and

Mr. Oldham, the Obstetric Assistants of Guy's Hospital.

London, Grafton
Street,

Bond

Street.

September, 1840.

CONTENTS.
Page

Pathology of Functional Diseases of the Uterine

System,
1

CHAPTER
Of
Chlorosis,

I.

Of Amenorrhea,

.......
II.

CHAPTER

84

CHAPTER
Of
Vicarious Menstruation,

III.

140
IV.

CHAPTER
Of Dysmenorrhea,

151

CHAPTER
Formulae of Remedies,

V.

179

CHAPTER
Of Menorrhagia,

VI.

192

CHAPTER
Of
Leucorrhoea,

VII.

238

CHAPTER
Of

VIII.

the Disorders attendant on the Decline of Menstruation,

295

CHAPTER
Formulae of Remedies,

....

IX.

305

A PRACTICAL TREATISE

DISEASES PECULIAR TO WOMEN,

PATHOLOGY OF FUNCTIONAL DISEASES OF THE UTERINE SYSTEM.

propose
in

to arrange the diseases peculiar to

woshall

men
eases

three great divisions.

;

In the

first, I

place the functional

;

in the

second, the organic dislast part

and

in

the third

and

of the work,

will be

comprised the affections of the pregnant and

puerperal states.

A
what

few preliminary observations on the pathology

of each of these classes

is

may

explain and

illustrate

subsequently to be advanced.

The

func-

tional are

more complicated and

less easy of accuIt

is

rate diagnosis than the structural diseases.

often difficult to assign a precise locality to the for-

mer, as few of them are exclusively confined to the

uterus, but exert, through the
lionic

medium

of the gang-

system of nerves, an extensive constitutional

2

10
influence.

FUNCTIONAL DISEASES OF THE

The

difficulty is

not so great in deterlesion.

mining the seat and degree of an organic

functional disease
viation
is

one which

is

dependent on de-

from

the

natural or healthy action of any

be uncon-

part of the organization, indicated by symptoms dur-

ing

life,

which after death are found

to

nected with discernible changes of structure.

trast
tially

Constrik-

such a disease with cancer or scrofula, essenorganic maladies, and the difference
In the latter, any part
is

ing.

which
its

is

attacked will

suffer conspicuous

changes of

texture,

and con-

formation.

Functional uterine affections are mainly

dependent on the derangement of menstruation

such
for

instance

as

chlorosis,

amenorrhcea

and

dysmenorrhcea, profuse menstruation, menorrhagia,

and

in

some measure

leucorrhcea.

In

all,

there

is

a deviation from the standard of uterine health.

chlorosis,

In
is
;

amenorrhcea and dysmenorrhcea, there

of the

scantiness

catamenial
its

secretion and
varieties there

pain
is

w hile
T

in

menorrhagia and
excess
;

pro-

fusion and

results
in

indicative, probably, of

marked

difference

the

nature of

the primary

affection, both of the organic nervous

system and of

the circulation.
is

In health, the catamenial secretion

generally of the color of the venous blood, perflorid,

haps slightly more

but less viscid and without

the power of coagulation, never separating, as blood

does, into
its

component
it

parts,

however long
in

it

may
for

be kept.

Ordinarily,

occurs once

every lunar

month, and without pain, the process continuing

three, four, or five days,

and the excretion amount-

UTERINE SYSTEM.
ing, in
fluid

11

quantity, to three, four, or five ounces

the

having a faint and sickly, and occasionally an

different

offensive odor, quite

little

from blood, and but

disposed to putrefaction.
is

There
In
in

considerable variety in these particulars.

is

some women, menstruation

others, less

performed more,
individual,

frequently.
secretion

In one

the

amount of the
it falls

exceeds, while in another,

also in

short of the usual quantity, differing

or

its

quality

character.

So

far,

however, as

my

observation extends, at least

within certain limits,

regularity in the periods of menstruation

appears of

greater importance, than either the absolute quantity

or quality of the fluid.
in estimating

Nor must

it

be forgotten,

the influence of menstruation on the

is

health, that the catamenial secretion

peculiar to
is

the female of the

human

race.

There

no analo-

gous secretion in other animals.

Their uteri are

neither so thick, so capable of development during

pregnancy, nor so vascular

nor

in

any of them, not

in

even

in

those species of apes

which walk nearly

the erect position, have

we any

proof that the muis

cus discharged during the oestrum,

the uterus
;

furnished by

it

is

thought to be almost entirely a

vaginal fluid.

Menstruation

may with

truth

be said to be a

function of the highest importance to

women

so

intimately connected with the whole of their econ-

omy,
ease.

that

its partial

or entire suppression,

may and

does often induce serious and sometimes fatal dis-

12
It

FUNCTIONAL DISEASES OF THE

might have been supposed that there would be

structural or physical
itant

changes

in the uterus,

concom;

with these affections.

But

it

is

not so

for, if

the undeveloped organization of the uterus and ovaria, in chlorosis,

be excepted, there

is

little

discov-

ered by post-mortem examination, to account for

these derangements.

Even

in

protracted and incurable

life,

menorrhagia,
rise

which occasionally destroys

by giving
if

to

dropsies and other secondary diseases,

there have

been no morbid growths co-existing, the uterus will

not yield evidence of
increased
softness

much
will

structural disease.
its

An

and paleness of

parenchyma

and lining membrane,

generally comprise the

whole of the

visible

organic change.

The same
in

may

be

said

of

amenorrhoea and dysmenorrhoea.

the
latter

Beyond hypertrophy and congestion

affection the organization

generally continues unal-

tered.

The
tions,

local

symptoms accompanying

these affec-

excepting dysmenorrhcea, are usually slight

and obscure.

The

constitutional derangements, on

the contrary, although functional and sympathetic,

are severe and extensive.
chlorosis,

Thus,

it

is

common

in

amenorrhoea and dysmenorrhoea, as well

as in menorrhagia, but particularly in the former, to

have marked disturbance of the nervous, vascular,

respiratory, and digestive
fact, that the

systems
its

pointing to the

womb

and

appendages derive their

nervous energy from the organic nervous system,

while the external genitals derive their supply,
al-

UTERINE SYSTEM-

13

most
great
other.

entirety from

the spinal

marrow.

Thus

are

the internal and external

organs of reproduction, in

measure,

functionally

independent of

each

Even
in

paralysis of the lower extremities

and

external

organs
the

may

exist,

without a similar want

of power

conceptive faculty of the ovaries

and uterus.

The proximate
rosis

cause of these functional mala-

dies has excited a good deal of controversy.

Chlo-

ought to be attributed

to

an impoverished circuDr. Hamilton, see-

lation

and undeveloped ovaries.

ing that costiveness frequently precedes and accom-

panies chlorosis,
state as
its

erroneosly,

think,

regards this

cause.

He

also denies the influence of

the genitals on the general

health, and

says " that

castrated and spayed animals

suffer certain

changes
of

of constitution, but
perfect health.
savs,

they retain the enjoyment

this

Reasoning from

analogy," he

"

do not understand how the influence of

so
great, as that
its

the female genitals can be

tial

par-

suspension

should

occasion

retention
I

of

the

menses, or

should induce chlorosis."

in error here.

think Dr.

Hamilton
and

is

In the case of castrated

spayed animals,

puberty

was
the

either

already

present, or would
tion.
is

have occurred, but

for the castra-

In

early chlorosis, on

contrary, puberty

absent

when

it

ought to
the

exist,

and the subsequent

absence or

evils are not so

much

result of the
in

abstraction of the genital organs (for

Mr. Pott's
after
defi-

celebrated case the

the

woman

lived

and did well

removal of the ovaries,) as of the early

14
ciency of
tiveness,
results.
effects

FUNCTIONAL DISEASES, ETC.

vital

energy or power, of which the coswith the chlorosis,

is

equally

one of the

This author overlooks,

of
life,

in the

conservative

when important organs have been

fatal

taken away, the injurious and sometimes

convital

sequences of such a congenital deficiency of

power, as

shall

permit the reproductive apparatus to

entirely undeveloped,

remain

partially or

and

who
?

can measure the amount of the injurious effect

The
gous.

examples, therefore, are by no means analo-

Amenorrhcea

is

connected with a torpid and

inactive state of the generative organs, excepting in

those cases where, from a variety of causes, marked

derangement of the uterine

most frequently induced by

circulation exists.

Dys-

menorrhcea, as a functional disease, appears to be

irritation

more

or less

acute, by a low inflammatory state

of the uterine

mucous membrane,
menstruation
the capillaries

or

by an active, or even slow

congestion of the uterus.

Menorrhagia and profuse

may
;

arise

from different conditions of

having lost

which are sometimes over-distended

;

from repletion
tone,
tents.

and

at

others,

their

permit the passive exudation of their con-

FUNCTIONAL DISEASES OF THE UTERINE SYSTEM.

CHAPTER
OF CHLOROSIS.
Definition.

I.

A peculiar
icheti
it

health; in which debility,

of the general languor, and deranged

affection
;

stomachic functions are prominent symptoms

most

frequently occuring

puberty

is

or ought to be

established, although

may

exist at

any subsequent

period, always characterised by ancemia of the system,

and a
;

yellowish, dirty green pallor of the sur-

face

ivhen a disease of early youth, almost invaria-

bly connected, either with entire absence of menstruation,

or

ivith

scanty,

painful,

and

irregular

performance of the function, and if a disease of later life, in addition to these causes, it may have
been preceded and produced by menorrhagia, or leucorrhcea.

History and Symptoms.

cision
is

In furnishing
incipient,

these, pre-

important, as chlorosis presents itself in

:

three forms

as a mild

and

an inveterate

and confirmed, and a complicated disease.

16

CHLOROSIS.

The

incipient
:

and mild form commences almost

patient has been, perhaps

unobserved

the

from

infancy, or at least for

cate

some years

previously, deli-

and
;

feeble, so that

anxiety has existed about

her

but now, at the age of twelve, thirteen, or

fourteen years

without
of

any

obvious

exciting

or

morbid cause, other than a negative one, the nonestablishment

puberty

series

of distressing
in,

and perplexing symptoms are ushered

servation
is

and obHither-

more especially directed

in

to her, because

an important epoch
to she

her

life

has arrived.

has been delicate, but there has been pro-

bably no disease.

Now
7

she excites apprehension

from the gradual but evident decline of her health,

in connection either

w ith

the

entire

or partial abto

sence of menstruation.

She does not pass on

soon
fatigued,

womanhood. Such a patient

therefore inactive
listless
; ;

is

languid,
is

and

she

not cheerful, but dull, and

sullen,

sometimes perverse and

and prone
it

to

solitude.

Her

appetite

is

capricious,

either
food.

fails

altogether,

or she

craves
;

unwholesome

Her complexion is altered although always pale, it is now much more so. The bowels are constipated
;

the tongue
is

is
;

of a dirty, pasty white

the

breath

offensive

she suffers from flatulence

the

slightest exertion fatigues

and induces short breath-

ing

frequent, severe, and peculiar head-aches, pal-

pitation of the

heart and pain in the side, are

;

comand
cata-

mon

occurrences

the

pulse

is

quick, weak,

compressible, and sometimes fluttering.

The

CHLOROSIS.
menia,
if

17 have
scarcely

not absolutely

retarded,

appeared, the discharge having been pale in color,

and scanty

in quantity.

The symptoms
vated degree, and

already described, in an aggra-

some new ones, attend

inveterate

and confirmed chlorosis.

The

debility,

languor,

and
is

listlessness, are

more complete, the appetite

desire

more marked. The depression is more morbid, with

very often for slate-pencil, chalk, acids,

pickles,

and other things equally pernicious.

still

The
;

complexion becomes
a yellowish,
junctivae,

more

characteristic

it is

dirty green, and

the

lips,

gums, conpaler white,

and lining membrane of the mouth, are

;

bloodless

the tongue, too,

soft

is
it

of a
is

still

and being
the teeth;

and flabby,
is

easily indented

by
is

the breath

more offensive; there

nausea;
burn
;

sometimes vomiting and

frequent heart-

the bowels, although

generally constipated,

are occasionally in
diarrhoea.

a
is

state of irritable

and painful

There

acute and anomalous headache,

of distressing- sensation,

attended by every variety

such as heavy weight

in

the front or at the back of

the head, vertigo, fixed and intense pain in one particular spot, paralytic feeling
is

and neuralgia.

There
the

a dark line underneath the eyes, about the alae of

the nostrils and at the

eyelids are

angles of the mouth

in

dark and cedcmatous

the morning
;

the ankles and legs are frequently so at night

cellular or soft tissues

the

are flaccid, and

the surface

generally, especially
tremities,
is

of
If

the upper and lower ex-

cold.

menstruation has continued

18

CHLOROSIS.
to this time, its

up
the

intervals
is

become more
scanty,

distant,

discharge itself

very

continuing to
it

flow only for a few hours, and in quality

serous and pale, and of offensive odor.

is

often
is
is

There
the skin

sometimes a general dryness of surface

no longer
resilient
;

there
;

is

a splitting and brittleloses

its

ness of the finger-nails

brightness,
color. for the
It
falls off in
is

the hair

glossy

large quantities, and alters in

in

not

uncommon
to

advanced chlorosis,
;

abdomen

be

full

and painful

and without

decided phthisical complication, there

short cough, pain under the left
teria in a variety of forms.

may be slight, mamma, and hysone or

so far mislead as

At

this period,

several

symptoms being confirmed,

belief, that

to induce the
liver,

the lung, the brain, the

organically diseased.

or
is

the

Such

the

may be malady when fully

heart

developed.
in the presence, in

Complicated chlorosis consists

greater or less degree, of the general

symptoms of

the disease, with a more prominent morbid affection

of some distinct organ or part of the system.

Predisposing causes.
developed

delicate, feeble,

and un-

constitution,

where the
in

circulation

and

nervous power are inadequately exerted to perfect

the

organization of the body

consequence of
is

which the evolution of the ovaries

their peculiar influence
larly

delayed, and

on the system, and particuwithheld

;

on the uterus,

is

thus, puberty is
all

only imperfectly or perhaps not at

established,

and menstruation, which must be preceded by puberty,

is

absent.

At a

later

period of

life,

when

CHLOROSIS.
even married
of
chlorosis,

19
are the subjects
is
;

women and widows

its

predisposing

cause

most
there

freis

quently

derangement of

menstruation

either retention, irregularity, or pain

in

and

difficulty,
it

the performance of the function.

Nor must

be forgotten, that profuse menstruation, monorrhagia,

and chronic leucorrhcea, may induce chlorosis.

cold,

A damp,

and marshy
late

locality,

insufficient

and innutritious food, the

of fashionable
the
life,

hours and excitement

the sedentary employments of

ill-ventilated

poor

in

crowded and
is

factories,

where the temperature

offensive, in
fact,

high and the smells are

whatever relaxes and enfeebles

life,

the system, at any period of

and especially
our

at

an early age, predisposes to

Chlorosis
sex,
is

this disease.

occasionally

met with

in

own

and

certainly have
it.

seen one or two well

marked instances of
Exciting causes.

Circumstances

which depress

the mind, and keep the feelings in a state of painful

suspense or delay, unrequited affection, an attach-

ment which

is

opposed on account of

its

impru-

dence, separation from family and friends, the sadness occasionally induced by being at school
;

ha-

bitual constipation of the bowels, according to Dr.

Hamilton.

Amenorrhcea, leucorrhcea, and monorvenereal

rhagia, excessive

indulgence, and manu-

stupration,

weaken

the powers generally, and espe-

cially the tone of the

sexual system, and thus conIn

all

duce

to chlorotic disease.

these causes, the

impaired influence of the organic system of nerves

20

CHLOROSIS.
be traced, not only on the ovaries and uterus,

may

but also on the organs concerned in digestion, circulation,

and respiration.

Pathology
fairly

of chlorosis. assumed, certainly it

It

may

probably

be

is

the most prevalent

opinion, that chlorosis primarily depends on a morbid condition of the blood,

which secondarily
their
fact, that

affects

the ovaries and

uterus,

by retarding

growth.
in the

This opinion

is

supported by the
is

blood of chlorotic patients there

portion of the serum, with a

an increased pro-

marked diminution of

the crassamentum.

This has always been

it

my

view
to

of the disease
this
all

nor would

be

difficult to trace

morbid condition of the blood, many

the
different

nearly
pro-

theories

which

have

been

pounded.

Gooch and Andral pointedly

riorated quality of the blood
;

allude to the dete-

the former in his pubgirls

lished lectures,*

says,

" If

in

who
is

have at-

tained the age at which this change

the
state

customary,

sexual organs
of
the

are

not developed, a deranged

constitution
ccc.

peculiar

symptoms,"

"

occurs, characterized by
In addition to the other

circumstances just enumerated, the quality of the

circulating fluid
is,

in

chlorosis, altered

blood has
has been

been taken by

way

of experiment, and

it

found to be of a pale red color and watery, like the

juice of a cherry."

After thus acknowledging that

the sexual organs are not developed, and that the

blood

is

morbidly altered, Dr. Gooch, inconsistently,

#

Vide Gooch's Lectures by Skinner, page

7.

CHLOROSIS.
I

21

think,

condemns, as entirely groundless, the opinion

influence

that chlorosis depends on the absence of the physiological

of

the

ovaries

and vet a

little

further on, in

explaining his

own

views, he says,

" that chlorosis depends on a want of that constitutional

vigor,

by which the sexual organs

;

brought into action

that to this

may be deficiency may be

the constituit

imputed the
functions.

failure

both of their development and

At the period of puberty,

rouse and excite
to

tion has not only itself to nourish, but

must have

energy
organs
;

to
it

action a
for

new

set of

must supply the materials

all

an increase

of their growth, and

their functions."

other purposes incident to

Dr. Gooch could not more accu-

rately have explained the course

by which the blood,

quan-

when impaired
tity,

in

quality and diminished in

delays puberty and menstruation, and in their

stead allows the establishment of chlorotic disease.

AndraP sobservations on the anaemia of

are
that

chlorosis

so
I

confirmatory of the views

now

expressed,

cannot

resist their entire quotation.

"
its

The

expression,* general
is

anaemia,
;

if

taken in

rigorous signification,

incorrect

for the sys-

tem can never

other

suffer the total

and complete absence

of blood, without the heart ceasing to act, and the

phenomena of

life

becoming

extinct.

The

term hyphemia would

therefore

be more

correct.

The

quantity of blood in circulation may, however,

be so diminished, as no longer to penetrate the miVide Pathological Anatomy, translated by Townseud and Vol. i., pages 97 and 106.
*

\Y est.

22

CHLOROSIS.
its

nute vessels of the cutaneous surface, in which

place
is

supplied

by a thin serous

fluid

and

after
is

death, a deficiency or even total absence of blood

observed, not only in the

large arteries, veins,

and
In

right side of the heart, but likewise in the capillary

system, which

is

remarkably pale and colorless.

these cases the

tissues, such

membranous and parenchymatous

as the brain, lungs, liver, kidneys, ali-

mentary canal, and the parenchyma of the heart

and muscles, are also remarkably pale and exsangueous."

Andral again says, " In chlorosis several of the

morbid phenomena
served
;

first

recorded are constantly obis

and

if this

disease, as

now

generally ad-

mitted, frequently results from a defective formation

of the blood, the cause of which

sively in the nervous system,

may reside exclucan we with any show

or

of reason refer either

congestion,
the

to

irritation

sanguineous
functional

proteus-like variety

of

derangements which chlorotic patients so constantly

present, such
as
epileptic

paroxysms, convulsions,
?

chorea, dyspnoea, palpitations, vomiting, &lc.

shall

Or,

we

not approach nearer the truth, in assigning

these different morbid

phenomena
in persons

to the

same cause
light,

which produces them

a state of anaemia

who

are reduced to

by the deprivation of food,

?

and wholesome atmosphere

We may

appeal to

the test of experience, to the leedentia and juvantia,

for the further confirmation of this doctrine.

Veneirrita-

sections employed in such cases to combat an

tion,

which

in reality

does not exist, invariably pro-

CHLOROSIS.
duce a marked aggravation of
all

23
the

symptoms

on the contrary,
ulating the
tients

it

frequently happens that by stim-

nervous system of these chlorotic pa-

by the physical and moral emotions of matri-

mony, we produce a more natural complexion and

color of the

whole cutaneous
and

surface, thus indicat-

ing a correspondent improvement in the process of

sanguification
;

in

proportion as the anaemia dis-

appears under the influence of this

tion of the nervous

new

modifica-

system, the whole train of disconstant sen-

eased action, the

sation

difficult respiration,

of uneasiness and listlessness, impaired di-

gestion, gastralagia, vomiting, tympanitis and limpid

urine, together

with

all

the strange nervous

symporganic

toms, which seemed dependent on some

alteration

of the

solids, gradually subside

is

and eventgenerated

ually vanish, as a fresh supply of blood

in the

system."

Diagnosis.

is

It

will

be allowed, after what has

is

been advanced, that chlorosis

disease.
It

not an inflammatory

indeed

most intimately connected

with anaemia, and closely resembles (except in the

pale greenness or dinginess of the skin,) that state

of system which

is

the result of hemorrhage or any

therefore, such

undue
as

secretion.

Those symptoms,

severe headache, pain in the side affecting the

heart,

breathing, distressing action of the

eral others,

and sev-

must not and cannot, where proper cautreated as

tion

is

observed, be mistaken for and

acute inflammatory affections.

this

From

the

want of

caution,

have witnessed the very injurious

24
consequences
of

CHLOROSIS.
such
mistakes,
in

the

practitioner
it

having forgotten, what

liarly

female disease

is

pecu-

important to remember, that the severity of

the pain, and the rapidity of the pulse, are generally

indications of irritability and excitement, not of in-

flammation

demanding

narcotics, carminatives,

and

at the most, counter irritation, not

bleeding, active

purgatives, or spare diet.

rect,

If

my

definition be corexist,

amenorrhcea, which may, and often does

quite independently of chlorosis, cannot be regarded

as a

synonymous
yet

disease.

It

is

impossible, that

there should

be chlorosis
it

without more or less of

seen,
that

amenorrhcea,

is

often

there

is

amenorrhcea without any degree of chlorosis.

quite true,
that

It is

cured or relieved

when amenorrhcea has not been when it has produced, by its long
symptoms
will

continuance, extensive constitutional derangement

that then chlorotic

appear, and that,

ultimately, the series of morbid

tuting chlorosis will be

clearly

phenomena constiseen. Nor must it

a frequent cause

be forgotten, that chlorosis

of amenorrhcea, by
its

is itself

prevention or protraction of
;

puberty, on which menstruation depends

sequently, even

and sub-

when
to
its

the catamenial function has

its

been established, leading to

partial suspension,

and occasionally
will be

entire

suppression.

There
from

no

difficulty in distinguishing chlorosis

chronic affections of the abdominal viscera, especially

from hepatic, splenic, and renal disease, or

from any morbid
state,

indeed

of which anaemia

and pallor are prominent symptoms.

The

period of

CHLOROSIS.
life,

25

the peculiar aspect of a chlorotic patient, and

the derangement of menstruation, will ensure a correct diagnosis.

In the complication of chlorosis icith amenorrhcea,

the ovaries and uterus are principally affected.

Here
pre-

the chlorosis

may have

existed

for

some time,

venting the complete establishment of puberty and

menstruation, but allowing both in a partial degree.

some months, when the function entirely ceases, there is a marked deterioration of the geneAfter
ral

health,

and the malady becomes a double or

It is

complicated one.

chlorosis with amenorrhcea.

Or

this

combination

may

gradually occur, as the re-

sult of

amenorrhcea produced slowly and insidiously,

or years of healthy

after

months
I

and natural menlatter disease is

struation.
rare, the

need not say that the

is

other
It
is

common,
the

and,

if

protracted, dan-

gerous.

this

complication with amenorrhcea

confusion of

which has

led

to

names
so

the
inti-

symptoms of menstrual suspension being

health, as to have induced, in
ion, that

mately blended with the affection of the general

many minds,

the opin-

chlorosis and amenorrhcea are convertible

terms, and that they really denominate one and the

same

disease.

It is

almost unnecessary to add, that

these are the cases which so frequently terminate in

health, if early, well, and sedulously treated.

Un-

der tonic treatment especially, the blood

ed, both in quality

is

improv-

and quantity
is

the

pallor of the

surface disappears; there

a vigor of system never

before possessed
4

and, prompted and sustained by

26
this increased

CHLOROSIS.
energy of the constitution, the various
;

functions of the system are better performed

pu-

berty

is

more

fully

developed

and thus, with or and pretty

at length

without the assistance of emmenagogue medicines,

the

catamenial

secretion

is

regularly

abundantly established.

few months demonstrate,

is

that the transition from disease to health

safely,

though tardily and with

difficulty

completed.

Of

course, in

some

instances, the duration of these

will

chlorotic

and

amenorrhceal complications

be

painfully protracted, and there will be an aggravated

severity

of symptoms, productive of great alarm.

it

In such circumstances,

will

be necessary to re-

double, not the activity of the treatment, but the

care and watchfulness bestowed
so that

upon the

patient,

we may
it is,

discern immediately any indications

;

of further complication

always remembering,

how

probable

in

this climate at least, that

phthisi-

cal disease
If the

may

occur.

malady continues, although the treatment

ably and perseveringly pursued, pa-

may have been

rental alarm

and professional anxiety will soon be

heightened.

There are instances, however, where

the critical point in the disease

may have
employed.

arrived,

before any treatment has been

Such

maladies are prevalent, and present nothing unusual

delicacy of constitution, and imperfect menstruation,
are events of every
lay consequent on

day
the

and to the neglect and dethe disease,

I

commonness of
attributed.

many

fatal results
last

may be

have often,

during the

few years, been requested to treat

CHLOROSIS.
such patients, of
heard,
I

37

whom, had

judged from what

;

should not have predicted any danger

inquiry

and

jet, on careful
first

sight

and,

in

some

instances, at

have been convinced that the case was

Chlorosis,

all

but hopeless.

combined with ame-

norrhcea, like other diseases, does not at once as-

sume an aggravated form

described exist frequently

the
for

symptoms already
a long period in a
to deny,

moderate degree; and

that

it

would be wrong
gradually

there are cases

the
air,

in

which, independently of
passes

treatment,

mischief

away.

Change

of

a residence in the country, and

more

natural and out-of-door avocations, seem,

by their

combined influence,

to

lead

to the

development of

puberty, and subsequently of menstruation and good

health.

This however,

is

not the usual course of events unsuccessful

more frequently
peculiarly
if

after

treatment, and

there be entire amenorrhcea,

some

or-

gan, the cerebrum, for instance, or the digestive apparatus, or the lung,

becomes especially deranged

for their

and the functions, dependent

natural

per-

formance on the healthy condition of

this structure,

are disturbed, and, to a degree, marking the fact,

that this
is

the organ or part peculiarly affected.

Complication of chlorosis with

blood from the stomach by vomiting,

discharge
is

of

This

not an

unusual

concomitant of protracted
In

chlorosis

and

amenorrhcea.

such cases, the treatment

may

have been partially successful.

The
if

nutritious diet,
iron

and the tonic remedies, especially

has been

28
used,

CHLOROSIS.

may have improved both

the quality and quan-

tity of the circulating fluid.

In this condition, the

suspension of the eatamenia continuing, congestion,

or,

according to the French, " engorgement," occurs

in

some of the organs of digestion and

nutrition
is

irregularity of gastric

and intestinal action

the

result: constipation, pain, spasm,

and nausea harass

the patient

and, in an effort to cough or to vomit,

is

a quantity of dark, venous-colored blood

up.
It

thrown

often happens, that these dissharges observe

a catamenial period, recurring every three or four

weeks;*

there being in the intervals more or less of

I

leucorrhceal secretion.

have seen patientsj*darm-

ingly ansemiated by these hemorrhages, especially

where the amenorrhcea has been of long standing,

and where
sometimes
it

has been greatly neglected.

to

It

is

perplexing

determine

whether the
quanpoint

blood comes from the stomach, the lungs, or the

mucous
tity

surface of the fauces and trachea;

its

and color will generally determine

this

although there are cases, where pulmonary bleeding

is

extensive, and

where, from some quantity of the

blood having been swallowed, and again rejected,

by vomiting,

it

has acquired a dark hue and a clotted

still

form, involving the point in

more

difficulty.
;

Doubt
if

will

not,

however, be of long continuance

the bleeding be pulmonary, there will be a preva-

lent cough,

and a

series of

symptoms
It is

plainly denot-

ing disease of the lungs.

observe, that local
*

scarcely necessary to
are here peculiarly

emmenagogues

Vide Chapter on Vicarious Menstruation.

CHLOROSIS.
useful
:

29
is

the quantity of the blood

increased

suffi-

ciently to allow of the

advantageous elimination of
;

the menstrual

secretion

and every

effort

must be
irrele-

employed

to establish the function.

Nor

is it

vant to remark, that persevering and active treat-

ment

is

generally successful, where the bleeding

;

is

not pulmonary

and

have seen two cases, where

the hemorrhage has been large, and from the lungs,

both of which yielded to persevering management.

Complication of chlorosis, with chronic derange-

ment of digestion and nutrition. In the milder form, there is always some disorder of these functions
:

it

but in

its

aggravated degree

demands much

professional attention.

In these cases,
tion

we do

not wonder at the emacia:

which may have occurred

interfered with.
;

our only surprise

is,

that the functions of life should not have been even

more
is
I

Patients in this condition eat

little

scarcely any thing

and the

they do swallow,

generally of the worst and least nutritious kind.

am aware

that families
this

and medical men are occapoint

;

sionally deceived on

but

am
I

also per-

suaded, that in

many

instances,

where

have been

consulted, there has

been no fraud, the patients not

:

having obtained food surreptitiously

and

may be
these

allowed to remark, that although medical scrutiny

and acuteness are never more useful than

cases, yet that
it is

in

unwise and unkind

to express a

suspicion of this sort, without

It is interesting to trace

some

tolerable proof.
this

and

to

watch

complica-

tion.

An

impression every

now and

then exists,

30

CHLOROSIS.
lit-

that such a patient cannot recover; she takes so

tle,
is

her strength

is

so impaired, the whole system

so emaciated, that she seems only to wait for

;

some
if

favoring circumstances to induce phthisis

and

she be hereditarily or constitutionally predisposed to

this fatal

malady, the probability

is

that she will not

escape

it.

And

yet

know

of no combination of

chlorosis

which affords such ample scope and reward

and observant treatment. change
to
for a structural
liver, or intestinal

to judicious, persevering,
It
is

rare

occur in the

stomach,

organs, in the most proit

tracted form of the disease, although

to see the largest

is

common
The

amount of functional derangement.

all

Nor

are

the attendant evils only physical.

mind, the disposition, the temper, are

disturbed.

Gloom and despondency,

satisfied feeling, oft
trol

ennui, irritability, and dis-

times exert an irresistible con;

over such patients

is

and when their present

t

state

compared with what they were months previously, the contrast

is

welve or

fifteen

lamentable

indeed.

Seclusion and solitary habits are frequently

indulged, and require the watchfulness and penetration of the physician

and the family.

Nor

are in-

stances wanting, in which mental peculiarity has for

a time assumed not only the appearance but the

reality of insane

aberration.

Such individuals are

;

seldom the subjects of high excitement

rarely violently insane.
in error

they are

More
;

frequently, they are

or,

on a few points only

giving up

all

for

lost, as to their

recovery, they indulge in depression

and despair.

It is

unnecessary, minutely to describe

CHLOROSIS.
the various indications of digestive disorder. are so

31

They

common, that they must be well understood. Nor can it be too strongly urged, that disorder of
the general health, on which, perhaps, delayed puberty depends, and to which menstrual irregularity

and suspension may be so often traced,

is

most

inti-

mately connected with the condition of the alimentary canal,

and of the organs subsidiary

to digestion;

and

if

the

peculiarities of the constitution, already

pointed out, together with puberty and menstruation,

especially modify the female

economy,

it

may be
in them,

allowed that the state of the digestive organs exercises a

more extensive and peculiar power

than in our

own

sex.

Complication of chlorosis with functional affection of the cerebrum, There is scarcely any complica-

tion

more

difficult

to relieve

than

this.

The

varie-

ties, as to situation,

and the

differing degrees of in-

tensity of the pain, are

worthy of observation.
is

In

some
pain

individuals, the uneasiness of the head

gen-

eral, but not

is

severe

while

in others, the site of the

limited,

and so

agonizingly

intense,

as

scarcely to be endured.

In not a few instances,

the pain

is

periodical,
it

and of neuralgic severity,

while in others,

is

so nearly constant, as to pre-

clude mental or physical exertion, and almost to in-

duce the belief that

ganic affection.

it

must be connected with

it

or-

Nor

is

very

uncommon

to

meet

with

fits

of hysteria, chorea, and epilepsy, attributed

by the patients themselves, and perhaps correctly,

to the

long-continued and painful affections of the

32
head.

CHLOROSIS.

These

diversified degrees

of suffering will,

of course, be associated with a variety of morbid

cerebral sensations
in others,
:

in

some, there will be vertigo;

an overwhelming sense of weight.

At

one time, there will be paralytic sensation about the

head and upper extremities;

at another, a painful

quickness of sensibility; and with

feelings,

many

of these
the
or-

there

will

be morbid sympathy, of

stomach especially, as well as of the digestive

gans and alimentary canal.
bered,
ed,

Let

it

only be

remem-

how these morbid actions will become blendhow irregularly and extensively they will affect
it

the entire system, and

will not be difficult to con-

ceive of the tedium and misery which these patients

endure.

It is

consolatory to know, that, in by far

the majority of individuals thus suffering, the affection

of the cerebrum
;

is

functional, there
if

is

rarely

structural disease

and

pressed for proof of this

opinion,

recovery, even

we may point to the numerous instances of when the symptoms seemed clearly

to indicate organic affection.

It is

nearly impossible, within reasonable space,

the distressing and intricate morbid re-

to describe
sults

attendant on this complication.

There

are,
dif-

however, as already stated, not only shades of

ference in the

amount
I

of suffering, but

marked exto call

tremes

and

know

nothing worse than the aggra:

vated cephalalgia peculiar to this disease

it

a nervous or a sick headach, even of the worst kind, gives only a faint idea of the intensity of the evil
for
I

have heard many patients deliberately declare,

CHLOROSIS.
that
life

33
it

would be undesirable, were

of

to be contin-

ued
rary

in

association with this sad infliction.

Tempo-

loss

memory and

aeuteness of perception,

physical irritability, torpor, and derangement of the

organs of digestion are amongst

consequences.

its

most common

Yet

it

is

important to know, that

there are, in most cases, limits, within which the

morbid influence
with which, even
greatly
interfere.

is

confined.

There

are functions,

this

amount of suffering, does not Such patients sleep tolerably

is

well

their appetite
;

capricious, but not wholly

is

destroyed
there
is

and,

although nutrition

imperfect,

not

much

or rapid emaciation

a
is

circumseen
in

stance

in

decided contrast with what

chlorosis complicated with organic

It
is

pulmonary change.

not meant to be stated, that structural altera-

tion

never occurs, nor that ultimate recovery from

is

the headache

invariable and certain.

But, after

having treated

many

of these diseases,
for a

and after-

wards having watched them

I

considerable time,

am

disposed to believe that the cerebral structures,

for the

most

part,

remain unchanged
and,

and that the

in

cephalalgia of

many months,
is

some

rare

cases, of years' continuance,

lost,

eventually completely

provided

puberty and menstruation are fully

established.

The

cerebral

affections attendant

on

epilepsy must be excepted from this statement, and,

perhaps, that highly nervous and paralytic tremor or shaking, which very
is

sometimes the consequence of a

Again,
it

protracted chlorosis.
that even
5

must be

re-

membered,

epilepsy

may

occur without

34
structural lesion,

CHLOROSIS.
and that paralysis may sometimes

be cured.
illustrative

of these opinions,

There are two cases (Nos. 10 and 11) and confirmatory of

the extraordinary curative effects attendant on the

development or restoration of the sexual function.

The vascular
the heart,
chlorosis
;

system, especially the capillaries and

is

frequently

implicated

in

protracted

and,

by patients and their immediate

are viewed

friends, such complications

with

much
entire

apprehension.
ache, are

Constipated bowels and severe headcircumstances

color of the
;

common

but

the

loss of the natural

surface,

oedema of

the face and extremities, palpitation of the heart

and syncope, are

less

frequent, and wear so formi-

dable an aspect, as to excite great alarm.

Ascites,
I

have rarely seen connected with the

;

oedema of

chlorosis

certainly not in early

life.

At

a more advanced period, derangement and structural

change of the
chlorosis^

liver or

kidneys may, combined with

induce effusion into the peritoneal sac.

are,

Such events
in

however,

rare.

No
is
is

doubt ascites

diminished quantity does occur, in the general tento serous effusion,

is

dency

which
but
it

so marked,

when

chlorosis

protracted

not a formidable

symptom

in itself,

and yields

to the

remedies which
blood.

would improve the

quality of the
is in

When,

however, the effusion

greater amount, distend-

ing the abdomen, structural disease of the liver or

kidney, as already observed, will be found to exist

when
is

only palliative remedies can be employed.

It

right also to caution the attendant

and the family,

CHLOROSIS.
against
slightly

35

supposing that every hue of the surface,

more ieterode than

usual,
is

is

to

be regarded

as an indication that the liver

seriously deranged,

and requires

for its restoration

mercurial remedies.

Complication of Chlorosis with structural change of the Lung. The malady rarely terminates fatally,

except
tion
is

in

combination with phthisis

and the ques-

not unimportant, whether the phthisis be init

duced by
ter

and amenorrhcea, or whether these

lat-

affections

do not owe

their

origin, at

least in

part, to the original phthisical

tendency of the systill

tem.

This predisposition may be dormant

;

the

epoch or puberty

and then
be a

its

injurious influence

may pervade
diate results
fect

the entire system.

will

One

of the

immethis

want

of energy, an imper-

development of the sexual character; and

failure of

puberty will lead to chlorosis and ame-

norrhcea.

These
the

latter affections will be the

promi-

nent, but not the real disease.

Yet

it

is

not aston-

ishing that

chlorosis
:

should principally arrest

the

medical attention

it is

malady peculiar

to the

age

there are only few and slightly-marked indica-

tions of phthisis;
T

and these, and even much worse

as within the scope of

symptoms, w ould be viewed

Occasionally, phthisis
sis

the curative influence of menstruation.

may
but,

be induced by chloroin

and amenorrhcea;

by

far

the greater

number
disease

of instances, the chlorosis only excites into

activity, the
;

previously latent tendency to this fatal

an opinion

which

receives

confirmation

from the

fact of the other complications rarely pass-

36
ing into
this.

CHLOROSIS.

There may have been extensive

vica-

rious hemorrhage, excessive

and long-continued leu-

corrhceal secretion, intense pain of the head, hysterical

and even epileptic seizures, a highly morbid

and yet there
shall

condition of the digestive organs, and a moderate

degree of emaciation
phthisis.

be no

The

individual shall recover

from these

morbid

states,

without even an apprehension of conmore, there

sumption.

Nay

may

be fearful protrac-

tion of these

maladies, and yet there shall not be

cough, pain
is

in the side, or

expectoration

so distinct

the

line

of demarcation between this and the

other complications.

From what

have seen,

am
is

convinced that structural disease of the

lung,

most frequently connected, either with chlorosis

alone, or with
hcea.

chlorosis in connexion with

:

amenor-

For instance
at
;

a girl of consumptive family,

arriving
chlorotic

the

age of

puberty, becomes slightly

and soon, instead of the negatively morto this period,

bid state

which may have existed up

there creeps on slowly, but certainly, a confirmation

of the disease.

There

is

no menstruation
it

or, if

the function be developed,

is

only once or twice,

is

and very imperfectly.

for apprehension, not

Then, there

great cause

that the series of

symptoms

belonging to the other complications will occur, but

rather that the anaemia and

want of

constitutional
to

power, will favor the predisposition

structural

pulmonary change.

Such patients

are not altogether

without appetite; the derangements of the stomach

and the alimentary canal are not prominent symp-

CHLOROSIS.

37

toms, the cerebrum does not painfully sympathise,

and frequently there

ria.

is

an entire absence of hyste;

But

there

is
;

quickness of pulse

irregular ac-

tion of the heart

tion
;

rapidity and difficulty of respira-

more

or less thoracic pain, frequently confined

;

to the left side

ciation.

a short, hacking

cough, and emait

Inquire particularly, and

is

will

sometimes

be found, that there

toration and

in slight degree,

both expec-

perspiration.

When

patients have ar-

rived

so far, and sometimes, happily,

this point,
is

before they

have reached

apprehension

is

roused, and

medical treatment

eagerly sought.
;

Many
to
lish

such cases are occurring

and

wish the

attention of practitioners, to be particularly directed

this complication.

The

vicissitudes of an

Engto the

climate predispose to phthisical disease; and

with the physiological circumstances peculiar

sex, explain

how

it

is,

that girls so frequently die,

at this epoch, of phthisis, in

rosis
ries

connection with chlo-

and amenorrhcea.
of

If asked,

what such

a se-

symptoms

as

have just enumerated indi-

cate, the reply must be, chlorosis complicated with

a tendency to phthisis.
is

And

if it

be inquired, what

the chance of entire recovery, a very guarded an-

swer must be given.

To
cover,

say that patients advanced thus far never re-

would be untrue

although

it

is

perfectly
constitu-

right, to give a

doubtful opinion.
if

If the

tional

power can be augmented,

in quality,

the blood can be

in quantity,

improved
the

and increased

then

symptoms may be

arrested, and renovation of

38
health

CHLOROSIS.

may

he slowly effected.
is,

A symptom
diminution

of im-

provement, of great value,

pidity of the pulse
:

in the ra-

for so long as the pulse heats 130,

120, or even

110

in

the minute,

it

must not he supin the opin-

posed that any real amelioration has taken place.

It will

be necessary,

also, to
:

be guarded

ion

we
is

ourselves form

the

same

self-delusion ex-

ists here, as in

phthisis at other
is

periods.

The
for

pa;

tient

convinced that there

no occasion

alarm

and the disease often creeps on so insidiously, as to

lead the
diate

family to believe, that there

is

no imme-

danger.

Let

it,

however, be remembered,
a rapid pulse, short
is

that so long as there

is

hacking

cough, and a want of nutrition, there

If,

real hazard.
fuller,
if

on the contrary, the pulse becomes slower,

softer
;

and

if

the cough be less frequent

if

the

pyrexia disappear; and especially,

gather flesh, in ever so
trivial

the
;

patient

a degree

hope may

be entertained.
Carefully treat such

an individual

avoid mer-

cury, drastic purgatives, and

emmenagogues.

Place

her in the country, where she shall breathe pure

air
:

let

her diet be simple and nutritious (milk and

animal food), and her medicine some of the various

tonics; and the expectation

the time
ter will

is

not far distant,

fully

may when

be cherished, that
the sexual charac-

be

developed, and the danger safely

has been stated,
is
it

passed.

From what
this
;

must not
the

be inferred, that
of chlorosis

the only fatal complication

it

but, comparatively,

is

rare for

others to terminate unfavorably.

Still,

after con-

CHLOROSIS.

39

tinued derangement of the viscera of nutrition and

digestion, the debility, pyrexia,

and emaciation may

become intimately blended with alteration of the pulmonary structure and the cough, expectoration and morning perspirations, may become prominently
;

influential, in bringing
1

about

final sinking.

have thus attempted to distinguish the morbid

circumstances appertaining to the different forms of

this prevalent

malady.

And

although the leading

and distinctive features will generally enable us to

determine the complication,
of the disease
still,

when any form may

has

become aggravated, severe and

the

of long duration,

blending of symptoms
It

perplex the diagnosis.

that

ought to be remarked,
is

leucorrhcea

in

various degrees

an

almost

constant attendant on chlorosis and amenorrhcea

and,

when

excessive, so

seriously impairs

the res-

torative
difficult.
I

powers, as to render

the

cure long and

wish to particularise, as correctly as

which, these
occur.
is

can, the

ages, at

various

complications

most

frequently

Chlorosis
a

alone,

independently
life.
it

of amenorrhcea,

disease of early

In con-

junction with

menstrual suspension,

may

be met

with at any period, between the ages of puberty

and the

final

cessation of the catamenia.

Chlorosis

conjoined
berty and

with phthisis,
thirty years of

may
age
;

be seen between pu-

sometimes
in

later

but

such
the

instances

are

very rare,

comparison with

numerous complications of

this kind, before the

attainment of the twentieth year.

Again, chlorosis

40

CHLOROSIS.

with amenorrhoea or phthisis, at an early age, are

forms of the malady, generally associated with debility

and delicacy of system

while the other com-

plications

may

exist at

any period, and are not un-

frequently combined with plethora or congestion.

Treatment of Chlorosis.
rosis, to

The treatment of

chlo-

be extensively successful, must be early and

most sedulously prosecuted.

It

cannot have escaped observation, that the disis

ease

one of almost universal influence

it is

not

confined to a particular organ, but affects the entire

system

and

yet,

it

is

often productive of so

much

functional
painful

derangement, of so many isolated and

to

affections, as
it

demand

local

treatment

which, while

shall

be in

complete

accordance
still

with the main principles of the cure,

shall

be

especially directed to ameliorate topical pain.

The

reader, then, will

be prepared for a classifi;

cation of the

means of cure

an
itself,

arrangement ne-

cessary, not only to

prevent confusion and disap-

pointment, but equally so for the attainment of that

correct

view of the malady

and of the par-

ticular stage

which

it

may have

reached, on which

will

depend the peculiar

fitness of the

whole

treat-

ment.

Thus, frst,
plicated

in mild chlorosis, either alone or

combe

with

amenorrhoea, the

remedies will

principally of a constitutional kind, directed to the

improvement of the general health, and

tablishment of puberty.
If,

to the es-

when

these points are

gained, the uterine functions are not developed, the

CHLOROSIS.
delay

41
to

may perhaps be

attributed

torpor of the

organs of reproduction, and emmenagogues

may

be

employed.
Secondly,
cated,
it

When

the disease

is

variously compli-

often happens, that the organ, or part of the

system principally

implicated,
to
its

becomes so promi-

nently morbid, as almost

the original chlorosis and
rhcea
;

throw into the shade

accompanying amenorsoil

but

it

must never be forgotten, that these

have been the source of the complications, the

in

which they have sprung up.

require

Here
will,

the treatment

will

modification

it

of necessity, be

less constitutional,

and must assume more of a topi-

cal

and symptomatic character.

lastly,

And,
lung
is

where

structural

alteration

of the

threatened or suspected, the

management

must have especial and almost exclusive reference

to this alarming complication
;

every measure being

Still,

adopted to avert

this greatest of all dangers.

if

even here,

it

must not he forgotten, that

puberty

could be sufficiently developed to allow of even the

partial

establishment of menstruation, a very for-

midable feature of the complication would disappear.

It is

evident, that a combination of

;

means
all

is
;

re-

quired
other
fail. is

medicine, alone, cannot accomplish

and

measures, without medicine, will

generally

Again,

if it

be remembered, that the disease

it

proteiform and of ever-varying degree,

will

be
re-

seen, that

constant and

unwearied

efforts

are

quired, not only to vary the old, but to suggest

new

resources.
6

42

CHLOROSIS.

The treatment
rosis,

of the most

common

form of chlo-

namely, that accompanying puberty, may be reall

garded as the type of the treatment of

the others

embodying the
less

principles,

which, with

greater or
It
is

modification, are

universally applicable.

here, at the very threshold of the disease,

when
is

its

character

is

not

understood, or

when
is

it

treated

empirically, that the greatest

It is

error

committed.

viewed as a
;

local,

not as a constitutional affec-

tion

and many are the individuals who have been

and ignorant attempt of pre;

sacrificed to the vain

maturely establishing menstruation

mercury, drastic

purgatives and emmenagogues, having irretrievably

destroyed the constitutional power and paved the

way
It

for phthisical disease.

is

not

my

intention elaborately to
in

comment

upon certain great mistakes

tion of female youth.
if
I

the fhysical educaI

And
It

yet,

must be excused,
and
be granted,

direct

attention to the

diet, air, exercise,

clothing of the sex.

that
if,

will

readily

in these particulars, there is

extensive devia-

tion from the dictates of nature

and common sense,

behoves

there must be a proportionate risk of debility and

disease.

In our

own

changeable climate,

it

the guardian of female youth to be

especially pru-

dent

and

am one

of those

who

think, that

it

is

scarcely possible to study these matters too closely.

If the national

practices in

these particulars could

be

changed and
to

the

remark applies with great

force

the

middle and higher classes of society

living in cities

and towns

chlorosis, imperfect

pu-

CHLOROSIS.
berty and amenorrhoea, would be

43

uncommon,

instead

of being, as they
eases.

now

are,

extremely prevalent dis-

Chlorosis

is

a rare affection
in

in

rural

districts,
air,

where female youth are much

it is

the open
run,

where

not unfashionable

to

walk and

and where

it is

not considered a gross violation of good breed-

ing to sport and play with activity and vigor.

girls acquire

Such
devel-

energy of system, each organ

is

is

oped, the blood

ity
;

abundant and of excellent qualhealthy, and

nutrition

is

puberty

is

attained

without

difficulty.

These remarks may serve as an illustration of the principles on which the treatment of simple and
amenorrhoeal
while
it

chlorosis

must

be

conducted

and

is

scarcely possible to present a succinct

and

specific history of the pathology of this

it

and the

other complications,

is

not difficult to describe,

with simplicity and tolerable accuracy, the order of

morbid events and the medicinal means, by which,

they are to be relieved
I

if

not cured.

have already observed, that a morbid state of

the blood, of

which anaemia
clue,

is

the prominent fea-

ture, lies at the basis of the disease.

This may be
will equally

viewed as the

by which the intricacy of the

:

symptoms may be unravelled

cific

and

it

explain the nature of the malady, whether the spe-

morbid impression be

in the

system generally,
in

in

an isolated organ, a particular texture, or

But, to be more precise

any

of the fluids of the animal economy.

:

would commence

44

CHLOROSIS.
to the
I

the treatment, by special attention

digestive

organs and alimentary canal

for
in

regard the dis-

order of these, as second only

pernicious effect,

to the peculiarity of constitution, already mentioned.

Nor

will the

advantage of their improved condition

:

be limited to themselves
of the blood and
its

the deteriorated quality

defective quantity,

may

both

owe
I

their origin to impaired digestion

to

and nutrition.

have already alluded

the jaundiced hue of the

complexion and of the surface generally, as leading

to the suspicion of hepatic disease. will be

The

diagnosis

made, by a careful examination of the region

itself,

of the liver

of the urine and the fasces

possibility of being misled

which
by the

will prevent, the

color of the lips and conjunctivas.

At

first,

then, a due evacuation of the bowels

;

must be

daily secured

and much will depend on

is

the kind of medicine by which this

effected.

If

mercury and drastic purgatives be frequently and

largely employed,
intestinal
irritation

will

ensue,

evidenced

by unhealthy

and

undigested

motions,
If

mixed with mucus, and occasionally with blood.

the purging be excessive

on

for the cure

if it

be exclusively relied
result,

debility

and exhaustion will

and, in

place
will

of

amelioration, the

whole of the
severe.

symptoms

become aggravated and

if

The

best aperients are aloes, rhubarb, the sulphate of soda

and manna, and,

an alterative be necessary, the

hydrargyrum cum

creta.

Nor must we

forget, that

an injection of a pint of

warm

water, two or three

is,

times a-week, into the rectum,

of

all

measures,

CHLOROSIS.

45

the most efficacious in aiding peristaltic action, and

in

removing the load of the large intestines.

aloes

The

compound decoction of tincture of cardamoms

with
the
oil

with the compound

aloetic pill

the

compound

of cassia

and hyosociamus, and

the

vinum aloes with the compound

tincture of rhubarb,
I

are the forms of these medicines

prescribe.

The

combination, with any purgatives or aperient remedies,

of mild

cordials,

is

exceedingly important.
:

The

following
Rhei
i.

may
5
ss.

be advantageously exhibited
Magnes.
Subcarb. 5
ix.

Pulv.

ss.

Conf.

arom.

9
ft.

Aquas Cinnamoni 5

Tiuct. Card. C.

i.

M.

Haust. bis terve in septimana sumendus.

Sulphatis.

Sodae Sulphatis vel Magnes.

iss.

Pulv.

Rhei
Pulv.

ii.

Magnes. Subcarb.
5
ss.
i.

Sodae Subcarb. aa.

iii.

aromatici

M.
vel

ft. ij.

Pulv. aperiens.

Sumat Coch.
aqua pura.

parva,

bis

terve

in

septimana, ex

It is

superfluous, perhaps, to observe, that

exercise,

warm
can be

clothing, regular

by walking,

if it

borne,

if

not,

on horseback, are valuable auxiliaries;

and, so soon as the repugnance to them can be con-

quered, nutritious animal diet and

will

mild malt liquor

be

productive of benefit.

The improvement
by return of ap-

of the digestive organs, indicated

petite

and the natural and daily evacuation of the

bowels, are generally accompanied by alteration of

the complexion, and by the partial disappearance of
the
chlorotic

hue

rarely

by the immediate estab-

lishment or return of the catamenial secretion.

this crisis,

At

some of the preparations of

iron

may be

46
exhibited
;

CHLOROSIS.
and the sulphate
is

probably the most

specific

efficacious,

and possesses more

rest.

properties

than any of the

If the

order of procedure,
if

now

pointed out, be reversed

the iron be used

before the bowels have

been freely evacuated and

tongue
will

their functional action improved, or while the

is

loaded and foul

;

aggravation
if

of

symptoms

be produced
debility

while,

there

be only the peculiar

and

pallor,

then the iron

may

be most bene-

ficially tried.

single grain, or even two,

may

be

given, twice or three

times daily, combined with

extract of
grain

hop, aromatic confection,

and a single

of extract of poppy or hyoscvamus.

effect
it

Occa-

sionally, the

of the iron

is

almost magical,

especially

where

does not confine the bowels nor

induce febrile heat.

prescribed
Ferri
:

The

following form

may be

Ammon. 5

iss.

Extr.

Humuli, Extr. Papav.

Sumat.

alb.

aa

gr. xv.

Ol. Cassise
quotidie.

xv.

M.

ft.

pil.

xxiv.

i.

vel

ij.

bis terve

Where

there

is

torpor of the system, flatulence,

and hysterical depression, a tea-spoonful of the an-

nexed mixture,
each dose of the

in

water,
:

may be swallowed with

pills

Tinct. Humuli, Calumbae vel Gent. C.

iss.

Tinct. Lyttae

3
It
is

i.

Sp.

Ammon.

arom. 5

iii.

ft.

Mist.

impossible minutely to describe every cir-

cumstance which may require medical management

in

lecture,

much more may be accomplished.

CHLOROSIS.
Still,

47
in

we must

keep constantly

view the pecuitself.

liarity

and the anaemia of the chlorosis

difficult

It

will

not then, be
In
it

to

vary and modify the

treatment.
hibited, or

some

instances, iron cannot

be ex:

may have been

too early used

it

may
the

not have been employed

in the right dose, or in

most desirable form.

minutiae,
sarsaparilia, gentian

These, and numberless other

attention.

demand sedulous
and

Quinine and

and zinc, are remedies of acin

knowledged power
were
a-day
injurious,

variety of instances,

where the sulphate and other preparations of

I

iron

have given, with decidedly good

effect, the
:

following powder, either once or twice

Ferr. Subcarb. gr.

viii.
ft.

Pulv.

Ipecac, gr.

i.

Hydr.

cum

Creta
I

gr.

ii.

M.

Pulv.

have already alluded to the necessity for conin

tinued care

the

progress of the treatment

and

the hope of cure must rest, not on the vigilance of

a week, but on
shall

the

perseverance and

skill

which

keep

in activity, for

months, every part of the

prescribed plan; not only the medicinal but likewise

that

which depends on
I

air,

regimen and active ex;

ercise.

do not dwell on the value of travelling

is

because

it

universally

admitted,

that

nothing

contributes more to cheerfulness and health, than

change of scene, of

air,

and of temperature.

Chalyeffica-

beate waters are sometimes extraordinarily

cious
;

and a sea voyage has, within

my own knowl-

edge, been productive of entire cure, not only completing puberty but leading to perfect menstruation.

48

CHLOROSIS.
shall
is

At what time

emmenagogues be employed
so far

?
is

When

the health

improved, that there

less pallor, regularity of

ter blood.

bowels, and more and betoften an efficient

hip

Iron

itself, is

emmenamustard
loins,

gogue.

The

use, every night, of the

bath, and the local salt

topically affects

shower bath across the

the

the uterus, and induces

cata-

menial secretion.

The ammoniacal

injection,

com-

posed of one drachm of the pure liquor ammonite

to a pint of milk, daily injected into the vagina, has

proved
I

efficient in the hospital.

am

not aware that any variation in this plan

will be required in chlorosis complicated with

ame-

norrhcea.

Caution will be most needed

in the se:

lection of the

time for the use of emmenagogues

is

but after what has been said now, and what

to

be said hereafter, the reader cannot remain long in

doubt.

The
doubted

iodide of iron has

been extensively

tried,

both in Hospital and private practice, and with unsuccess

;

especially

when

glandular ena

largements and
habit,

other

indications

of

strumous
I

have been associated with the chlorosis.

in the subjoined
Iodidi
gr.

give

it

form
Tinct.

Ferri

xvi.

CalumbsB

vel

Gent. C.
ii.

i.

Aquce

distillatae

vii.

ft.

Mist.

Surnat coch.

magna,

bis terve quotidie.

Three

or

four

leeches have been applied to the

mammae, on
can
I

alternate days, with very doubtful effect

:

as to the restoration of the menstrual function

nor

speak more favorably of the employment, to

CHLOROSIS.
the

49
Marriage
:

same organs, of mustard cataplasms.

effects are not certain

frequently cures chlorosis and amenorrhcea

yet

its

good

and invariable

nor

is it

uncommon
malady
that
is

to witness the

aggravated forms of the

in

married

life.

passing allusion
;

is

all

necessary on

its

remedial influence

as in
is

the chlorosis of early

likely

life,

such a connection

un-

and distant, and even at

is

later periods, its ex-

istence
control.
a local

not

matter for medical discussion or

to
I

Electricity deserves
uterine
its

be mentioned, as

stimulant
efficacy

and

have seen many

cases where

was decided.
and perhaps enough
its

The

complications of chlorosis require extended

;

and scrutinizing investigation

has not been said of hysteria and chorea, as

binations.

comis

The

former, in differing degrees,

an

almost invariable attendant on the malady; while

chorea
sixteen
tions

is

rarely seen after twenty, and seldom after

or

seventeen years of age.

The
cases.

observa-

on the treatment of the various complications

will be

appended

to the

illustrative

By

this

method, the cases themselves will be rendered more

interesting, and their peculiarities

and plan of man-

agement more

distinct and prominent.

it

In conclusion, let

be remembered, that the prois

gress of these affections

often

interrupted; do-

mestic occurrences of a vexatious or painful kind

produce frequent relapses

as the patient, despond.
errors of diet,

and the family as well

cold,

Repeated attacks of

and a neglect of especial attention to

the

evacuation of the bowels,

7

may

be enumerated

50
as

CHLOROSIS.
the causes of delay.

These, the address and

practical skill of the attendant

it is

must control
in

and

no

slight tribute to his

worth

such protracted

cases, that the confidence of the invalid

and of her

friends

is

continued to him unimpaired.

is

He must

repeatedly urge, that while there

sistent

only one con-

plished,

method by which recovery can be accomthere are almost innumerable ways by

which a simple case may assume an inveterate or

complicated form.

CASES OF SIMPLE CHLOROSIS.

MANY OF THESE AND THE SUBSEQUENT CASES WERE REPORTED BY THE GENTLEMEN OFFICIATING AS CLINICAL

Case

I.

Mary
well's

aged 14, an out patient (under Dr. Ash-

care),

January

6,

1S35,

is

stated

by her mother

to

have been from birth a delicate sickly

girl,

and frequently

the subject of cough with mucous expectoration and pain in

the
is

left side.

Her symptoms

are entirely chlorotic.

There

pallor of countenance, coldness of surface

and especially

of the lower extremities, lividity of the hands and of the tips

of the
fingers,

and emaciation.
there
is

Puberty appears

partially

established, as

some development of the mammae

respiration

the

pulse

is

120 and feeble;

quick and short;

;

cough

distressing at night with slight

mucous expectoration

CHLOROSIS.
the bowels generally constipated, but
appetite capricious, dislikes
tea,
all

51
occasionally purged
is

animal food,
is

fond of pastry,

and bread and butter.

are girls and

She

one of nine children, two

herself; and in both, the

of

whom

older than

same symptoms have attended the establishment of puberty

and menstruation.

The
in

tongue
is

is

loaded and tumid, and the

mucous
teeth.

lining of the

mouth

pallid

and indented by the

street,

She

resides
in

a confined

narrow

and sleeps
is

in a small

room,

which are three beds.

discharge
;

There
is

at

times

a slight leucorrhocal

the urine

scanty and high

colored.
Pil.

Rhei

Julep.

c. gr. v. omni nocte hora somni. Amnion, cum Magnes. i. bis quotidie.

To

live

on beef-tea and arrow-root, and

if

possible, to

be

removed
last out,

to a healthier residence.

Jan. 16.

Her mother

stales that

she caught cold

when
is

but she thinks her bowels more regular.

She

to

continue the remedies.

26.

The bowels
the pallor
is

are regularly
less
;

and more healthily acted

upon
fuller

and the pulse does not exceed 98,

is

and softer
is

the tongue

nearly clean.

She
ture

to continue

the ammoniacal julep

;

with magnesia

two or three times weekly

:

and to take the following mix-

Ferri Iod. gr.

vii.
ft,

xviii.

Tinct. Calumbae

i.

Aquae

distillatae

Mistura.

Sumat

coch.

i.

magnum

ter quotidie.

pint of mild ale daily,

Is

and animal food.

;

Feb. 10.

greatly

improved

complains of headache
full;
;

and throbbing of the temple; pulse 80, and

rather confined.
Is to

bowels

omit the iron

for a

k\v days
pill

and to

take ten grains of the colocynth and calomel

night.

every other

17.

The bowels

are quite regular

the cerebral symp-

52

CHLOROSIS.

toms are alleviated; but she complains of languor and debility.

Rep. Mist,
Julep.
Is

et Cerevisia ut antea.
i.

Amnion, cum Magnesia

in the

bis quotidie.

ordered to go
air.

country, and to be out

much
is

in

the

open

March

1.

Is

better in

every respect; and

now

re-

quested, in addition to the remedies, to use the mustard hip-

bath every night.

8.

Has menstruated
;

for

three days, with

little

previous

indisposition

and

is

so

greatly improved, as not to require

further treatment.

Case

2.

reported by the clinical clerk.

Jane
Admitted
aged 19, a native of London, a
hair,
fair

girl

of ordi-

nary stature, light

complexion, and brown eyes.

to

May

2.

She began

menstruate at 16

years of

age, and has regularly observed a period of three weeks, until

within the last two months.

The

only peculiarity con-

nected with the catamenia, has been the light color of the
discharge.

Her

situation, as a
;

house-maid, exposed her to

very irregular hours

and her enumeration of the symptoms

in

which attacked her, when

the

this capacity,

seems

to indicate

commencement

of disorder of the general health.

the side, languor, and
in

She
rest-

suffered from headache, pains in

lessness,

which were succeeded,

two months, by a supSince

this

pression of the catamenial

discharge.

time, her

disorder has increased, and she

now

presents the

following

symptoms:
color,

The
in
is

surface

is

uniformly of a very light-yellow

and

parts,

assumes an icterode hue.

Around the

eyes, there

a darkened areola, and the integuments appear

CHLOROSIS.
puffy.

53
the

The

prolabia, with the

gums and

mucous mem-

brane of the mouth and fauces, are exsangueous.

flabby, with indentations from the molar teeth on

Tongue
each side.
off.

The The

nails are brittle

and the cuticle around them peels

legs are

free

from swelling.

She

experiences consideis

rable dyspnoea on any slight exertion, and

very susceptible

of fatigue.
ifested
tive.
full.

The

appetite

is

capricious, but she has not

manpulse

any particularly

vitiated taste.

Bowels

naturally cos-

The

pulsations of the heart are loud, and the

No

leucorrboea.

There

is

no fixed pain

in

any part of

the abdomen.

Colocynth

cum

Cal. gr. x. statim.

May
ence
in

6.

Bowels well open.

There

is

very

little differ-

the character of her symptoms, and the general sur-

face remains pallid.

There

is

a slight leucorrhceal discharge.

bellows sound accompanies the heart's pulsations.

Ferri Iodidi gr. xvi.
cochl.
ij.

Tinct. Calumb.

|i.

Aq.

|vii.

Cap.

magna

bis die.
ss.

Habeat

Cerevisiae Oct.

quotidie.

She was kept on

and daily exercise,
she
felt
;

this tonic plan,

with occasional aperients

until the

end of the month.

Appetite good

At
;

this

time

considerably improved.

secretions

natural

countenance

still

pale, although

the yellow color

and dark areola had disappeared.

presented.

At her request, she was

week

after

her departure from the hospital,

under the same treatment, the catamenia returned, and her

countenance assumed a more ruddy aspect.

Case

3.

reported by mr. henry oldham.

Harriet S
short
;

aged 18

a girl of strumous diathesis;

to

thin

made, and rather inclined

emaciation.

Ad-

54
mitted

CHLOROSIS.

May

II.

She was born

in

continued to reside, being

in service as a

London; where she has house-maid. She

at

has always been delicate, but has not been the subject of any
particular illness.

She began

to

menstruate

16 years of

age, but has

never accurately observed the regular periods.

About

five

months ago the catamenia became suppressed,

appear since that time.

and have

failed to

This seems
and back

to be
fluc-

the date of her present illness.

tuating

She now complains of

left

pains

about the chest,

side,

somethe

times in the loins, and which occasionally proceed

thighs.

down

She

suffers

severe

headache,

giddiness,

vertigo,

muses

volitantes, singing noise in the ears, with other

symp-

toms of imperfect cerebral

circulation.

Her arms,

too, are

sometimes benumbed; and the fingers deadened, so that she

cannot grasp anything firmly.
at times there are

Her manner is hurried and movements about her like the first indica;

tions of chorea.

Several of the teeth have lately become

;

carious.

Her

legs swell

appetite

fickle

pupils dilated.

There
rients,

is

a general pallid appearance, although this has

a steel mixture,
as an

been

somewhat improved by
open.
Ferri Iodidi
gr.
xvi.

and occasional ape-

which she has taken

out-patient.

Bowels well

Tinct.

Calumb.

i.

Aq.

vij.

ft.

Mist. Cap. cochl.

ij.

magn.

ter die.

May

1G.

Feels

much

better, looks

more

lively,

and her

appearance has improved.

unusual exertion.
vibrating.

Complains of dyspnoea, on any

;

Bowels open

pulse small, quick, and

;

Has continued

the iron mixture

sufficient clothing

was enjoined to
and was ordered

keep the surface warm by

to take

exercise daily.

Under

this

plan,

her strength incolor.

creased, she

became

stouter and of a

more natural

She

suffered
;

headaches occasionally, which an aperient usu-

ally relieved

and on June the 4th, the following report was

entered.

"

The catamenia appeared two

days ago, the discharge

CHLOROSIS.
lasting

55
felt

only twenty-four hours.

this
;

She has

great relief

from

circumstance
;

her general health has greatly im;

proved

pulse SO

bowels well opened daily

tongue clean."

July 4.

Presented cured.

Case

4.

repored by mr. foote.

Charlotte

aged 2G, an unmarried woman, with

dark hair and eyes and chlorotic aspect.

function for the last seven years has been

The

menstrual

irregularly per-

formed, there having been suspension for

five or six

months,
are, pal-

and always a scanty flow.

pitation,

Her
Her

present
in

symptoms
chest

dyspnoea, cough, pains

the

and

loins
:

and

between the shoulders.

no appetite
;

legs

are cedematous

she has

her pulse

is

80, and soft; tongue clean; bow-

els confined.

Cap. Jul.
Beef-tea.

Ammon. cum Magn.

Arrow-root.

et Tinct.

Card. Co.

i.

ter die.

June 20.
in loins

Appetite slightly improved

still

there

is

pain

and back.
xviij.

Ferri Iodidi gr.

Tinct. Calumb.
ter die.
;

i.

Aq.

vij.

ft.

Mist,

Cap. coch.

ij.

mag.

Allowed one pint of porter daily

and a
half.

and of wine, an ounce

July

5.

She has been improving considerably under the

treatment, and

makes but

little

complaint.

Her bowels

are

very confined.
Pil.

Rhei.

co. gr. x. o. n.

s.

Tinct. Castor. Sp.

9i.

Lavand. Co. aa

vii. ft.

i.

Ammon.
ij.

Subcarb.

Aq. Cinnam.

Mist. Cap. cochl.

magna

ter

quotidie.

56
26.
respects.
Inf.

CHLOROSIS.
Face
losing
its

chlorotic appearance

better in

all

Gentian. Co. Inf. Sennae aa 3vi. bis die sumend.

4.

Aug.
1st,

The

menstrual discharge, which appeared on the

has lasted three days; complains

now only

of headache.

12.

She was discharged, with her health and countenance

Returns to-day,
to

very

much improved.
say that she
in
is

Sept. 6.

well.

The
for

catamenia have again appeared,

four or five

proper quantity, and

days.

Her cough, dyspnoea, and

palpitation

have not returned

at all since the last period.

These few

cases,

selected from

many
and
to

similar
for

ones, are sufficiently

numerous

to ensure a trial

the plan of treatment pointed

strate the importance of early cal care.

out,

demon-

and unremitted medi-

Neglect, in these instances, would proba;

bly have insured aggravation and severity

and

in-

stead of a cure easily accomplished, there

would
It is

have been protraction,

difficulty,

and danger.
will

worthy of remark, that the iron

individual
;

not suit every

and although

it

has a more direct and

salutary effect,
pid, than

where the uterine functions are torcannot forbear

any other known remedy, yet the quinine

I

must occasionally be substituted.

independently of
it

especially to urge the daily use of mild ale or porter;

as,
its

agreeable properties as a

beverage,

greatly assists in the restoration of flesh

If these

and strength.
ry, or

cannot be taken, port, shera

little

madeira wines, with hot water and

spice, will

advantageously excite the stomach, and

promote digestion.

CHLOROSIS.

57
is

The temperature
with
difficulty
in

of the body
chlorosis
;

often

supported

and as cold induces

circulation of delicate
their

congestion,

warm

clothing and exercise are import-

ant adjuvant measures.

girls
is

The

feeble

and lymphatic;
;

stomach and

bowels are soon deranged

and by such causes the

uterine functions are interrupted and impaired.

CASES OF INVETERATE AND CONFIRMED CHLOROSIS.

I

shall

insert

only two such

because

it

is

easy,

after

what has been already advanced,

to

imagine

an aggravated form of the malady.

not be right altogether to omit

Still, it

would
by ex-

its illustration

amples.

Case
Miss
at 15,

5.

B
till

set.

27, March, 1833, began to menstruate

years has enjoyed good
in

and

within the last three

this

health.

Since

period

she has lived

town, and the

in

catamenia have been gradually diminishing

in color,
till

quantity and

now

the

discharge
all

scarcely lasts

more than a

a few hours, and

is

has lost

sanguineous tinge.

The
;

pulse

108
is

to 120, irritable

and easily compressed; the breaththe slightest exertion

violently.

ing

quick and short, on

and the
is

heart palpitates often and

Her depression

ex-

treme, and she entirely desponds as to her recovery.

There
suffers
is

is

no acute neuralgic pain of the head, but she

vertigo and loss of

much from

memory.

Her

aspect

a dirty, almost green yellow, very

much beyond
motions

the pallor

of incipient chlorosis; the bowels are generally constipated,

but

occasionally

much
8

purged, the

being highly

58
offensive and dark.

CHLOROSIS.
There
is

a fetid odor about the breath

frequent nausea, and sometimes

vomiting; the cellular and

muscular tissues are flabby, and the alarm of her friends has

been especially excited by her progressive emaciation, and

her icterode hue
;

the tongue, lining

;

membrane
there
is

of the
a

mouth

and

lips,

are

of unhealthy paleness
at
:

dark mark
;

under the eyes, and

the angles of the

mouth

the nails

are chipped and dark

and the skin

is

dry.

In addition to
;

these

symptoms she has frequent hacking cough

it

and
it

al-

though

is

thought to indicate approaching phthisis,

evi-

dently depends very

much on nervous excitement

it,

emotion or

hurry invariably produces

and there

is
;

no expectoration,
on the whole there

pain in the side, or morning perspiration

can be no doubt that

chlorosis, as

this is a

severe and aggravated case of

yet a functional disease, and one which will

probably yield to persevering and careful treatment.

She was ordered the following

R.

Ferri Iodidi gr. xv.

vij.

Tinct. Card. C.

j.

Aquae

distil-

late

M.

ft.

Mist.

Sumat Coch. i. magnum ter quotidie. R. Pil. Rhei C. Extr. Colocynth.

Chloridi gr.
v,
iij.

C.

aa 3

ss.

Hydr.
xiv.

Ol. Cassias gtt.

alternis noctibus.

xii.

M.

ft.

Pilulae

Sumat

ij.

vel.

Chocolate or coffee and broiled bacon

broiled meats for dinner, with mild
a!e
;

for

breakfast

roast or

malt liquor, especially

;

weak

coffee or chocolate in the afternoon

for supper.

and a sand-

wich, with a small quantity of ale

March
better
;

14.

Is

still

feeble
;

although

in several
;

respects

has less cough

breathing less quick

nor does the

heart palpitate so violently.

are in a healthier state
;

Has more
is

appetite; the bowels

and there

less leucorrhoea.

She

is

strictly to
1.

continue the same plan.

April

Is

steadily improving; there has

been a very
days and a

slight menstruation.

Pergat.
the catamenia for two

April 14.

Has had

CHLOROSIS.
half; the secretion of good color and large
pitation and pain of side
in

59
amount
;

pal-

much

less

appetite improves very

iron produces

slowly

aspect clearer.

Thinks the

headache;

pulse 100.
Omitte. Mist,

cum

Ferr. Todid.

Cont.

Pilulas.

R.
M.

Infus. Rosre C. vij. Tinct. Hurnuli, Tinct. Card. C. aa

5iv.
ft.

Quininae Sulph. 9i.

Mist.

Acid. Sulph.

dil.

"^x.

Take one

tablespoonful three times a day.

May
last visit
still

26.
;

The catamenia have

returned twice since her

Is

and the secretion has been altogether healthy.

all

far

from strong; but the cough and

are so greatly improved
;

the distressing-

symptoms
saw
this

as to

leave no doubt of
I

ultimate recovery

she

is

about to
in

visit

Tunbridge Wells.

patient once

more

the latter part of the summer,

and she was entirely restored.

The

next case

is

one of aggravated chlorosis,

complicated with menorrhagia and leucorrhcea.

Case
Mrs.

6.

aet.

3S,

is

the mother of six children, the

for-

youngest now, July 1837, four years old; she has been

merly weakened by over

carriages.

lactation,

and by several bad misfor the last

Has been menorrhagic

three years,

the discharge not only being profuse and clotted, but lasting
for eight or nine days, with

leucorrhoea in the intervals.

disease
;

A
is

humid atmosphere has aggravated the

highly chlorotic
;

the aspect
;

the

hue of the skin dirty white

and the
alae

dark marks about the eyes and angles of the mouth and
of the nose are especially apparent.
ry to say more than that every
ists

It is

scarcely necessathe
disease

symptom of

exnot,

in

aggravated form, especially vertigo.

She dare
;

sometimes, for a day or two, walk across the room

her body

60
seems
to

CHLOROSIS.
have been almost drained of
judging from what
is

its

blood

and what
is

remains,

lost

in

epistaxis,

very

watery and attenuated.

Her
cal, as

great fear

is

that

she shall become entirely dropsi-

her lower limbs are anasarcous and the arms oedema-

tous.

She

is

hysterical and nervous, almost to insanity.

need not detain the reader by the daily and

details
;

weekly
liative

suffice it

to say, that a

year elaps-

ed before the disease was cured.

variety of pal;

and adjuvant remedies were employed

but

the great benefit

was derived from

pill

iron, ergot,

and

camphor.

The form
annex.

of

most frequently exhibited,

R.

Ferri Sulph. vel ammoniat. gr.

q. s.
ft.

ij.

Camphorae
pill

gr. iss.

Cons. Ros.

pilulae.

Take one

twice or three

times a day, or

R.

Ferri Sulph.
q.
s.
ft.

B'i.

Secalis Cornut. (in pulvere) Bii.

Syr.

Simp.

pilulae xii.

Take

one, or two

pills,

twice or

three times daily.

It

must be borne

in

mind, that the ergot

is

a
fit

remedy
fresh,

of variable power, although, in the cases

it

for its use,

more frequently
to

fails

from not being

in

and from having been long and exposed

the
light, in

powdered
bottle,

state

a white

than from a want of beneficial activity in the genuine drug.

The menorrhagic and

malady
is

leucorrhceal
It

form of the

rare

in early life.

generally occurs in

women who

have borne children,

who have worked

CHLOROSIS.
hard, and

61

who have
I

lived irregularly

and on scanty
this
it

and poor food.

have seen several eases of

in

form of the disease

is

the wards at Guy's

and

worthy of observation, that iron sueceeds almost

Perhaps
this

invariably in their cure.

may

prove

that they are ehlorotic maladies.

Were they merely

T

cases of loss of blood and simple anaemia, nutritive

diet

and a restraint of the hemorrhage w ould cure

;

them

but

am convinced

they are more than

this.

The
the

indications of chlorosis are really present, and

remedies for chlorosis, especially iron, will be

required.

CHLOROSIS COMPLICATED WITH VICARIOUS DISCHARGES OF

Case
reported by

7.

dr. joseph ridge.

Aug.
rotic

9,

1836.
with
in

Eliza
London, and

aged 16, a delicate, ehlo:

girl,

pale

cheeks and exsanguine prolabia

has

has

always lived
health.

enjoyed tolerably good

She has been engaged

for the last four

;

years in a sedentary

occupation (waistcoat-making)

and has rarely quitted the

house, sometimes not for weeks together.

The catamenia
were
for five or

appeared

first
:

a year ago, continuing for three days, but

of light color
six

they observed the natural period

months; but on each successive recurrence were more

scanty and serous, with lumbar and pelvic pains, and great

62
lassitude.

CHLOROSIS.
For the
;

last

twelve weeks, the function has been

lias

entirety suspended

and she

suffered, for

some

time, from

dyspepsia, constipation of the bowels, and intense headaches.

Nine weeks ago, she had a severe attack of haematemesis,

which was preceded and attended by considerable pain over
the stomach, and sickness after eating.
It

continued for four

days

and,

according

to

her

own

account, she must have

vomited altogether several pints of blood.

occasional epistaxis since; and
turn of

There has been

at

once or

twice, a slighter re-

hemorrhage from the stomach.

;

She
;

present
;

comdis-

plains of flatulency

pain in the

left side

of dyspnoea
;

turbed
occiput.
silky,

action of the heart

upon exertion

and pain
;

in

the

The

tongue

is

pale, moist,

and flabby

pulse quick,

and

irritable.

Sumat
Mist,
Liq.

Pil.

Colocynth.

cum

Calomel, gr.

x. bis in

hebdomada,

hora somni.

cum Ferri Sulphat. Ammon. pur. 5iss.

utend.

i. ter

quotidie.

Lactis tepid.

Oct.

i.

pro Injec-

tione, quotidie
daily.

Meat
from

diet,

and a pint of porter

Aug. 20.

Is

relieved
:

many

of

the

symptoms
stomach and

slight epistaxis yesterday

bowels well open.

Pergat.
appetite good
:

24. Complains of fullness and

pain of the

head; her aspect

27.

is

less anaemiated.

Considers herself
:

much improved
in

pulse stronger

complains only of headache

the square.

she was order-

ed

to take air

and exercise,

30.

Makes no complaint.
;

Some
is

color

is

returning to

her cheeks

and though the catamenia have not yet again

so

appeared, her general health

she
is

rapidly improving, that

allowed to become an out-patient.

Sept. 8.

Has menstruated

fully

and without pain, and

is

rapidly recovering her health.

CHLOROSIS.

63

Case

8.

REPORTED BY DR. JOSEPH RIDGE.

Eliza.
,

aged 19; a
;

girl

with light hair

of pale,
:

waxy, and

chlorotic aspect

and under the middle stature

7,

admitted as a patient of Dr. Ashwell, Jan.

1836.

She was born

tic

in

London

has been occupied as a domeslast

servant

and

till

within the

twelve months has en-

joyed good health.

Menstruation
till

16; and was perfectly natural

illness; at

the

commenced at the age of commencement of her

health has been

which time, the function was suddenly suppressed,

still

the suspension

continuing.

Her general

gradually giving way, and there has been progressive emaciation.

Vicarious discharge

first

occurred

during the last

week

and on three successive days she vomited about half a pint

of dark-colored and clotted blood.
are, pain
in the

Her present symptoms

head, accompanied, on assuming the erect

posture,
sight

by violent throbbing, giddiness, swimming of the

in

and singing

the

ears.
;

There
slight

is

palpitation of the

heart, increased on exertion

inability to lie

on the

left side

globus hystericus
expectoration
;

dyspnoea with

cough, but without

side
:

constant

pain of the right

loss of ap-

petite; occasional tumefaction of the

abdomen

constipation

of the bowels
ness.

and, at intervals, abdominal pain and tenderis

The

tongue

clean, but pale and relaxed

pulse 90,

compressible, yet jerking.

Sumat
Mist,

Pil.

Colocynth.

cum Calomel,
more
solito

gr. x. ter in

septimana.
ii.

cum

Ferri Iodido

praeparat, coch.

ma-

jora ter quotidie.

Utatur Injec.

cum

Liq.

Ammon.

pur. et Lacte quotidie.

Diet, Beef-tea, and Arrow-root.

64
Jan. 12.

CHLOROSIS.
Complains of pains
in

the sternum, in the region

:

of the heart, and of throbbing pains in the head

ness.

sleepless-

Skin cool.

Pergat.

App. Cucurbitulse sine

18. dizzy.

ferro nuchse.

Feels better, though the head

is

still

painful

and

To
23.

be

electrified.

Severe pain
is

in

the

left

side,

probably hysterical
:

head

very painful, and throbs violently

bowels open

tongue clean.
Omitte Mist, cum Ferro.

Sumat Decoct.

Aloes C.

iss.

quoque primo mane.

28.
the side
Suffers
:

still
:

from dyspnoea, and neuralgic pains

in

headache

abdomen tumid

bowels open.

Pergat.
:

Feb. 4.

There has been considerable improvement

is

she

has been freer from pain, and

els are well relieved.

active about the

ward

bowdysp-

6.

Continues to improve
:

is

much

less subject to

ncea and palpitation

lieved.

the pains

in

the head

and side are rethe

There has been no appearance of

menstrual

secretion.
9.

Has

a return of the former

symptoms, though not

in

so aggravated a form.

Bowels open.

Mist. Ferri

c. i.

ter die.

Pergat.
is

15.

The

pain in

the

side

increased; otherwise she

continues the same.

Emplast. Opii
part. dol.

22.

She now complains of a load

at

the stomach, after

CHLOROSIS.
taking food
;

65

and

for the last

day or two she has vomited

clean
:

about an hour after dinner.

27.

Tongue

pulse feeble.

Since the

last report,

she has been better until yes-

terday afternoon, when, after dinner, she retched violently,

and brought up a small quantity of dark-colored blood,

after

which the dyspnoea and pain

80,
soft,

in

the chest returned.

Pulse,

but somewhat sharper.

2.

March
last

The

oppression at the chest returned again

evening; and

this

morning she was seized with another

pulse 96, and feeble.

attack of hcematemesis, and vomited half a pint of dark-col-

ored blood.

Bowels open

Cont. Medicament.

At her own request, she was made an out-patient

under
rious
a similar

and

course of treatment, in country

;

air,

the vica-

hemorrhage was subdued

she returned again to the

iodide of iron, and after six

I

weeks the catamenia appeared.

times since
;

have seen

this patient several

and, by purga-

tives, iron,
tions, are

and exercise, the bowels, and the uterine funcin a

preserved

healthy active condition.

Case

9.

reported by mr. henry oldham.

Eliza
dark

aged 24, a

woman

of moderate stature,

hair, fair

complexion, and spare habit, was admitted

She has been married nine months, without pregnancy, and is employed in general She began to menstruate at 15 years of household work.
July 4, 1835, under Dr. Ashwell.
age, since

which time she has had occasional attacks of ame-

norrhcea.

These never extended over many periods

in delicate

but the

discharge was usually restored by

eggs.

taking aloes, with new-laid

She has been

9

health for four or five years

principally complaining of a

bad cough with expectoration

66

CHLOROSIS.
by pains about the
at

occasionally accompanied
gion.

epigastric re-

For
the

this

she has been frequently blistered and leeched.

For

last

half year,

every monthly period, she has

vomited a quantity of dark-colored grumous blood, and the

catamenia have proportionally diminished
in

their

amount.

These

attacks of haematemesis once or twice

supervened on

coughing;

but usually they were the result of vomiting.

She has

latterly abstained

from intercourse, as

it

produced

intense pain in the vagina and hypogastric regions.

She looks pale and wan

perform her usual duties.
rhoeal discharge for
tion,

complains of considerable headis

ache and lumbar uneasiness: she

weak, and unable

to

There has been profuse leucorin micturi-

seven or eight months, pain

effort
is

and a tenesmic

to
;

evacuate the contents of the

but has lost
its

bladder.
that,

The

skin

moist

resiliency, so

ing

its

when pinched between the ringers, it is slow in Tongue flabby, indented natural position.
and rather
are
foul.

regainat

the

edges,

Bowels naturally
is

costive.

The

mammae

very tender, and there

uterus was

occasional
its

nausea.

On

examination, the

found of

natural size,
:

and the os and cervix of their normal form and dimensions

they were, however, tender to the touch.
Col.

Abdomen
alt.

tumid.

cum

Cal. gr. xv. statim

et

repet.

noctibus.

Su-

mat
July
8.

Inf.

Rosas

cum Mag.

Sulph-

i. bis

quotidie.

The

general uneasiness was relieved by the free

action of the purgatives.

The headache

has been intense,

and increased when

heavily
;

in

the recumbent posture.

She

sleeps

and being continually disturbed by

unrefreshed.

frightful

dreams,

she

rises

She complains of
the margin of the

a fixed sharp pain,

on pressure, beneath
right
side.

lower
:

ribs

on the
100.
is

Leucorrhceal
in

discharge
is

profuse
;

pulse

The

pain

the

left

mamma

severe
is

the

left

nympha

elongated, and a superficial ulcer

seen on

its

inner surface.

Heart pulsates

forcibly.

CHLOROSIS.
Ferri Iodidi gr. xvi.

67
i.

Tinct. Calumb.
ter die.

Aq.

distillat. vij.

Cochl.
Pil.

ij.

magna
5i.

Rhei

c. gr. x. p. r. n.

Liq.

Ammon.

Lactis Oct.
vi.

i.

fiat

Injectio,

omni nocte

utenda.
10.

Hirudines

mammae

sinist.

applicand.

She

feels better.

The headache and

Bowels open
:

pains in the

mamma

have decreased.

pulse 90.

Rep. Medicamenta.
13.

There

is

heavy

dull

pain

in

the head
free
;

aggravated

on lying down, and preventing its pain in the loins occurs in paroxysms
occasion

movements.
is

The

and

so severe as to

sudden and spasmodic

shock.

starts, like

those produced

by an

electric

Pulse 86,
is

soft
:

and regular.
os
is

The
tender.
:

leucorrhoeal

discharge
the

lessened
is

the

still

The

ulceration on

nympha

healed.

Bowels open

countenance and general surface more healthy.

15.

The

white

discharge

has

been

examined, and

is

found to be mucus.

This

is

the period for the return of the

catamenia, and the usual time for the reappearance of the

hasmatemesis.
cus, but

She has expectorated some gelatinous mu-

no blood.

Bowels open.

Pulse quiet

lumbar

pain diminished.

Repetantur Medicament.
20.

and she

The paroxysms of lumbar looks much more healthy.

Headache

pain have entirely ceased,

The

catamenia have not

appeared, and there has been no premonitory

the haematemesis.
entirely relieved.

symptom of
Skin moist

bowels open.
Omittant Injec. et Mist.

Capiat Ferri Carb.

3i. ter die.

Electric sparks to be passed through the loins.

24.

The

electricity has

been four times repeated

and
pain,

was

to-day

immediately

succeeded

by considerable

68
both
in

CHLOROSIS.
the
loins

and thighs.

greatly diminished.
natural
:

She

feels

The leucorrhoeal discharge much improved. Secretions

appetite good.

25.

From

her sensations, she expected the re-establish:

ment of the catamenia

terday.

in

other respects the same as yes-

Rep. Medicamenta,
26.

et Scintillae Electr.

The

catemenia appeared early

in the loins

this

morning, accom-

panied by great pain

and thighs.

Balneum tepidum hac node.

Pergat.
experienced considerable re-

The
28th.
lief,

discharge continued to flow until the evening of the

With

its

cessation she
to

and quickly began

alternate

amend.

The

electricity

was conof the

tinued on

days, with

the

daily exhibition

carbonate of iron.

On

the 11th of August she

complained
head-

of severe pain at the scrob. cordis, sore throat, and

ache, the effects of an imprudent exposure to cold.

These
disap-

were relieved by
peared.

antiphlogistic

measures, and soon

Under
and

continuation

of the tonic plan of treat-

ment,
pallor,

her strength was

renovated.

The
and

surface

lost

its

the circulation

was

well

vigorously car-

ried on.

Aug. 24.
mammae.

The

catamenia have again appeared, accomirritation

panied by lumbar pain, and sympathetic

of the

On

Sept. 2, she

left

the hospital, free from serious malady

as to leave

and so greatly improved

recovery.

no doubt of her ultimate

OBSERVATIONS.
It will

not be necessary to offer

many remarks on
and
in

the preceding group of cases.

Hsematemesis oc;

curs

more frequently than

is

supposed

con-

CHLOROSIS.
nection with so
in several

69
congestion

much

pain, fulness, and

organs, as might
I

appear to justify active

treatment.
lavishly

have seen bleeding, purging, and lead,

;

employed
the

but with decidedly bad effect.

narrated, there

In

all

four cases

was anaemia,

quick irritable pulse, and excitement, precisely the

symptoms of
difficulty,

chlorosis,

and such as may, without

be distinguished from similar symptoms

dependent on acute
transient neuralgic

inflammatory

disease.

The

character of the chlorotic pains,

severity,

notwithstanding

their

the

amenorrhcea,

countenance, and pulse, must lead to a correct diagnosis,

and

to

modified and local

is,

treatment.

The

great indication

either, to
;

establish or to restore

the catamenial function

and to attempt the attain-

ment of this point, even by the empirical use of emmenagogues, bad as the practice may be, is less
injurious than a full pursuance of the
plan.

antiphlogistic

Blood-letting can seldom be required.

I

On

one occasion,

visited

a chlorotic

patient

who had

been bled from the arm

fulness

for the relief of thoracic

:

and

difficult

respiration
It

she was partially

advisable

and temporarily relieved.

to repeat the bleeding
;

was thought Her

and nothing could be more

effects.

conspicuous than
of strength
laborious
;

its

bad
;

prostration

was extreme

the breathing

was more

and an anasarcous state of the body was

universally apparent.
reiterate the caution

Nor

is

it

less

important to

against excessive purging, es-

pecially

where mercurial or drastic medicines are

employed.

The

first

object, doubtless,

is

to

pro-

70

CHLOROSIS.

cure, by proper aperients, healthy and regular evac-

uations

but the anaemia of

the

patient

must be

increased by their undue exhibition

practice so

common, that some individuals doubt whether more harm than benefit has not accrued from their use.
Let
this be as"
it

may,

it

is

quite true, that the evil

results of such a

plan are not confined to the sto;

mach and bowels themselves

flatulent distension of the

the irritation

and

intestines

leading to ag-

gravation of the chlorosis, and to nervousness and

distressing sinking, very difficult to be borne
yet, with such an increase of disorder,
I
:

and

have

known
So

mercury and aloes persevered

strong
is

in

for

weeks.

the prejudice in

favor of a " good, active

purgation."
Electricity, the mustard hip-bath, the
injection, leeches to the vulva,

ammoniacal
to

moderate cupping

the loins, the various emmenagogues, and occasionally a very active purgative, are the

remedies pecu-

liarly appropriate to this complication.

Case

10.

chlorosis complicated with cerebral affection.

Mary
13 years of age
&c.
;

aged
10,

19, admitted as an out-patient

under
at

Dr. Ashwell, Nov.

1S33.

She began

to menstruate

and from that period was never quite well,

indiges-

frequently complaining of lumbar pain, headache,

tion,

four years,
ticed.

These symptoms were disregarded for three or and then they became too acute to remain unnois

She
in

now

considerably emaciated, suffers intensely

is

from pain

the head,

frequently unconscious, and her in-

CHLOROSIS.
tellect
is

71
is

greatly impaired.

Her breathing
in

laborious, with
in

frequent palpitations of the heart, and pain

region.
If she lie

the cardiac

down suddenly
is

bed, and without two

is

extra pillows, her breathing

afraid of suffocation.

so interfered with, that she

is

Her

digestion

bad, her appetite ca-

pricious and depraved, caraway-seeds and mint being favorite

articles of diet.

Aperients are constantly given, and never

without the removal of scybalae.

ble,

Pulse 130, quick,

very acute
:

irrita-

and feeble

pain in the

side

has not

men-

struated at

all for

the last three months, and not properly for

Her tongue is marked by the teeth, and the lining membrane of the mouth is unhealthy. Her aspect is Her blue and leaden, and the prolabia almost bloodless.
the last year.
finger-nails are cracked,
rotic hue.

and her extremities are of the chlo-

Urine scanty, and high-colored.

Ordered, Cordial aperients; Leeches behind the ears; the

iEther-wash
to

the

head

and a

Pill

three times daily,

composed of one grain each of Quinine, Camphor, and Hop; with nutritious Animal Diet and mild Ale.
Dec.
6.

Somewhat

better.

The catamenia have

*

not

appeared.
Pergat.

24.

Less headache

acute lumbar pain

spasms of the

lower part of the abdomen.

Applicentur Hirud.
x. labiis

pudend.

Hot mustard baths.

for

Jan.

6,

1834.

Has menstruated
;

nearly

four

days,

plentifully, and without pain

is,

in all respects,

improved.

Pergat.

20.

Headache nearly gone

of respiration
less;

acute pain

in

the side, and

difficulty

still

emaciated,

and appetite

impaired; bowels

much

constipated.
x. alternis

Sumat

Cal.

cum

Colocynth. gr.

noctibus.

72
31.
in

CHLOROSIS.
Bowels well cleared, and more regular; improved
Calls to say she
quite well.

appearance.

Feb. 28.

is

Case
Jan. 23, 1836.

11.

Miss
;

aged 34; of delicate and

leuco-phlegmatic appearance

menstruating irregularly and

;

scantily, but especially for the last year

devoted to reading,

and occasionally oppressed by anxiety, but never called upon

for

any laborious exertion.

:

Bowels confined: pulse quick

and feeble

appetite

never very good.

On

the whole, up

to twenty-five or perhaps thirty years of age, she

was tolerafor

bly healthy, and sometimes

florid.

The

complaint

which

she

now

seeks advice

is

headache, which has existed more

It

or less severely for six or seven years.

first,

was unnoticed

at

and was accompanied by a jaundiced appearance of

skin,

and by retching
palliated

but the vomiting never removed, and

pain
in
first

scarcely

the

the head.

There was not

;

much done

medically for the

few years
;

but her health

became gradually more impaired

never previously belonging to

and about twenty-four

intensity and constancy
this

months since the pain assumed an

it ;

every symptom since

;

period has been grievously aggravated

and the disease now

absorbs her whole attention.

In

October, 1835,
in

new symp-

toms arose

pain deeply seated

in
;

the

orbit, tension of the

tympanum with
ness, lasting
till

soreness and painful hearing; throbbing and

a

beating of the head, and,

few days, almost entire deaf-

December

since

which time the deafness

(which
is

has

only

recurred during

menstruation,

almost

amenorrhceal,) alternating with a

peculiar sensation of syn-

cope, tension, and

tried,

noise in

the ear.

Remedies have been

antiphlogistic

of

mercurial,

depletive,

and

kind.

Pulse 110, quick and

irritable.

Good

diet, principally

animal food and

ale,

without wine or

spirit,

were enjoined.

CHLOROSIS.

73

Iodide of Iron, and Colocynth as an aperient, but without

Mercury, were exhibited

and the head was shaved, and

the^Ether wash applied.

Feb. 20.

Considerably improved
the

in

all

respects.

To

use the mustard hip-bath before

continue the same remedies.

catamenial

period, and

pain.

March 20. Has menstruated for Her cerebral symptoms less

;

three days, and without

still

very

far

from well.

April 30.
aches return
at

Is certainly greatly better.

very distant intervals.

Her intense headShe is gaining flesh;

90, but feeble,
iron,

and

is

able

partially to
;

resume her occupation of teaching.

;

Bowels regular
easily

urine natural
Still

pulse

and
out-

compressed.

continues the
Is

and the mus-

tard-bath, before

the period.

ordered to take

much

of-door exercise.
I

have not since seen

I

this patient

but during the present

lives

month, September,
in

have heard, from a relative who

that there
is

the

same town,

has been no relapse.

;

The

catamenial function

well

performed

and the headache

and the cerebral affections have entirely disappeared.

Case

12.

reported by mr. blackburn.

Emily

aged 17, a

tall

thin

girl,

of florid

com-

plexion, and of intelligent

appearance, was admitted under

5,

Dr. Ashwell's care, Feb.

1836.
or
five

She has always been

years has been subject
free

weakly

and

for the last four

to chest affection,

from

which she has been

malady.
in

since the

existence of her present

phrenitis, and has since

Two

years ago she had

been
fits

imperfect health, being often

falls

seized with aggravated

of hysteria, so that she

for

and

remains insensible and motionless

is

hours
;

together.

She

now

deaf,

and has once had otorrhcea

10

but

its

presence

74
was
nus.

CHLOROSIS.
attributable to an accidental injury of the

meatus exter-

She has

intense headache, chiefly affecting the occiput.

The

cephalalgia

was unusually severe

subsequently she

in

Dec. ro35

and
in

soon afterwards her right foot and hand were frequently

agitation.

A month
this

lost

all

control over

them
pain.

and since

time there has been aggravation of the

Ten

days ago she was delirious, and remained so for

Menstruation has been only once regular and
present
;

a few hours.
natural.
cility

Her

symptoms

are

dulness, almost
or

imbe-

of intellect

constant and

rather acute occipital pain;

frequent but not very violent agitation of the right side, with
occasional
face
tive
;

spasms of the

left;

little

no

affection

of the

no

difficulty of articulation.
;

Bowels open by purga-

medicine

skin soft, and moist.

Pulv. Scam,

cum

Cal.

gr.

xv.

statim.

Ferri Subcarb. 3i.

quarta quaque bora.

To

take half-a-pint of porter daily, and use the flesh-brush.

This treatment was pursued

for a fortnight with

advantage;

and the daily reports exhibit progressive

agitation
is

amendment.

The

decreased, and the pain

gr.
ij.

in

the head diminished.

Zinci Sulph.

ter die.

Balneum pluviale omni aurora.

much
less
left
;

Feb. 22.
covered

The

agitation

is

and she has rehand, but not so

considerable

power of the
;

much
25.

of the leg.

Bowels open
has
in the affected

tongue clean.
increased,
leg.

The

agitation

somewhat

and

she

complains of pain

arm and

Augeatur dosis Zinci Sulph. ad

gr. iv. ter die.

She continued

to

improve

until

March
fit

1 1

when the

nurse reported that she had had a

in

the night, in which

she appeared to have lost the power over her limbs, and the
legs

were somewhat contracted

the hands were placed over

the occiput, where she appeared to suffer pain.

She

is

now

CHLOROSIS.
rather

75
to
light.

confused
is

pupils

dilated,

though obedient

There
the

some involuntary

movement

principally confined to
;

left side.

Bowels well opened yesterday

pulse small,

and

soft.

Radatur Caput.
Sulph. gr.
iv.

Lotio frigida constanter applicand.

ter die.

Zinci

March
creased.

1G.

Had
before.

another

fit

this

morning, but
in

much

less

severe than

Pulse quick; pain

the head not in-

22.

Has had no

return

of the

fits,

and appears much

are

improved.
slight.

The
is

involuntary

twitchings

comparatively

She

more

collected, and
still

can articulate clearly. her strength

is

Bowels open; pulse quiet;

increased, that this morning

deaf;

so

she was able to walk twelve or

fourteen yards.
Inf.

Rosae. curn Quin. Sulph. gr.

r.

ij.

t.

d.

Pil.

Rhei C.

gr.

x. p.

n.

She remained
presented
quite

in

the hospital

till

April

21,

when she was

well.

During
all
;

this

time she gradually re-

gained her strength, losing

symptoms of chorea.
her appetite returned
; ;

The
the

general health was confirmed

catamenia appeared, though scantily

and her countenance

assumed

its

natural aspect.
is still

Her
free

intellect

somewhat impaired

but the

head

is

from the occipital pain, and there

is

no symptom of

structural change.

The

cases narrated, illustrative of this complicalittle

tion, require

comment.
of

They

attest

the ag;

gravated

severity

the cerebral affection

and

present indications so similar to those resulting from

structural change, as fully to demonstrate the
diffi-

culty of correct diagnosis.

Although

it

is

very rare

76

CHLOROSIS.
cerebrum
to
if

for organic affection of the

chlorosis,
it

must not be forgotten,

a

accompany the malady

functional

continue,
at the

that

complication

entirely

commencement, may

lead to change of struc-

ture

and that whilst the greater number of accom-

panying symptoms are merely functional, there may

exist, in

some one organ

nape
;

or

viscus, organic disease.

;

Local cupping, not general blood-letting

to the

a blister

of

the neck
air
;

moderate and cordial

aperients

change of

and cheerful occupation

in

and amusement of the mind

out-of-door pursuits, are

society, or

active

means the most

likely to

restore or to establish the catamenial function.

cases of chlorosis complicated with functional or

structural disease of the thoracic viscera, especially of the lungs.

Case

13.

reported by the clinical clerk.

Mary
into

aged 21, an unmarried woman, spare

1835.

made, and of pale and emaciated appearance, was admitted

Mary's Ward, under Dr. AshwelPs care, Dec.
delicate,
3,

She has always been

attacks
:

and

liable
at

to

inflammatory

she began
function

to

menstruate

sixteen years of age,

but

the

has

always

been

irregularly

performed.
:

Sometimes a suspension of
others, the discharge has

five

months has occurred

;

at

been suddenly checked

and rarely

has she had a

full

and healthy flow.

CHLOROSIS.

77

On
which

the

8th

of

November
an

last

the catamenia appeared,

five

terminated

amenorrhcea of

months duration

yesterday there was another attempt, which lasted for eight

or nine hours, then ceased
:

and the discharge, although pale

and serous, has

this

morning returned.

She has
a

for

some

time been subject to leucorrhoea.

About two years and

treatment
there

a half

ago she had

severe attack
its

of thoracic inflammation,
:

and was greatly weakened by

;

now much debility the face is flushed, dyspnoea and pain at the and the surface pale and waxy has had cough She and mucous expectoration epigastrium. Somefor several years, from which she is still suffering.
is
;

times she coughs up three or four ounces of a

fluid

slightly

muco-purulent, and occasionally half a pint

in

the four and

is

twenty hours.

The
:

heart beats violently, and

is

excited on

the least exertion

her appetite

impaired; and the pain at

is

the epigastrium, occurring after food,

relieved

by vomiting a
;

quantity of watery fluid, with a remarkably sour taste

limpid, and secreted in large quantity
;

urine
full

pulse 72, rather

bowels constipated.
Colocynth.

cum

Cal.

gr.

x.

statim.

Infus.

Rosas

cum

Magnes. Sulph.

bis die.

December

8.

Feels better.
:

The cough
improved
:

is

less

trouble-

some

pain diminished

appetite

still

headache

and wakefulness.
Hydr.

cum

Creta

gr. v.

cum
;

Pulv. Tragacanth.

Comp.

gr. v.

omni

nocte.

Mist. Oleosa

cum Manna
improved

et Vin. Ipecac. v\ xv. bis die.

11.

Is greatly

in

her feelings and general aspect.

Pulse

86,

regular.

Yesterday she ate meat without the

Leucorrhoea
still

usual pain at the scrob. cordis.

continues.

Rep. Medicamenta.

78
17.

CHLOROSIS.
There
is

an attack of pneumonia, cough, and dyspleft

noea

severe crepitation at lower part of

;

lung, involving

a very small portion

or quantity
;

expectoration not altered in character

skin hot.

Cucurbitulae postea

Cruentne ad

x.

infra

mammam

sinistram

Emp. LyttGe. R. Vin. Ant. Colocynth. cum Calomel, gr. xv. statim. Tinct. HyosTart. m. xv. Liq. Ammonise Acet. 5iv. Mist. Camph. 3vi. ft. Haust. ter die. cyam. Tit xx.
sumend.
27.
dies,

The

inflammatory attack readily yielded

:

to the

reme-

and she appears to have gained strength

complains of

nausea.
Mist. Ferri

Comp.

i.

bis die.

The
vered
in

tonic treatment
;

was occasionally

varied, but

perse-

and she daily improved.

The

pulse

beat regu-

larly, usually

80

in

the

minute.

Bowels open.

She can

eat,

and easily digest meat.

5.

January
less pain
;

The

catamenia appeared, accompanied with

lasting

and of a more natural color than formerly,

five days.

The cough and

expectoration daily diminished.

left

She was

able to walk about, and

the hospital Jan. 19, with a slight

bronchitis remaining, but

restored.

the general health almost entirely

Case
Feb. 28, 1S35.
a half has enjoyed

14.

Miss
;

aged 26, began

to

men-

struate at 14 years of age

and

till

within the last year and

this

good health.

Since

period she has

lived near town, and the catamenia have been gradually dimin-

ishing in quantity.

At

first,

the discharge continued for half

CHLOROSIS.
a day, or a day less

79
full
is

than

when

in

health.

Now,

the

flow does not last

more than
is

a day, but

unaccompanied by
is

uneasiness

there
;

no acute

pain

of the head, but she

frequently giddy

her digestion has been interfered with, and

:

her appetite greatly impaired

the thoracic

thirst

is

sometimes distressing:
;

symptoms
is

are,

however, the most pressing

as

her breathing

short,

hurried, and laborious, and

she has

frequent hacking cough.

Still,

these

thoracic

symptoms precisely resemble those

by any mental emotion; and
loss

sometimes produced by chlorosis complicated with hysteria.

The cough
voice and

is

excited

of

sudden

difficulty

of respiration are often induced

is

by the same cause.

Palpitation

of frequent occurrence.

There
brash
:

is

no expectoration of phlegm, but frequent waterare constipated

:
:

the bowels

the

pulse

is

quick and

irritable.

The

aspect icterode

the tongue and lining

;

memits

brane of the mouth are unhealthy

and there

is

the dark

mark under

the

eye

the

conjunctiva preserves nearly

healthy and natural color: the nails are chipped and dark;

and the fingers partake of the general jaundiced hue.

Ferri Iodidi gr. xvi.

ft.

Tinct. Calumbae
i.

i.

Aq.

distill. gvii.

Mist.

Sumat. coch. magn.

3ij.
alt.

ter die.

Pil.

Rhei. Co.
ii.

Ol Cassianoctibus.

gtt. xij.

M.

ft.

Pil. xxiv.

Su-

mat

vel

iii.

April 4. and
less
is

Has had

the catamenia for

two days and a

half,

more relieved by the flow than formerly.

pain in side diminishing
:

Palpitation
:

more strength

appetite not

much improved.
Bacon with chocolate
with mild
ale, for

for

breakfast; roast beef and mutton,

;

dinner
little

weak chocolate
28
to

for tea
:

and a

sandwich, with a

mild ale, for supper

:

these were

the directions given Feb.

the result was as described

above.

She was ordered

continue the same diet.

80

CHLOROSIS.
16.

May
debility

Bowels

irregular and

confined:

less

cough:
and the

pulse 100, fuller and

is

softer; the

pallor continues,

considerable.

Cataraenia appeared at the usual

time, but continued only for a day.

Cont. Remedia.

To

use for a week, previously to the period, the strong mus-

tard hip-bath, every night.

Sumat Decoct. Aloes C.

matutinis.

|ii.

cum

Pulv. Jalape gr.

x.

altemis

June 20.

Has menstruated

fully,

and without pain

the

hysteria has nearly ceased.

ture, relative to an

Circumstances of a painful na-

engagement which she had formed, were

;

unexpectedly removed

and cheerfulness and vivacity have

succeeded

to

gloom and anxiety.

Pergat.

It is

unnecessary to say more about

this

patient, than that

by

a sedulous prosecution of the

remedial measures, she en-

tirely

recovered,

is

now

married, and the mother of two

children.

Case

15.

CHLOROSIS COMPLICATED WITH PHTHISIS.

Miss
intelligent
at

aged 15, a young lady of dark complexion,

countenance, and of great delicacy, was attacked,

13,

the

age of

with hooping-cough.

The paroxysms
little

were frequent and violent; and, notwithstanding" treatment

and change of
air,

the disease lasted

some months, with

or no diminution of severity.

At

first it

was unaccompanied

by expectoration
up.

but shortly a
;

mucous phlegm was thrown

her appetite was capricious;

Her
it

strength decreased

and

was feared

that the lungs

would become phthisically

dis-

CHLOROSIS.
eased.

81
;

She was sedulously watched

lost its

and her exercise,

diet,

and clothing were carefully regulated.

her 14th year, the cough had

Before she attained

peculiar character, and

appeared

to

pass

into

chronic

bronchitis.

The
it

generally

emaciated state of the body, with the pallor and concomitant

symptoms, clearly indicated

chlorosis

yet

was hoped that

im-

the establishment of puberty and menstruation might lead to

a restoration of health.

For

(ew months, remedies

to

prove the constitutional power, and induce the desired change,

were

ineffectually

employed.

Her
mucous

countenance
lining

more
more
spine

chlorotic
pallid

the lips and

;

of the

became mouth

and unhealthy

and the anterior wall of the tho-

rax seemed daily to approximate more closely towards the

;

there was not the slightest enlargement of the

it

mam-

mas

nor did

appear

at

all

probable that puberty or men-

struation
its

would be developed.

The

expectoration changed

character, and, instead of mucus, large quantities of dark-

colored pus were coughed

up, so offensively fetid as to re-

quire immediate removal from the

cation

apartment.

Every

indi-

was decidedly phthisical

pulse
in
:

there

was

hectic flush

and
in

quick

the evening, and appetite

exhausting perspiration

the morning

the

was, at limes, morbidly great;

eaten.

while

at

other times

scarcely any thing was

Her

strength

rapidly failed.

Pectoriloquy, gurgling cough, and

cavernous respiration, were severally detected by the stethoscope

;

and before she reached her fifteenth

year, she sank

from phthisis complicated with chlorosis.

Case
April
1,

16.

1838.

iMiss

B.,

set.

19,

of light complexion,

delicate from infancy, and frequently suffering from

amenor-

rhoea,

was exposed,

in

September 1837,

to

a cold,

damp

at-

mosphere.

The
its

result

has been entire suppression of

men-

struation, with

accompanying inconveniences, and severe

11

82
cough.

CHLOROSIS.

The

aspect

is

entirely chlorotic, the skin being dirty-

white, the

conjunctivae,
;

gums, and

lining

membrane of

the

mouth
absent.

bloodless

nor

is

there one indication of the malady

The
pain
in

expectoration,
the
left side,

which

is

occasionally

purulent,

the

the

morning perspiration, and the emaphthisis.

ciation, point very clearly to

There

is

also consid-

erable leucorrbcea.
structive
:

The

progress of this case

did

has been in-

at first the

amenorrhea
serious

not attract attention,

indisposition.

because

it

was unattended by important

But,

in

December 1837, some more

pulse, with the icterode

symptoms showed them-

selves: the chlorosis was fully established, cough, and quick

hue and gradual emaciation, alarmed

her medical attendants,

who had
it

carefully watched and treatis

ed her.

Since

this

period,
;

unnecessary

to detail

the

course of the disease

struation
in the

but

it

is

sufficient

to add, that

men-

was never

restored, that tubercular cavities

formed

substance of the lung, and destroyed the

patient in

October 1838.

Many
a year

similar

examples
without
I

could furnish, scarcely

passing

my

seeing

several

such

melancholy cases.

forbear offering
this

many remarks
complication,

on the treatment of

most

fatal

having already insisted upon the absolute necessity

of continued vigilance and care.
I

may, however,

suggest the importance of early and entire change

of
air.

sea voyage, a milder climate, frequent

travelling,

and cheerful society,

offer the best pros-

pect of creating or renewing the vigor of the system,

and establishing
nary organs.
I

a healthy

condition of the pulmo-

have purposely avoided the discussion of the

stethoscopic signs of phthisis, not to dissuade the

CHLOROSIS.
practitioner

83
examination of the

from the careful

I

chest, but because

am

fearful of his attaching too

much importance to the absence of physical evidence of

excited
this disease.

His apprehensions should be

patients

by the peculiar condition of the

already described

condition favorable to the de-

position of tubercular matter in the lungs.

viate the
will

To

ob-

probable consequences of this condition

If,

require the utmost forethought.

till

however,

he wait

these consequences have ensued, or, in

till

other words,

auscultation affords proof that oractually

ganic change

is

commencing,

all

his

care

and

all his skill

will be unavailing.

CHAPTER

II.

OF AMENORRHEA.

Definition.

The Absence of Menstruation.

at
is

There
First,

two principal forms of the disease. The Amenorrhea of Retention, where,

are

the appropriate age, menstruation

three varieties.
a.

absent, including

Amenorrhea, dependent on congenital

defi-

ciency,

malformation or structural disease of the

genital organs.
b.

Amenorrhea, where,- independently of

is

defi-

ciency or malformation, there

partial
c.

either a slow

and

development, or an entire absence of puberty.

is

Amenorrhcea, after puberty

fully established.

Second, The Amenorrhcea of Suppression, where

menstruation having existed perhaps for a length of

time, has, independently of pregnancy or lactation,

become suppressed, including two

a.

varieties.

Recent and acute suppression.

Chronic suppression.
Amenorrhcea, dependent on Congenital Defi-

b.

a.

ciency,

Malformation or Structural Disease of the

Organs of Generation.

AMENORRHEA,
History, Pathology,

85

and Diagnosis.
is

These are
difficult,

happily rare cases, and the cure,

favorable circumstances,

under the most

hazardous and
It
is

and sometimes impossible.

versally

now

almost uni-

acknowledged, that menstruation, as well

is

as conception,

dependent on the existence and

If,

influence of the ovaries.

therefore, the absence

of the function

is

connected with the absence of

is

these organs, the disease

irremediable.
if

Nor

will

the chances of a cure be augmented,

both ovaries
as one

have become structurally diseased.

So long
is

of them, or even a portion of one of them,

sound,

menstruation
entire

may be performed

but

if

there be

disorganization, complete
result.

amenorrhcea will

be the

These opinions receive additional

the age of puberty, from the dimi-

confirmation, from the development of the ovaries

not occurring

till

nution of their size,

when
;

the catamenial and repro-

ductive functions cease

and from the gradual

les-

sening of the menstrual discharge, as disease of the

ovaries progresses.

In Mr. Pott's celebrated case

of the removal of both ovaries, menstruation entirely

disappeared, although, previously to the extirpation,

puberty existed, and the function had been well performed.

An

instance of complete scirrhus of the

ovaries, attended
in

by a similar

result,

and occurring

my own
The

practice, will be narrated hereafter.

history of these

cases

is

not encouraging
is

the health often suffers, and there

either to irritability

a proneness,

and excitement, or torpor and

depression.

have

now under my

occasional care,

86

AMENORRHEA.

a lady of thirty-two years of age,

who

has never

menstruated,

believe from congenital deficiency of

is

the ovaries, and she

never quite well.

Of
;

late,

her health has been more seriously deranged

she

loses flesh, has frequent febrile attacks, a trouble-

some cough, pain

piration.

in the

side,

and embarrassed

res-

The
is

probable termination of this unhappy

In this instance, sexual de;

condition

phthisis.

velopment and feeling are entirely absent

there ever been leucorrhceal discharge.
I

nor has

cannot, without

more

qualification

than

my

friend has appended, entirely concur in the follow-

ing statement of Dr. Churchill, in his very able and

interesting work on the Diseases of Females. " These patients," Dr. Churchill says, " have the

body generally well developed and healthy, the

culation active

cir-

and regular, the organic functions

(save one) fully performed.

But the

breasts are not

prominent, the genital

characteristics

and
is

sexual

propensities are not developed, the voice

deeper
lip,

than usual, a slight beard appears on the upper

and there

is

a mixture of masculine with feminine

peculiarities."
fully

The

latter

part of this statement

is

borne out, but the author has probably under-

rated the general

amount of

ill-health in cases

where

the ovaries are wanting.

Other organic deficiencies

exist

and malformations produce amenorrhcea.

There may be no
anormal
in

uterus, or if

it

it

may

be

form,

its

together with the os,

may be wanting, or impervious. The vagina may

cervix
it

be entirely absent, or so imperfectly formed, that

AMENORRHEA.
shall

87
;

not
be

be connected
solid

with the uterus

its

sides

may
rate
I

adherent,
its

growths may obstruct the

continuity of

canal, or there

may

be an imperfo-

hymen.
have seen several cases where the uterus could
to exist
;

not be ascertained

although the presence

of the ovaries

was
in

tolerably certain.

One
all

or

two
not

such

will

be

given.

Here the health was

at

seriously,

and

one case, not

deranged.

The

uterus did not exist, and, of course, healthy

menstruation was absent.

No

mischief, therefore,

arose from the retention of the catamenial discharge.

But

it is

far different
is

where there

is

a uterus,

where

menstruation

performed, but where the escape

is

of the secretion
tion.

entirely prevented

by malforma-

Distension of the uterus, pressure on neighboring

organs, impeding
the
their functions,

derangement of

general health, and periodical efforts at men-

struation,

occurring probably at monthly intervals,

these examples of retained

clearly distinguish

men;

struation

from cases of absent ovaries or uterus

for

and show the absolute necessity

examination.
Prognosis.
there
is

a most careful

This

must

be

unfavorable

where

a congenital deficiency or extensive organic

disease of the ovaries

tion

or uterus.

In

neither condiIt
is

can menstruation be established.

not,

therefore, probable that the usual

shall be enjoyed, although
in
it is

amount of health
individuals

quite true, excepting

structural

disease,

if

such

escape

88

AMENORRHEA.
and
in

phthisis, to which, in early life,

our climate

they are especially prone, they may, and often do,

become vigorous and

robust.

Where

the other malformations are present, the

prognosis must mainly rest on the nature and extent

of the obstacles, on the practicability of a surgical

or any other operation for their relief; on the degree

of danger, not only in the operation

itself,

but to

surrounding parts
tainly the

and especially on the

all,

risk, cer-

most serious of

of peritoneal inflam-

mation.
the

membranes also, pleura and pericardium may become inflamed,

distant serous

The more

as a secondary result of any operation on the genital

organs.
If a safe passage

cannot be made, then a

fatal or

very dangerous result may ensue from immense ac-

cumulation
tis.

in the uterine cavity,

is it

inducing peritonithis

Nor,

perhaps impossible that

organ
con-

shall be ruptured,
tents.

and permit the escape of

1

its

Such

a case

have never seen

nor from

the acknowledged distensibility of the uterus, can

I

think

it

probable.

It is far

more

likely, the

accu-

mulation being gradual, that the parietes of the or-

gan

will

be slowly and sufficiently developed,

to

prevent rupture.

The derangement

of health, and

the mechanical inconveniences consequent on retention, will almost certainly

induce amenorrhcea.
ovaries
or

Treatment.

Where
is

the

uterus

are

wanting, the case

perforate

irremediable.

Where an imseptum

hymen, an occluded
vagina, prevents

os, or a thin

across the

the exit of the

men-

AMENORRHEA.

89

strual secretion, the knife, the bougie, or the finger,

may accomplish
a firm

a cure.

If the cervix uteri

exist,

without a pervious canal, a trocar of small

bougie,

size, or
;

may form an

artificial

one

but in

the other and

there
is

more serious malformations, where

obliteration
this

extensive

of the

vagina,

or

merely a rudiment of
is

passage, or where there

urethra and

only a space between the

rectum

(vide cases), and where, although the uterus be present,

it

cannot be reached, except by exploratory

examples, the safety

incisions, in such complicated

of the patient will generally depend on the discreet

non-interference of

the

surgeon,
his

while

her

cure

must be looked
It is

for,

from

courage and enterprise.

almost needless to remark that few men, quali-

fied for

such operations, are unwise enough to un-

dertake them, without the sanction and assistance

of able professional colleagues and friends.

case of

M. Amussat, appended
may

to this chapter,

will illustrate these remarks.

Among

the

means

at

the disposal of the surgeon,

be mentioned the

formation by the knife, trocar, and bougie or sponge

tents, of
artificial

canals and passages, the removal

by incision, by caustic and ligatures of tumors and

attached growths
;

and where

the

uterus sutlers

from augmenting accumulation, so as to endanger

its

rupture,

all

other

means

failing,

it

may

be punc-

tured from the rectum.

It is

impossible, in a syste-

matic work, to lay

down

precise rules for the treat-

ment of such maladies.

sidered alone
;

Each case must be conmust be coolly

re-

its

peculiarities

12

90
fleeted on
;

AMENORRHEA.
and, while temerity
is

to be

condemned,
the danger

enterprise, short of recklessness,

where
is

of

non-interference

is

so

great,

deserving

of

praise.

In the simpler obstructions, the operations, either

by the
it

trocar, knife, or bougie, are not difficult

but

must not be forgotten, that such

facility the

patients,

with
re-

whatever

impediment may have been

is

moved, and a mere incision

really

often

sufficient, are

exposed to the danger of peritoneal inflam-

mation.

When

the operation has been successful,

which it almost invariably is, in the simpler and more frequent cases, a quantity of dark, uncoagulated secretion escapes, and continues to drain away
for several

days.

At length the uterus

is

emptied,

and under favorable circumstances menstruation will

occur naturally at the next, or at a more deferred
period.

Peritoneal or local

inflammation, especially the

;

former,

must be carefully guarded against

it

and

where

is

necessary to keep the canal open, by

tent or dossils of
lint,

bougies, sponge

the earliest

approach of abdominal or local tenderness must be

promptly treated.

After such a warning, every ex-

pedient for preserving the aperture must be discontinued.

If the

inflammatory symptoms are

slight,

local depletion, by cupping on the loins or hypogastric

region, leeches, numerously applied, purgatives

suffice

and narcotic fomentations or poultices may

but
the
if

the pulse be

full

and hard, the skin hot, and

a

abdomen

really tender, in

word,

if

there be

AMENORRHEA.

91

peritoneal inflammation, nothing short of large and

repeated general

bleedings will avail as preliminary

to these milder measures.

6.

Amenorrhea where

there is

either a slow

and

partial development or an entire absence of puberty.

Causes.

As

the age varies considerably, at

which

puberty

is

established, not only in different countries,

but in individuals residing in the same country, the

absence of menstruation, at the usual epoch, must

not, at once, be regarded as a disease.
Its

delayed

appearance

may be caused by

idiosyncrasy or deli-

cacy of constitution, by a tardy development of the

body generally, often dependent on impure

finement
in factories, or close

air,

con-

apartments,

and many
be so fee-

other similar causes.

ble,

Or

the health

may

owing

to rapid

growth and excessive leucorrhcea,

is

that the

development of the genital system

neces-

sarily delayed.

We
its

ought not, therefore, hastily to

conclude that puberty will not be established, and

still

less that

non-appearance depends on con;

genital deficiency or disease

every measure for the

health should
is

invigoration of the general

be fairly

and long employed before the case

hopeless.
It is

regarded as

very remarkable that Lisfranc should

total

have met with fourteen cases of the

absence

of menstruation, where he was unable to attribute

such absence to physical obstacle or chronic affection of the uterus.

Pathology.
norrhcea
is

The pathology of
same
persist,

this

form of ame;

the

as that of chlorosis

let

the

amenorrhoea

and the anaemia and

pallor of

92
the
latter

AMENORRHEA.
disease, so

indicative

of attenuated and
I

impoverished blood, will soon appear.

refer the

reader, therefore, to the chapter on chlorosis,

where

he will

find the subject fully explained.

Progress and termination.

The majority of these

if

cases terminate favorably, especially

violent

emcall-

menagogue medicines,

for

they ought not to be

;

ed remedies, are abstained from

months and years,

is

however, may elapse before the cure

completed,

during which the confidence of the patient and her

friends in medical skill will be severely tried.

Exceptional instances, where there never

berty and menstruation, are rare
;

is

pu-

but they do occur.

Nor

are they always dependent on congenital defi-

ciency and malformation

the powers of the

ovaries are
is

consti-

tution are sometimes entirely inadequate to the task

of developing the genital system.

Treatment.

When the

wanting,

or

destroyed by disease, there

no remedy.

Where
I

only feebleness and delicacy of constitution delays

puberty, judicious treatment will avail.
to enter at large on the
it

forbear

management,

as

have done

so fully in the chapter on chlorosis.

c.

Amenorrhea,

after puberty is fully established.

in

This form may occur, either

a.

The The

too plethoric, although

otherwise healthy

and
b.

robust, or in
delicate, irritable,
in

and

hysterical.
is

a.

Amenorrhcea

the former class

invariably

characterized
plethora, and

by symptoms of congestion or active

is

not so

common

as the second form

AMENORRHEA.
of the maladycities
It
is

93
seen
in

not

often

crowded
in

or

large

manufacturing
girls
It

towns, but

the
are

country, where

live
is

more naturally, and

much

in the

air.

generally curable, although

often neglected.

Symptoms.

headache, tension, and weight about

about the cerebelin

the brain, with a sensation of fulness and throbbing

in the centre of the cranium, or

lum, a

florid

countenance, torpor, lassitude, pain

loins,

the back

and

full,

and generally a slow

it

pulse, though occasionally in irritable females

is

rapid

irregular

circulation, evidenced
hot,

by the

feet

and hands being, the one

both
at short intervals

and the other cold, or

harsh and dry, and
if

remarkably hot and remarkanot to be supposed,

bly cold.
at others

The

skin sometimes
It is

clammy.
after

the
will
is

amenorrhcea continue,
pass
over.

that

these
at
first

symptoms

away,

the

attempt

menstruation

They may do

so for the

few periods, but

subsequently they will continue, during the catamenial intervals, recurring with aggravation as the

menstrual epoch again approaches.

If the

malady

has been long neglected, or inefficiently treated, a

cure will not soon be accomplished.
tion

The

constitu-

sympathizes so entirely, that months and per-

haps years

may

elapse, before

it

resumes

its

healthy
natuI

and natural
rally

actions.

Some women, however,

;

menstruate only at distant intervals

and

had

lately

under

my

care a patient,

who

for

two
;

or three

years menstruated only every four months

other,

and an-

who

never had the discharge oftener than

94
every six

AMENORRHEA.
months.
Instances
are
also

recorded,

where
tients,

healthy

menstruation

occurred

only
In

once
pa-

every year, or once every two years.

my

symptoms of plethora were always

present,

and the menstruation was painful.

es,

Cupping, leech-

and purgatives, with narcotics, were the means

Causes.

employed.

Exclusive of organic deficiency or malis

formation, the most simple cause

tion
;

uterine conges-

so active
fluid,

as to

prevent the secretion of the

is

menstrual

and

this

most frequently induced

arrests the se-

by exposure

to cold,

which suddenly

cretory process.

Less

intelligible causes

have been

adduced, such as torpor of

arteries

the secreting uterine In

and spasm of their extremies.

some of
diet,

these examples, the patients are indolent and sedentary, indulging in a luxurious
soft beds,

and stimulating

warm

apartments, and too

is

much

sleep.

Diagnosis.
disease
is

There

little

difficulty,

where the
neither
present,

seen early, in forming a decided opinion

character.

of

its

precise

At

first,

there

is

anaemia nor pallor, and

when subsequently

the history of the affection will prevent error.

From amenorrhcea, where

retained
either
in

the menstrual fluid

it

is

the

uterus or vagina,
the

may

be

easily distinguished.

In

former there will be

an absence of plethoric symptoms, the particular

feature of this species
;

while the increasing size of

the uterus, and the mechanical pressure on neigh-

boring organs, so characteristic of retained catamenia, will decide the diagnosis.

I

need scarcely add,

AMENORRHEA.
that,
if

95
of preg-

there be the slightest suspicion

nancy, examination per vaginam becomes an imperative duty.

Course of the Disease and Prognosis. It is rare for plethoric amenorrhcea to resist all attempts at
cure.

In such

an

event the plethora most com-

monly disappears, and the patient becomes chlorotic, or suffering

no longer from repletion, months

pass over, without the establish-

and years, or even the whole of the menstrual period

of

life

may

ment of
teria,

the

function.

Occasionally chorea, hys-

epilepsy, hepatic
is it

and intestinal disease may

occur, nor

impossible that the patient

may be

destroyed by a general cachexy, tabes mesenterica,

or phthisis.

The

prognosis

must therefore depend

on the character of the complication.

Treatment.
reference
to

This

must primarily have especial

will rarely be

the plethora, abstraction of blood and

It

purging being essential remedies.

necessary to bleed generally, except there be marked

congestion of some of the more important organs.

Such, for
liver, &lc.
;

instance,
in

as

the

brain,

the

lungs,

the

which case twelve,

fifteen, or

twenty

ounces of blood may be promptly abstracted.

cal depletion, by

Lo-

cupping on the loins or over the

labia,

sacrum, leeches to the

thigh, the groins
cient,

inner surface of the

ordinarily suffiis

and os

uteri, are

and give decided

relief

where there

severe

pain of the head, back, or loins.

Active purgatives,
in chlo-

and local depletion, so rarely advantageous

rosis, are beneficial.
It is requisite

to

improve and

96
increase
the

AMENORRHEA.
secretions of the
the

whole canal, and

to

unload and stimulate

lower intestines.

Jalap,
at

rhubarb, colocynth and

night,

scammony with calomel

and a dose of
in the

salts

and senna or infusion of

rhubarb

morning, answer the purpose exceed-

ingly well.

(Vide formulae.)

These must be

re-

peated with a frequency and a modification of the

dose, suited to the urgency of the case.

Auxiliary

remedies must not be forgotten, such as the mustard

hip-bath, at 96 or 98, every other or every night,

the

common

practice being

to enjoin its use for ten

or twelve

minutes, instead of half an hour, one or

to

even two hours, taking care

preserve the high

temperature during the whole time.

in this

The
Nor

bath used
is
it

way

is

a powerful remedy.
the
feet

less

valuable

sometimes, when

only are im-

mersed, every night and morning, especially where

the circulation
tient suffers
is

torpid

and irregular, and the pa-

much from
Such

cold, flushing of the face, or

headache.
enjoined.

Exercise and a spare diet must also be

patients should not be allowed
to

ride in easy carriages,

is

which favors congestion

so good
as

nor

riding on horseback

a regular

walk

of several miles per diem, the length of the walk

and the degree of exertion being, of course, proportioned

to

the

strength.

have several times wit-

nessed greater uterine fulness, and impaired circulation of the

ercise.
I

lower limbs, as the result of horse exinvariably, therefore, strongly

recommend

walking

in this

form of amenorrhoea.

Animal

food, malt liquor, or wine,

must be spar-

AMENORRHEA.
ingly taken.
If

97

they are freely used, under the

impression that they will excite menstruation, further repletion

must ensue.

have several times

;

advantageously practised small revulsive bleedings

four,
five,

or six ounces of blood

may be drawn
effort

from the arm, at the period when menstrual

exists
;

leeches to the

servation,

done good.

mammas have not, in my obThe treatment, therefore, so

long as plethora continues, includes occasional venesection, revulsive

and small bleedings, cupping and

leeching, active purging, constant and careful regulation of the bowels, a spare

and sometimes a vegewalking

table diet, prolonged

mustard baths, and

exercise.

The
tered

condition of the system

may have been

al-

and improved, the treatment may have

plethora, but

re-

moved the
tion.
It

there

is

yet no menstruait

may be
I

asked, whether
to

be necessary in

such circumstances at once

employ emmenaelapse

gogues

think

not.

Some months may

its

before the uterus shall perform

proper function,

but eventually, menstruation will most probably occur.

If,

however, the health

is

fails,

and instead of a

ruddy and robust, there

a pale and

wan

counte-

nance, and a gradually pervading debility, the amenorrhcea will merge into chlorosis
a termination
:

to prevent such

must

also observe, that

emmenagogues may be used. But I if, when the plethora is rethe

moved, menstruation does not quickly occur, the

continuance
attributed to

of

malady must not always be

debility.

Such an opinion leads

to

98

AMENORRHCEA.

the premature and injurious exhibition of tonics and

stimulants

for although
it

weakness
its

is

a cause

of

amenorrhcea
since
often,

is

by no means

only condition,
reI

where

debility has been entirely

failed to

moved menstruation has

shall at the

be established.

end of the chapter discuss the various

considerations, justifying and

bition of
b.

demanding the exhiis fully established,

emmenagogues.

Amenorrhcea, after puberty

in delicate, irritable
is

and

hysterical females.

What

there to distinguish this form

from amenorrhcea

in females who, having been plethoric, are so no

longer
erally

have observed that the former are gen;

more healthy

and after the removal of the

easily menstruate
delicate, if
;

plethora they
girls,

more quickly and

on the contrary, naturally

menstru-

ation does not quickly succeed

suffer for

puberty, very often

months and years from non-performance

of the secretion.

In both forms of amenorrhcea

eration, viz.,

now under
plethora

considis

where

it

exists

after

re-

moved, and
puberty
is

in delicate females, it is
:

understood that

established

but even with this advan-

tage, presuming that the amenorrhcea persists, chlorotic

symptoms

will ensue,

and

if

emmenagogues

have not been successfully used or menstruation has

not naturally occurred, the proper definition of the

malady
and
to

is

amenorrhcea complicated with chlorosis

perplexing
repetitions,
I

avoid

refer

the

reader to the preceding chapter of the work.

Second, The Amenorrhea of suppression, where

AMENORRHEA,

99

menstruation having existed, perhaps for a length of

time, has, independently of pregnancy or lactation,

become suppressed. There are two varieties.

a.

Recent and acute suppression. Chronic suppression.

b.

Causes and symptoms.

cult, in

If

it

be somewhat

diffi-

every instance, correctly to discriminate the

it

complicated forms of amenorrhcea and chlorosis,

is

easy, from the

history and

symptoms, accurately
Menstruation

to distinguish a case of suppression.

is

healthily suspended
;

only during pregnancy and

lactation

but

it

must not be forgotten that the natfunction may, from idiosyn-

ural termination of the

crasy of constitution, arrive some years before the

usual age.

The two

great causes of acute suppression are

mental emotion and the application of cold.

Sexual

intercourse during menstruation, fever, either idiopathic

or

secondary,

hemorrhage or venesection,
ices, are auxiliary

severe trying or drastic and emetic medicines, iced

water and confectioners'

frequent causes.

and

less

The

effect
is

of cold in

suddenly
it

arresting menstruation

well

known

whether
air,

be applied by a stream of cold and

damp

by

wet

feet,

by drinking cold water when hot, or by

undried linen.

Nor

are

we

less familiar

with the

injurious effects on

the sexual functions of joyous

and painful emotions.

Not only
present
it

is

the secretion of
to

the catamenia prevented,

when about
is

occur, but

when menstruation

is

often

imme-

100

AMENORRHEA.

diately checked by sudden terror.

The same

ob-

servation

is

true also of the secretion of the

effect

milk.
is

Happily the

of several of these

causes

diminished by the frequency of their occurrence.

The

bathing

women

go into the
;

sea, during

men-

struation,

with perfect impunity

life

and the habitual

necessarily dimin-

exposure to the casualties of

ishes their injurious impression.

Dr. Gooch relates

that a patient of his

consulted him, long after the

entry of the Cossacks into Paris, for an amenorrhcea,

which was

solely produced

by the alarm she

to the

then suffered.
all

the

And women who

Dr. Churchill states that almost

are
sent up

Richmond

Penitentiary, near Dublin, after having been tried

at the Recorder's
in

Court, labor under suppression,

consequence of the mental agitation and distress

be asked

they have undergone.

If
it

very differently.

how these causes operate, I reply, The effects being modified not

only by the intensity of the cause, but in great

measure also by the constitution of the individual.

In a young or middle-aged
thoric

woman,

fleshy, of ple-

habit and ruddy complexion, the

secretion will

immediate

suppression of the
congestion,
if

be followed by

not by inflammation.

While

in

woman

delicate, thin,

and spare, of sallow aspect,

and highly nervous, the more probable consequences

are irritation, attended

by spasm and paroxysms of

In the former

severe pain, with intervals of ease.

case there will be sensations of weight and pain in

the head and loins, tension and

acute and constant

AMENORRHEA.
pain
in

101

the region of the uterus aggravated on pres-

sure, short breathing, a

hot skin, and a

full,

hard,

and rapid pulse

hysteria, and
I

occasionally there will be

violent
deliri-

have several times observed

um.
sion,

It is

scarcely necessary to add that

is

suppresfar

accompanied by such symptoms,

more

immediately dangerous than any of the other de-

rangements of menstruation.
the uterus

Gooch, indeed, menstate

tions an instance of suppression, where, after death,

was found
this
;

in

of gangrene, the

result of intense inflammation.

About
ment are more than
uterus.

form of suppression, then, there can

neither the

be no doubt

symptoms nor the

or perplexing
;

treat-

at all

masked
it is

it is

much

irritation,
is

decided inflammation of the

Apoplexy

said,

by Capuron, to result from

I

sudden suppression:
although
there
7

this

have never met with,

hysteria, an

have seen seizures of a mixed kind, where

w as something beyond
Partial

approach

to epilepsy.

and transient paralysis of the

in

lower extremities has occurred once or twice

practice
;

my

and Churchill mentions that the patient

be attacked by local inflammation, either

may

also

of the brain, lungs, or intestinal canal.

The pathology
There
is

of

acute

suppression

is

clear.

in

the

marked

cases, inflammation of the

substance and of the investing and lining branes of the uterus.

is

mem-

true of other viscera,

Of course, a similar remark when they are inflamed durand robust

ing menstrual suppression.

Diagnosis.

In plethoric

women

the

102

AMENORRHEA.
difficult.

diagnosis of the malady cannot be

The

history of the case removes every doubt as to the

fact of suppression
;

and the character of the sympallow any other conviction

toms

is

too decided to
is

than that the disease

inflammatory.
safety of the
uterus,

Treatment. \t is essential to the patient, where inflammation of the

appendages,
really
exists,

or

its

that
to.

general

bleeding

should be at once resorted

If cordials be

given

and fomentations applied, with the view of restoring the suspended secretion, valuable time will be
lost,

and inflammation may, during the

interval, ad-

vance rapidly to an incurable or gangrenous stage.

Even were menstruation to be re-established, inflammation would scarcely be diminished

;

the
the

disease,

therefore,
it

being

so

dangerous,

must be
to be

treated as though

were quite independent of the

suppression.

Of

course, the

amount of blood
the

abstracted must depend on the intensity of the in-

flammation, and

the

strength of

patient.

It

may
once

be necessary to bleed largely, and, more than

:

fifteen,

twenty, or twenty-five ounces,

may

be abstracted, and colocynth, with calomel, must be

immediately exhibited, to secure a

effect
If, in
;

full

purgative
the
pills.

a powerful

enema should succeed

first

a few hours after the

venesection, the

pain

and the pulse are unimproved, more blood

;

should be drawn

if,

however, there

is

less

abdomi-

nal tenderness, and a diminution in the

number and
without the

hardness of the pulse, twenty or thirty leeches applied to the uterine region,

may

suffice,

AMENORRHEA.
second bleeding.
pill

103

saline mixture with digitalis, a

containing antimonial powder, opium, and calo-

mel, (vide formulae)

or

may

be administered every two

these

three

hours.

After

measures,

auxiliary

ones

may

be employed.
96,
is

general or partial

warm

bath, at

a powerful sudorific, particularly

where the
remains

patient, being placed in an easy position,

in the

bath thirty or forty minutes

fomen-

tations of equal parts

of gin and strong decoction

of poppies, and an injection into the rectum of half

an

ounce of barley-water and

thirty

minims of

liquor opii sedativ. often produce great relief.

ifications of this

Mod-

treatment will be suggested by the

of severity,

differing degrees

and consequently of

danger, appertaining to each case.

Nor must

it

be

forgotten, that the suppression, although the cause

of the malady,

is

unimportant,

when compared with

and

active inflammation in an organ highly vascular,

covered externally by a serous membrane.

But suppression of menstruation occurs also, and perhaps more frequently, in delicate and spare women, who are highly nervous and irritable. Inflammation may, even in them, be the product of suppression
;

but in the majority of such attacks, the

al-

pain and other symptoms are not inflammatory,

though

it

is

sometimes

difficult to

distinguish the

aggravated neuralgia and spasm of the different ab-

dominal organs, and of the uterus and

dages, from real inflammation.
Still it

its

appendone,

may be
a

although

it

requires

some of

that unwritten experi-

ence, that incommunicable tact,

which

man can

104

AMENORRHEA.

alone acquire by long and accurate personal observation.

The

pain

is

rarely fixed,

attacking
its

first

one and then another viscus, changing

without the use of remedies
;

locality

and,

if

treatment be

employed, such as local bleeding, a mustard poultice, or a

stimulant and narcotic embrocation,

it

is

remarkable

how

quickly the pain

is

transferred from
to the chest

the uterus to the head, from the

or heart,
canal.

head

and again from these parts

patient
fits is

to the intestinal

The

prone, during these attacks

of irritation, to

of hysteria, and syncope.

Treatment,

General
its

bleeding

is
:

inadmissible,

nor are leeches usually advantageous

the pain, but rarely

metastasis of

permanent removal, may be

Active purgatives

produced by their application.

are necessary, for the bowels are

commonly

loaded,

and hard scvbalous f^ces

general

Ions:

retained in the large

irritation.

bowels, excite and maintain painful

warm

bath at 96

bath, or mustard pediluvia,

warm mustard hipmay be advantageously

a
till

employed.

The

following antispasmodic draught

the

may

be given every three or four hours,

to subside.
5ii vel.
iii.

symptoms begin

Liq.

Ammon. Acet
vel.

Tinct. Castorei

Assafoetidse 5ss. ad 5j.

iv. vel. v.

Pulv. Ipecac. C. gr.

Mist.

Camp.

3vii.

M.

ft.

Haust.
pill,

In addition,

if

the pain be severe, a

contain-

ing two or three grains of camphor, and

two grains

of antimonial powder

may

be exhibited.

Injections into the rectum sometimes produce an

AMENORRHEA.
almost magical
effect.

105
assafcetida,

Laudanum,
for this

and

poppy syrup are employed

formulae,) and as
it is

purpose, (vide

necessary that they be retain-

ed

for

some time
a

after their introduction, a piece of

sponge or
closely

napkin, should be
to

kept
of

firmly the

and

applied
narcotic

the

extremity

bowel.
quantity

When
will

enemata are

injected, the

should not exceed two or three ounces, as more

unnecessarily dilute
the anodyne
ingredient,
action.

and by distending the gut, induce expulsive

The

pain and spasm, in this form of acute suppres-

sion, are thus relieved,

and menstruation does oftenin

this,

er recur during the

in the

immediate period,
;

than
it

inflammatory species
If,

but in neither can

be invariably expected.

however, the treatment

has fortunately re-established the discharge, every

precaution ought to be employed to prevent the ex-

posure of so susceptible a patient to any of those

causes

which might induce a

relapse.

It

need
in-

scarcely be remarked, that

an attack, either of
is

flammation or irritable suppression,

often the pre;

lude to more permanent menstrual obstruction

if

and

month

after

month

elapses, without the perform-

ance

of the

secretion,
of, will

chronic suppression, to be

next treated

be the result.

After a primary attack of suppression, unless any

symptoms of

uterine

congestion remain, treatment

in the interval is

rarely necessary, but immediately

previous to the subsequent periods, every measure

should be adopted calculated to ensure natural menstruation.

The bowels
14

should be kept free by mild

106
laxatives
:

AMESORRHCEA.
cold should be guarded against
;

the feet

and the surface of the body generally should be

kept
effort

warm

mental emotion and undue physical

should be avoided, and the mustard hip and

foot-baths, should be used

on alternate nights.
first
is at

If

menstruation return at the expiration of the

or

second month after the suppression, anxiety

end.
shall

an

If not,

and leucorrhcea with other symptoms

appear, then

more

active treatment

must be
if

adopted in the intervals, so as to prevent,

ble,
b.

possi-

chronic suppression.

Chronic suppression.

Causes, Symptoms, and Pathology.

pression

Chronic supit

may

result

from an acute attack, or

may

gradually supervene, as the effect of some perma-

nent irregularity
rus
;

in the secreting

power of the utebe the issue of or;

dependent on increasing constitutional delicacy,

ill

or decided

health.

It

may

ganic disease of the ovaries or uterus

ral

or the natu-

consequence of a premature cessation of the

It is

menses.

not to be expected that causes so va-

rious should operate uniformly, nor do they.

In
in

some women the mischief having commenced

an attack of acute suppression, healthy menstru-

ation cannot be restored, at least without difficulty

and delay.
tervals
;

painful effort

is

made

at

monthly

in-

but the discharge does not appear, and the

In

amenorrhcea becomes chronic and inveterate.

others the function
ularly
fluid
is,

for

some time,
;

scantily, irreg-

and painfully performed

is

but the excreted

after

pale

and

serous,

and,

few more

AMENORRHEA.

107

months, the periodical molimen having died away, chronic menstrual suppression is permanently established.

There

are,

however, cases of healthy menis

struation,

where the quantity of the secretion

for

so
its

extremely small, that, but

return,
it

the regularity of

might be believed that chronic suppression

Several examples of this kind

was approaching.
are

known

to

me.

Nor does such

I

a state greatly In

interfere

either with

the health or conception.

one patient,
confinements,
lasted

whom
the

have attended

in

numerous
never

menstrual periods
;

have

more than a day yet she has been exempted from anything beyond the indisposition common to women. In another, married late in life, where
the menstruation

was equally

scanty,
;

tried, at

her

su-estion, to increase the secretion

but the various

remedies employed, such as iron, sarsaparilla, quinine, mercury, and iodine,

failed.

Her marriage,

however, has been

prolific,

and she has become the

mother of four healthy children in three years. Since her last confinement the same sparing menstruation again returned, proving that,
least,
in

her case at
as neither

the peculiarity

was not morbid,

remedies,

pregnancy, nor parturition, effected any

change.

Dewees

says of these instances,

if

there

be no ill-health, that infertility after marriage

often be attributed
strual decline.
to

may
men-

an anticipation of

final

He

mentions three instances where

the twenty

the function ceased altogether before

fifth,

and two where

year.

it

terminated
the health

finally before the

thirtieth

In

all,

was

perfect.

108

AMENORRHEA.
in

have now a patient,

one, ceased

her thirty-sixth year,

who

having suffered from dysmenorrhea up to thirtythen to menstruate.

Her

health has

been gradually improving ever since.

It is

not difficult to recognize the symptoms at-

tendant on chronic suppression.

Among

the head

symptoms
obstinate

there

is

occasional vertigo, diffused and

headaches, muscae volitantes and dilated

pupil, with involuntary twitchings of the eyelids

and

muscles of the face.

The

surface
is

is

irregularly

cold, hot, or dry, while there

bility to the

a manifest suscepti-

impression of cold, causing shuddering.

is

The

prevailing state of the bowels

;

constipation,

from weakened muscular power

lations in the

and the accumu-

bowels greatly interfere with nutrition,

as the flabbiness of the textures and the occasionally

rapid

emaciation sufficiently prove.

The

urine

is

abundant and limpid.

The

thoracic

symptoms

are

dyspnoea, palpitation, pains in the chest, &c.

suppression continue, these
or
if

If the
persist,
it

symptoms may

the constitution be

equal to the task,

may,

aided by remedies, re-establish natural menstruation.

The
sis,

health may, however, seriously

fail

and phthi-

organic disease of the liver or other abdominal

viscera, or secondary dropsy,

may

destroy

life.

The pathology

of chronic suppression,

where

it

does not depend on organic disease,

to torpor or congestion

may

be referred

in the earlier stages,

its

and to

constitutional debility in

more advanced periods.

with other organs,

In the protracted and inveterate forms of suppression,

the ovaries and uterus, in

common

AMENORRHEA.
suffer

109

from defective nutrition, the blood having betoo impoverished to excite the organic nerves,

come
and

to

supply the requisite secretion to the several

tissues of the body.

Treatment.

It is

important to determine, not only

the exact treatment to be adopted, but the precise

period
for

when

it

shall be

commenced.
interference.

It is

not right,

instance, to regard

every menstrual suspension

as justifying

medical

Many

of

the

slighter irregularities arising

tion,

from cold, mental emowithout

If,

and other causes, quickly subside,

medicine or professional
fore, the health

management.
be safely

there-

does not suffer from the absence of

the discharge, the case

may
is

left to

nature,

excepting

where there

excessive
the

leucorrhcea,
that
it

which

so rapidly impairs

strength,

is

proper at once to attempt the removal of the suppression.

Where
the

the amenorrhcea originates

from a con-

gested state of the uterine vessels, the cure under

treatment recommended,

will

in

general

be

found more rapidly effected than

in the other variety.

Among

the irritable and delicate

women, where

the

discharge has

become gradually
to be

lessened, a series of

functional disorders, the

result of sympathetic dere-

rangements have

removed, which generally

quires a prolonged treatment.

It

has been already remarked, that debility

sole

is

not
is

the

cause of absent menstruation, and

it

peculiarly necessary, in protracted

fore

suppression, be-

entering upon the use of stimulant remedies,

110
clearly to ascertain

AMENORRHEA.
whether there
is

not congestion
its

or latent inflammation of the uterus and

appen-

dages

if

there be, such medicines must do harm.

An

examination of the uterus, externally and by the

will

vagina,

procure

the

requisite

information.
fre-

Dewees
quently

strongly insists,
fail

that

emmenagogues
debility has

from

this
it

cause, and adduces cases to

is,

show how important

where

been
is

only presumed to exist, but where there really

inflammation, that depletion should precede the use

of this class of medicines.
three months of suppression,

During the

first

two

or

when
is
is

the constitution
is

sympathizes but
sary.

little,

active treatment

unneces-

And

the

same remark
exposition

applicable, so long

as the question of pregnancy

undecided.
of
the
it

After

the full

already given

treatment of the different forms of amenorrhcea,

is

scarcely necessary to say more,

than

that

in

chronic suppression, the treatment will principally

be determined by the predominance of plethora or

debility.

In

the

former, depletion

in

the

latter,

tonics and stimulants will be required.

The
I

following remarks on complicated amenorrhcea,

extract from

my summary of

obstetric cases treated

at

Guy's

Hospital'.

The
chorea.

six cases of

complicated amenorrhcea were

it

very interesting;

In one,

was associated with

This patient, after protracted treatment,

by sulphate of zinc, and the
into

was

eventually cured

injection

of

liq.

ammoniac

the

vagina.

In

another, amenorrhcea was complicated with epilepsy.

AMENORRHEA.

Ill
i.

The medicine
digitalis gr.
q. s.
fiat
i.

prescribed

was

ferri sulph. gr.

pulv.

pulv. myrrhse

gr.

ij.

mucil.
It
is

Acaciae

pilula ter die

pills

sumenda.

worthy of

remark, that these

were persevered

in for three

weeks, without any injurious consequences from the

use of the digitalis
;

a circumstance attributable,

probably, to

its

combination with the iron.

;

At

this

period, the catamenia appeared

and there has been

hemiplegia

no return of the

fits.

In a third case,

was attendant on the amenorrhcea. This complication was tedious, and difficult to manage. At first, the mist, ferri c. was prescribed afterwards, the sulphate of zinc and an iodine liniment was well
; ;

rubbed over the spine, night and morning.

struation

Men-

was eventually
was
taenia

established, and the patient

regained the entire use of the side.

case there

In the fourth

with the amenorrhcea.

ol.

In

addition to the other remedies, the

curatively employed.

terebinth,

In the

fifth

patient
in

was there was

vicarious discharge from the

mamma,
c.

conjunction

with amenorrhcea
well

as the daily

was ordered, as employment of the ammoniacal

the mist, ferri
patient had, in addition to the

injection.

The

last

amenorrhoea, a peculiar nervous affection of one of

her lower extremities, which completely
subsided

when

the cata menial function was, by appropriate

remedies, healthily established.

It is

right also to mention, that

amenorrhcea

may
and

occasionally be traced to hemorrhage during

after labor.

In one well marked case, occurring in

my own

practice, the patient had three times suffer-

112

AMENORRHEA.
this cause, lactation not

ed amenorrhoea from

having

been attempted.

Twice pregnancy

recurred, inde-

pendently of the return of menstruation.

In the chapter on chlorosis, ascites
as one of the
is

enumerated
In

uncommon
is

results

of that malady

the

same observation
improvement
all,

true of amenorrhcea.

both, an

in

the quality of the blood,

and above

the re-appearance of menstruation,

are essential to the cure.

Dr. Churchill alludes to several cases of amenorrhcea,

where

a distinct

bruit de soufflet existed

without other evidence of heart disease, and which

disappeared spontaneously upon the reappearance of
the catamenia.

Emmenagogues
specific

are remedies supposed to exert a

in exciting

power over the uterus

in

menstrua-

tion
fluid

or

other words, regarding the menstrual

as a secretion,

emmenagogues

are the medi-

cines by

which we endeavor

to give to the secreting

organ the state or condition on which the function

depends.
It is requisite, therefore, that

these stimit

ulating agents should

be appropriate, and

would

be indeed fortunate,

if to

aid the elimination of the

catamenial secretion,

we

possessed a medicine, as
is

uniformly and beneficially stimulant as mercury

in

torpid

states

of the biliary function.

this

Whether
is

any medicines certainly possess

question to which
affirmative reply.
positively
ties of

influence,

my

experience does not afford an

Still,

although there are no drugs

in their action, the

emmenagogue
in

proper-

some

stimulating the uterus, render them

AMENORRHEA.
important
auxiliaries
in

113

the treatment of various

states of diseased menstruation.

In chlorosis, and in amenorrhcea, where there

deficiency or malformation, the local
often do

is

emmenagogues
In cases too of
either a slow

harm, never any good.

absent menstruation, where there

is

and

partial

development or an entire absence of

if

puberty, emmenagogues,
perly employed
:

used

at

all,

are impro-

and

in chronic

amenorrhcea compli-

cated with dropsy or phthisis, and in amenorrhcea

with general and uterine plethora,

still

further con-

gestion must result from their administration.

But where the uterus

escent, puberty having

is

inactive

or

entirely qui-

been established, and neither

plethora nor debility existing,

emmenagogues may be
are they less valuable,
in

advantageously

tried.

Nor

where amenorrhcea continues,

and hysterical women,
have
failed to after

delicate, irritable,

tonics

and

cordials

produce the menstrual discharge.

In

chronic suppression, emme*nagogues are clearly indicated.

their

Plethora,

loaded

bow els and

7

fever

forbid

use

spare diet, purging, local depletion, and

occasionally a small bleeding from the arm, prepare

the

way for their beneficial exhibition. Emmenagogues are of two kinds First, Local or immediate Emmenagogues
:

directly

applied to the uterus or the neighboring organs.

Second, Constitutional Emmenagogues, producing

their effect

through the medium of the system.

first

Of

the

class,

Electricity

is
;

the

only agent

justly entitled

to
15

the

appellation

the only

power

114

AMENORRHEA.
It

by which the uterus can be directly stimulated.

is

well known, that local pain

is

produced whenever
is

a sufficiently strong electric shock

a sensitive part.
directly

passed through

Thus,

if electricity,

by shock, be

applied to the uterus, a highly stimulant

effect will ensue.

Nor

is

the organ less beneficially

affected, in

some

instances,

by the

electric sparks,
it

or by a continued current being passed through

still it is

an uncertain emmenagogue.

In the ward
it

at Guy's,
late

and amongst the out-patients,

with

has of

been used
In

more than the usual good

its

effects,

Dr. Golding Bird having superintended

application.

some of

the cases, where, after the

condition of the alimentary canal had

thy, the amenorrhcea continued, with

become
slight

healpallor

and weakness,
loins

electric shocks

passed through the

In others,
its

quickly induced menstruation.

continued repetition three or four times a week led

to a similar result
;

and instances were not wanting

flow.

where a shock suddenly produced the

tricity

Elec-

must,

however,

be

cautiously

employed.

Where the patient really dreads its exhibition, it may depress the nervous system, and still further protract the malady. Nor must it be forgotten, that
if

syncope, sickness, or diarrhoea follow

to

its

use,

it

ought

be discontinued.

Electricity moderately
activity the

applied, frequently, rouses into

energy
excess
rarely

of torpid organs and parts, but

it

when used
it

in
1

may

altogether destroy their excitability.

it

trust to
eral

alone, nor do

employ

in cases of
If

gen-

plethora or local congestion.

pregnancy be

AMENORRHEA.

115

suspected to exist, however strenuously denied by

the patient, electricity ought not to be used
;

once

ordered

it,

quite ignorantly,

where the amenorrhcea

;

depended on concealed pregnancy

curred within an hour.

and abortion ochave no ex-

Of

Galvanism as an emmenagogue
it

perience, but
cursorily,

is

mentioned favorably, although

by several authors.

The
uteri,

application of leeches to the os

exists, will
it is

and

cervix

where congestion
;

frequently prodifficult so
it

duce menstruation
to
is

but
in

somewhat

employ them, and

almost impossible.
the
practice,

young unmarried women

Dr. Stroud strongly recom-

mends
effects.

and speaks favorably of

its

proper leech-glass must be used by a

well-instructed nurse, a few days prior to the period,

and repeated several times.

Stimulant Injections.

These were formerly much

irritating
:

employed, and a variety of

entered into their
vaginal enema,
is

ingredients

composition

at

present, as a
fort,

the Liq.

Ammonias
I

in milk,
it

generally

administered.
last

have often used

twelve years, both
(vide
formulae.)

with success during the

hospital

in
It

and private

practice

rarely does good,

if it is

not attended and followed

by a pungent sensation of heat, tingling, and some

pain in the vagina.
Its

use should be

commenced
;

three days prior to the expected period

patient, after

and the

each injection, should apply a napkin

fluid

to the vulva, so firmly as to cause the injected to be retained for ten or fifteen

minutes.

It is

not

116

AMENORRHEA.
is

a safe remedy where there

In

uterine congestion.

two such cases dangerous inflammation

Where, however, uterine torpor
is is

of the
its

cervix
use.

and upper part of the vagina followed

irritation, the

unaccom-

panied by congestion and acute

am-

moniacal injection
ally,

often efficacious.
it

Occasion-

like

electricity,

produces
in

menstruation at
the

once, while, in

some women,
it is

common with
effect.

most approved remedies,

the patient remaining in

without

The

strong mustard hip-bath, used twice during the day,

it

for nearly

an hour each
is

time, at a temperature of 96 or 98,

an effectual

auxiliary remedy.

Stimulating fluids have been, as emmenagogues,

injected into the uterine cavity
;

and they may, per-

haps,

by some

who have

not used them, be yet

recommended.
tion,

Death, from peritoneal inflamma;

has several times followed the practice

instances, occurring

and
eye,

in

two

under

my own
It

fatal results

had nearly ensued from most alarming

this

attacks

of

formidable

malady.

has been

supposed, but certainly without due consideration,

that as

cold water alone or with sulphate of zinc

may with impunity

labor, so

be injected into the uterus after

with equal impunity a similar injection

in

may

be thrown into the interior of the uterus

rhoea
;

amenor-

but there

is

little

or no analogy to support
it

the reasoning.
fairly

In the former instance

may be
is

presumed that the mucous membrane

heal-

thy, and, uterine contraction being secured, restraint

of the bleeding will be the consequence of the rem-

AMENORRHEA.
edy
;

117

but, in
is,

menstrual suppression, there

may

be,

and often

congestion and irritation, and perhaps

a diseased state of the tissue lining the uterine cavity

here,

on the contrary, inflammation will proba-

bly ensue.

Excepting as a means of arresting heI

morrhage,

never

now

inject the uterine cavity.

Of

the
1

emmenagogue

properties
;

of

medicated

bougies

have no experience

when

used, stimulais

tion

of the lining

membrane

of the cervix

in-

tended

to be produced,

ith the

hope that a similar

action will extend through the continuous

membrane

of the uterus.

These, with the exception of the

mustard and the variously medicated hip-baths, are

all

the local

emmenagogues

directly applied to the

if

uterus.

The mustard
at

hip-bath,

well employed,

seems

times to exercise an almost specific influ-

ence over the uterus.

tard by the

Nor

is the.

exhibition of

musI

stomach without a similar

effect.

have often given eight, ten, and twelve grains of

mustard, in camphor julep, three, four and
daily, prior to the menstrual period,
five

times
effect,

with good

the regularity and the quantity of the

secretion be-

ing beneficially affected by

that

it.

Dr. Rigby relates

some school

girls, for sport,

swallowed mustard
all

spread thickly on
girls
it

their

bread, and in
in

the elder
al-

produced menstruation
for its

a few hours,

though the regular period

arrived.
It is right

appearance had not

to allude

to sexual intercourse as

an

emmenagogue,
means

as

marriage

often,

though

by no

invariably, cures amenorrhoea.

118

AMENORRHEA.

Stimulating Injections into the Rectum are

relied on

much

by some practitioners, as emmenagogues,

I

and certainly

have used with advantage an enema

recommended by Dr. Schonlein composed often

grains of aloes, and one ounce of mucilage, twice
or three times a day.

Leeches

to the

Vulva, above the pubis, and at the

upper and inner part of the thighs, are occasionally

beneficial.

Nor

are stimulating embrocations,

to

warm They

frictions,

and

the flesh-brush to be

the

hypogastic and

lumbar regions,

entirely

neglected.

must, however, only be relied on as adjuvant remedies.

Of
moral

the

utility of

Pressure on the Iliac and Fe-

arteries, as a

remedy
first

for

amenorrhea,
I

have
Dr.

no knowledge.
about
seventy

Not once have

years
ago.
It

seen

it

tried.

Hunter, of Beverley,

successfully

employed it was subsequently

reports that
It
is

practised in Edinburgh, and Dr.

in his hands,
it

Home

succeeded once

in six times.

not a satisfactory or rational thing to induce congestion of the uterus,

if it

can be accomplished, as
it is

remedy

for

amenorrhcea, since
is

admitted that

the disease in question

often attributable to this

very condition.
tinued.

The
class of

plan

has been long discon-

The Second
stitutional,

emmenagogues

is

The Con-

producing

their effect

through the medium

of

the system.

Mercury

is

our most powerful deobstruent, and

first

deserves to be mentioned

amongst the remedies

AMENORRHEA.
of this kind.
It is
is

119

not to be used in slight cases,

nor where there

extreme exhaustion, a predomia tendency to phthisical or struin obstinate

nant

irritability, or

mous

disease.

But,

amenorrhcea, where
is

other treatment has failed, where there

chronic

inflammation or permanent congestion, and any evi-

dence of incipient structural change, there

is

no

remedy comparable
as in

to this.

In medicine, however,
is

matters of less moment, there

a fashion':

and

in

obedience to

its

dictates,

from one extreme to

its

we too often pass opposite. The extravagant

at

employment of mercury
bestowed upon
others,
it

one time, and

its

unde-

served neglect at another, the indiscriminate praise

by some, and
this
it

its

unjust abuse by

abundantly verify
I

observation.
successfully
;

As an
but
if

alterative

have not used

salivation

be

produced

and

maintained,

mercury

often ensures decided and permanent benefit.

The

inconveniences

of

a mercurial

course, protracted

through three or four months, however modified and

lessened, are quite

enough

to induce not only great

caution in the selection of an appropriate case, but

great watchfulness of
its

effects.
;

If the pulse beif

comes more rapid and

irritation

less strong

constitutional
;

and weakness daily increase

if

there be

cough or diarrhoea, these not having previously existed, the

mercury should be at once discontinued.

it

No
its

prudent practitioner will administer

after such

warnings.
use,

More

frequently,

in

cases

warranting

improved symptoms will follow moderate

salivation.

The tongue becomes

clean, moist,

and

120
of healthy color
;

AMENORRHEA.
digestion improves, and there
;

is

some return of healthy appetite

loses
its
;

the complexion

dingy,

icterode hue,
is

and becomes more

greatly improved.
I

clear

and the entire state

a matter of

am

not aware that the

is

form of mercury to be ad-

ministered

much consequence.
blue
pill,

The

Plummer's
ment,
rial

or

the

common

calomel, the

grey powder, or the inunction of the mercurial oint-

may any

of them

be selected.
far, as

The mercuto

effect

should be carried so

produce
;

soreness of the

gums and moderate

kept

salivation

and

these

should

be

up

for

twelve

or

sixteen

weeks.

The

frequent daily use of the chlorate of soda as

a gargle, will dimish the inconveniences of the salivation, by

removing the

fcetor

of the breath and

cleansing the mouth, so as to prevent the unpleasant

taste.

Sarsaparilla

is

a valuable

adjunct

it

allays

irritability

and prevents emaciation.

its

Iron, in

various forms and

is

in

modified doses

and combinations,
Its

most valuable emmenagogue.

worth, in

all

diseases

where the blood

is

is

impovis

erished and

where there

general

weakness,

well known.
of injuring,

Its protracted administration, instead

improves the health

and the blood,

instead of remaining a watery and attenuated fluid,

acquires from iron more healthy and nutrient properties.

In

this

way
it

its

emmenagogue power

is

realized.

Nor must
is

be overlooked, that iron pos;

sesses this additional value

that, as the cure of the

amenorrhcea,

mainly dependent on the improve-

AMEiNORRHCEA.

121

ment which has been

so
it is

effected in the general health,

more

likely to

be permanent, menstruation

not having been reproduced

sient stimuli.

by powerful and tranto its

These remarks are pertinent

in

exhibition,

whether

a form purely medicinal or

various chalybeate springs

chalybeate water.

The

contain different quantities of the carbonates and

sulphates
cient
;

and their waters are certainly most

the spot.

effi-

when drunk on

The

regulations for

exercise in the intervals of swallowing the water

ought to be sedulously followed.

Nor must

it

be

forgotten, that plethora and constipation

should be
;

removed
and
if,

prior to
its

any form of iron being exhibited

during

use, giddiness, headache, sickness,

and a quick or

full

pulse should occur, the ircn must

be immediately discontinued.

Ergot of Rye, or Secale Cornutum, as an emmenagogue, I cannot speak favorably nor is it

the
;

Qf

on principle easy to understand

how

it

should pro-

duce such an

effect.

As
in

powerful stimulant of

the muscular substance

peral

the pregnant and puerit

conditions of the
;

uterus,

is,

if

judiciously

employed, invaluable
torpor,

but the removal of uterine

and the arrest of uterine hemorrhage by the

from the restoration of a secretion, often
its

excitement of muscular action, are entirely different

effects

owing
bility.

suspension to plethora and extreme de-

Nevertheless,
papers,

Dr.

Locock, the brevity of

is

whose

on the diseases of menstruation,

their only fault, speaks favorably of the deobstruent

properties of the
16

rye.

cannot say that

have

122
never succeeded,

AMENORRHEA.

when

have used

it

but

it

is

necessary to be cautious, not only in selecting the

case, but likewise

the precise time

It
is

when

it

shall
in

be administered.

most to be relied on

somewhat relaxed and

to be

debilitated patient,

and ought

given, not in

the intervals of menstruation,

efforts are

but

when determinate
in conjunction

being

made

to es-

tablish the secretion.

Occasionally, at these periods

it

and

with strong mustard hip-baths,

menstrual discharge.
I

has produced

the

rarely

now
nal
use.

give

it,

but never

when

these efforts having

been unsuccessful, subside.

Irritation

and abdomicontinued

spasm are almost sure

In one
or

to follow its
I

two instances

have witnessed
it

alarming seizures of this kind,

long

where
(see

has been
in
is

employed.

The powder

formulae,)

doses of ten grains, two or three times daily,

probably more efficacious than the tincture, although

the latter induces less severe uterine and intestinal

spasm and pain.

Iodine
there
is

is

occasionally a good
this

emmenagogue
which
in

but

no remedy of

class

my

hands

has so frequently failed.

In patients predisposed to

struma, or actually suffering

from scrofulous en-

largement of the glands, the iodine exerts an almost

specific influence

on nutrition, and by improving the Dr. Coindet was perhaps

blood, favors secretion.

scarcely correct in attributing to this drug such

erful

pow-

and certain emmenagogue properties. I have made numerous inquiries about its effects, and have
not discovered that others have used
it

more sue-

AMENORRHEAcessfully than myself.

five, eight,
It

123

may

be given in doses of

twelve, or fifteen drops, or even more, of

the tincture, twice or three times daily, in sugared

water.
istered,

Or

the iodine, in substance,

may

be admin-

combined with the hydriodate of potass.

Caution must be observed after
amenorrhcea, lest a return of this state,
slight

(Vide formulae.)
plethoric

accompanied by vertigo, cerebral fulness, or

haemoptysis,

may

succeed

its

use.

Strychnine

was introduced

by

my

friend

Dr.

James Bardsley, of Manchester,

pressed menstruation.
rhcea, occurring
in

in cases

of sup-

In four instances of amenorI

delicate females,

have unsuc-

cessfully used

it.

In

two out of the

four,
;

one

fifth

of a grain was taken four times a day

but vertigo,
se-

and spasmodic twitching of the muscles, with

vere headache, compelled
late

me

to lay

it

aside.

The

Dr. Cholmeley, of Guy's Hospital, employed

strychnine in several cases of amenorrhcea, in

the

the wards, but without

any success.

He began

with the sixth of a grain three times a day.

Of Madder,
In the

the
I

root of the

rubia tinctorum, as

an emmenagogue,

have
of

little

personal experience.
I

commencement
its

my
;

professional studies,

witnessed
very

successful use

but

believe

it is

now

rarely

employed.

Madder
;

tinges the bones

and the urine of a red color

fore,

it

is

supposed, therecirculation,
it

that finding

its

way

into

the

directly

influences the
It
is

secretory function
3j.

of the
of the

uterus.

given in doses of 3ss. to

powdered

root, two, three, or four times a day.

Dr.

124

AMENORRHEA.
says that out of nineteen cases of amenorIt

Home

rhea he cured fourteen by madder.

tions, but

does not

quicken the pulse, or derange the stomachic funcappears to operate almost insensibly in

producing the return of menstruation.

Rue, so much praised

in

former times

for its

em;

menagogue
that
it

properties,

is

now
its

scarcely ever used

nor does the evidence in

favor prove

more than

may

be a cordial antispasmodic of uncertain

efficacy.

Savine, the juniperus sabina,

lant and

is

powerfully stimuis

emmenagogue;
Its
oil,

but

its

use

at present

much,

restricted.

deobstruent power
is

is

attributed to a

volatile

which

similar in
is

its

properties to turits

pentine.

Popular opinion

decidedly in

favor,

and

it is

the medicine most

commonly employed

to

procure criminal abortion.

Dr. Davis, in his elab-

orate work, mentions on the testimony of one of his

pupils,

who

served his apprenticeship at Tonbridge,

that in the neighborhood of that

town there was a

of the

remarkably

fine

savine

tree,

the decoction

leaves of which

was

successfully used, not only to

also
to

remove menstrual suspension, but

abortion.

induce

Where
is

there

is

a feeble and languid cir-

culation, savine
is

a suitable
is

stimulant

but

its

use

injurious

where there
leaves,

plethora and irritation.

oil

The powdered

and the
;

of savine, are the

preparations employed

of the former from four to

oil

twelve grains, and of the

drops

from two

to

twenty

may be taken two

or three times daily.

Seneca Root, and Black Hellebore, are deobstru-

AMENORRHEA.
ents, but
allusion.

125

they do not merit more than a passing

Nitre,

by stimulating the kidneys,

It

is

a decided

emmenagogue.
tion.

seems
its

to reach

these latter or-

gans, judging from

I

effects,

without decomposi-

lately

gave to a
in

patient,
this

whose mother
one scruple
full

placed great
three

confidence

salt,

or four times
It

daily, in

a wine glass

of
;

water.

purged and produced bloody motions

but on the third day there was a copious flow of the

catamenia after a suppression of seven months.

The Infusion and

Aloes
is

the Tincture

of Digitalis, pro-

duce their uterine effect through the kidneys.

doubtless the most efficient of the
cathartics, acting

em-

menagogue
the rectum.

on the uterus through

Even
to

after

menstruation has ceased,

the disposition

the

function often remains, but

the discharge can rarely be produced by the natural

efforts

alone

here,
It

if

a drastic dose of aloes be

in

given, the

catamenia are frequently,

slight

de-

gree, restored.

that a similar effect

exhibition

may easily, therefore, be allowed, may occur from the continued

during
the

of
life.

the medicine,

epoch of

menstrual

Aloes cannot, however, be always

If there

administered.

be an irritable uterus or a

highly irritable

stomach and alimentary canal, the

drug cannot be borne

sickness, intestinal tormina,

and extreme
bid
its

irritation of the

rectum and anus,

for-

use.

Several formulae will be given.

serpentaria,

Gamboge,

wormwood, musk, myrrh,

castor, valerian,

and lavender, with several others,

126
are regarded as

AMENORRHEA.

emmenagogues, but the majority of these remedies can scarcely be viewed as more than
and powerful medicines of
this class.

stimulant antispasmodics, and as aiding the more

direct

CASES OF AMENORRHEA DEPENDENT ON CONGENITAL DEFICIENCY, MALFORMATION OR DISEASE OF

THE GENITAL

ORGANS.

Case

17.

amenorrhea gradually supervening on diseased

OVARIES.

October 10th, 1838, Miss

G
fair

aet.

17, a patient of
in

Mr. Bailey, of Limehouse,

rather thin,
established at fifteen, and

is

and strumous

aspect,

ahvays delicate, but not sickly.

Puberty was

menstruation quickly supervened.

In

February, 1838, nearly nine months before the present

time, a tumor about the size of a goose's egg, hard, uneven

on the surface, and only

discovered low

slightly tender

to the

touch, was

down

laterally in the right hypogastric region.

Up

to this period the

catamenia were regular

in their return,

although the quantity was lessened, and the color

light.

few weeks afterwards,

growth appeared on the

in

March, a

similar

though smaller
there are two
iliac fossa

left side,

and several of the inguinal

glands were enlarged and indurated.

distinct tumors, that

Now,

on the right extends from the

left iliac fossa is entirely

to the umbilicus, while the

occupied

by the other and smaller growth.

They

are of stony hard-

AMENORRHEA.
ness, at times
cally,

127
;

painful, independently of pressure

mechani-

they derange

the action

of the bowels and bladder,

while fever and defective nutrition are rapidly destroying her

strength.

Appetite

is

impaired, and there

is

a frequent dull

pain

in

the stomach, accompanied

by acute pain and cramp

in the

backs of the thighs and

;

legs.

The
is

sleep

is

much

dis-

turbed

pulse

from 100 to 110, small and weak, and there

neither cough, ex-

are nightly

paroxysms of fever; there

pectoration, nor morning perspiration.

'

Since June, menstruation has progressively decreased, and

has been attended with severe pain.
are believed
to

it

Six weeks ago, the

at-

second growth (both

be ovarian) having

tained a large size, and having probably completely destroyed

the healthy structure

of the organ,

a painful

effort

alone,

without any discharge, marked the menstrual period.

Eight weeks subsequently amenorrhcea continued.

to

my

first visit in

October, the

Only

palliative

treatment was re-

commended,
ference.

the extent of the disease forbidding active inter-

In February, 1839, she died,

febrile irritation,

worn out by mechanical and

and by want of nutrition.

For

six

months

before death

there

was

entire

amenorrhoea and excessive

leucorrhoeal discharge.

A post

mortem examination confirmed the opinion that the

uterus was perfectly healthy, and that the ovaries were entirely
scirrhous, so

much

so

as to

have obliterated every trace of

their natural organization.

This case requires no comment.

It

confirms the

doctrine that the ovaries are the efficient cause of

menstruation.

128

AMENORRHEA.

Case

18.

amenorrhea with congenital malformation of vagina

and uterus.

Hannah
into
lars are

set.

22, was admitted June 13th, 1832,

Dorcas Ward, Guy's Hospital.

taken from the case-book and

The

following particunotes.
is

my own

This patient has never menstruated, but there

dominal
enlargement.

no ab-

Has

suffered

severely
in

for

many

months from headache, pains and tightness

loins.

the chest and

;

She has been

full
;

plethoric, but

is

not so

now

pulse 90
at night.

moderately

tongue white, skin hot, especially

For these symptoms, subsequently attended by dyspepsia,

she was bled and purged, and put on low diet
;

and on July

7th, she left the hospital cured of her indisposition, but with-

out having menstruated.

tion

As

it

was thought that malformaher

existed, this

patient was, at
is

own
:

request, carefully

examined, and the following

the report

Hannah
manly

is

well developed as to her general

wo-

structure, and

has therefore probably perfect ovaries.

But the external aperture of the vagina is closed by a firm membrane, which being pushed up two or three inches
towards the sacrum, forms a shut-sac, without the slightest
openening.
Neither the finger nor a probe can detect an os

or cervix uteri
finger in

beyond

this closed

extremity

nor does the

the rectum

when

pressing forwards, nor pressure

firm body, like

downwards from above the pubes, cause any

It is quite certain that

the uterus, to impinge upon the finger remaining in the vagina.

there
is

no large accumulation of menor upper part of the vagina.

strual

fluid either in the

womb
all,

These

parts,

if

they exist at

must be of small dimensions.

AMENORRHEA.
No

129

exploratory operation was recommended, as any attempt

to lay

open

this

shut-sac might expose the cavity of the peri-

toneum.

If catamenial

accumulation shall heareafter render

an opening expedient, the containing parts will be so dilated

as to be felt

by the

finger

then the knife

I

may

probably be

used with a prospect of success.

have, however, already

said that these operations are scarcely ever devoid of danger.

Here menstruation was not performed, because I the secretory organ, the uterus, was wanting.
two years afterwards, when she had quite recovered her health, and wished to be

saw

this

patient

married; but hesitated because she had not menstruated.

I

declined to give any advice.

Case

19.

amenorrhea dependent on absent uterus and

VAGINA.

Dec. 20, 1836.

of Mr.

I visited

Mrs.

st.

27, (a patient

New,
is

of Mile-end).

This lady has been married two

years, and

well developed about the pelvis and

is

mammae.
She has
sexually

Her

general health

tolerably good,

if

a proneness to fever,

susceptibility to cold,

and hysteria be excepted.

in

never menstruated, but

healthy.
is

other respects she

is

The

genitals

are singularly anormal.

The mons
There
passing
car-

large, the

labia are well

formed, and the fourchette and

perineum do not deviate from healthy conformation.

is

however, no vagina, and

think, no

uterus.
it

On

the finger in the direction of the os externum,

ried about an inch

may be

onward between the urethra and rectum.

is

The

former canal

very capacious and distensible, for after

17

130

AMENORRHEA.
at
its

overcoming the contraction

traverse
it
till

entrance, the ringer may-

it

enters the bladder, the rugae of

which viscus
no body
to

are easily

felt

in its

empty

state.

Examination by the rec-

tum, the finger being retained

like the

in the urethra, detects

uterus, the
;

two fingers approaching very closely

of

each other

a fold

membrane only being

is

interposed be-

tween them.

Intercourse

imperfectly accomplished, and

yet not without gratification; the urethra being the recipient

canal.

That there
is

are ovaries

is

certain

but

I feel

con6dent

there

neither uterus nor vagina.

Case

20.

amenorrhea with closure of the

vagina, consequent

on protracted and instrumental labor.

In August, 1837, Mr. Maccay, and a neighboring surgeon,

requested

me

to visit

Mrs. B., residing

in

Whitechapel; she

was twenty-one years of age, had been married ten months,

and had been
a midwife.
in

labor nearly sixty hours, under

the care of

As

there were not

more than three inches and a

quarter of space between the sacrum and pubis, as the internal parts

were

hot,

tumid and tender, and the abdomen tym-

panitic and extremely painful on the slightest pressure, I pro-

posed perforation.

brought the head of the child through

it

the pelvis with great difficulty, even after I had reduced

to

the smallest dimensions.

the long

There

resulted, as I feared, from

continued pressure of the head on the soft parts,

;

vaginal abscess and ulceration

and the subsequent cicatrization

In July, 1839, not having
at

was accompanied by contraction.

seen Mrs. B., since the delivery, she called

told

my

house and

me

that she

had never menstruated since the labor, but

constant leucorrhcea.

she was

much weakened by
I

On

ex-

amination,

had no

difficulty in passing

the finger into the

AMENORRHEA,
vagina, for about two inches and
in a

131
where
is
it

a half,

terminated
firm,

pointed extremity.

The
beyond

closure

quite

and

cannot discover, either by the speculum or probe, the slightest aperture.

In

front,

this

shut-sac, I
it is

cannot

feel

the uterus, but

through the rectum,

easily discovered,

nor

is it

at all enlarged.

This patient

is

failing

in

health,

is

dyspeptic,

emaciated, and, since the labor, has become entirely

devoid of sexual feeling.

But

cannot persuade
It is

her even to think of surgical aid.

an interest-

ing case as showing the increase of constitutional

morbid

effect

beyond what

exists in the

examples of

congenital deficiency, where menstruation

was never
cases,

performed

and such an instance

may

be regarded

as the connecting link

between the congenital

of congenital

and those where the menstrual

retained.

fluid is secreted,

but

The examples
;

deficiency

are the least dangerous

cases like the one

;

now

deseif

scribed are
creted,

more hazardous

and instances of
full

but retained catamenia are

of risk,

the fluid cannot be evacuated, and even then there

is

abundant cause

for anxiety.

Case

21.

amenorrhcea dependent on malformation of the

VAGINA.

REPORTED BY MR. HENRY OLDHAM.

Elizabeth
into

R
in

aged 22, a well-developed

fair

girl,

of

short stature, florid

complexion, and

skin,

was admitted

Guy's Hospital

February, 1836, under Dr. Ashwell.

132
At the age of
with
ago,
this
1

AMENORRHEA.
5,

she had some affection of the eyes

but

exception, she enjoyed good health until ten months

first

when she

became troubled with headache,

in in

vertigo,

and

lassitude, a sense of fulness

the hypogastric region,

the side, and
into

with lumbar pain, capricious appetite, pain

irregularity of the bowels, for

which she was received

the Hospital, under Dr. Cholmeley.

At

this

time the catainstituted,

menia had not appeared

to ascertain if

and an examination was

any mechanical obstacle existed.

and

The

parietes

of the vagina, about two inches from the vulva, were found
closely adherent
;

fluid

could be detected immediately

;

above.

Mr. Key divided the septum

fluid,
;

and a large quantity

of dark-colored, viscid

was evacuated.
left

The
the

opening
Hospital,

was

dilated

by bougies

and she shortly

feeling well.

There was but one scanty appearance of the

;

catamenia

after this period

but her health was not materially

time, a white

deranged

until six

weeks of the present

alone

mucous
of
the
for di-

discharge having

occurred.

recurrence
to

above-mentioned symptoms induced her

advice
;

apply to
that the

me
two

and, on

examination,

it

was found

vided surfaces of the vagina had again firmly united, but that
the catamenial fluid was accumulated
in

small quantity only,

a

which was proved by the absence of

above the
cicatrix.

fluctuating

tumor

Finding her general health somewhat

impaired, and the morbid sympathies with the uterus, such

as sickness, headache, Slc, continually present,
I

prescribed

laxative medicines, mild tonics, nutritious diet, and palliative

remedies, to remove urgent symptoms.

The symptoms

be-

came more
ed
;

severe, as the quantity of menstrual fluid increas-

and she was readmitted into the Hospital under Dr.

Ashwell.

At

this time,

she complained of giddiness, head-

ache, and tinnitus aurium, lumbar pains, with a sensation of

fulness

and

bearing-down, occasional

dyspnoea, uncertain
irregularity of the

appetite, depression of spirits, and great

bowels, sometimes being troubled with diarrhoea, followed by

constipation.

The

uterus

was not

to

be

felt

above the pubes

AMENORRHEA.
but a feeling of fulness, not of distinct fluctuation, was

133
com-

municated

to the finger,

on examination.

The same

class of
;

remedies was used, under which her general health improved

and

in

two months' time, the tumor above the united parietes

distinctly bulging, as to
fluid,

was so

warrant the evacuation of the

less in quantity

retained catamenial

which was

than on

the previous occasion.

In twelve hours after the operation,

symptoms of
active

peritonitis

were present, which were met by

measures, such as bleeding, both general and local,

purgatives, calomel, &c.

They, however, continued unsubto the mother's

dued, and she died.

The body was conveyed

inspection was obtained.

house, where an

On

opening the thorax, marked traces of recent

diffused.
to the

pleuritis

were universally

The

lungs,

in

some
costalis,

portions,

were found adherent

broken down.

opposed pleura

by

deli-

cate bands of imperfectly-organized fibrin, which

In other parts, layers of plastic

were readily

lymph were

found loosely attached to the pulmonary pleura, and within

the
pleural

sac

on both sides there were three or four

fluid,

ounces of serous
it.

with some flakes of

lymph

floating in

The depending

parts of both

lungs were gorged with

blood and serum, which ran out from the two surfaces of a
divided portion.
T

edges w ere too rounded.

healthy.

The upper lobes were The heart and

crepitant, but their

large arteries

were

On

opening the abdomen, layers of lymph were found on

liver, particularly

the surface of the

around the acute margin,

intestines.

and between the convolutions of the

This lymph

varied in degrees of firmness, appearing, at the under part of

the liver, to be converted into

tolerably well-organized
it

band of

false

membrane, attaching
:

to the

opposed surface
and
in

of peritoneum

in

other parts

it

was

plastic,
in

the pelvis,

some
the

little

flakes

were seen, swimming

serous

fluid.

The

mesenteric glands were greatly enlarged, and also those along

psoas muscle and brim of the
pelvis.

Some

of these

134
were of
a scirrhous

AMENORRHEA.
hardness, others of a chalky consistence.

Those on
strait.

the brim of the pelvis were particularly enlarged,

so as greatly to encroach on the

dimensions of the superior

The

uterus and

its

appendages had not contracted

adhesions, both anterior and posterior pouches being entire.

The

situation of the stricture

;

was a

little

more than an

inch below the os

and above

this part, the

vagina appeared

thin and distended, forming a continuous line with the dilated

os, the

circumference of which was above four inches.

rapidly

The

cervix

became

thicker,

and, for upwards of three

inches towards the fundus, the parietes were fully double

their

normal

size.

The upper

half of the
natural,

body of the uterus

its

was somewhat more bulky than

increased.

and

cavity slightly

The

broad ligaments were unaffected, but their

less delicate

appendages were much

than natural.

There

was a cavity within the cervix, which formed the chief dilatation, so expanded as to be able to enclose a goose's egg.

The
and

rugae

and

cells of the cervix

were greatly diminished,

their surfaces

presented a slight appearance of fibrinous

longitudual
striae

effusion.

Some few

were

visible,

more par-

ticularly at the posterior part, apparently the result of a re-

cently-contracted cavity.

The

preceding case confirms the

opinion, that

operations about the vagina and perineum are occasionally followed by inflammation of the peritoneum
;

and

it

ought to induce caution

division of the

in

the

prognosis.

The

first

septum was not succeeded

:

by mischief of any kind

no difference
in the

yet,

although there was

mode of

operating, a second in-

cision through the parts led to a fatal attack of peritonitis.

The

distention of the cervix, while

the

fundus and body of the uterus retained their normal

form

and

size,

is

singular,

and

corroborates

the

AMENORRHEA.

135

statements, lately made, as to prolapsus of the neck

of the uterus by stretching, and perhaps by growth,

while the parts of the viscus, above the cervix, re-

main

in their original state.

If,

as this case proves,

effused fluid

may

distend and stretch the cervix, init

dependently of other parts of the organ,

difficult to

is

not

conceive that the same result

may occur

from other causes.

Case 22.

AMENORRHEA DEPENDENT ON CONGENITAL ABSENCE OF THE VAGINA.

Abridged from the case, as reported by M. Amussat in the

Gazette Medicale

for

December

12, 1835.

young

lady,

set.

15,

was

in

bad health, owing to ameoccurred every month, but

norrhea.

The

menstrual

effort

without any discharge, and the abdomen was distended by the

gradually enlarging uterus.

There was no vagina, but the

urethra terminated naturally.

finger introduced into the

rectum, and
uterus, large

a sound

passed into the bladder, detected the

it

and fluctuating; and

so
little

was

also

ascertained,

that there

was

space between the posterior part of

it

the bladder and

rectum, as to render
artificial

impossible, or very

hazardous, to form an

vagina by the knife, lest these

important viscera should

be wounded.

M. Amussat,

the

other medical attendants having given up the case as hopeless,

proposed to separate the contiguous organs by

traction.

He

began by depressing the mucous membrane of the puden-

136
dum,
sound
just

AMENORRHEA.
below the
orifice

of the urethra.

Guided by a
in the

in the latter canal,

he carried his finger onwards

urethra,

space between the rectum and

and secured the

ground he gained each day, by a properly adjusted sponge

tent.

At length he reached the distended open

for

uterus, and, after

a small opening by a trocar, he

bistoury, keeping
strual fluid
it

enlarged the os uteri, by a

a canula.

some time by

Men-

was evacuated, not only through the aperture thus

sequel of the case
and,

formed, but also by a spontaneous opening through the rec-

tum.

The

is

encouraging

the patient

entirely

recovered,

when

the acount was

published,

was not only menstruating

ried.

regularly, but about to

be mar-

Other cases of
medical authors.

this

kind

may

be found in the different

forbear to enlarge

the size of the book by the

addition of illustrative 'examples of the other forms

of amenorrhoea.

They

are so

common and
of

so well

understood, and in some respects so closely resemble chlorosis, that the description

them

in

the

text will suffice for their ready detection.

Case 23.

protracted amenorrhoea cured by mercury.

Mrs. H.
of dark and

xt. 23, a native of the north of

England,

sallow aspect, and

evidently unhealthy, was

placed under

my

care

in

August,

1S23.

lias been married

between three and four years, but without pregnancy.

Men-

AMENORRHEA.
struation

137
has scarcely ever ob-

commenced

at fifteen

but

it

served the regular periods, and

for several

it

has occasionally been absent

months together.

Her

present

symptoms
:

are

amenorrhea of seven

or eight

months' duration

profuse

leucorrhcea,

sometimes of bad

odor; pruritus of the genitals, always severe, but occasionally

so intolerable as to

compel her

to

keep her own room.

Con-

stipated bowels, the

offensive
;

evacuations dark, scybalous, and highly

healthy appetite destroyed, frequent craving for

articles of food,
lips

improper

and progressive emaciation.

Skin

of dark, icterode hue,

colorless.

and lining membrane of the mouth

Pulse 95 to 100, feeble and easily compressed

the
slightest exertion,

frequent dyspncea, especially on

there
is

but

neither thoracic pain nor cough.

On
of

inquiry, I found that Mrs.

practitioners, both in

H. had been under the care

the country, and
tried,

many

London and

that nearly every plan of treatment

had been

only ex-

cepting the mercurial.

ly, that as

After explaining to herself and famiit

medicine had hitherto been unavailing,

to

was im;

portant at once

employ the most

efficient

means

pro-

posed that mercury should be exhibited

to affect

to

such an extent as

the system,

and that soreness of the mouth, and

do
because I found the utethe os and cervix hard,

gentle salivation should be kept up for three or four months.

I

was the more induced

to

this,

rus

generally slightly enlarged, and

uneven, and tender to the touch.

The
ment
:

patient

was removed a few miles

into

the country,
treat-

and on August 20th, 1823, commenced the following

Sumat

Pil.

Hydr.

gr.

iij.

Pulv. Opii gr.

-J-

in

forma

piluloe

nocte, maneque.

Infricand. Ung. Hydr. Biss. inter femora quaque nocte.

She was allowed wine and meat

joined to keep
in

diet,

and particularly en-

the house and avoid cold.

18

138
Sept. 10.

AMENORRHEA.
Gums
is

very tender for the

days, and there

decided salivation.

last two or three There has been no

menstrual

effort.

Complains of the inconvenience of the

spitting, but the

bowels are more regular, and the evacuations

more healthy.
Sept.

20.

The gums

are not so tender, but

they are

slightly swollen

and spongy.

Has only taken

to

three grains
the
effect.
is

of Pil.

Hydr. occasionally, just

keep up
but the

There has been no catamenial

nearly gone, and her aspect
better.
is

effort,

pruritus

certainly improved.

Appetite

Oct. 20.

On

the

17th of October,

after

some

suffering,

menstruation returned, and the flow continued for three days.

In
all

respects better, and the family are struck with her im-

proved complexion.

Nov. 28.
without
its

Was

ordered to discontinue the mercury, as

it

was thought the

effect

would be maintained some weeks

further exhibition.

The

catamenia re-appeared
;

at the expiration of the

month without pain

color.
I

the discharge
return of pru-

was abundant, and of sanguineous

ritus.

No

On

examination,
softer

found the uterus

less

heavy, and

the

os

and cervix

and

less

tender.

Gargles for the

mouth, sarsaparilla and bark, porter and wine, were freely

given during the continuance of the treatment.
In January, 1824, Mrs.
rial

H. was

quite free from

all

mercu-

influence, and in

better

health

than she had been for

many years. In November, 1S24, now (1839) living.

she gave birth to a boy,

For several years

she
sive

this lady

remained healthy

but

was subsequently
hemorrhage

so

much exhausted by

exces-

after childbirth, that dropsy super-

vened, and she died before she reached her thirtieth

year.
I

could add

similar

cases,

demonstrating

AMENORRHEA.
the value of

139
amenorrhcea,
Dr.
his

mercury
is

in

protracted

and where there

congestion of the uterus.

in the first

Davis relates several such

volume of

Principles of Obstetric Medicine, one of the most

valuable works of reference

we

possess.

CHAPTER

III.

OF VICARIOUS MENSTRUATION

Definition.

A
in
its

discharge,

generally of blood,
;

from

other parts than the uterus

superseding men-

struation,

and

return, occasionally observing a

menstrual period.
History and Symptoms.

This
it

vicarious discharge

can scarcely be regarded as a disease,

when

the

hemorrhage does not

system.
ture.
I

really
calls

derange and exhaust the

a curious freak of na;

Dr. Locock
think he
is

right in doing so

for the

pro-

cess, in

most instances, equally wants the regularity

an event entirely out of course
scarcely ever
for

of a healthy function, and the injurious influence of a

disease.
It is
it is
T

met with except in connection w ith amenorrhcea, still by far the greater number of instances of this latter malady are unaccompaied by vicarious discharge. Generally, it ocalthough
curs in the unmarried, at least

my

observation war-

rants this conclusion, but quite as often in the

weak

and delicate

as

in

the

robust.

When

married

VICARIOUS

MENSTRUATION.
conception
rarely

141
takes

women

are

its
its

subjects,

place during

continuance, although an interestsus-

ing case, in which pregnancy more than once

pended the vicarious discharge,

Davis.

is

recorded by Dr.
tor-

The

sterility,

depending principally on

por of the organic system of nerves,

may
it

likewise

be farther insured by the amenorrhceal state of the

uterine lining

membrane, incapacitating

for the

formation of the decidua.

is

The

vicarious discharge

usually blood, but

it

may

consist in an excess of

the natural
leucorrhcea.
intestinal

mucus of

the genital organs, constituting

Some

portion of the pulmonary and

mucous

tissues are

thought to be the more

;

common
is,

seats of the

vicarious loss

but certain

it

that the nipples, the ears, the gums, the umbili-

cus, the bladder, the axillae,

any part of the skin or

the surface of an open

the

mucous membranes,

or

ulcer,

may

occasionally by gush,

more usually by
its

slow transudation
rious blood.
turn,
it

for several days, furnish the vica-

In the regularity of

periodical re-

seldom

resembles

the

healthy function,

although cases are recorded where the menstrual

epoch has been exactly observed.

It

has been assumed, but without proof, that be-

fore furnishing the vicarious discharge, the part

must
;

be
it

in a disordered, irritable, or

weak

condition

but

has been frequently seen, that so far from struc-

tural

change taking place

its

in

the vicarious organ,

is

even

functional disturbance

generally slight,
disor-

and the amount of subsequent constitutional

der,
is

only proportionate to the blood

lost.

Where

142

VICARIOUS

MENSTRUATION.
are the seat of the hemor-

the nipples or

mammae
often

rhage, there

is

the formation of a crust over

off,

the affected spot, which being thrown ing occurs.

the bleed-

The time during which vicarious may continue to be repeated, is very

menstruation
uncertain.
I

have admitted patients into Guy's, expecting

its re-

appearance, and after keeping them in the ward for

many weeks,
returning.

have been completely disappointed, the

amenorrhcea persisting, and the vicarious flow not

Local
pain,

constitutional
its

irritability,

and hysteria, are often premonitory of

approach
;

periodical

and

in a patient,

who was

subsequently

a nurse in the

Hospital, the surface and edges of a

large menstrual ulcer on the thigh,

were invariably
are cases

more

painful, hot,

and swollen,

prior to its furnish-

ing the vicarious evacuation.

record,

There

on

by Churchill and Siebold, where excessive

the place of the catamenia.

salivation has supplied

Such an instance
Causes,
cretion,

have never seen. an accustomed se-

The suppression of
and vicarious
losses.

and the sudden, or even the gradual super-

vention of plethora or congestion,

these local

may account for But why this form

if it

of menstruation should occur so rarely,

be preis

ventive or curative of these morbid conditions,

question which

cannot answer.
distinction can scarcely be
diffi-

Diagnosis.
cult,

The

between vicarious and common hemorrhage.

existence of amenorrhoea, the occurrence of
effort

The

marked catamenial

and the vicarious evacua-

VICARIOUS MENSTRUATION.
tion, together

143

with the absence of the local and conwill

stitutional

symptoms of primary hemorrhage,

doubt.

remove

all

Prognosis.

am

not

aware that any case has

ever terminated fatally.

So

far

as

my

observation
its

has extended, the uterus has ultimately resumed

peculiar function, nor has the vicarious organ ever

suffered

any permanent

this curious process will

injury. The duration of much depend on the obstieffect of the vicarious

nacy of the amenorrhcea, the

loss,

and the treatment.

Treatment.

The extent
approach.

to

which remedies

shall

be employed, must be determined by the amount of

the hemorrhage, the effects of the loss,

and the

warning of
frequently

its

If the

process has been

are

repeated, and

there

premonitory
if

symptoms, emmenagogues may be used,

no plethora or congestion.
If,

there be

however,

there

is

engorgement of the uterus, cupping on the sacrum

or loins, leeches to the os uteri, vulva or anus,

must

precede the use of any stimulants.

tic

A
;

smart dras-

purgative

may

not only prevent the vicarious at-

tack, but also induce menstruation

eral

and

have sevwitnessed

times,

after preliminary

depletion,

the good effects of electricity and the strong mustard hip-bath, at a high temperature.
If the

hemorrhage, having come on suddenly and

is

without any previous indication,

ference
is

moderate, inter-

unnecessary, the advantages of healthy

it.

menstruation being partially secured by

But
is

if,

on the contrary, a large quantity of blood

lost,

144

VICARIOUS

MENSTRUATION.
to
in
life,

and from an organ important

measures must be adopted as
vicarious.

then similar

hemorrhage, not
with nitrate of

The

infusion of roses

potass, dilute acid and digitalis, cubebs

and bismuth,

the acetate of lead, ergot, turpentine, and opium

(vide formulae),

may be

exhibited.

In the intervals, the treatment must be directed

to the removal of the

amenorrhcea

tonics,

and

es-

pecially iron,

ought to be given.

residence at

Tunbridge Wells, Malvern, Buxton or Matlock, or

by the sea-side,
is

often decidedly advantageous.

Vicarious Leucorrhcea.
cretion,

There

is

in health a se-

exceedingly small in quantity, of colorless

transparent mucus, poured out by the uterine lining

membrane,
site

for the

purposes of lubricating the oppo-

surfaces of the organ, and preventing friction

and adhesive inflammation.

stituing leucorrhcea,
it is

When
of

excessive, con-

occasionally, and

more

fre-

quently

than

blood,

vicarious
is

menstruation.

Strictly speaking, there

amenorrhcea, because a
is

mucous, instead of a sanguineous secretion,

fur-

nished by the minute extremities of the uterine arteries.

it

But there

is

activity instead of torpor

all

and

will be found,

on inquiry, that

the

symptoms

denoting menstruation regularly appear, especially

when

this condition is vicarious of the

catamenia at

an early age.

The
ation.

disease

is

most common
also in

in delicate

and sus-

ceptible girls, at the epoch of

I

have seen
I

it

commencing menstruweak and exhausted

care a patient

women, and

have

now under my

VICARIOUS MENSTRUATION.

145

nearly thirty-five years old, who, in consequence of

frequent abortion and protracted suckling, being ex-

ceedingly impoverished and feeble, has for the last

twelve months, suffered from vicarious leucorrhcea.

The

regular menstrual period has been exactly ob-

served, and although the discharge has been fully as

abundant as the natural catamenia, and has lasted

three or four days,
it

has never

till

the last

month
not an

been colored.

Conception

in these cases is

improbable event, as in several females

who have

come under my
colorless,

notice,

where the menstruation was

from
to

pregnancy has occurred.

life this

In early

vicarious leucorrhcea,
return,
it

if

its

amount and

periodical

is

believed
all

be

uterine and not merely vaginal, removes

impres-

sion of congenital defect or malformation.

Nor,

if

the interval be free from excessive

is

mucous discharge,

the health

much deranged

a circumstance mark-

ing the difference between this form of vicarious

menstruation,

and chlorosis and amenorrhcea.

is

It

rarely happens that the uterine function

fully deair,

veloped independently of medicine or change of

although

it

is

quite

possible that,

under

favorable

circumstances,

perfect

menstruation

may

almost

spontaneously occur.

Pathology.

There

can be no doubt that vicarialone

ous leucorrhcea depends not

on disordered

action of the secretory apparatus of the uterus, but

also

on the impoverished and attenuated condition

blood
is
;

of the

and,

in

those instances

where the

discharge

always present,
J

we may

probably infer

146

VICARIOUS MENSTRUATION.

the existence of sub-acute inflammation of the uterine lining

membrane.
action
it

It
is,

is

difficult to

explain by

what diseased
to eliminate a

that vessels accustomed

fluid

sanguineous

should so far lose

their full

secretory

power

as to furnish only an in-

creased

amount of mucus.

Some

years

ago

pointed out a similarly perverted action, occurring

after

labor,

where aqueous discharge, occasionally

quantity,
in
is

in

immense

poured forth instead of the

intestines,

lochia.

And

hemorrhage from the

is

an

analogous phenomenon

sometimes presented, when

flow.

a large quantity of mucus, exhaled from the villous

coat,

supersedes the sanguineous

Dewees

regards vicarious leucorrhcea as a slow development of the menstrual function.

Friend and Astruc were

both

cognizant of

its
it

occasional existence.

The

former denominated

" the lymph-like menses,"

as leucorrhcea taking the

and Astruc recognises

hensive, valuable

it

place of the catamenia.

Nauche,

in

his

compre-

work,

" Maladies

propres

aux

Femmes,"
tary, thus

looks upon vicarious leucorrhcea as salu-

confirming the views

have guardedly
his

expressed.

He

says that in

1824 he had under

care a patient, twenty-four years old, plethoric and

robust, but

healthy sanguineous menstruation

it,

was

absent.

Instead of

there

was secreted every

month, and with satisfactory results as regarded the

health, a quantity of white mucus.

Diagnosis.
at the

The

occurrence of

the leucorrhcea

monthly

intervals,

the other attendant cir-

cumstances, and the absence of healthy menstrua-

VICARIOUS MENSTRUATION.
tion will fully elucidate

147

the

character and origin of

the malady.

Treatment.

This

is

nearly, if not entirely, the

is

same
tion.

as

where hemorrhage
nutritious
air,

vicarious of menstruadiet,

A
pure

and easily digested

exer-

cise,

and tonics, especially

iron, will so far

improve the blood and impart constitutional vigor,

as sooner or later to induce healthy menstruation.

CASES OF VICARIOUS MENSTRUATION.

Case 23.
reported by mr. ebenezer vorley.

Sarah
ion,

aged 17, of short

stature,

fair

complex-

and unmarried, became an out-patient of Dr. Ashwell,

August 19th, 1836.

fever,

Excepting an attack of intermittent

which occurred about four years ago, her health,

though delicate, has been generally good.

first

The

catamenia
hours
in

occurred two years since, while engaged

;

many

the 'day at a sewing business

their second appearance.

twelve months elapsing before

Since this period, the function has

been irregularly and scantily performed.

sequently to
this

Half a year subhad a vicarious

return of menstruation, she

secretion from the breast, preceded

by an

effusion of blood

under the skin of the mammae.

discharged
pitted,
its

The
edges.

cyst soon burst, and

contents

a cicatrix partially formed, slightly

its

and discolored round

at

The same

process
;

has been performed

every menstrual period since

ex-

cepting on one occasion,

naturally.

when
is

the catamenia appeared more

left

The

secretion

almost invariably from the

148
breast
;

VICARIOUS MENSTRUATION.
the
right

only once having been similarly affected.

The mammae

are

much

enlarged, exceedingly painful, and

at

very tender a few days prior to the expected period,

which time there are severe pains

in
is

the lower part of the

also

abdomen,
ing.
It

loins,

and back.

There

abdominal swell-

has several times happened, that there has been a

it

very slight catamenial show, but

full

has not proceeded to a

menstruation

and the breast, under these circumstances,

its

has invariably performed

vicarious

function.

There

is

moderate leucorrhcea during the

sive at the periods.
suffers -greatly

intervals,

becoming exces;

She has
in

little

appetite

and, after food,

from pain

the

epigastrium, flatulence and

heartburn.

The

bowels are very confined, requiring large

full

doses of aperient medicine for their

evacuation.

Pulse

08, feeble,

and
;

easily

compressed.
is

The

tongue

is

coated with white fur

and her sleep

disturbed

by pain

in

the inferior extremities and lower part of the abdomen.

Let her use the Ammoniacal Injection daily

ocynth and Calomel
Pill

take the Col;

three times a-week

and the

Mist. Ferri C. twice a-day.

The

treatment was continued for some months, her health

the

gradually improved,

leucorrhcea

disappeared,

and

in

February, 1837, the catamenia were natural and regular.

Case 24.
August 20th, 1838.
London, began
do so
to

Miss

aged 17, a native of

menstruate at 15, and after continuing to

for a year, the discharge entirely ceased.

Soon

afterlatter

wards she had cough, and

slight

hemoptysis.

The

symptom
vicarious

disappeared, and for the last six

months she had

I visited

hemorrhage from the

ears.

At the time
was

her, the blood filled the external meatus, and I

told

by

VICARIOUS MENSTRUATION.
her mother, that the
than three ounces
slowly.
at

149
less

loss

from both ears had never been

it

each period, and that

of sponge
I

came away

By
I

piece

cleared the meatus, and

afterwards

saw the blood slowly exhaling from the inner surface. As there were decided symptoms of chlorosis, and a feeble pulse, I ordered small doses of iron, an improved
diet,

and a

visit to

Tunbridge Wells.
till

I did

not see this patient again

I

several
that

months

after

her

return, but

had previously heard

in

the vicarious disin the in-

charge entirely ceased

terval

two months, her health

having been

materially improved

by the return of

natural menstruation.

Case 25.
VICARIOUS LEUCORRHffiA.
aged 40, residing in Kent, consulted me Mrs. L 2d of August, 1838, for vicarious leucorrhoea. She is
,

the

thin, pallid,

and extremely weak, although formerly robust

Menstruation

and embonpoint.
and

commenced

at

seventeen,
thirty

after her marriage,

which occurred when she was

its

years of age, she frequently suffered from

painful return.

scanty and

She has had two children at the full term, and five miscarriages, alarming hemorrhage having attended every abortion. For the last year the menstrual period has
been regularly observed, but the discharge has been
less
less

and
has

sanguineous

and

for

nine months the secretion

is

been entirely bloodless.

rhoea
in

There

also

considerable leucor-

the catamenial

intervals.

Complains of extreme
stand
upright.

giddiness,

and cannot occasionally

Pulse

from 90 to 110, weak and small, appetite nearly destroyed,

and the bowels never act without medicine.

often occur, and she
is

Hysterical

fits

nervous almost to insanity.

150

VICARIOUS MENSTRUATION.
to the seaside, a nutritious

She was ordered

salt

diet

was en;

joined, with a small quantity of wine and malt liquor

the
air.

shower tepid bath, and constant exercise

in the

open

R Tinct.
Take

ferri.

Muriat. Tinct. Humuli. Spir.

Ammon.

Aro-

matic aa

3iv.

M.

ft.

Mist.

thirty drops

in

tablespoonful of port wine

three

times a day.

A
I

mild aperient

when
this

required

and a vaginal

injection

twice daily of sea-water.

heard
:

from

patient

after

a month's residence at
respects, but the vica-

Brighton
rious

she was improved in

many

leucorrhcea continued.
at

down, and when she called

She followed the plan laid my house in' December, havfrom the sea-side,

ing only a few days previously returned

she said that her health was perfectly re-established, but that
the menstrual
discharge

was only

slightly sanguineous.

enjoined a continuance of the iron.

CHAPTER
OF

IV.

DYSMENORRHEA.
preceded

Definition.

Menstruation,

and

ac-

companied by acute, and often lancinating pain in

the
the
tion

uterus and adjacent parts, and occasionally in mammce, with derangement of the secretive func;

the

catamenia being usually, though not inva-

riably,

scanty in quantity, and in the severer

cases, clotted,

and

more chronic

shreddy or membranous.

History and

Symptoms.
It
is

Dysmenorrhea

is

an

important

disease.

very common, and prooften prevents concepits

duces extreme suffering

tion
;

it

and

if

pregnancy has occurred during

is

continuance, the patient

abortion.

exposed to the risk of

it

Although,
it

in

itself,

is

not

fatal

malady, yet
eases have
lastly, it is

admits of proof, that malignant disits

followed

protracted existence
difficult

and
not

exceedingly

to cure.
;

It

is

confined to one class of females

the married and

the single, particularly the latter, are obnoxious to

it.

It

prevails

among women
habits

of irritable tempera-

ment, and of delicate, strumous, and phthisical constitutions.

The

of

the

rich,

therefore,

by

152

DYSMENORRHEA.
a direct influence

fostering these tendencies, have

in

promoting

it.

There

are examples too, although

rare,

among

women

of

sanguine

temperament.

Every case of merely

painful menstruation
If,

must

not be regarded as dysmenorrhcea.

for

example,

the pain and tightness of the head, the pain in the

lumbar and hypogastric regions, which have preceded the menstrual period, diminish and pass away
as the secretion increases
;

such a case
is

is

not dys-

menorrhoea.
painful
tion
is
;

Scanty
is

menstruation,

not always

nor

the opposite state,

where the func-

copiously performed, always free from suf-

fering.

Dysmenorrhcea
;

is

often co-existent with

menstruation

often after a prolonged and healthy

in the general

continuance of the function, a change

system, or some of the exciting causes, to be mentioned hereafter, induce

its

approach.

symptoms of irritable or neuralgic dysmenorrhcea, where there is neither inflammation

earliest

The

nor congestion are referrible to general disorder of

the health, such as impaired appetite, great languor,

gradual loss of flesh, and uncertain action of the

bowels.

The catamenia become

irregular,

some-

times appearing in excess, with a prolonged interval

;

while at other times suppression

is

an early

morbid indication.

The

discharge

is

emitted with
clotted,

almost indescribable pain, being shreddy,

and generally scanty

vary

in quantity.

much

in different cases.

These symptoms In some individuals,

first

they are but temporary, continuing only for the

day or two of the period

when

after the expulsion

DYSMENORRHEA.

153

of a small clot not always firmly coagulated, the

discharge assumes

its

natural

consistence,

and

is

unaccompanied by more than the usual

ness.

local uneasi-

In others, the

whole time

is

one of intense

suffering,

commencing with
in

sharp, darting, lancinat-

ing pain

the uterus and

vagina, and extending

apparently to the uterine appendages.

There
;

is

acute sympathetic pain in one or both breasts

the

lumbar pain, running down the sacrum

and
groins,

to the thighs

becomes excessive

and during the

expulsatory pains,

emission of the discharge, the

much to the The intensity and duration of the pain depend much on the nature of the discharge, the
resembling the throes of labor, add
suffering.
rigidity of the structures,
bility of the patient.

and the nervous suscepti-

In

some
for

instances, the cata-

menial period

is

preceded

two, three, or four

days, or a week, by

severe pain in the

mammas.
is

When
ing
less
is

the menstrual period has ceased, the sufferfor the

time

at

an end, and the strength

reduced than might have been expected.

little

Dur-

ing the whole period,

febrile

excitement exists,
injury,
is

and the amount of constitutional

or even
several of these attacks,
if

from one

inconsiderable.

By

and by, however,

proper treatment be negis

lected, or if the disease

so inveterate, as

not to

yield to

it,

the general health

becomes much imaction of the one

case.

paired, and the reciprocal morbid

upon the other greatly aggravates the

tion of the

With-

out any sympathies of the uterus, with the excep-

mammary
20

being called into prominent

154
exercise, the
tion,

DYSMENORRHEA.
bowels become uncertain
from a mild purgative
;

in their ac-

being sometimes constipated and then unduly

:

relaxed, even

the

hepatic

secretions are variable in quantity

and occasionally
capri-

there
their

is

pain and excoriation about the anus, from

acrimonious nature.
small, food
is

The

appetite

is

cious and

almost loathed, the blood

nutrition
is

becomes impaired, and imperfect

loss of physical

evident

from paleness of the general surface, emaciation and

power.
In this stage of the disease
if it

leucorrhcea becomes profuse,

existed
;

has not habitually

and sometimes amenorrhcea supervenes,

In

thus entirely suspending the uterine suffering.

connection with the continuance of this menstrual

suppression, the

mammre become

flaccid

and almost

disappear

and the torpidity of the uterus excludes

its

that viscus from a healthy discharge of

functions.

In plethoric dysmenorrhea there

viation from the

is

not

much
;

de-

symptoms now described

will

but the

menstrual

period

be preceded

by headache,

flushing of the face, full and quick pulse, a sense of

weight
lirium.

in

the pelvis, rigors, and sometimes by de-

These precursory symptoms are followed by the catamenia, which are sometimes profuse with more or less of coagula. More frequently,
however, the discharge
clots with portions of
is

scanty,

and consists of
difficulty

membrane, and the

of emission
of labor
effort,
;

is

extreme.

the patient bears

after

The pains resemble those down with considerable

by the expulsion of

and

many

abortive attempts, a paroxysm

relieved,

of uterine suffering

is

DYSMENORRHEA.
a small concrete clot, or a detached portion of

159

mem-

brane.
thoric

It

must not be supposed that only the pleexpel these false membranes
;

women

women
for a

of an

opposite

temperament may do
;

so,

and

lengthened period

an ill-advised use of
result.

emmena-

gogues aiding such a

Congestive Dysmenorrhea.

When

the affection

of the mucous membrane

inability
to

is

attended with a partial

quantity of menstrual

secrete the

full

discharge, the large and repeated doses of aloes and

steel, so often

given

with the intention of compelthe quantity of blood in

ling menstruation,

augment

the uterus, which remaining stationary, every successive period

is

accompanied with an increase of

disease
is

congestion,
fully

till

at length this form of the

established.
are

The premonitory symptoms

slight.

in

this variety

comparatively

sense of
pains

weight

in the pelvis,

with the bearing

down

of prolapsus, lumbar pain, frequent micturition and

constipated bowels, denote an enlarged uterus.
it is

But
then

not

till

the function

is

about to commence, that

arise.

the very severe

intense

symptoms
pain,

There
in

is

uterine

with a sensation as though

the

some
cavity

foreign body
;

were shut up
attempts at
its

uterine

and

in the

expulsion, the

uterus

is

aided by the voluntary, as well as involun-

tary efforts.
in

The paroxysms
is

occur as in labor, but

eas,e.

dysmenorrhcea there

no interval of
;

In-

cessant restlessness comes on

the patient

looks

anxious and pale, and frequently attempts to micturate,

and as the contraction of the bladder

is

evacu-

156
ating

DYSMENORRHEA.
the urine, she uses
to expel
all

her

power

in the vain

endeavor

a clot or portions of
is

membrane.
by
is

Sometimes there
temporary, and

spontaneous

relief afforded
;

the passage of a small concrete mass

it is

but this

only with the cessation of the

period, that she

can be said to be relieved from

peculiarity of this form

her sufferings.
is

One marked

the absence
is

of inflammatory symptoms.

The

pulse

rather weak, sometimes quick and irritable,

is

the skin

perspirable, and there

is

exhaustion, not

inflammation.

During the

intervals of congestive

dysmenorrhcea, where false

stantly expelled, there
rhoeal discharge,
is

membranes

are

con-

generally abundant leucor-

the health

becomes increasingly
and the legs are

disordered, the

mammae

shrivel,

cedematous.
tion

It is in this

variety that spurious abor-

most frequently occurs.

is

mass

is

ejected

from the uterus, which

or laminated
or a

made up of

a condensed

coagulum with portions of membrane,

to the cavity of the uterus,

membrane moulded

inclosing a large coagulum.

Illustrations of these

are beautifully delineated in Dr. Granville's work,

and hereafter
tinctions

shall
this

give Dr.

Montgomery's

dis-

between

form of membrane and the

true decidua.

The

late

Dr. Mackintosh, of Edinburgh, pointed

attention to dysmenorrhcea dependent on mechanical

obstruction, caused by contraction or stricture of the

canal of the cervix, or by partial imperforation of

the os uteri.

Capuron
that in

also alludes to

it,

and other
cases,

authors think

some very

rare

the

DYSMENORRHEA.
malady may be attributed
is

157
cause.

to such a

There
by no
its

no doubt that dysmenorrhcea has occasionally cosuch malformation

it
;

existed with

but

it

is

means

certain that

owed

either

its

origin or
its

con-

tinuance to such a state of parts as

cause.

Dr.

Churchill, in one instance, distinctly ascertained the

presence of a stricture half

cervix
;

way up
I

the canal of the

but

its

dilatation

left

the dysmenorrhcea as

bad as before.

A few
I

years ago

examined the

cer-

vix after an extremely severe and protracted attack

of the disease, and

satisfied

myself and a profes-

sional friend, that there

was

really

narrowing of the
;

canal.

This was entirely cured by bougies

but

the catamenial suffering

In another case

was not at all alleviated. was more successful, and Dr.

bad forms of
In Dr.

Ryan

entirely cured one of the very

dysmenorrhcea by metallic bougies.

intosh's

Mack-

examples there

is

nothing proved as to re-

tention of the menses, which might have been lookthe mechanical impediment had been so complete as " scarcely to admit a bristle." He

ed for

if

tried the treatment

by bougies
twenty-four.

in

twenty-seven
In

in-

stances, and cured

latter

eleven of the

number,

pregnancy subsequently occurred.

As

the introduction of bougies

;

must act as

a direct

and powerful uterine stimulus

the advantage, even

is

where contraction

really

exists

not necessarily
In doubtful cases

entirely attributable to dilatation.

an internal examination ought

to be

made

as dysos,

menorrhcea may depend not only " on a small

but on inflammation of the lining membrane, and of

158
the neck of the

DYSMEiNORRH(EA.

womb, and on tumors

diminishing
Still

the calibre of the passage through the cervix."

I

believe that the views of Dr.

is

Mackintosh are more

correct than

generally supposed, and they should

not be disregarded in protracted and obstinate dys-

menorrhcea.
Causes.

It is

not at

all

times easy to specify the

exciting cause.

The

history usually brings to light

some symptoms of uterine irritation, more or less some catamenial irregularity, some proof of acute
;

a temperament disposed to strong emotions.

Among
confine-

married women,

miscarriages,

premature

ments, and particularly the various effects of cold,

may

be enumerated as preceding

the

complaint.
for-

Nor must uterine determination or congestion be

gotten, by

some

pathologists regarded as the

all.

most

frequent cause of

Diagnosis.

But

little
;

need be said on the diagas in the great majority of

is

nosis of dysmenorrhcea

cases, the functional disorder

clearly ascertained,
Jt
is

and the symptoms well defined.

individuals

only in the

cases of spurious abortion, where the characters of

may
is

be ignorantly aspersed, that

required.

much
of the

discrimination

The

duration

complaint, the nature of the menstrual secretion in

former periods, the enlarged state of the uterus from

congestion, as ascertained from examination by the

vagina and

rectum, independently of the physical

characters of the product, are quite sufficient to satisfy

any observer.

Dr. Montgomery, in his elaborate

and accurate work, on "

The

Signs and

Symptoms

DYSMENORRHEA.

159

of Pregnancy," thus expresses himself, in reference

to the peculiarities

which distinguish the dysmenor-

rhceal

membrane.
substance expelled in this disease will be
in several of the properties of the true

"

The

found deficient
decidua
;

for

although produced by an action in the

uterus analogous to that by

w hich
r

it

prepares the

decidual

nidamentum
it

for the reception

and support

of the ovum,
points
;

differs
it

therefrom in two essential

is

first,

that

morbid

product

and
of

secondly, that not being intended, like the true decidua, to

nutrition

become an organ, for the ovum, it

or at least a
is

medium
for
is
;

not furnished with a

the

structure such as

would only be required

office
;

performance of such an
flimsy,

hence,
its

it

thin,

and very unsubstantial

in

texture

of a

dirty white or yellowish appearance

when

slightly

agitated in water, devoid of the soft, rich, pulpy ap-

pearance, deep vascular color, and numerous forami-

na

for the reception of the nutrient vessels

from the

uterus,

which are always so

distinctly observable in
in

the true decidua, which

however

one point

it

re-

sembles, having

its

inner surface smooth, and

the

outer unequal, but of a ragged, shreddy appearance,

unlike that of the healthy uterine decidua, and

it

is,

moreover, entirely destitute of the

sacculi already described
in the
latter

little

cotyledonous
character

as an

essential
it

structure.

In texture,

more nearly

resembles that of the reflexa than any other structure

;

but no trace of the transparent membranes of

discovered within
it,

the

ovum can be

or attached

160
to
it,

DYSMENORRHEA.
and should
it

happen

to

come away

entire, in

the form of a hollow triangular bag,

we

never find

within

it

a duplicate of itself forming an inner pouch

or reflex layer, as in the case of the natural decidual

envelopes of the ovum.

accurate account
of this

Morgagni has given a very

accidental product, as
it

occurred in the case of a noble matron of his country,

w ho
r

expelled

it

almost every month with pains

like those of child-birth,

having

its

external surface
filaments
that

'unequal

and

not

without

many

seemed

to

have been broken off from the parts to

;

which they had adhered but internally hollow, on which surface it was smooth and moist, as if from
an aqueous humor which
Pathology.
it

had before contained.'

dysmenorrhcea

Some authors regard

hysteralgia

as a neuralgic affection,
identical

a disease of enervation,

with

and

irritable

uterus.

Others take a different view of the malady, and consider

it

as invariably

dependent on a morbid condi-

tion of the

mucous

lining of the uterus.

The

for-

mer
to
tion.

attribute the pain,

;

and

all

the other symptoms,

acute irritation

the latter, to inflammatory acare

These

conflicting opinions

not irrecon-

cileable.

In a great

number of

cases, particularly
is

in delicate

single females, there

only acute ner-

vous

irritation, affecting the

muscular tissue as well

In other

as the

mucous

lining,

and producing pain.

and aggravated examples of the malady, there exists

a low form of inflammation, modified by the peculiar

membrane which
There are

it

affects,

and inducing intense

pain.

facts strengthening the impression,

DYSMENORRHEA.
that

161

dysmenorrhea

is

often a disease of irritation.

Hysterical and susceptible females are more prone

to
it

than any other class.

The

pain

is

mostly un;

accompanied by symptoms
pulse
is

of inflammation

the
this

quickened only during the paroxysm,

it

being over,

again subsides

and the flushed face

without in-

and hot skin are often succeeded by a cold and

clammy
tery, be
face,

surface.

Acute pain may

off

exist

flammation, and a layer of lymph may, as in dysen-

thrown

from the intestinal mucous surNeither

without decided inflammatory action.

the pain of labor nor the after-pains, occasionally so

protracted

and agonizing, are inflammatory

and

yet, if the degree of pain

were

to be the

criterion,

one might easily believe that inflammation

isted
;

really ex-

for certainly

no suffering from dysmenorhcea

In
other cases,

can be greater than the pain attendant on labor and

its

subsequent contractions.

and

which are thought, (by the supporters of the opinion

that inflammation
is

invariably present,) alone to

deserve the appellation of dysmenorrhcea, a modified

and low form of inflammation certainly

stances,

exists,

which

produces a false membrane, assuming, in some inthe shape of the uterine cavity, and in
I

others, being expelled in detached portions.

quote

the following remarks

from a clear and practical

1339, by Mr.

paper on this malady, read before the Medical Society of

Guy's Hospital

in

Henry

Oldham, one of the

tution.

obstetric assistants of the insti-

" There are so few instances

21

in

which minute

in-

162
vestigations

DYSMENORRHEA.
of the exact condition of the

mucous

membrane and body of

are permitted, that

the uterus in dysmenorrhcea

we

cannot offer any remarks on

the visible changes in these structures.

We

are

consequently
admissible
alterations,

left to

the far less secure, but the only

mode

of inferring the character of these

from the symptoms which accompany

the affection and the analogous productions from

other mucous membranes.

that

There can be no doubt

to suppura-

mucous membranes, though prone

throw
off

tive inflammation, often

false
in

from their surface

membranes of organized lymph. The trachea croup, the intestines in some forms of dysenthe urethra under inflammation, are familiar
;

tery,

examples of the kind

and there

is

but one com-

mon
lining

explanation of this occurrence, viz. that the

products of inflammation are present, and that the

membranes of these

several organs are the

seat of the diseased action.

The
in

uterus presents a

precisely analogous instance

dysmenorrhcea, and
lining is in a similar

we

hence

infer, that its

mucous

state."

paper presented to the Statistical Society in

1839, by Mr. Lever, another of the obstetric assistantsof the Hospital, and displaying his usual research,
confirms these views, by slfowing that one of the occasional ultimate results of dysmenorrhcea,
tural
is

struc-

change of the uterus.

protracted dysmenorhabitually

rhcea,

where the

false

membrane has been

secreted, (and the fact will be noticed in the append-

ed cases,)

is

liable to

induce thickening and indura-

DYSMENORRHEA.
tion of the

163
is

os

and cervix.
is

This

the

result

of

chronic inflammation, and

the probability of
ter in
its

only to be feared from

assuming a malignant charac-

women

possessing a cancerous diathesis.

it

By
may

such a structural change, whenever

affects the

channel of the cervix, mechanical dysmenorrhoea

be induced.
Prognosis.

This

will

be more or less favorable,

its

according to the views entertained of

like

nature.

If,

irritable uterus, dysmenorrhoea be regarded as

invariably a neuralgic, not an inflammatory disease,

it

may

be severe and protracted, but

In fact,
I

it

will

not be

fatal.

know

of no instance where a terits

mination so serious has been

immediate

result.

But,

if a

scirrhous or carcinomatous change of the

its

uterus follow, even very rarely in

train,

then a
It

prolonged dysmenorrhoea
not,

is

a great evil.
in

must

however, be forgotten, that

is

the majority of

instances, the affection

cured, either by medical

or

treatment, marriage and child-bearing,

natural
tion.

by the

permanent cessation of the catamenial func-

From

observation,

am

disposed

to*

think,
fre-

that marriage and

connubial

intercourse are

quently remedial

the probability or impossibility of

such events must therefore influence the prognosis.

It is

not meant to be affirmed, that they are invaria-

bly curative, or that aggravated examples of the affection are not to be found
I

amongst married women.

fifteen

am now

attending an unmarried patient in her

year,

forty-fifth

who, from
entirely

to

forty-two,

(when

the function

and suddenly ceased,)

164

DYSMENORRHEA.
Her
sister

invariably suffered from dysmenorrhoea.

was

similarly

affected

till

her

marriage, but that

event,

and frequent pregnancy, entirely displaced

and cured the dysmenorrhoea. In the former case, have examined the uterus very carefully, but I
in the
os.

cannot discover any structural change either

body, cervix, or

The utmost

caution should be
structural

used

in

the

investigation of

suspected

change, supposed to be connected with dysmenorrhoea, as, in the* opinion of the

sex, very little suf-

fering

is

sufficient to

induce them to denominate any

case painful menstruation.

few years ago,

a matter of doubt whether the false

was membranes of
it

dysmenorrhoea could be
impregnation.

formed independently of
is

This point
for a

now

laid

at rest,

and
has

no suspicion can been thought, nancy occur

moment be

entertained of the
It

purity of any individual so circumstanced.

too, that

conception was entirely inI

compatible with this disease.

have known pregalmost immediately

;

in several instances,

after the marriage of a dysmenorrhceal patient

it

but

cannot be doubted, that an aggravated form of the

to

malady must be unfavorable

that sterility

such an event, and

to such

may

often be fairly attributed

a cause.

Treatment.

This

is

necessarily

different

for,

while inflammatory and congestive dysmenorrhoea

require depletion and
antiphlogistic

measures, the

neuralgic or irritable form calls only for narcotic and

slightly nauseating remedies.

There

are,

however,

in the treatment of every variety,

two

principal in-

DYSMENORRHEA.
dications
;

165

to alleviate the urgent pain of the

men-

strual period,

and

to

employ, during the intervals of

the discharge, such remedies as shall restore to the

uterus

its

healthy secretory power.

;

sionally accomplished with difficulty

ever,
is

Both are occathe first, how-

generally the most easy of fulfilment.

In the more ordinary variety of the malady, the

neuralgic, the mustard hip-bath and
are especially beneficial
;

some narcotics

if

the attack be aggravated

or of frequent recurrence, then

ipecacuanha or an-

timony ought
cise
:

to be

employed.
on the

But
first

to be

more pre-

let

the patient,

premonition of

pain,

commence

the use of the hot bath at 96 or 98,

in
it

and ordinarily remain

ters of

for a half or three quarit

an hour, repeating

three or

four times in

the twenty-four hours, and always guarding against

the effects of cold, by keeping in a hot bed, so long
at least as to allow the skin to

resume
is

its

ordinary

temperature.

When

the

pain

very

severe, the
is

bath

may
if it

be continued until faintness

induced

and

be inadequate for this purpose, then half a

grain of ipecacuanha, or fifteen or twenty drops of

antimonial wine

may

be exhibited every hour.

It

will be found, that the general relaxation of the cu-

taneous surface, and the attendant and temporary

depression of the system, greatly favor menstrual
secretion.

In the milder cases, a hot hip-bath and

slight narcotics will suffice.

Camphor, ipecacuanha,

and hyoscyamus, the Dover's powder, the extract of

hop, lettuce, conium and belladonna, variously com-

bined '(vide formulas), relieve the pain and induce

166

DYSMENORRHEA,
If perspiration
is

perspiration and sleep.

with

dif-

ficulty obtained, three, or four, or five grains of an-

timonial

powder may be

given,

by which a diapho-

retic effect will

be insured.

Sometimes, when the

pain

is

terribly severe,

and the cerebral excitement

goes on nearly to delirium, one quarter or half a

grain of the acetate of morphia

may
it,

be given at
the muriate
opii

night
or

and smaller doses, either of

meconate of morphia, or Battley's Liquor

sedativus, at intervals during the day.

A
In

suppositois

ry of opium,- conium, hyoscyamus or belladonna,

often effectual in relieving the pain.

some

cases,

from the forcing, bearing

tinctly recognize the

down

efforts,

we

can dis-

attempt on the part of the ute-

rus to expel

a clot.

Here the

ergot, either

in

de-

coction or tincture,
interval of

may
ease,

be repeatedly given, and an

marked
its

however
It

brief, will

occa-

sionally follow
to

expulsion.

would be

difficult

speak with precision of every modification of

;

treatment

but enough has been said to enable the

practitioner,

while he maintains the

of management.

principle,

to

vary the

mode

In a French publi-

cation of the Society of Agriculture, Sciences, and

Arts, Dr. Patin
for

recommends
;

the acetate of

ammonia

dysmenorrhcea
it

enjoining,

however
it

this caution,

that as

diminishes the discharge,

must be used
from being a
;

with reserve.
stimulant,
it is

He

says, that so

far

really a sedative
in

remedy

and he

re-

gards

it

as applicable

any case, whether of dys-

menorrhcea, profuse menstruation, or menorrhagia,

if

there be morbid excitement of the female genital

DYSMExNORRHCEA.
system.

167
forty to seventy

This physician gives from

;

drops three or four times daily

the only inconI

venience being slight

and transient giddiness.

this

have no experience of

remedy.

In the inflammatory and congestive forms of dys-

menorrhea,
there are

in addition
is

to the

remedies already en;

joined, local depletion

cases,

peremptorily required
is

and

where there

vascular fulness, in

which a small general bleeding

Congestion

will be advantageous.

almost invariably prevents

secretion

the unloading of the vessels, therefore, aids the flow

of the discharge.

In the majority of instances, cup-

ping on the loins, to the extent of eight, ten, or

twelve ounces, or leeches will

sary, the bleeding
to the os uteri

suffice,

and,

if

neces-

may
well

easily be repeated.

Leeches
I

have been already mentioned, and

applied,

think, that

when
I

they are decidedly

local

more

beneficial

than

any other

depletion.
effica-

Several times

have witnessed their superior

in

cy in relieving the severe pain;

one instance,

where the patient had been

in the habit, for several

years, of being occasionally cupped, the relief afford-

ed by thus directly unloading the congested vessels

themselves, exceeded, to use her

any idea she could have formed.

tube

own expression, The speculum

may be

introduced into the vagina prior to

;

their application

and

if

the cervix be brought fully

into view, neither the vagina nor

this portion of the

any other part than

congested viscus will be fixed on

by the leeches.
sible, be

Their use should, as much as posto married

confined

women, and

a clever

168

DYSMENORRHEA.

nurse should be taught to apply them.

bath, as

The

hot-

heretofore

advised,

sudorific,

nauseating

and anodyne medicines may

all

be used.

Hot pop-

py fomentations
ral

to the

abdomen

generally, and par-

ticularly to the hypogastric region, injections, seve-

times during the twenty-four hours, of poppy

to

and conium into the vagina, so as constantly

the discharge and sooth the pain.

bathe the lower part of the uterus, will encourage

The

second part of the treatment comprises the

the catamenial
intervals.

management during
object
is

In

the neuralgic and irritable form of the disease, the

to

improve the general health, principally

to the disordered state of the digestive

by attention

organs, and by the avoidance of local excitements.

I

need not dwell on the importance of mild and cor-

dial aperients, in preference to drastic

and mercurial

purgatives.

An

occasional alterative, such as the

pill, is

grey powder, or a moderate dose of blue

quired, but active and repeated
jurious.
iron,

re-

purging must be inpreparations

Afterwards, the

various

of

combinations of the mineral

and vegetable
are disposed
diet,

tonics, omitting
to be

them when the bowels

nutritious

relaxed, a
air,

and unstimulating

pure

a temporary residence at places celebrated

for their

chalybeate waters, and

gentle but perse-

vering exercise, are the most important indications.

Dr. Dewees, one of our ablest obstetric writers, regards the neuralgic form of dysmenorrhoea as analo-

gous

in

its

nature to

chronic

rheumatism;

and

strongly recommends, in the intervals of the disease,

DYSMENORRHEA.
the volatile tincture of guaiacum
;

169
adding, that he
patients

has relieved

many dysmenorrhceal

by the

antiphlogistic plan, but cured none.

He

begins with

drachm doses of the tincture three times daily, increasing the quantity to three drachms three times
daily, in a

glass of wine.
I

His success has been

great

mine, although

have often tried the guaia-

cum, has been inconsiderable.

In the inflammatory, and especially in the more

frequent congestive form of dysmenorrhcea, local depletion, saline aperients,

larly necessary
;

and spare

diet, are particutill

nor should they be discontinued

is

the

volume of the uterus

satisfactorily lessened.

The

hot hip-bath three times a-week, and

warm

in-

jections of the fotus papaveris twice a-day,

topically aid
dies.

will

the former and

more important remecomplete the

in

Afterwards,

mild tonics will

mind what has been already said, of structural uterine change following chronic dysmenorrhcea, mercury must not
restoration of the patient.

Bearing

be forgotten in the inveterate cases.

ceding chapter,
fects, I

In the pre-

w hen
T

treating of

its

deobstruent ef-

pointed out certain conditions as unfavorause

is
;

ble to

its

but,

where these
in

indications are abto prove efficaif

sent, there
cious.
It

no medicine so likely

may be employed
is
is

both the varieties,

their continuance
false

exceedingly prolonged, and the

;

membrane
is

habitually expelled

but certainly
is

mercury

most beneficial where there

a thicken-

ed and indurated cervix, the result of chronic inflammation.

170

DYSMENORRHEA.
effect of the inunction of the iodine
it

The

ointment

on the neck of the uterus, where

hardened,
is

is

enlarged and
will,

most

satisfactory.

This subject
in the

however, be more fully treated of

hard tumors of the os and cervix.

chapter on

Case

26.

chronic dysmenorrhea pregnancy supervening after fourteen months.

occurring in the practice of mr. henry oldham.
Oct. 20.
habits,

Mrs.

H
in July,

young lady of

lively, active

was married
and

1838.

For three or four years

suffered

previous to her marriage, she appeared constitutionally delicate,

during this

time

she

from

occasional

menorrhagia, followed by menstrual suppression, the continu-

ance of which varied between six weeks and two months.

This condition of the uterine function was attended with

great languor under exertion, imperfect nutrition from loss of
appetite, irregular action of the bowels, tympanitis, hysterical
eiriotions,

and leucorrhoea more or

less profuse.

During the
perma-

latter part of this time she had several attacks of glandular

swellings, and the

right lobe of the thyroid remains

nently enlarged.

The first three months of marriage were attended with marked improvement in her general health. The appetite became healthy, the features firm, the animal spirits buoyant, About the fourth and everything indicated confirmed health.

DYSMENORRHEA,
month
pain
in

171

after

marriage the

first

symptoms of dysmenorrhea
which was relieved only
flow.

appeared.
the

The

menstrual

period was preceded by intense

mamme,

lasting for days,

when
itself

the catamenia

commenced
local

to

The

discharge
its

was altered

in quality,

being clotted, and in

expul-

sion occasioned

much

suffering.

The

pains, however,

subsided with the discharge, and the

first

periods were pass-

ed, leaving only a temporary sense of exhaustion.

She came

under

my

care in March, 1839.

At this time she was laborwhich had been premammae, lasting eight days.
and the discharges condetached portions of

ing under an attack of dysmenorrhea,

ceded by great

irritability

of the

The

local sufferings

were very

great,

sisted of occasional fibrous masses, with

membrane and
and the

a brownish colored fluid.

During the attack

left

she complained

much

of exhaustion, her appetite

her,

least exertion

aggravated the pain.

She was ordered

fol-

the hot hip-bath, with hot

poppy fomentations, and the

lowing

pills

R.

Ext. Hyoscy. gr.

iv.

Camphorse Rasae,
Pulv. Ipecac, gr.

gr.
i.

iij.

Ft. Pilul,

ij.

Ter

in die

sumend.

These had the desired effect of relieving the pain but the symptoms after the catamenial period did not kindly pass away. There was continual aching of the loins and groin,
;

as

though the uterine ligaments were strained

;

perpetual

sense of weariness
sleep.
itals,

indifferent

appetite

and unrefreshing

She

also

complained of pruritus of the external gen-

and leucorrhoea was present.

The bowels were

irregu-

lar,

sometimes constipated, and

at others relaxed.

Circula-

tion feeble.
It

would be tedious

to

recount even a monthly report,

although the symptoms were accurately noted.

They

par-

172

DYSMENORRHEA.
At one time

took generally of those already enumerated.

the tonic

treatment

pursued

during

the
;

interval

seemed

almost to have re-established her health

but the intense

;

agony of the succeeding period

left

the

same exhaustion
effects.

and was followed by the same constitutional

sedative treatment, with slight variations,

The

was enjoined during

the attacks, and chalybeates variously combined

occasional
to the sea-

purgatives, with good, but unstimulating diet, were the main

therapeutics in
side,

the intervals.

She was ordered

but there

and marital intercourse was suspended.

Temporary
remained

alleviations

were often procured

general health indeed

still

delicacy, and continued ailment with the

order.

same

functional disto get

Her
;

seemed gradually

worse

and some of her friends foreboded

phthisis, without,

however, any physical sign of thoracic disease being recognised.

Iodine with the hydriodate of potash

;

in

small doses

was given with some benefit

decidedly good effect.

and the iodide of iron had a

In September, 1839, she menstruated naturally, without an-

tecedent pain

and the discharge was of

its

proper consist-

ence, color, and quantity, and the appetite greatly improved.

In a fortnight after this period she complained of more intense suffering than she

had ever before experienced

in

the

hypogastric region, with lumbar and bearing

bility to

down
also

pains, ina-

exert

herself, etc.

The mammae

became

in-

tensely painful, so that the least pressure on

them occasioned
body

shivering and sudden pallor.

On

examining the uterus, the

os and cervix were found hardened and painful, and the

of the uterus fuller than natural,

its

weight being sufficient to

bear

it

low down

in

the

vagina.

previous examination,

about six weeks before this time, had detected the os and
cervix larger than normal
;

but soft and rather painful

local

when
pains

even gently touched.

The

and

sympathetic
;

seemed

to

be premonitory of the menstrual flow

but this

period passed away, and

ten days afterwards Dr. Ashwell

DYSMENORRHEA.
saw her with me.

173

On

examination, the volume of the uterus

it

was found considerably augmented, and

this

was suspected that

however,
of
the

suspension of the catamenia had occasioned the conges-

tion.

Upon more
a

careful

examination,

mammae,
ence of

well

formed

areola was visible,

and the existin

pregnancy became probable, and now,

Novem-

ber, the sympathetic affections

have abundantly confirmed the

opinion.

Case 27.

PROTRACTED DYSMENORRHCEA CURED BY MERCURY.

In January, 1837,

visited

Mrs.
is

set.

24, residing a
of strumous

few miles from town.

She

delicate

and

aspect, and has been married nearly

two years.

She aborted

soon afterwards, and has never since been pregnant.

present

The

symptoms
Prior

are intensely painful menstruation,

accom-

panied by the expulsion of clots and portions of

brane.
to marriage she suffered

false

mem-

in a similar

way, but

not to the same extent.

the dysmenorrhcea was
abortion
in the
it

For

few months

after this event,

;

materially alleviated

but since the

has returned in aggravated degree.

loins,

Now,

pains

hypogastrium,

and thighs, occur several days

prior to

menstruation, inducing fever and depriving her of

;

appetite and sleep

the dysmenorrhcea lasts seven or eight

is

days, and from exhaustion she

generally on the sofa a

its

w eek
?

afterwards

so that the disease and

consequences absorb
little

nearly the whole month, and leave but

curative treatment.
is

opportunity for

Leucorrhcea
;

is

always present when she

;

not menstruating

the bowels are irritable and uncertain

at

sometimes constipated, and

other times, after a gentle

174
aperient, or

DYSMENORRHEA.
even
after
trivial

mental excitement, violently

purged.
In
fully

May, Mrs.

was no
laid

better,
in

although she had

the previous pages.

pursued the treatment

down

She was emaciated, and

and pain
I
at the

as she

complained of constant heat

also in coitu,

neck of the bladder, and of pain

examine.

was allowed

to

The lower

part of the
;

body of
the cer-

the uterus was enlarged, hard, and slightly tender

vix

was thickened, generally increased

patulous, and

in size,

indurated and
;

uneven, but without the stony hardness of malignant disease

the os was
viscus
its

edges not smooth.

The whole
fin-

was increased

in size,

and on raising

it

up on the

ger, she

was immediately relieved from pressure on the neck

at

of the bladder, of which

I

other times she complained.

of mercurial treatment, the

now urged

the importance

recumbent posture, and the

course.

entire avoidance of sexual inter-

June 20.
pill

Mrs.
;

was ordered three grains of blue

quinine

every night

and four ounces of the compound decoction

twice a day.

of sarsaparilla, with two grains of

Meat
to

diet

and mild

ale

and she was

also especially enjoined

be careful not to expose herself

July 24.

to cold.

The mouth
for the

has been affected, and the flow of

last

saliva increased

fortnight

but there has been

neither premonitory pain nor menstruation, although

more

than a month has elapsed since the

spects there
is

last period.
;

In other reis
still

not

much

alteration

the countenance

wan and anxious. August 10. Menstruation has occurred with much less Gums pain, and without either narcotics or the warm bath.
are sore, and the salivation
is

still

going on, although one

three-grain

pill

only

is

taken every third night.

discontinued
the

Sept. 25.

Has

entirely
last

mercury

for

several weeks, and the

two periods have been passed

with scarcely any pain, and without clots or membrane.

DYSMENORRHEA.
I

175
and although
it is

have twice examined the cervix

tender, the induration
is

uteri,

still

gone, and the size of the uterus

and of the cervix

also are again natural.

in

This patient

after-

wards spent a considerable time

the

country and by the

sea side, entirely recovering her health and strength.

Case 28.
SEVERE DYSMENORRHEA DEPENDENT ON INFLAMMATORY CONGESTION OF THE CERVIX AND BODY OF THE UTERUS.

OCCURRING IN THE PRACTICE OF MR. FENNER OF PENTONVILLE.

Miss

aged 29, began

to

menstruate so favoraunconscious of
suf-

bly at seventeen
the occurrence.

years of age, that she was

But

after

some months, she invariably

do so
to the present year,

fered, (and has continued to

1839,)

a few days before the

periods from acute pains in the loins,

flatulence, retching

and

left

hypochondrium, headache,

and

violent palpitation of the heart.

The

pain in

the

left

hypo-

chondrium and the palpitation have since been almost constantly present
in

greater or less

degree.

The

periodical

discharge

is

always dark, scanty, clotted, and membranous,

half,

never lasting more than a day and a

so long.

and sometimes not

leucorrhcea, and
patient ex-

During the year 1838, there were superadded a

left thigh,

shooting pain on the inside of the

intense pruritus, rendering the condition of the

tremely distressing.
Sept. 20, 1839.

period has just passed with such ag-

gravation of the above

ed.

symptoms

as led to

my

being consultI

On

examining the uterus by the speculum,

found

its

cervix and body considerably congested, and very painful to

176
the touch.

DYSMENORRHEA.
Moderate pressure with the finger instantly rein the left

produced the palpitation of the heart, and the pain

hypochondrium, causing the

heart
!

patient to

exclaim "
!

Oh my

how

it

beats !"
in

Then, "
side !"

Oh my

side

you are bringing

on the pain
uterus.

my

thus

demonstrating that those

sensations were merely sympathetic of the condition of the

Treatment.
a pill of Pulv.

She was bled

Antimon.
-},

to fifteen or

sixteen ounces

gr.

iii.

Antimon. Pot. Tart.

six hours until the

Chloridi. aa gr.

was given every

it

Hydr. mouth

became

sore

afterwards

was continued once or twice

daily, to maintain the derivative action,

up

to the time of the

next period.

hip-bath, and an injection

of

warm water
was en-

into the vagina,

were used twice every day while the pains

continued severe,
joined to keep

then every
in

night.

The

patient

much

her bed, and to use the Hydrocyanic

the
left

lotion (vide formulas)

for

pruritus.

External

irritation

was

also

kept up on the

hypochondrium by the Ung.

pulse

Antimon. Pot. Tart.

Sept. 29.

Much

better
left

90, and less

irritable

mouth sore
less.

pain in the

hypochondrium, and palpitation

found

Oct.
to

1.

On

examination by the finger, the uterus

is

be

much
17.

softer,

and

less sensitive

nor even the pain and

palpitation produced, as before, by pressure.

Oct.

As

the

period was expected to return very

shortly, the patient was again moderately bled, complaining

only of slight premonitory pain

in

the hip and head.

;

She

has suffered less during the interval than for years

petite

her ap-

and sleep being greatly improved.

After passing a good night, and getting up well,
first

Oct. 23.

the catamenia appeared, as at

pain.

unconsciously, and without

DYSMENORRHEA.
It

177
statements of the
;

would be easy

to verify the

text by a far greater

number of cases
different forms,

as

examples

of the disease in

its

and of every

degree of severity, are continually presenting themselves in private and

in hospital

practice.

But the

instances cited

may

suffice to

impress the importance

of a correct view of the precise pathological condition

of the uterus before

commencing any

active

treatment.
as

Nor can

it

be too strongly urged that

pain

is

the accompaniment of so
it is

many

different

morbid conditions,
essential to
irritable

in

dysmenorrhcea absolutely
it

know whether

be associated with an

and neuralgic, or an inflamed and congested

Palliatives and narcotics
in the
latter,

uterus.

may
till

suffice in the

former varieties, but

inflammation

and congestion be removed by depletion and antiphlogistic

measures, neither narcotics, tonics, nor

will avail.

emmenagogues
I

have already spoken of the advantages of leeches

directly applied to the cervix uteri,

when
;

the
I

dys-

menorrhcea can be traced to congestion

lately seen several cases,

and

have

one

in particular,

with Mr.
to

Fenner of Pentonville, who devotes much time

the investigation and treatment of
disease,

female sexual

where by the aid of

his

speculum tubes,

scarification of the

neck of the uterus was freely

and as three or four
it

practised.

There was not during the operation, nor

;

afterwards, any decided pain

ounces of blood were quickly drawn,

far

will prove a

better,

quicker,

and

less

troublesome remedy

178

DYSx\IENORRH(EA.
the relief attendant

than the application of leeches

on

this

novel process,

was

superior to
I

resulted from the leeches.

what had ever believe this method of

depletion

may

be

safely,
to.

and often most advan-

tageously resorted

CHAPTER

FORMULiE OF REMEDIES.

It

may

not be without advantage that

in

should
hospital

select,

from the various remedies used

practice,
in

and private
scribed,
all

the diseases already de-

of which are distinguished by paucity of

the catamenial discharge, those which, after repeat-

ed

trials, I

have found most

efficient.

APERIENTS AND PURGATIVES.

Form.
R. Magnesias
vel pulv.

1.

Pulv. Magnesia. Comp.

Sulphatis

iss.

Magnes. Carb.
5ii.

Sodae Ses-

qui-Carb. aa 5iv.

Sodas Hydrochlorat.
5j.

Pulv. Zinzib.

Aromatici

M.

ft.

Pulvis.

Take
the

one, two, or three teaspoonfuls at bed time, or occa-

sionally in the day,

when
is

the bowels are confined.

in

Usually

powder may be mixed

warm water
salt,

but

if

more de-

cidedly aperient effect

desired, then half a bottle of soda

water

may be poured

over the

and

it

may

be swallowed

in a state

of effervescence.

180

FORMULAE OF REMEDIES.

Form.
R.
Pulv.

2.

Pulvis Purgans.
Potassae Sulphatis vel Sodae Sulphaiii.

Rhei

gr. vj.

tis
ft.

gr. x.

Pulv. Zinzib. gr.

Ol. Cassiae gtt.

ii.

M.

Pulvis Purgans.

Take one powder

in

warm water

night and morning.

Form.
R. Hydr.
Pulv.

3.

Pulvis Purgans.
ii.

Chloridi [Calomel] gr.

gr.
ft.
iij.

Pulv. Jalapae, gr.

vj.

Cambogise
ii.

Pulv.

Zinzib.

gr.

iv.

Olei

Cassiae gtt.

M.
in

Pulv.

Take one powder

a week, at bed time.

gruel, or barley-water,

once or twice

Form.

4.

Pulv. Scammonii cum -Hi/clr. Chlorid.

Pulv. gr.
viij.

R. Scammon. Gum. Resin.

[Calomel] gr.
ii.

Hydr. Chloridi
Sacch. Alb/

vel

iii.

Potassae Supertart.

aa

gr. x.

M.

ft.

Pulv.

Powders three and

four will only occasionally be required;

intestinal canal

but where the secretions of the

are vitiated,

and the hepatic functions are imperfectly performed, they,

or

some of the more

be

active aperients (with occasional altera-

tives), will

efficient

remedies,

if

judiciously and sparingly

exhibited.

Form.

5.

Pilulce Colocynth.
Pil.

Comp.

R.

Extr. Colocynth. C.

C. aa 9i. Olei Cassiae

gtt. vj.

Rhei Comp. Pil. Cambogise M. ft. Pilulse xii.

Take one

or

two

pills at

bed time every night, or every

other night, or

FORMULAE OF REMEDIES,
R.
Pil.

181
aa
3ss.

Colocynth,

C.

PH.

Galbani

M.

ft.

Pilul. xij.

Take two

pills

twice a day.

Form.
R.
Pil.

6.

Pilulce Aperientes.

Cambogise C.
xv.

gr. xxx.

Sods Carb. Quiniae

gtt.
vj.

Disulph.

aa

gr.

Ol.

Menth. Pip.

Syr. q.

s.

M.

ft.

Pilulae xii.

Take two

or three pills at bed time.

Form.
R.
Pil.

7.

Pilulce Aperientes Alterative.

Hydr.

B'i.

Hydr. Chlorid. [Calomel]

x.

gr. x.
iii.

Pulv.

Antimonial. gr.
C.

Antimon. Tartarizat.

gr.

Pil.

Rhei

Bl

Syr.

q. s.

M.

ft.

Pilulae xii.

Take two

pills

every other night.

Form.

8.

Pilulce Aperientes Alterativce.

R.

Pil.

Hydr. Chlorid. Comp.

B'\.

Pil.

Aloes

cum Myrrha
Syr.
q. s.

9ii.
ft.

Extr. Sarsae. Extr. Taraxaci aa gr. x.

M.

Pilulae xv j.

Take two

or three twice a day.

Form.
R.

9.

Mist. Purgans Communis.

3ii.
iij.

Pu!v. Rhei, Magnes. Carb. aa

Conf. Arom.

3iss.

Infus. Rhei, Aquae

Cinnamomi aa

M.

ft.

Mist.

Take

a wine-glass

full

early in the morning,

two or three

times a week.

182

FORMUL/K OF REMEDIES.

Form.

10.

Mist. Rhei Comp.

From Guy's Pharmacopoeia.

R. Rhei

pulv. 5j.

Sodas Carb.
fontis

5ii.

Pulv. Calumbae
vj.

3ii.

Aquas Menth. Pip. Aquas

aa

M.

ft.

Mist.

Take two

table spoonfuls three times a day.

STOMACHICS AND TONICS.

It

has already been observed that the

I

various

preparations of iron, several of which

annex, are

by

far

the most

valuable in these affections, but

If the digesif

they cannot always be administered.

tive

organs are

much deranged,

or

there be a
still

proneness to diarrhoea, they will probably

irritate the intestinal

more

mucous membrane.

Prelimi-

nary and cautious directions about the diet and the

alvine

secretions will be required, and

is

when
till

the

tone of these organs

iron in
ed.

restored, and not

then,

some of

its

forms

Occasionally,

may be when the general

efficiently

employhas

health

been long disordered and tympanitis has ensued,

other remedial combinations will be required.

Form.

Pilulce Ferri
9ii.

Ammon.

R.

Ferri

Ammon.
q. s.

Extr. Gent. C. Extr. Papav. Alb. aa gr. x.

Theriaci,

Ft. Pilulae

xii.

Take two

pills

three times a day.

FORMULA OF REMEDIES.

183

Form.

12.

Pilulce Ferri

cum Gentiand.

From Guy's Pharmacopoeia.

R.

Ferri Sulphatis gr.

i.

Extracti Gentians Mollioris gr.

iii.

M.

ft.

Pilula.

Take one

pill

three times daily.

Form.
R.

13.

Pilulce Ferri

cum Quinicz Disulphate.

aa
9i.

Ferri Sesquioxydi Quiniae Disulphatis

Extr.

Gentians
gtt. vj.

Mollioris, Extr. Papav. Alb. aa gr. x. Ol. Cassiae

ft.

M.

Pilulae xii.

Take two

pills

twice or three times a day.

Form.
R.

14.

Pilulce Ferri

cum Galbano.

Ferri Sesquioxydi, Pilularum Galbani Compositarum, aa

Extr.

gr. xxv.

Humuli.

gr.

x.

01.

Cinnamon,

gtt. viij.

Theriaci

q. s. Ft. Pilulae xii.

Take two

pills

twice or three times a day.

Form.
R.

15.

Pilula Ferri cum Myrrka.

ii.

Ferri Sesquioxydi, gr.

Pulv.

Gummi
q.
s.

Myrrhae, gr.

iii.

Theriaci

ut fiat Pilula.

Take two

pills

three times a day.

184

FORMULA

OF REMEDIES.

TONICS WITH PURGATIVES.

Form.
R.

16.

Pilulce Aloes

cum Ferro.

Ferri Sesquioxydi gr.

i.

Extracti Aloes Aquosi, Exgr.

ii.

tracti Gentianae Mollioris

gtt.
i.

aa

Ol. Mentha? Piperita

ut

fiat

Pilula.

Take two

pills

twice or three times a day,

Form.

17.

Pilulce Colocynthidis

cum Ferro.

R.

Ferri Sesquioxydi gr.

xviii.

Pilularum Galbani

ComThe-

positarum, Extracti Colocynthidis Compositi aa 9i.

riaci q.
s.

ut fiant Pilulae

xii.

Take two
day.

pills

once, twice, or more frequently during the

Form.

18.

Pilulce

Rhei cum Ferro.

9ii.

R. Pilularum Rhei Compositarum

Ferri Sesquioxydi 9i.

Theriaci

q. s.

ut fiant Pilulae xii.

Take two
day.

pills

once, twice, or more frequently during the

Form.
R. Zinci

19.

Pilulce Zinci Composites.

Sulphatis gr.
gtt. vj.

xii.

Extracti Gentianae
xii.

3j.

01.

Anthemidis

ut fiant Pilulae

Take two
day.

pills

once, twice, or more frequently during the

FORMULA OF REMEDIES.

185

Form. 20.
R.

Mistura Ferri Aperiens.

No.

1.

Ferri Sesquioxydi gr.

x.

Magnesiae Sulphatis.

Sodae

Sulphatis aa 5iv.

Aquae

destillatae vj.

M.

ft.

Mistura.

Take two

tablespoonfuls twice or three times daily.

Form. 21.
R.

Mist. Ferri Aperiens.

No.

2.

Ferri Sulphatis gr.

5iii.

x.

Magnes. Sulph.

Acid Sulph.
Infus. Gent.

dil. 3j.

Comp.

Infus. Rosae

Comp. aa

|iv.

M.

ft.

Mist.

Take two

tablespoonfuls twice or three times daily.

Form. 22.
R.

Mist. Ferri Muriatis.

Infus. Gentianae Compositi vij.

i.

Syr. Aurantii

Tinct. Ferri Muriatis nxl.

M.

ft.

Mistura.

Take two

tablespoonfuls twice or three times daily.

Form. 23.
R.

Mist. Quinice Disulphatis.

Infus. Rosas Compositi v.

Tinct.

Cardamomi Comp.
dil.

j.

Quiniae Disulphatis 9i.

Acid. Sulph.

*lx.

M.

ft.

Mistura.

Take one

or

two tablespoonfuls twice or three times

daily.

24

186

formula of remedies-

Form. 24.
R.
Ferri Iodidi gr.

Mist. Ferri Iodidi.

Tinct. Calumbae
j.

xviii.

Aquae

destil-

latse |vij.

M.

ft.

Mistura.

Take one

or two tablespoonfuls, two or three times daily.

piece of iron wire should be kept in the phial, to prevent

decomposition of the iodide of iron and precipitation of the

sesquioxyd of iron.

CORDIALS, ANTISPASMODICS AND NARCOTICS.

Form.

25.

Mist. Jlmmonicc Composita.

R. Ammonia? Carbonatis 9iss. Tinct. Castorei, Sp. LavanTinct. Hyoscyami 5i. vel Syrupi dulae Comp. aa 3vj.
Papav. Alb.
5iv. vel

Morphiae Acetatis

gr.

vel.

j.

Aquae

Menthae Piperitae

|vj.

M.

ft.

Mist.

Take one

tablespoonful three or four times daily.

to

It

may

be unnecessary

add any of the narcotic ingredients.

Form. 26.

Mistura Castorei Composita.

5iv.

R. Tinct. Castorei, j. Sp. Lavandulae Comp. Camph. C. 3iv. M. ft. Mistura.

Tinct.

Take

half a teaspoonful every three

or four hours in a

tablespoonful of water.

Form. 27

Mistura Morphia
gr.
i.

Acetatis.

R.

Morphiae Acetatis
gtt. x.

vel.

ii.

Acid Acetici

FORMULAE OF REMEDIES.
Aquae
destillatae 3iii.

187

Tinct. Card. C.3i.

M.

ft.

Mistura.

Take

five or ten

drops occasionally

frequently,

if

pain or

spasm be urgent.

Form. 28.

Mistura Vini.

From Guy's Pharmacopoeia,

R.

Vini Albi,

vel.

Rubri,

vel.

Spiritus Gallici vj.

gfs.

Ovo-

rum Duorum
guttas
iii.

Vitellos.
ft.

Sacchari

Olei

Cinnamomi

JM.

Mistura.

Take two

tablespoonfuls

frequently during the

day,

if

there be languor or faintness from debility.

Form. 29.

Mistura Cretca Opiata.

From Guy's Pharmacopoeia.

R.

Pulveris Cretae

Comp. cum. Opio.

Mistura.

3iij.

Aquae Menth,

Pip. ix.

M.

ft.

Take two

tablespoonfuls after every liquid motion.

Form. 30.

Julepum Potassce Carbonatis.

From Guy's Pharmacopoeia.

R.

Liquoris Potassae Carbonatis

Sj.

Aquae Menthae Viridis

xi.

M.

ft.

Mistura.

Take one

or two tablespoonfuls in barley water or linseed

tea, twice or three times daily.

Form. 31.

Infusum Serpentarice Compositum.

From Guy's Pharmacopoeia.

R.

Serpentariae

Contusse,

Contrajervae

Contusae

aa 3 v.

188

FORMULA OF REMEDIES.
Aquae Ferventis
pentariae
xvj.

Post Macerationem in vase leviter

clauso per duas horas, liquorem cola, et adde Tinct. Serij.

M.

ft.

Mistura.

Take

three tablespoonfuls every four or six hours, occaif it

sionally adding to each dose

be required.
vel.

Liquor. Amnion. Acet. 3iv.

Liq.

Amnion. Sesquicarbonatis ^xxx.

Form. 32.

Pilulce

Moschi Composite.
vj.

R. Moschi
lae xii.

gr. xl.

Pulv. Zinzib. Pulv. Valerianae aagr.

Camphoras

gr. xii.

Conserve Rosae

q. s.

M.

ft.

pilu-

Take two

pills

every three or four hours.

Form. 33.
R. Pulv. Opii. M. ft. pilula.
gr. J.

Pilula Sedativa.

Camphorae

gr. iv.

Cons. Rosar.

q. s.

Take one

pill

every four or six hours.

NARCOTIC INJECTIONS AND SUPPOSITORIES.

Form. 34.
R.

Enema Antispasmodicum.
Infus. Valerianae i.

Liq. Opii. sedativ.in.xxx.

ss.

Mucil.

Acaciae

M.

ft.

Enema.
into

The

injection to be

passed

the bowel

by a syringe

night and morning.

Form. 35.

Enema Contra Spasmas.

From
Dr. Copland.

R. Camphorae

Rasae

gr. v.

x.

Potassae Nitratis

3ii.

Olei

FORMULAE OF REMEDIES.
Olivae
j.

189

Tere simul,

et
ft.

adde Infus. Valerianae, Decocti

Malvae. C. aa v.

M.

Enema.

Form. 36.
From

Enema

Emolliens.

Dr. Copland.
ss.

R.

Flor. Anthemidis,
vj.

Semin. Lini. Contus. aa

et cola
;

Aquae
ii.

fervid.
vel. vj.

Macera

dein adde Opii. gr.

iii.

Half

this

quantity to be used at a time.

Form. 37.
From

Enema

Belladonnce.

Dr. Copland.
xii.

R.

Fol. Belladonnas Exsic. gr.

Aquae Fervid.

vj.

M.

ft.

Enema.

In severe dysmenorrhoea, in retention of urine from spasm

of the sphincter

vesicae, or

spasm of the rectum.

Form. 38.

Enema

Olei TerebinthincB.

From Guy's Pharmacopoeia.

R. Olei Terebinth
et

gss.

Ovi unius Vitellum.

Tere simul,

gradatim adde Decocti Hordei tepid. x.

To

be used once a day or more frequently.

FoR3i. 39.

Enema Saponis Compositum.

j.
ft.

R. Saponis
Ferventis

Mollis.
vj.

Pulv.

Opii. gr.

iii.

vel. vj.

Aquae

M.

Enema.

190

FORMUL/E OF REMEDIES.
to

Half or the whole quatity

times daily.

be used once, twice, or three

Form. 40.

Enema

Tabaci.

From Guy's Pharmacopoeia.

R. Tabaci

5j.

Aquae Ferventis

|xvj.

Macera per sextam

horae partem et cola.

One

quarter or half the quantity

may
in

be used, and

if

neces-

sary the injection

may be

repeated

an hour.

Form. 41.

Suppositorium Opii.
Sapon. Castiliensis
gr.
iii.

R.
ft.

Pulv. Opii gr. | vel.

i.

M.

Suppositorium.

The

suppository to be used once, twice, or thrice daily.

Form. 42.
R.

Suppositorium Belladonna.
Saponis Castiliensis

Extr. Belladonna? gr.

i.

vel.

ii.

gr.

iii. vel. iv. ft.

Suppositorum.

To

be used once or twice a day.

emmenagogues.

Form. 43.
R.
Liq.

Ammon.

fort. 5i. vel. 3iss.

Lactis tepid, gxvj.

M.

ft.

injectio vaginalis.

third part to

be passed into the vagina three times daily.

FORMULAE OF REMEDIES.

191

Form. 44.
From
Dr. Schonlein.

R. Aloes

Socotorin. gr. x.

Mucilaginis Acaciae

j.

M.

ft.

Injectio intestinalis.

The

injection to

be thrown into the rectum two or three

times a day.

Form. 45.
R.
Sinapis pulveris
5ii.

Aquae Ferventis

xvj.

M.

ft.

Injectio.

third part to be passed into the vagina three times daily.

CHAPTER
OF
Definition.
to

VI

MENORRHAGIA
Menstruation, both
as

Inordinate

frequency of return, and the amount of the secretion ; in the majority of instances accompanied
the

by direct loss

from

the uterine arteries.

There are two forms of the

disease.

First, Profuse Menstruation, either as to frequency

of return, or the amount of the secretion, or both,

without uterine bleeding.

Second, Profuse
direct loss of blood

Menstruation accompanied by
from the uterine arteries, in-

cluding three varieties.

a.

Acute or active menorrhagia

occurring in the

plethoric and robust.

b.

Passive or chronic menorrhagia

the subjects

of this variety being the delicate,

hysterical,

and

exhausted females
c.

and,
;

Congestive menorrhagia

generally

met with
life.

at the middle or

more advanced periods of

MENORRHAGIA.
Profuse Menstruation, either as
return, or the
to

193
frequency of

amount of the

secretion, or both, without

uterine bleeding.

History and Symptoms.

that

may

at

once observe,

the hemorrhages of abortion,

pregnancy, and

parturition,

and of the various organic diseases of

not

the

uterus, do

come within

the scope of this

chapter; and to avoid a perplexing multiplication of

names,

include profuse secretion of the catamenia,

it

as a form of menorrhagia, as

is

rarely a disease of

long continuance, unaccompanied by bleeding directly

from the uterine vessels.

If

we

reflect

on

the large supply of blood constantly furnished to the

uterus during the greater part of

life,

and which
still

is

every month, for a functional purpose,

further

augmented,

it is

not at

all

surprising that the limits

of secretion are occasionally exceeded,

instead of a fluid
usual

and

that,
its

only partially
blood,

sanguineous,

product,
its
if

pure

should

be

discharged

from even

vessels.
it
;

Thus, so long as the discharge,

is

be

profuse,

not blood, menstruation

is

only exists

but, if the secretory function

either

altogether or only partially superseded

sive

from excestheir

determination

to

the

uterine

vessels,

orifices

may

give way, and, as then they will permit

is

blood to pass unchanged, menorrhagia

established.

Profuse menstruation and menorrhagia are neither

confined
to

one class of females nor to one age.

The young are less liable than those more advanced The plethoric and robust less frequently in life.
than females of susceptible and feeble constitutions.
25

194
Still,

MENORRHAGIA.
circumstances
class, the

may

induce these diseases in

every

periods of reproduction and cata-

menial cessation being more obnoxious to them than

all

others

climate and peculiarity of

importance.

system being

criteria of
tries,

In northern and cold counis

the

amount of menstrual secretion which

climates,

only natural here, would be regarded as excessive

and

in hotter

what we consider profuse

strictly

menstruation,
individual, or

w ould
r

be

normal.

In

one

in the

female branches of a whole

family, five,

six,

or seven ounces

may be
It

only a

healthy amount of discharge, while in others such a

quantity

would be morbidly profuse.

in

follows

then, that in the

one case, health not weakness

the
other,

would accrue, while

weakness not

health would be the result.

The

question, therefore, whether menstruation be

healthy or inordinately profuse, will mainly depend

on climate and idiosyncrasy, and especially on

constitutional effects.
If
it

its

occur during pregnancy

;

and

lactation,

it is

unnatural and in excess

in

and on
espe-

several
cially,
I

occasions,

married
it

women more

have

known

recur after long periods of

suspension, so profusely, as to have been mistaken

for abortion.

The way
is

in

which profuse menstruaI

tion

comes on
for

various.

have

now

a patient in

whom,

some months, the discharge, without any admixture of coagula, has every second week set in
suddenly and with a large gush
T
;

this

discharge,

with an interval of only a fcw hours, being repeated

for four, five, or six days.

This individual

is

thirty-

MENORRHAGIA.
one years
ascertain,
tural
old,
is

195
far as
I

and unmarried

and so

can

without the slighest evidence of struc;

disease

but

she

is

anemiated

and feeble.
is

More
from
is

frequently, however, the secretion

its

excessive

continuance, lasting ten or twelve days, or

its

too early in

return.

Young and

single

women
leu-

are more prone to the latter; while married females,

weakened by
corrhoea,

child-birth,

undue lactation and

to

corrhoea are obnoxious to the former variety.

indeed,
has
is

Leu-

much
or

do with profuse

menstruation, and

generally present, either in the

catamenial intervals,
excessive

has existed

prior

to

the
in

menstruation.

America he has scarcely

genuine
profuse

Dewees states ever known a

Such

that

case of

menstruation.

examples
dis-

being almost invariably accompanied

by the

charge of pure blood.

of this statement
country, and of
correct, as
;

do not doubt the accuracy

experience, would not be

but a similar statement of this

my own

instances,

and not a few, have come

precisely those induced

under

my own

observation.
are

The symptoms

by a

drain on the sanguineous system, varying in degree,

according to the amount, the continuance, and the

more
At

or less frequent recurrence of the

discharge.

first

languor, inactivity, aud sensations of

weak-

ness, rather than

pain across the loins, are comis

plained of; subsequently there

severe and almost

constant aching

in

the

back

and lumbar region,

coming round
and
to the

to the

hips and front of the thighs,

lowest part of the abdomen.

The

face

196
is

MENORRHAGIA.
sometimes bleached and cadaverous.
suffers

pale,

The
pain

patient

from

nervous

headache,

the

being often confined to one spot, tinnitus aurium,

throbbing
of
the

temples,

frequent

vertigo,

and

where the

loss

has been excessive, a sensation as

though a clock

were ticking

in

the

head.

The

heart acts feebly on small quantities of blood, and

there

is

in

consequence chilliness of the surface and

If the

coldness both of the hands and feet.

continue, and particularly
rhcea, the
if

malady
leucor-

there be

much

whole

series of

symptoms now described

becomes more
the

distressing.

The

disordered state of

brain from a diminished supply of blood, some-

times closely resembles that arising from repletion.

From
ness,

ignorance or a disregard of this

confusion,

fact, giddi-

and a sensation of
in turning

falling

from
head,

sudden movements,
have excited a

or lifting the

fear of apoplexy,

and the bleeding

and antiphlogistic treatment which have been practised,

have ensured a

still

further aggravation of the

original disease.
tions

Nor

will the

more serious

indica-

dependent on excessive catamenial discharge,

be confined to the brain alone.

central pains

The lumbar and

the headaches

become more decided,

is

more agonizing, the derangement of the stomach

and bowels
permanently increased, and there
felt in
is

almost constant pain,

some part of the course

sides or centre of

of the colon, affecting either the

the abdomen.

There

is

palpitation,

and

all

the

symptoms

so graphically described by Dr. Addison.

Occasionally, in some of the worst examples, there

MENORRHAGIA.
is

197

confirmed

diarrhoea.
in

have many times seen

oedema, and

one case, where the patient had long

resided in the East Indies, and

was much exhausted

melancholy, and,

by frequent abortions, there was general anasarca.

Nervousness almost
from the
to insanity,

according to some authors, epilepsy have resulted

disease.

So

far

as

my

observation has

gone, a vaginal

examination has revealed nothing

condition of the vagina and
slightly

beyond a

soft, flabby

uterus, leucorrhcea,

and an os

more patulous
if

than natural, but without tenderness or induration.

The consequences
tracted, are
detail of the

of profuse menstruation,
sufficiently

pro-

almost

evident

from

the

symptoms.

Dr. Marshall Hall,

its evils,"

in his

" Essay on Blood Letting and

explained them.
I

has fully

may, however, remark that they

are precisely of the

same character
part.

as are

produced

by hemorrhage from any other

Of

course the

probability of early cure will greatly

severity

depend on the
In

and

repetition
little

of

the
is

attack.

the

slighter cases

treatment

required, and the

;

disease often

subsides almost spontaneously

and

even

in

the

more aggravated examples,

treatment
generally
if

suitable

and

persevering

avails.

greater proneness to abortion,

the patient

become

pregnant, and a disposition to prolapse of the uterus

and vagina, are results of the malady.

Causes.

Delicacy and
;

debility of

system and un-

due plethora conduce

frequently

to the

disease.

The former
In
all

the latter only in few instances.

classes these causes

may

be brought into activity by

198
cold, inordinate

MENORRHAGIA.

physical effort, and mental excite-

ment.

In

married

women, repeated

labors

and

abortions, and

undue suckling,
In
all,

lay a foundation for

the malady.

excessive use of the genital or-

gans may lead

to this or

any other form of menorits

rhagia, and the disease has often had

origin in

hemorrhage occurring
Diagnosis,

after labor.
difficult to distin-

It is

by no means
If the

guish this from the other forms of menorrhagia by

the absence of coagula.
clot,
it is still

discharge does not

;

menstrual secretion

if

on the contrait

ry, like blood lost

from other parts of the body,

it

separates into serum and crassamentum,

is

no

longer a case of simple catamenial excess.

The

freedom of the patient from organic uterine disease

will be satisfactorily ascertained

by a vaginal exam^

ination.

Treatment.
constitution,
tinction

This
and

will vary in females of different

and

in all

there will be a

marked

dis-

between the measures adopted during the

itself,

discharge
plethoric

in

the menstrual intervals.

In

and
is

robust individuals, the larger

often salutary, and

amount

of secretion

may

be allowed

to continue in
sides.

many instances till it naturally subWhere treatment is necessary, moderate vemay, a few days before the expected
;

nesection

period, be practised
tion,

more frequently
loins, or

local

deple-

by cupping on the

leeches to the puto the

dendum

or perineum, and in

some instances
is

cervix uteri.

When

the loss

really excessive, the

patient should be confined to the sofa or a mattress,

MENORRHAGIA.
strictly

199

maintaining the recumbent posture, and the

diet should bo unstimulating

and cold.
nitre,

Saline pur-

gatives, with dilute acid

and

may always be
should

exhibited
lead

more

rarely digitalis

and superacetate of
be bed clothes,
be carefully

(vide

formulae).

The apartment
kind must
it

cool, the patient being lightly covered by

and excitement of
avoided.
to

(ivery

In

some severe cases

:

may be necessary
and
ice
7 .

apply cold locally

iced

water,

itself,

wrapped

in bladders, are

used with this view

It

has

been thought right to inject cold stimulating fluids

into the vagina, and, in
into the uterus,
I

a very

few examples, even

and

to plug this canal as far as the os.

do not say that such extreme measures are never

if

demanded, but happily,

judicious treatment be

early adopted, they will rarely be required.

In the interval of menstruation, a spare, unstimulating,

and only moderately nutritious

diet,

and

fre-

quent saline aperients, should be enjoined.

there
is

Where
full,

decided plethora, shown by a red and flushin the

ed countenance, swimming

head, and a

hard and quick pulse, small and repeated bleedings,

are beneficial.

Daily exercise by walking or riding,

is

although the former

to

be

preferred, and

the

avoidance of heated apartments and luxurious indulgences, will contribute to a healthier state of the

system generally, and particularly of the uterus.

In delicate, pallid, and feeble patients, the disease

must be treated
is in

differently.

Here the excess of

it

se-

cretion, so far from being salutary, as

occasionally

the plethoric and robust,

is

decidedly injurious

200

MENORRHAGIA.

every return, by weakening the uterine capillaries,

aggravating the anemia.
antiphlogistic

Instead of depletion and

means, ammonia and small doses of

the acetate of morphia, and the mistura vini of Guy's

Pharmacopoeia, are to be employed

loss
is

and where the

effi-

large,

no remedy will generally be more

it,

cient in checking

and

in shortening the period of

It

the flow, than the ergot.

may

be given either in

powder

or tincture

of the

former, five grains, and

of the tincture, thirty drops every six or eight hours.

Cold applications, and astringent

formulae,) into
tioned.

injections, (vide

the vagina have been already menfor this purpose, su-

Dewees recommends,
and laxatives.

gar of lead and laudanum, and speaks highly of

elixir of vitriol

Mackintosh enjoins

the

use of an enema, containing a scruple of the

All the remedies are intended, either

sugar of lead.

by lessening the activity of the general circulation,

or by securing the contraction of the uterus, to di-

minish the quantity of blood sent to

curtail the

it,

and thus to

amount of

secretion.

In the interval such measures

must be employed
If
it

as shall

preclude the return of the malady.

can be attributed to over lactation, excessive leucorrhcea,

or frequent

abortion,

the

child

should

be

weaned, the leucorrhcea cured, and the risk of pregnancy for a time prevented by abstinence from intercourse.

Chalybeate water, and mineral tonics, a

residence by the sea, or at

in this

country or

some of the various spas abroad, salt-water baths, of any

kind, most agreeable to the patient, vaginal injec-

MENORRHAGIA.
tions,

201
all

sponging with cold salt-water

over the

loins

and hypogastric region, are well calculated to

relieve local

weakness and

to aid

the more direct

and powerful measures.

Second,

Profuse Menstruation, accompanied by

discharges of blood directly from the uterine vessels,

including three varieties.

a.

Acute or active Menorrhagia', occurring prin-

cipally in the plethoric

and

robust.

History and Symptoms.

is

This form of
live

the disease

much

less

common
It

than the passive and conges-

tive varieties.
ric

occurs most frequently in plethogenerously,

married

women who
is

and

in

whom

the circulation

active.

In such individuals

exposure to cold or wet during menstruation, or any

circumstance

deranging their health,

may

induce

fever, inordinate action of the heart, congestion

and

subsequent rupture of the uterine capillaries, and

menorrhagia.
I

have also occasionally seen inflamin

matory and spasmodic menorrhagia, and robust unmarried

are really often
girls
:

young,

florid,

although these varieties

I

more

rare than

the others,

believe they
plethora,

exist

unnoticed.

The undue
is

on

which they mainly depend,

periodical loss, and
if it

relieved by this larger

this

do not occur too often,

it.

morbid state may be altogether cured by

healthy

In

women
it is

also, a profuse

catamenial discharge,
is

even

when

attended by pain,

often long dis-

regarded, such an event being generally viewed in

a favorable light.
really excessive
It is

not, therefore,

till

the loss
till

is
it

and somewhat alarming, or

26

202

MENORRHAGIA.

has induced marked debility and a pale,

tenance, that medical aid
is

wan coun-

sought.

In active me-

norrhagia there generally exist, immediately before

the expected period, and occasionally for a few days
prior to the flow, considerable tension and

fulness

within the pelvis,

accompanied by a feeling of weight

the uterus
itself.

and throbbing
often

in

The mammae

sympathize, becoming tumid, hot and tender

on pressure, and the external genitals are sometimes

slightly swollen

and painful.

The

pulse

is

quicken-

ed, there

is

oppression of the head, and often deIn this

is

cided head-ache, with sympathetic fever.

way

the acute or active form of menorrhagia

is

ush-

ered in and

throughout characterized by a pre-

dominance of inflammatory or spasmodic symptoms,

or by a combination of both.
is

Where inflammation

present, there
;

will

be fixed pain in the uterine

region
pulse.

a hot dry skin, and a frequent hard and full

Where spasm
;

prevails, the pain will not

be

constant

but having continued a longer or shorter

it

time, and often most severely,

after

will subside, and,

an interval, again recur with throes resembling

the pains of labor.

The
it

discharge, too,

is

equally

variable, ceasing for short periods, during the pain,

and returning when

the spasm,
is

subsides.

The

pulse, during

contracted, irritable, and quick; aftersofter

wards

it

becomes

and slower, giving proof by

this rapid

change, of a state of system, neither of

irritation.

inflammation nor debility, but of

The

progress, duration, and severity of these attacks are

extremely variable.

Sometimes the discharge comes

MENORRHAGIA.

203

on and continues by gushes, and numerous coagula

are
expelled/*"
;

The

patient,

in

many

instances,

is

thus relieved

the head-ache, tension, and

;

pain in
the pulse

the uterine region are quickly diminished

is

softer

and

less

quick

the skin cooler and moist

is

and the remainder of the period

tolerable comfort. In the

passed over with

more protracted and ag-

gravated cases, the discharge often continues for

three, four, five, or six days, not without diminution,

but

still

with such a proneness to excessive return,

patient
is

that the

compelled

to avoid exertion,

and

to maintain, almost constantly, the recumbent position.

On

the subsidence of the flow, she

is

weak
and

and exhausted, and several days elapse before she

regains
her

usual

freshness
It is

of

countenance

strength of pulse.

easy to mark the transition

from

this to

the passive
first,

form of menorrhagia

for

although, at

the recurrence of the events just

now

described,

may

not seriously impair the health,

yet after a time, the loss produces a marked impression on the

system^ the flow

lasting longer,

and the

number of days between the catamenial periods being so diminished, that scarcely
is

one attack over,

the
active and

before another approaches.

Thus
the

acute variety
disease.

is

merged

in

passive form of the

Causes.

From the
may

history already given,

is

it

will

be inferred that menorrhagia

generally dependent
;

on morbid conditions of the constitution

its

although

causes

be accidental or local.
is

Thus, while

the active form

mainly associated with a plethoric

204
habit,

MENORRHAGIA.
and does, under such circumstances, afford

relief, it

may

still

be frequently traced to morbid

uterine activity and excitement, arising from local

injuries,

such as blows or

falls,

sexual excesses, re;

peated abortions and leucorrhcea

irritation

of the

bladder and of the intestines generally, and especially of the

rectum, from hardened fceces, hemor-

rhoids,

worms, tenesmic purging, constant and even

Doubtless such causes will

occasional constipation.

be rendered additionally injurious by too protracted

and severe mental and physical

heated apartments and
soft beds,

efforts, rich living,

indolence and too

much

sleep.

Diagnosis.

The

distinction

between the active

not always easily
is little

and inflammatory or spasmodic menorrhagia, and

the passive form of the disease,
is

made.

In the beginning there

difficulty

but when, from frequent repetition, debility

exists,

we may
shall not

err.

Still

the countenance, the pulse, and

the " tout ensemble" of the patient are such that

we

remain long

in doubt.

Nor must

it

be for-

gotten, that on a correct discrimination of these different conditions, the

success of the treatment will

true that active menorrhagia

greatly depend,

it is

may

co-exist with, debility, the

uterine vascularity
causes, morbidly
to treat

and circulation being, from

increased
;

local

but

it

would be a great mistake

this latter condition as

we

should that form of the

malady where the discharge was dependent on general

fulness and

activity.

If to

aid the

diagnosis

the uterus be examined per vaginam, there will rare-

MENORRHAGIA.
]y

205
in
its

be discovered any marked change

position, although
I

volume

or

have noticed some fulness

and heat about the cervix and body of the organ.

Treatment.

This

is

scarcely different from

what
198.

has been already enjoined in profuse menstruation,

occurring in plethoric individuals,
vide page

But
good.

may remark,
purges,

that the

employment of smart
often

drastic

(vide

formulae,)

does

great

The

late

Dr.

Cholmeley, of Guy's, relied

;

almost exclusively on their exhibition

and he has

frequently, as he passed through the wards, pointed

out cases entirely cured by these alone.

In spasmodic Menorrhagia, to which
I

have

al-

ready referred, the pulse

is

irritable
is
;)

and quick, not

subsides and

hard and

full.

The system
(vide

not plethoric, nor the

pain constant,

cases

but

it

again recurs.
fail

Here bleeding,
;

nitre,

and

digitalis,

to relieve

and recourse must be had

to anti-

spasmodics, anodynes, and occasionally to alteratives.

It
is
;

not always easy at once

but
if

to distinguish this

form

antiphlogistic

means have been

Dr.

tried

unsuccessfully, the patient will often be cured by

remedies

of

different

class.

Gooch

says,

" that a lady laboring under spasmodic menorrhagia,

went through the whole routine of

treatment without any benefit.
adds,
I

antiphlogistic

then gave her, he

one

grain

of

ipecacuanha

every hour
sick,

in

eight hours she

became nauseated and

for a

and the

discharge immediately ceased.

sea

This state of nau-

was kept up

day or two, and the discharge

did not recur.

When

you have a case of menor-

206
rhagia, attended

MENORRHAGIA.
with a quick and
recurring,
irritable

pulse,

the pain subsiding and

tain that
it
it

you may be cerand that

arises from spasm or

irritation,

will be relieved

by antispasmodic remedies.

The
rec-

two
and
tum.

best are ipecacuanha taken into the

assafcetida, with

stomach,

opium injected into the

is

A
till

grain of ipecacuanha

to be taken every
state

hour

nausea
for a

is

produced

which
for

must be
purpose

maintained

day or two, by repeating the same

suffice

dose as frequently as may

this

and quiet

local irritation in the uterus

by injections

of assafcetida and opium,

by the enema antispas-

modicum, form. 34, So, 36, 37, or 39, to be found There is a very marked at pages 188 and 189.
connection between the pain and the discharge
if
;

for

you can

relieve the one, the other will cease."

Nor must
garded
;

the treatment in the interval

be disre-

in

profuse

menstruation,

unattended by

real uterine

hemorrhage, allusion has been pointedly

made

to

its

extreme importance.

If the bleeding

and the antiphlogistic regimen, practised as a period

approaches, be exchanged, after
sides, for nutritious diet

the

disease sub-

and wine, the malady will

it

not only continue, but

will

become aggravated,

and the

loss,

during menstruation,

may

be so large

as to excite considerable apprehension.

tients protract the

Many
is

pa-

menorrhagia by such

error, and,

by repeated discharges, the passive form

induced.

nice distinction

is

necessary here

thus, several

times

when

have thought that the loss has de-

pended on

debility,

and

have unsuccessfully ex-

MENORRHAGIA.
hibited

207
have gone back to

the

ergot and tonics,

the antiphlogistic plan, and

have cured the patient.

is

Nor

let it

be forgotten, that local depletion

;

some-

times

most beneficial
in the

especially

in

those cases
is

where,

absence of general plethora, there

local uterine fulness.

b.

Passive or chronic Menorrhagia

variety

the subjects

of

this

being delicate, hysterical, and ex-

hausted females.

History and Symptoms.

This

is

the

most comin fre-

mon form
quency

of menorrhagia,

and approaches
amenorrhcea.

to chlorosis

and

partial

explanation

may

be found in the want of attention

to early menstrual profusion,

and

in

the too indis-

criminate use of wine and other stimulants.

various degrees in which
In
it

The

exists,

deserves notice.
hardly to
this

some the excess may be

effect
;

so

slight, as

produce any morbid

and from

stage

onward,
tion,

to

examples of marked hemorrhagic prostraof

the complaint

every shade
I

may

be wit-

nessed.

have

in

my

recollection several instances

where a

fatal

result
is

seemed highly probable.

An

additional reason
gation, prior to

thus supplied for careful investi-

and during the treatment, by tonics

and wine

and where such measures are determined

on, their use

must be watched, modified, and occa-

sionally suspended.

An

attack of fever, or uterine

this

congestion, will

demonstrate the propriety of

admonition, and prove that the management should

rest

on principle, and that

it

must not be pursued

merely as a matter of routine.

208
1

MENORRHAGIA.
need scarcely mention the class of

women most

liable to passive

menorrhagia

those

originally deli-

cate, or

who have become

so from anv of the causes

already enumerated at the

commencement of

this
its

chapter, and not the robust and plethoric, are

subjects.

The symptoms
Causes.

are

precisely those of morbidly

profuse menstruation, fully pointed out at page 195.

Diagnosis.

The same profuse menstruation. The presence of

as in
clots
in
its
it

the disflow,
If
in-

charge, or the stiffening of the linen by

sufficiently explain the character of the disease.

the uterus be examined,

will rarely

be found

creased in size
the
lost

but

its

cervix and os, as well as

soft,

vagina, are generally

its

the

former having

close,

welted

feel,

and the whole being

bathed in leucorrhceal discharge.

will also reveal

Such an inquiry

any structural

lesion of these parts,

should

it

exist.

Prognosis.
say

It

may

perhaps be unnecessary
is

to

much on
;

this point, as a fatal result

exceed-

ingly rare

but, as the long continuance of the malcavities,

ady may induce dropsies of various

and

may
Our

call

into play

morbid tendencies about other

should spring not only

organs, a too confident opinion should not be given.

anticipations of cure

from the tractable character of the malady, but from

a conviction that the patient will strictly and perseveringly carry out our measures of relief.

Treatment.
198,

Reference

must be made

to

page

where the means generally successful

in arrest-

MENORRHAGIA.
ing excessive menstrual flow are enumerated.
in the

209
Rest
to

recumbent posture, during and previously

the attack, either in bed on a mattress, or on the

sofa, is indispensable.

Without

it

the best devised

treatment will
injunction
;

fail.

At

first,

patients disregard the

but the continuance of the discharge,

increasing debility, and the attendant evils, compel

obedience.

Astringent injections should rarely be

first

used during the few

riod, as

days of the menstrual pe;

they often produce uterine spasm

but

when

coagula are passed, either alone or mixed with the

catamenial
tially
fluid, the

secretory function

is

either par-

or

entirely

suspended,

and injections

then be highly beneficial, (vide formulae.)

patients derive
little

may Some

or

no advantage from them

not a few ascribe pain,
passive

others use

them

so partially, as to preclude any pro-

bability of benefit

while
in
lie,

an unusual symptom

menorrhagia, and
It is
is

increased discharge to their exhibition.

tial

essen-

that the patient

when

the injection

thrown

into the vagina, that the pelvis be raised by placing

a sofa-cushion under the hips, so that the fluid

easily reach the

may
and

upper extremity of

this canal,
it

that

whatever quantity be injected,

shall

be re-

tained for ten or fifteen minutes in direct apposition

with the parts.

To

effect

this,

the

nurse should

make

firm pressure on the vaginal orifice

by a nap-

kin accurately applied.

Where
the

these conditions are

in

complied with, and where occasionally,

ble and
irritable

suscepti-

women,

injections are slightly

warmed,

so as to prevent the probability of the oc-

27

210

MENORRHAGIA.
I

curence of uterine spasm and pain,

cally that great

know

practi-

good

will generally result

from their

administration.

But
duced

life

is

occasionally well nigh destroyed

loss

by

excessive

menorrhagic

the

patient being re-

to the

same

state

as

by uterine hemorrhage
has reason, from
its

after labor.

If the practitioner

previous occurrence, to apprehend a renewed visitation of this kind, every preventive

measure must be
pages

adopted.

Not only must

the treatment in the in-

terval be carefully followed out, as directed at

200 and 201, but

turn

absolute rest must be enjoined for

several days prior to the expected catamenial re;

sexual excitement, physical exertion, stimuli

likely to affect the vascular system

and the uterus,

all

and intestinal constipation, must

avoided.

be carefully

During the flow,

injections

if

alarming loss of blood

seem

to be approaching, the ergot

and opium, (vide

plugging

formulae)
lotions

of cold water and astringent

all,

into the

rectum, and, above

far

the

vagina,

as

as the

os,

must be practised.
forms the best

Soft dry tow, slowly introduced in small quantities,

till

the

passage
or plug,
for

is

entirely
it

filled,

tampon

and

may

be allowed to remain

unchanged

twenty-four or thirty hours.

The

patient will probably object to such a remedy, and

suffer slightly

from
are
it

its

use

but neither of these

to justify the

circumstances
tioner in giving
linen,

sufficient

practilint,

up.

silk

handkerchief,

or

may

be used, but they must be dry.

If

wet
is

or saturated

with moisture, their

introduction

MENORRHAGIA,
painful and difficult
is
:

211
in

dry soft tow,

I

small pieces,

certainly
if

far

better.

have

seen

two

cases,

where

the
I

apparatus for transfusion

should have used
it.

had been
patients,

within reach,

Both

however, gradually recovered.

It

may be
I

urged,

that injections of cold or medicated water into the

uterine

cavity,

would

be

important.

confess,

without knowing that the mucous lining was healthy,

the

fear of

subsequent inflammation

would,
I

with me, generally prevent their employment.

am, however, convinced

rhagia, plugging
It
is

that, in

excessive monorto.
is

not sufficiently often resorted

if

need scarcely be enjoined, that

if

the patient

reduced to a very low ebb, or

there be prolonged

and profound syncope, she must be moved with the

greatest care.

In

the syncope following excessive

is

puerperal bleedings, such precaution

tant, as

all

impor-

asphyxia might result from

It is

its

non-obser-

vance.

scarcely less necessary in the exhaus-

tion produced
c.

by excessive monorrhagia.

Congestive monorrhagia, generally met ivith at

the middle or

more advanced periods of life. History and Symptoms. On this form of the

malady enough attention has not been bestowed.

And
is

yet,

it

differs so

much from
its

the others, that

it

a matter of surprise that

peculiarities should
It

have been only slightly noticed.

quently in alarming excess.

continues long,

occasionally for several years, (vide cases,) and freIt

is

often preceded
dis-

and followed by large watery and leucorrhoeal

charges
;

and pain

in the uterine

and lumbar regions

212
is

MENORRHAGIA,

common accompaniment.
;

Its

sympathetic

ef-

fects

on the brain, lungs, and heart, are occasionally

and,

severe
there
ble

where the disease has continued

pulse,

long,

is

generally coldness of hands and feet, a fee-

and

quick

and an anxious

pallid

and

sunken countenance.
and
feel of the

The

alterations
a

in

the size

uterus,

which form
life,

part of the

disease, cannot, at this period of

be recognized,

without some alarm.

to

one class of
I

The malady is not confined women. The plethoric are not, as

to
it

far as

know, more prone

I

than the debilitated

ever seen
;

and

irritable.

have rarely,

if

it,

before

thirty-eight or forty years of age

eral times

but

have sev-

met

with modified attacks, independently

of organic complications, after menstruation might

have been supposed to have ceased.

In

the milder instances, the

symptoms already
or less protracted
;

described, terminate after a

more

continuance in the entire cessation of the function

but
in

other and

more protracted examples, the

real appreis

symptoms
hension.
tain,

are so extreme, as to excite

The

recurrence of the bleedings

in

uncer-

although

general, a catamenial

period will

be partially observed.
tinues for
plete

Occasionally the loss conor months, without

many weeks
:

any com-

cessation

the only appreciable

change con-

sisting in

a diminished flow, or the discharge be-

comes

either aqueous or leucorrhceal, and perhaps

siighly or offensively odorous.

will, at the expiration of a

In

many

cases there

fortnight, or

midway

in

the interval,

be a peculiar bearing, acute pain in

MENORRHAGIA.
the lower part of the uterus.
tients

213
Several of

my

pa-

have

noted

this

pain
it

very accurately, and

have correctly regarded

as indicative of a repeti-

tion of the menorrhagia.

This symptom has oc-

curred too often, to allow

me

to doubt, that
affection.
all

it is

in

some way connected with the

chill

Dr. Chur-

mentions that

in most, if not

the cases he

has seen, there was considerable dysuria, and that,

in

several,

it

was necessary

for

the patient to

lie

down
ated.

before the bladder could be completely evacuIrritation

about the neck of this viscus, exits orifice, is

tending along the urethra to

common
it

but the dysuria, especially to the

above,
I

extent related

have rarely met with.

Nor must

be for-

gotten that after these morbid occurrences have repeatedly taken place, and

when
for

every thought of

pregnancy has been given up, conception has occurred.

Such an event,
to

a time at least, and

perhaps

permanently, cures

the

affection.
its

It

is

therefore important
1

bear in mind

possibility.

have known two examples of healthy pregnancy

five

under these circumstances, after an interval of

or six years from the former accouchements.
ache, embarrassed
nose, sometimes
petite,

Headthe

respiration,

bleeding

from

excessive, dyspepsia, impaired ap:

and emaciation, are frequent concomitants

these various mischiefs

after

all,

may

only be tem-

porary.

The

function, on
is

whose morbid condition

waning, and a few more

they

all

depend,

itself
its

months may secure

permanent suspension. Thus,

sometimes, even with only domestic care, and often

214
with
clines,

MENORRHAGIA.
proper

medical treatment, the

patient

affection de-

and eventually the

not always so.

regains

more

health than she has for a long time enjoyed.

this
is

But

Unhappily there are cases

their attendant evils,
for several years,

where the hemorrhages, and

continue for inducing a strong belief that
really
exist
;

many months, even

nor must

organic disease must

forget that

we
is,

malignant

changes do, although

rarely,

develope themselves.

Even

in their absence, life

now and

then, eventre-

ually destroyed

by exhaustion, arising from the

peated bleedings, by phthisis, or by dropsies of some

of the great serous cavities.

Anxious inquiry
these bleedings

is

directed to the probable time of final cessation, and

it
is

often asked,

how

long

may

continue

ral disease ?

when they are not connected with structuIn many instances, the function ceases
;

at forty-four or five or fifty

;

in

more, at forty-seven, eight,

in a few, at a

much more advanced

between
confess
;

period,

and

in

fewer

still,

at thirty or
I

thirty

and
an-

forty years

of age.

my

inability to

swer the

latter question

but

have met with more

than several instances, where hemorrhages, alarming

in

degree,

have

continued for twelve, eighteen,

ulti-

twenty-four, and forty-eight months, and have

mately declined, and the sufferer has regained good

health.
It is

right in

every protracted hemorrhage from

the uterus to examine.

that even then

By

this alone,
fail,

and

allow

we

frequently

can

we

expect to

ascertain whether there be

polypus, a submucous

MENORRHAGIA.
tumor, or so

215

much

increased bulk as to render the

In the

existence of organic lesion highly probable.

majority of the examples of congestive menorrhagia, I believe that increased uterine bulk, fulness of
the cervix, and openness of the os, constitute the

whole of the diseased change.

Pathology.

Congestion of the uterine

is

vessels is

the explanatory cause of these bleedings.

instances, there

In

some

an unusual and excessive accumulation of blood, and then it is not at all improbable that
ries,

some of the branches of the uterine arteramifying on the mucous membrane, give way.

In submucous tumor of the

womb,

these vessels are

abnormally large, and are by their rupture the source

of frequent hemorrhage.

On
disease

the whole,

the

symptoms are

indicative of
that the

slow progress, and lead

is

to the conclusion

of the passive kind.

The

affection is

the probably dependent on the peculiarity of age important period having arrived when this most
function
its
is

about to cease.

have already noticed

organic
anxiety on
tis-

supposed frequent complication with

:

disease

nor

is

it

possible not

to

feel

this point,

when we remember

that vessels and

sues in a state of nearly constant congestion, become hypertrophied, and liable to the invasion of
structural

and malignant change.

Diagnosis.

It

must not be forgotten

that losses

of blood occur in connection with other states of

the uterus than the various forms of menorrhagia.

Approaching abortion

is

often supposed to be menor-

216
rhagia
is
;

MENORRHAGIA.
nor
is

the mistake corrected,

till

the
I

ovum
lately

expelled, and the

a case, and
it

hemorrhage ceases.
is

saw

unnecessary to mention the

this kind,

more common occurrences of

tion,
I

where, from

the emaciation, bleached countenance, and exhaus-

had formed a most unfavorable opinion, the

flooding having continued, although not excessively,

for

nearly six months.

On

examination,

found

the uterus large, and the lips of the uterine aperture

swollen, but not patulous.
as the patient

The

idea of pregnancy,

was

forty-four,

and had not borne

1

children for several years, did not occur to me.

prescribed

some medicine containing

ergot,

and

gave a doubtful opinion.

After taking three doses,

she expelled a blighted ovum, and in a few months entirely,

although with

difficulty,

recovered her health.

in the earliest for a

"

was

called," says Dr.

Gooch, "

part of

my

practice, to a lady

who had

con-

siderable time a dropping from

the uterus, which

had produced a bleached, cadaverous countenance,

cold hands and feet, and great debility.
nation,
little
I

On

exami-

found at the upper part of the vagina a

I

long projecting tumor, which

thought might

possibly be a peculiar formation of the cervix uteri.

I

was afterwards

called

in

great haste to see her,

said

and, on

my

entering the bed-room, she

;

there

was something coming away

I

and, on examination,
I

found the leg of a foetus in the vagina.

her
of
a
foetus

speedily

delivered

of about

four

months

growth

the placenta soon followed, and the hemor-

rhage ceased.

This was a blunder of mine

for

MENORRHAGIA.
that

217
uteri,

which

supposed to be the cervix

foetus, just

was

no other than the foot of the

beginning

to protrude through the os tincae."

The
its

diagnosis of menorrhagia from pregnancy

:

is

important

but not so important, nor so

difficult,

as

distinction

from some of

the

more concealed

organic diseases.

Corroding ulcer, cauliflower ex-

cresence of the os, ulcerated carcinoma of the cervix

and

polypus, descended

into

the vagina, are

;

easily

made

out by

common

examination

but

whether protracted, frequently recurring, and dangerous hemorrhages arise from uterine congestion, or

from submucous tumor, a polypus yet retained

uterine cavity, or from organic disease of the
lining itself,
it

in the

mucous
is

is

by no means easy to determine.

Often
so

in

the course of these hemorrhages, there

much

pain, such apparent traces of malignant dis-

ease about the face, so

much

emaciation, and such

very

trivial

and temporary benefit from every remedy

it

used, that in despair one believes, that

must be a

malignant affection, (vide case.)

ever,

After a time, how-

and perhaps unexpectedly, the bleedings parpain

tially cease, the

diminishes, and

the patient's

health

is

improved.

vaginal examination reveals

nothing beyond what has been already mentioned,

and hope
the

is

again

encouraged.

Thus

a favorable

diagnosis will mainly depend

uterus,

on the healthiness of

so

far

as

the finger can

examine

its

structure

ed emaciation
ing,

on the absence of progressive and markon diminishing, not increasat least

;

hemorrhages
28

on the general concurrence of

218

MENORRHAGIA.
;

the bleedings with the menstrual periods

the

and on
the

lessened

volume of

the

uterus

during

menstrual intervals.

Other circumstances, which

cannot be accurately expressed, but which form a

part of that

unwritten and
all

incommunicable

tact,

acquired

by

observant men, will aid the judg-

ment.
in other

strumous constitution, glandular tumours

parts, hard

tumours of the fundus or body

of the uterus, broad ligaments or ovaries, increasing

hemorrhages and uterine pain, a gradual giving way

of health, and the absence of any beneficial effect

from remedies, point

to

an unfavorable termination,
is

and lead to the conviction that there

beyond the

reach of an examination, by the finger or speculum,

some malignant
Prognosis.
I

structural change.

Dr. Churchill
This
is
is

says, " of

all

the cases
directly

have seen, none have proved

indirectly."

fatal, either
I

or

more than

can affirm.

Happily the malady

it

generally cured, or perhaps

to say, that as the eatame-

would be more correct

nial function ceases the

bleedings cease also.

If

there be no latent tendency to malignant or pulmo-

nary disease,

it

is

not likely that such will occur.

And

it

must be allowed, that

fatal

women do
it

sustain

excessive and long continued uterine hemorrhages,

without a

result.

But

let

not be supposed

that these formidable losses

do not seriously injure

the health.

They

deprive the body of that blood

by which

its solid

structures are nourished, and thus

lay the foundation of uterine

softening.

There

is

MENORRHAGIA.
also a probability of dropsy, and the patient

219

may be

destroyed by phthisis.

Treatment.
it

So much has been already

necessary to enlarge
here.

said, that

is

scarcely

In the

hemorrhagic
plethora, a

intervals, if there

be local or general
the loins,

small bleeding, cupping on

if

leeches to the anus or vulva; and

heat,

there be fulness,

and pain about the cervix

uteri, scarification,

as already

recommended, may be

practised.

Sexual

intercourse and stimulants, mental

excitement and

physical effort, must be avoided for ten or twelve

days before the periodical returns.

increasing pallor, oedema, threatened

When

there

is

dropsies, soft-

ening of the cervix, and aggravated debility,

air,

sea

a mild but nutritious diet, consisting of animal

food and milk, or malt liquor, must be enjoined.

Where
cially

there

is

universal coldness of surface, espe-

of the extremities, frictions,

by stimulating

embrocations, the flesh-brush, and horse-hair gloves,

the wearing of flannel, and
indicated.

worsted stockings, are

The

salt

hip-bath, the local salt shower-

bath, applied

night

and

morning,

by a

common
is

garden watering pot, over the hypogastric and lumbar regions, are often
injection of cold

advantageous.

Nor

the

water, once or twice a day, into

be forgotten.

the

rectum, to
are

Astringent
on,

vaginal
if

injections

deservedly

relied

especially

carefully administered, as already urged, (page 209,)

during the
occasionally

intervals.
I

Still

there

are

cases,

and

meet with

good many, where cold

Local fulness, excite-

injections cannot be borne.

220
ment and
larger

MENORRHAGIA.
pain, follow their
to their

use,

and sometimes
earlier

have attributed

employment an
is

and

return of the

hemorrhage.

Thev

are most

beneficial

where there
this

copious leucorrhoea, and

from the cure of

invariably

morbid secretion, good

It
is

may be

anticipated.

to

be

remembered,

that the unmarried

are liable to congestive menor-

rhagia, and

have often thought that their cure was

more
but

difficult

and protracted, and their hemorrhages

;

larger, than
I

where many children had been borne

attack, the

am

not prepared to give a positive opinion.

patient should
lie

During an

on a hard

mattress, be

kept perfectly quiet, covered lightly

with bed clothes, and have warmth applied to the

feet

and legs
used
for

hot bottles, or mustard poultices

this

may
is

be

purpose.
cold,

Her drink must be

except

unstimulating

and

where there

syncope, and then wine in small quantities

given.
I

may be

have

for

several years tried the ergot in these

;

cases,

are

but there and I think highly of its efficacy more than a few instances in which it has

entirely failed,

and several

in

which
I

it

has induced

spasm, and increased bleeding.

have two patients

it

who,
not

for these reasons,

always request that

may

be used.
I

prefer the tincture to the powder,

and

give thirty drops for a dose.

Frequently lead

and opium, turpentine, muriated iron and opium,

(vide formulae,) have proved
serviceable.

Cold to

the lower

abdomen and

genitals,

and particularly

MENORRHAGIA.

221
is

plugging the vagina with soft tow, where the loss

excessive, are effective remedies.

Few

cases will be introduced; very

few of every-

day occurrence.

But where the

shall

history and

symp-

toms, the pathology or treatment of menorrhagia

require illustration,
I

not scruple, as briefly as

possible, to confirm the text by their insertion.

Case

29.

spasmodic menorrhagia.
July 24, 1836.
residing at
I

visited

Mrs.

set.

37, a

widow,

Walworth, and under

my

care as an out-patient of
children, and
is

Guy's Hospital.
menorrhagic

She has never borne

several
years, and

of

spare habit, but neither

for

weak nor emaciated.

habitually

She has been

suffers

from
her

dyspepsia, earning a livelihood

needle.
last

by close application

to

Menstruation occurred two days since, and for the

hours,

twenty-four

the

paroxysms of pain and spasm

about the uterus have been very severe.

Much
on

blood

has

been

lost

by gushes, and many

still

large

clots

have been ex-

pelled.

The spasm
chill

continues, and

my

visit I

found

the pulse quick (130) and irritable, but neither

full

nor hard.
;

She

is

and

faint

the countenance pallid

the

and anxious
the

has had no sleep

since

commencement of
disease,

attack,

although there have been rather long intervals free from

pain.

At the commencement of the

effect.

three years

since, she

was bled and purged, but without any other than

Urine scanty and high colored.

an injurious
I

ordered hot poppy fomentations to the abdomen, and the

following mixture.

222
R.

MENORRHAGIA.
Pulv. Ipecac, rad. i.

Tinct.

Camph. C.

3ii.

Mist.

Camph. 5xiv. M. ft. Mistura.

nausea
is

Take one

teaspoonful

every

hour

till

produced.

In the evening she was considerably relieved

six doses of the ipecacuanha

had taken
and

mixture, and was completely

nauseated.

The
off,

pain occurred at

more

distant intervals,

the flooding had nearly ceased. rhagia passed

In a few days the menor-

and she recovered her accustomed health.

periods she

For

several subsequent
I

pursued

this

plan

and

when

saw her

six

months afterwards, she informed me, that

the menstruation was performed so naturally, that she had

entirely laid aside the use of the medicine.

There
towns.

are

numerous

examples

of

spasmodic

menorrhagia, especially in crowded manufacturing

The treatment by
till

bleeding and purging

;

is

too indiscriminately adopted

often,

nor
is

is it, at

least very

the patient's health

is

decidedly injured,
I

that a different plan

practised.

have repeat-

edly cured this form by nauseating and anodyne

remedies.

Case

30.

congestive menorrhagia, nearly fatal.

In 1833,
I

was asked by Mr. Rendle of Southclinical

:

wark, formerly a

clerk of Guy's

Hospital,

to see the following case

Mrs.

set.

42, of spare habit, the

mother of several

children, and compelled to work hard

as a

washerwoman,
its

has long suffered from menorrhagia,

dating

commence-

MENORRHAGIA.

223

ment from the birth of her last child, now three years old. At times the bleedings have been less in quantity, but they
have never entirely ceased.
have occurred
Till
;

lately,

the

menstrual

period has been nearly observed

at

but recently, the losses

very short intervals, and she has

their excess.

been

weakened and emaciated by

Two

days before

my

visit,

menstruation commenced, with sensations of fulness

in

and weight

the

hypogastric
;

region.

For twenty-four

hours there was no hemorrhage

but soon afterwards, large

quantity of blood was lost.

coagula passed, and an immense

On

our entrance,

we

feared she

was dying.

The

pallor

and

coldness of the face and extremities, the scarcely perceptible

pulse and
surface,

breathing, and

the

clammy

perspiration of the

betokened the greatest danger.

We
;

stood over the

bed, doubtful whether she would live or die.

We

feared to

move her, least fatal asphyxia should ensue nor was it till we had waited several minutes, and she had opened her eyes
and breathed more
ergot and brandy.
distinctly, that

we
I

dared to give some

At

this

moment,
at

wished

to transfuse,

and had the apparatus been

hand,

we should
As
this

certainly

have injected blood

done,
several

into

her veins.

could

not be

we

repeated the ergot and brandy

(vide

formulas)

times,

and

the vagina was

plugged.

No

further

bleeding occurred, but the recovery was very slow.

Case

31.

protracted menorrhagia, terminating fatally, by phthisis and ascites.

Mrs. T.,
set.

45, an out-patient of Guy's,

is

the mother

of eight children, and of dark complexion.

July 10, 1835.

Has

suffered from menorrhagia for three

years, remedies having hitherto

done

little, if

any good.

The

224

MENORRHAGIA.

bleedings generally occur in connection with menstruation,

although flooding

in the intervals

have not been uncommon.

attack,
if

Always and correctly prognosticates an

hypogastric
region,

she
in

has,

about the middle of the period, acute pain low

down

the

with sensations of weight and fulness

about the uterus.

Pulse 110, and compressible; counte;

nance
ed
;

pallid

and sunken

bowels easily and frequently purg-

urine scanty; perspiration frequent; marital intercourse,

is

which rarely occurs,

often followed

by bleeding.

R. M.

Secalis Cornuti 9ii.

xii.

Morphiae Acetat.
q. s. pill

gr.

iss.

Ferri

Sulph. gr.
ft.

Cons. Rosas

pilulae xxiv.

Take one

three times daily.

To
daily,

use the tepid or cold hip-bath every evening.

Two

ounces of the compound alum injection three times

and to abstain from intercourse.

July 30.
report
;

Has had one excessive

flooding since the last

stopped by cold, freely applied over the abdomen

and

loins,
is

and cold alum wash injected into

the
;

vagina.

There

much
;

leucorrhoea,

and frequent cough

counte-

nance pale
remedia.

more emaciated and increasingly weak.

Cont.

August
120
;

\0.

No

better; leucorrhoea

still

continues

pulse
;

feverish at

night, with

perspiration in the

morning

complains of some, although slight pain, about the cervix

uteri.

To

use an injection of sulphate of iron

(vide for-

mulae.)

R.

Tinct. Ferri Muriat.

5iv.

Tinct.
ft.

Secalis Cornuti.

Tinct.

Hyoscyami, aa

M.

Mistura.

Take

thirty

drops three times daily,

in

a teaspoonful

of

port wine.

September 20.

To-day she

states that

there

is,

and has

MENORRHAGIA.
been
for the last

225

few weeks, a constant sanguineous discharge,

few drops
at a

not by gushes, but scarcely by more than a

time.

Her
:

legs

pit

on

pressure, and

they are cedematous

;

and cold

urine

scanty and
;

high colored

breathing short,
;

and often

difficult

leucorrhoea scarcely diminished

cough

short, hacking,

and frequent, with a continuance of the morn-

ing perspirations.

Her countenance has

in his

the sallow leaden

hue, pointed out by Sir James Clark,

invaluable practical

Work on Consumption,

as

so characteristic of tuberculous
life.

cachexia, acquired in mature

Is to

go into Wiltshire,

her native county, and to follow out the plan before pursued,

and so

fully pointed out in the

preceding page.

On
of
its

examination

found the os uteri patulous and large,

the neck of the uterus soft, almost spongy, and entirely devoid
firm, glandular
feeling.
I
;

carried

my

finger,

without

difficulty, into the uterine cavity

but

could detect no hard

nor soft tumor.

The

uterus

is

not greatly increased in size,

nor did any bleeding follow this inquiry.

November

15.

Her mother informed me

that

she had

died about a month previously, from

dropsy and consump-

tion, the bleedings continuing to the last.

She was exceed-

ingly emaciated.

No

examination was made after death.

This case scarcely requires any comment.

interesting* because,
fatal

It

is

happily,
is

it

is

rare

and the

pulmonary mischief

clearly attributable to

the repeated bleedings.

It

cannot be said that there

;

was no organic
be
of
fairly

uterine change

but

it

may,

think,

assumed, that the structural degeneration

reproductive
is,
I

the

organs

was not malignant.

frequent accompani-

Such softening

believe, a

ment of very protracted congestive menorrhagia,

29

226
and points

MENORRHAGIA.
to the propriety of

improving the health,

and of restraining the hemorrhage, the former condition being mainly dependent on the latter.

Case

32.

CONGESTIVE MENORRHAGIA AND PREGNANCY.

had

frequent occasion to see Mrs.

aet.

42, dur-

ing the years 1837, 1838, 1839, and

several times in 1840.

in

This lady was thirty-eight years old

ried eighteen

1836, had been mar-

years, and

was the mother of many children.

Her
life,

health had been good during the whole of her married

with the exception of slight illnesses connected with her

In

various confinements.

1837, she

first

suffered

from mo-

norrhagia, and in that, and the following year, the discharge

was often so excessive

as to

alarm her.

Once

happened

to

be present, and certainly nearly two pints of blood were

lost

by gush

in a

few minutes.
at

These

attacks induced

syncope
intervals

and prostration

the

time, and in the menstrual

there was pallor, weakness, and

some emaciation.

Tow,

for

the purpose of plugging the vagina, has often been in readiness

;

but her unconquerable aversion to this valuable remehitherto

dy, has
its

most improperly been allowed

to

prevent

use.
I

The

acute bearing pain, low

down

in

the uterus, to

which

have already alluded, invariably occurred about the

middle of the interval, and was the certain precursor of a

coming hemorrhage.

Nor

as a

premonitory condition, were

there ever absent, feelings of weight, tension, and distressing

fulness in the lower part of the pelvis.
isfied

Several times

I sat-

myself by examination both by the rectum and vagina,

MENORRHAGIA.
that the uterus was really larger, and congested prior to
struation.

227
mencold

During
ed.
acids,

the

attacks,
loins,
its

astringent

vaginal

injections,

sponging over the

and pudendum, were freely employ-

The

ergot, in

various forms, the acetate of lead and

all

opium and turpentine, were

strictly

given.

The recum-

bent position was long and

observed.

In the intervals, tonics, stomachics, sea air and bathing,

local salt-water

shower

baths,

good

diet, rest,

and as much

quiet as could be obtained, were insisted on.

I

am

often very anxious about this case.

There

is

emaand

ciation, a sallow,

wan countenance, impaired

is
it is

appetite,

great debility.

Leucorrhcea

always present during the me-

norrhagic intervals, and

sometimes slightly sanguineous

last

and offensive.

have repeatedly examined during the

os
is

two years.

The

constantly patulous,

its

lips

swollen,

and, together with

the cervix, soft and

flabby.

Still,

there

has never been either hardness, fissure, or abrasion.

After the continuance of the menorrhagia for more than

three years, and

when

all

idea of pregnancy had been aban-

doned, conception occurred.

Over

fatigue, the patient being

ignorant of her real state, produced abortion at the end of the

third

month (July 1840).

The ovum was

quite healthy.

This

is

one of the large class of cases.

difficult.

need

not say that they are perplexing and

The
But

protraction and the debility induced by the repeated

hemorrhages,

fully justify

such a conclusion.
is

additional confirmation of the opinion

afforded by

the possibility that structural

dropsies, or exhaustion,

malignant change or
destroy the patient.
I

may

Congestive menorrhagia may,

quently than
is

think,

more

fre-

supposed, be attributed to the avoid-

ance of complete sexual intercourse, and to conse-

228

MENORRHAGIA.

quent derangement and congestion of the ovaria and

uterus.

This abstinence

is

dangerously practised

number of a family, already thought to be too numerous for the peBut this cuniary means of its principal supporter. is obviously a subject on which one cannot, with
to avoid the risk of adding to the

propriety, enlarge.

Case

33.

CONGESTIVE MENORRHAGIA

DIAGNOSIS DIFFICULT.
and

Mrs.
of large make.
to the

set.

52, has not been married,

in or

is

tall,

Has always resided

illness,

near London.

Up

time of her present

has been

has

enjoyed unbroken

health, and
activity.

remarkable

for

muscular strength and

November, 1836, when she was 48 years old, menstruation first became irregular, returning very profusely
In
after longer

intervals.

Sometimes she was alarmed by the

;

numerous and large coagula which passed, and by syncope

but she quickly
if

rallied,

and

as she believed

such occurrences,

not natural, were very

common, she

refused to adopt any

I

medical plan, or to take any particular care.

frequently

saw her during these hemorrhages

and
end.
faint
;

she was

chill, prostrate

but, after their subsidence,

management was

at

an

In

August, 1S38, almost two years after the commence-

ment of the malady, there was emaciation, frequent hot

flushes,

and

distress

from heat

in

any form

blanched skin,

a quick vibrating pulse, and slight uterine pain.

The

patient

could not walk so

mestic duties.

far,

nor attend so energetically to her do-

MENORRHAGIA.
Prior to

229

the occurrence of the menorrhagic attacks, Mrs.

always complained of weight, fulness and tension in the uterine region, of pressure on the bladder and dysuria. and occasionally of pain about the neck of the womb. In

November, 1S38,
gina and rectum.
larger than natural

was allowed

to

examine both by the vapatulous, and the cer-

The body
;

of the uterus was heavier and

the os

somewhat

vix swollen.
firm,
I

did not use the speculum, as the

hymen was

and prevented even the easy passage of the finger; but

confident there

am

was no abrasion.

All

the parts were

fol-

unusually soft and flabby, but neither pain nor bleeding

lowed the inquiry.

From 1838
In

to

August, 1840, the course of

unsatisfactory.

this disease

has

been perplexing and

March and

April, 1838, Sir

James Clark was consulted

:

is

at that

time her state was as follows

;

the general surface

pale and exsanguined

the least excitement quickens the of

heat.
in

pulse,

and

produces flushings

The

emaciation

slowly increases

there
A

is

oedema

various parts of the

is

body, but no anasarca.

Only

slight uterine pain

complain-

ed of; but she has the appearance of a patient suffering from

malignant disease.
joined.

continuation of the treatment

was en-

The
zoin
;

remedies have been the ergot

;

in

every form and dose

;

turpentine

the acetate of lead

;

acids and refrigerants

ben-

opium

the various astringent, stimulant, and anodyne

injections; country and

sea air; spare

;

and nutritious diet;

in a carriage,

leeches and small bleedings

the recumbent position.
derived.

easy exercise

and

But only
last

transient benefit has

I

been

Often, in the

two years,
a

have given

it

up

as

a lost case, as there has never been

day during that time,

without either sanguineous, sero-mucous or muco-purulent

discharge
;

but after

have arrived

at

this conclusion, for

is

week, perhaps

for several, the discharges decline, there

is

no

uterine pain, there

a rally of the

strength

she becomes

cheerful, walks

about the garden, sleeps better, enjoys her

230
food, and
this

MENORRHAGIA.
gathers flesh
;

thus leading one to doubt, whether

may

not be a very rare example of protracted, congestive

menorrhagia, without any more than the usual non-malignant

changes of structure.
Several circumstances deserve attention
patient or four
is

in this case.

The

often

entirely free from sanguineous loss for three

its

weeks; but

place

is

always supplied by copious

discharges of sero-mucous, not aqueous, and occasionally of

muco-purulent or purulent

fluid

generally as

nine, and ten napkins are used daily, and

many as eight, when the sanguineso that

it

ous discharge
is

is

present,

impossible not to wonder

many more are required, how these large and

constant

drains are borne.

The hemorrhages
entire,

are invariably preceded

by sensations of
cavity.

uterine congestion, and several times a clot has been passed

presenting an
its

accurate cast of the uterine

size,

From

comparatively small

and unaltered form, an

is
still

inference has been

drawn

that this viscus

of nearly

normal volume.

There
nent kind
viation.

is
:

scarcely any pain

none of a severe or permaits

an anodyne has never been required for

alle-

An

examination

made

few days since (August

edges are large

1840), both by the rectum and vagina, reveals no traces of

disorganization.

The

os

is

patulous, and
is

its

and swollen
changes
I

the cervix too

more bulky, but beyond these

can discover nothing anormal.

have dwelt at some length on

I

this

case, be-

cause

know

it is

but of rare occurrence.

posiits

tive opinion

cannot be given.

My own

leans to

malignant character.
bleedings,
serous,

The

emaciation, the repeated

the constancy of the serous, the muco-

and purulent discharges, the gradual dimiof strength, and the trivial benefit derived

nution

MENORRHAGIA.
from remedies,
Still
ficial
all

231

point to disease of this kind.

at all likely to exert

no care, no remedy
control,
to

bene-

should

be

withheld.

The

patient

ought

be

encouraged,

and especially on the

ground, that her long struggle

stationary,

may

terminate in a

inactive

condition of the disease, and

perhaps in recovery.
I

could add several examples of protracted con-

gestive menorrhagia,

where the congestion was conbeen

sequent on a loaded condition of the bowels and luxurious living.

already made.

To

these, as causes, allusion has

In one instance,

where the patient

of an inn, nearly

was middle-aged, and the landlady

as increased

constant hepatic and intestinal derangement, as well

bulk of the

liver,

was thus induced.

difficulty in

The menorrhagic

attacks were most frightful, and

on not a few occasions, there was great

rousing her from the consequent syncope.

The

late

Dr. Cholmeley visited her, and stated that she might

be cured by spare diet and purgatives.

The
I

impor-

tance of these measures was enforced, and in a few

months the hemorrhages were prevented.

this case especially, to

mention

show

the value of purgatives

prior to the anticipated return of the

riod.
I

menstrual pe-

often ordered for this patient, after the disfull

ease had continued some time, a

oil,

dose of castor

twenty-four hours

before the

expected

com-

mencement
sults.

of the discharge, and with the best rein

Dr. Locock observes, " that

examples of by

this

kind of menorrhagia, the next return of men-

struation

may

be rendered comparatively

trilling,

232
the use of a
full

MENORRHAGIA.
purgation about twenty-four hours

before the period,

when

that can be ascertained,

avoiding
nature."

every medicine of a drastic, stimulating

He
is

also adds,

thus

confirming

what

have just advanced, " that chronic (congestive) menorrhagia

occasionally connected with organic or
;

functional disease of the hepatic system

it is

and when

recollected

how

notoriously inattentive
7

are to the state of their bowels, and

women w hat enormous

it

masses of

fcecal

matter are allowed to take place,

may

what degree the abdominal circulation must become obstructed, and how powerfully such obstruction must act in producing
easily be supposed to

congestion of the pelvic viscera."

In conclusion,
I

think

it

right

to observe, that I

have twice witnessed, in most extreme cases, the

beneficial effects of injecting into the uterine cavity

a small quantity of the spirit of turpentine.

not be supposed, after what
that
I
I

It will

have heretofore

said,
I

advise this procedure on slight grounds.

believe such injections to be very certain but highly

hazardous remedies, and they never ought

ployed except as derniers ressorts.

to

be em-

The

uterus has

also been injected with a small quantity of lead and

alum

in solution;

and the narrator of the treatment

is a dangerous one, for in two was followed by vomiting, uterine inflammation, and death." At page 243, vol. II. of

says, " the remedy

it

instances

Guy's Hospital Reports, and

be found.

at

page 115 of the

present work, additional cases and observations will

MENORRHAGIA.
I

233
in a

first

employed the turpentine

as follows

menorrhagia
ineffectual.

where every previous remedy had proved

The

case

is

Mrs.

G., forty-five years

of age, and habitually intemperate, requested

give her

me

to

some medicine
She was

to prevent

hemorrhage from

the
still

womb.

large,

and rather bloated, but

capable of great exertion.

several

She was married,

and had
remonstrat-

was the mother of

living children,
I

miscarried a few months previously.

ed with her on the excesses to which she acknowledged she was prone, and fully explained to her,
that

they were the source of the bleedings.

The
full

uterus

was
;

large

and

soft,

and the cervix was

and flabby

but although the os

was

sufficiently
I

patulous to permit the entrance of the finger,

could

not detect further structural change.

tion

An
She

examina-

by the rectum was also made.

I

lived in

my

immediate neighborhood, and as

plan and diet.

had frequent op-

portunities of seeing her, she adopted for a time the

prescribed
intervals,

By

purging during the

losses

and especially before the period, the

a few

were

for

months greatly diminished.

At

length she thought herself so well, as to be no lon-

ger under the necessity to adopt any plan which

curtailed her usual indulgences.
for
I

lost sijrht

of her

some months, and

know

during the interval,

that highly seasoned

ale

food,

and large quantities of

and wine were daily taken.

in haste to visit her,

One
and
I

evening,

was requested

found her

almost dead from uterine bleeding.

informed me, that since
.30

Her husband

my

last

attendance, she had

234

MENORRHAGIA.

very frequently lost large quantities of blood, and he

had thought that on several occasions she must have

died, but that hitherto she had always slowly rallied.

Brandy and ammonia and

but she had not said

ergot, restored animation,

many words

before a fresh

gush again induced alarming syncope.

Cold water
applied to

was dashed over the

face,

ammonia was
rallied.

her nostrils by a camel-hair pencil, and after a very

lengthened fainting, she again

I

On

inquiry,

found the attack had already lasted two days; and

was evident that her powers were exhausted. Her voice was scarcely to be heard, the pulse was quick and feeble, and her breathing was very short, the countenance was livid and anxious; in fact, it seemed as though another gush would destroy her. Her medical attendant, Mr. Burton, plugged with
it

sponge, but ineffectually.

On

the instant,
spirit

pro-

posed to inject a small quantity of

pentine
;

of tur-

and having procured a gum-elastic male

its

catheter, and cut off

end, so that there

it

open mouth,

introduced

through the

os,

was an which

was very
syringe
spirit.
I

patulous, into the uterine cavity, and by a

injected about

two
I

or three

drachms of the

Soon afterwards

plugged the vagina with

tow.

There was no further bleeding, but the pain

great, as

was indescribably

though there were burn-

ing coals in the uterus and bladder.

The
feared

evidences

of hysteritis seemed so clear, that

we must

have taken

away

blood.

Fomentations of poppy
;

and conium applied very hot

camphor and lauda-

num, together with a purgative enema, allayed the

MENORRHAGIA.
intense suffering.
In twenty-four hours
I

235
removed

the tow, and there was no further bleeding.

Men-

struation never returned, and from the continued and

occasionally severe

pain which

followed the use of

the turpentine,

suspect that adhesion of the sides

of the uterine cavity resulted from the inflammation.

Her former intemperate

and
in less than a

habits

were soon resumed,

year she died.

No

inspection

could be obtained.
I

again witnessed the advantageous effect of this

in July,
visit

remedy

1838.

On

that occasion

was

re-

quested to

a lady under the care of

arrival, the

Mr. Price,

of Margate.
lars
aet.

On my

following particu:

were communicated
45,
is

to

me

Mrs. M
or three years

the mother of several children, and has

suffered from menorrhagia for

two

of

late, the

losses

had been large, and she had

re-

paired to the

sea-side for a

restoration of health.

Two

days before

my

visit,

July 17th, the period re-

turned, and in a

few hours much blood was pumped

Mr. Price promptly,

out of the uterus by gushes.

but

without stopping the hemorrhage, gave large

doses of ergot, acetate of lead, and sulphuric acid,

at the

same time applying cold externally, and

It

in-

jecting astringents into the vagina.

soon became

evident that more must be done, and Mr. P. boldly

determined to throw a small quantity of turpentine

into the

uterine cavity.
;

On my
all

arrival

this

had

been effected some hours

the bleeding had ceased,

and she appeared

teritis.

to

have

the

symptoms of hys-

The

agonising pain, described in the pre-

236

MENORRHAGIA.

ceding case, was present, requiring aid to keep her

in bed.

The

pulse

was 140,

irritable

and

thrilling,

but compressible, and without hardness or power.

The abdomen was painful to the same way as in puerperal

aggravations
it

the touch, but not in

fever.

The

pain had

and

intervals

of

less
is in

severity,

and

was not necessary,

as

it

often

puerperal pe-

ritonitis, to

prevent the pressure of the bed-clothes

Still

by placing a cradle over the patient.

ferings

the suf-

were described

as

almost

unendurable.

Opium, a purgative enema, and afterwards a suppository, together with

anodyne and mustard fomen;

tations, palliated the pain

and, under the influence

sleep.

of a

full opiate,

she got

some refreshing

The

vagina had been plugged prior to the injection of

the turpentine, and before
I

we

left

her for the night,

it

carefully filled

it

with tow, wetting

afterwards

by a syringe with decoction of ergot (vide formulae).

In the

morning there had been no return of hemorI

rhage, and

was subsequently informed, by Mr.

it

Price, that she had recovered well but slowly.

In cases of alarming menorrhagia,

of

is

a matter

moment

that the practitioner remain with the pa-

tient

and ascertain very frequently the extent of the

In puerperal
bleedings, after the exoften dependent on
Austria,

hemorrhage.

pulsion of the placenta,

this precaution.

life is

crown princess of

who

had been attended by the celebrated Boer, of Vienna, (the case

is

related by Dr. Rigby,)

lost

and many
its

other

women, have been

from the neglect of

observance, and in the instances

now under

inquiry

MENORRHAGIA.
it
is

237

scarcely less necessary.

After excessive me-

norrhagic bleeding by gushes, or in a stream, the

powers of

life

are often reduced to a very

slight drainings

low ebb
therefore

and protracted but

may

afterwards insidiously and unexpectedly

patient.

sink

the

CHAPTER

VII

OF LEUCORRHCEA.

Definition.

An

excessive

of the mucus, furnished by the vagina and uterus, by the follicles of

the cervix uteri,

and altered secretion membranes lining the

the interior

of

and by

the lacunce

of the vestibulum,

generally white or nearly colorless and transparent,

usually tvithout

much

odor, glutinous, muco-purulent,

or purulent, sometimes yellow, green or slightly san-

guineous, and of varying degrees of consistency.

The amount of
bility

constitutional derangement depend-

ing on the severity of the affection and the suscepti-

of the patient.
three forms of the disease.

There are
First,

The common

leucorrhcea, often mild,

some-

times acute.

Second,
Third,

The inveterate and chronic leucorrhcea. The symptomatic leucorrhcea.

Acute and mild leucorrhcea.

History and Symptoms.
vision,

have adopted

this di-

because

it is

both correct and comprehensive.

LEUCORRHCEA.
It is

239

common, and inflammatory leucorrhcea, from one of the same orAnd it is certainly der, only of chronic inveteracy.
proper to distinguish a recent,
not less correct to distinguish both these from the

symptomatic form, when the discharge owes

gin

its ori-

and

continuance to

structural

or

malignant
It is

changes of the uterus or

comprehensive, not

its

appendages.
the

also

only including
is

examples

where
cases,

the pathological condition

inflammation or

simple uterine catarrh, but also the symptomatic

where changes of a more serious

or disorgan-

izing kind are the source of the mischief.

Of
if

all

the diseases peculiar to the sex, there

is

none so
they

common.
are

Few

married women, particularly

its

mothers, escape

attacks.

The young and

more advanced were
it

the robust are less liable than those

in
life,

especially if the

latter

possess susceptible
re-

and

delicate
its

constitutions.

If evidence

quired of

almost universal prevalence,

might

be found

in the

number of

its

synonymous names,
its

in the vast variety of real or supposed remedies, and

in the
ture.

many
In
its

treatises

published to elucidate
is

na-

milder forms, there

so little pain and

constitutional disturbance, so

little

interference with

the uterine functions and the comfort of the patient,

that

we

cannot wonder at

its

neglect.

And

yet

believe, if care

ablution only
all

the parts,

were taken at this early stage, if was frequently practised, the tone of and more particularly of the secretory
so far as

membrane, would be regained, and further mischief

entirely

prevented

my

observation has

240
gone, there
generally, in
is

LEUCORRHCEA.

amongst female youth, and

country, an

women

this

unfounded dread of

ablution of the external organs, either cold or tepid.

The
less

vicissitudes of our climate in

for
is

count
it

some measure acand justify the impression, but neverthetoo

general,

and extensively

injurious.

The

duration of the affection has often astonished

me

many
it

individvals stating that they have sufferfor years,

ed from

and some few during the whole

it

of their lives.
there
is

But

is

disease

still;

for in health

an accurate relation between the amount of

it

secretion and the purpose which

brication

serves, viz. lu-

of surface.

amount
this

is

increased beyond
it

important end,

When, from any cause, its what is necessary for is morbid although, in many
;

instances, remedies are scarcely required for

It

its

cure.

was

stated,

when

treating of menorrhagia, that

climate and peculiarity of constitution were criteria

of importance in determining whether menstruation

was morbidly
districts

profuse.

The

observation

is

partially

true of leucorrhoea, as in hot climates and in

marshy
a larger

in

Holland

for

example

there

is

quantity of

mucous

naturally secreted than in drier

I

and more temperate regions.

do not w ish
r

to ex-

tend these general observations

but

still,

without

some clearing of the ground,

to

it

will be very difficult

convey any correct ideas of the

the

different degrees,

and of the various seats of

this prevalent

malady.

Thus, although the vagina

all

is

common

outlet for

leucorrhoeal discharges,

it

must not be forgotten,

other, being fur-

that

these differ

much from each

LEUCORRH(EA.

241

nished by parts of different structure and vascularity,

whose healthy secretions are far from identical. precise knowledge of these differences will not
efficient.

only assist us in the diagnosis, but will also render

our treatment more

The mucus
in

naturally secreted

by these various
differ

parts, although not entirely the

same, does not

any of

its

essential

properties from

mucus
and

fur-

nished

by similar membranes
It

in other parts of the

body.

consists

of albumen and
it

soda,

in

transparency, color, and viscidity,

bles the white of

closely resem-

an egg

in its natural state.

The mucus secreted by the the uterus and fallopian tubes,

ised

lining
is

membranes of
is

correctly characterIts

by the above description.

purpose

such

a degree of lubrication of the sides of the tubes,

and

of the opposing surfaces of the uterine cavity, as shall

prevent their adhesion.

It
is

need scarcely be added,

sufficient,

that a very small quantity

and that with

the exception of the period of pregnancy,

when

the

decidua covers the membrane,

constant.

its

secretion

must be

The mucus furnished by

the vagina,
is

the lining
in

membrane of
less
is

more abundant
mucus.

quantity, and

viscid than the uterine

This

fact

readily
If the

proved by examination under procidentia.

finger

be merely introduced into

it

the

vagina and

withdrawn,
only
;

will

be

covered
it

by a thin

mucus

but

if

it

be carried, as

often may, through

the os

into the interior of the uterus, the adherent

will be found

mucus

much more ropy and

tenacious

31

242
generally, indeed,

LEUCORRHCEA.
it

may

be considerably

drawn out

without breaking.

The mucus furnished by

is

the lacunce

of the vestibu-

lum, or that part of the vagina external to the hymen,

probably slightly more tenacious than the vagisecretion,

it

nal

and

is

said to exhale a peculiar odor.

Whether

possesses this latter property independ-

ently of pregnancy or

morbid action, or

in higher

degree than the mucus furnished by other parts, admits,

I

think, of doubt.
secretion

The
rhoea.

from
is

the

glands of

the interior

of

the cervix uteri,

I

not often found in

common

leucor-

had

lately

an opportunity of examining

these glands and their product, in a patient

who had

died in early pregnancy.

The

glands themselves

were numerous and

cus

clearly discernible, and the mudrawn out entire and unbroken. Sir Charles Clarke, whose work on Female diseases

was

easily

cannot be too highly esteemed, says, " that this mucus contains a smaller proportion of water than any
other, approaching nearer to the nature of a solid

than a

fluid

body.

These glands,

in

a state of

health, perform the office of secretion in

pregnancy

only
is

or

if,

at

any other time, the matter secreted

of a very different kind, so resembling

common
in

mucus as not to be distinguished from it." A remembrance of these facts will aid us
of the several forms of the disease.
If,

form-

ing a correct opinion of the nature and precise seat

then, these

secretions differ from each other in health, doubtless

under various degrees of

irritation

and inflammatory

LF.UCORRTKI

V.

213
be apparent.

action, a similar difference will

The

simplest idea of leucorrhcea

ing
its

is

obtained, by regard-

mildest acute form as the result of mere hyor

peremia
tion.

vascular congestion, whether

all

it

affect

one only, or

the

parts enumerated

in its defini-

Under such an amount

of morbid influence,

the secretion furnished by these various parts will

be more abundant than

its

in health

but

it

will retain

natural characters,

it

will
;

still

be a white, trans-

parent, and glutinous

mucus

there will be derangefebrile

ment of system, produced by

slight ardor urinee,

excitement,

and some sensations of heat and

It is

tenderness about the generative organs.

after
this

easy,

description, to understand the

transition

to its

more serious forms, where the healthy proper-

ties of the

mucus

are lost

where

it

has become not

only excessive in quantity, but muco-purulent, entirely purulent, or ichorous

and watery, and of yel;

low, green, or sanguineous color

constitutional
affection
is

and where the

acute
in

and

extensive.

Here we

shall

have no hesitation
irritability

believing, that

congestion and

have been succeeded by

all

inflammation, and that whether several only, or

the parts
are affected, they have
lost

their healthy

secretory action,

and are pouring out pus, the pro-

per and usual product of an inflamed mucous

brane.

memis

Nor

is

this

statement

less true

of the third
the

or symptomatic

form, where

the discharge

consequence of any of the grave structural

of which
it is

lesions,

so constant an accompaniment.

Often, in

common

leucorrhcea,

have examined

244

LEUCORRHCEA.

by the vagina, but without discovering more than

trifling increase of the

body of the

uterus,

some

ten-

derness of the cervix in the inflammatory form, but

none

in

the

protracted
cervix
is

or chronic variety.

The
all

state of the

occasionally soft, and the os

orifice is

rather patulous.

Sometimes the

not at

open,

but generally the whole of these parts are

supple, bathed in discharge, and

much more
where

relaxed
I

than in health.

In several

instances

have

used the speculum, the cervix has been pale,

acute cases slightly red, and
it

in

more

in

two severe
In none
taint,

attacks,

was of

deep crimson

tinge.

where
have
I I

there

w as
r

not suspicion

of venereal

seen erosion or ulceration.

few days since

superficial

had

an opportunity of examination, and there were three

distinct

and large patches of

;

ulceration

on the cervix

but the other symptoms were too unpresence of

dis-

equivocal to leave any doubt of the

gonorrhoea.
I

have already stated, that the

in

charge varies much

quantity

sometimes

it is

so

profuse as to oblige the

kins several times daily
;

patient to

change the napit is

at other times

less in

quantity, but acrimonious; and in color and consist-

ency there

is

almost endless variety.

different

Viewing the

forms

in

this

way, there

ill

be less difficulty in assigning to each, either a

mild,

aggravated, or symptomatic character.

least severe kind, arising

Ex-

amples of the

from excite-

ment, are most frequent.

The

blood-vessels of one

or several of the secreting parts, from increased circulation,

become congested, and soon afterwards ex-

LEUCORRHCEA.

245

cessive secretion, constituting the leucorrhcea, takes

place.

In
is

many

of these instances, the augmented

in this

secretion

probably confined (and

to the

idea Dr.

Burne concurs)
the

muciparous glands of the os-

tium or entrance of the vagina, scarcely affecting

membrane

of the whole canal,

much

less the

uterine secretory surfaces.

This opinion becomes

highly probable from the fact, that recent and mild

leucorrhcea often yields to ablutions and lotions, applied, not as injections, but as

washes

to the exter-

nal parts, the genital

fissure

being exposed by the

separation of the labia.

Here the accompanying

symptoms

will be so slight, as scarcely to secure the

attention of the

patient.

From

this

incipient and

mild form, every degree and variety will be met

with, up to the most aggravated and symptomatic

examples of the

affection.

In some, the vascular

excitement and irritation will be more marked, and

the local

symptoms and

constitutional

derangement
not only be

more

distressing.

The

discharge

may

excessive,

but highly irritating, and there

may

be

ardor urinse, heat of the genital fissure, and dysuria.

But

this

assemblage of symptoms, constituting a

case of acute, inflammatory leucorrhcea,

yield to ablutions of tepid water or
tion,
diet,
in

may

quickly

poppy fomenta-

aperients, abstinence

from intercourse, spare

and

rest.

These, therefore, are not the cases

aid
is

which medical

anxiously sought.

But

in a

still

more severe

attack,

where, from any of the

causes to be hereafter specified, inflammatory action has been followed by excessive and acrimonious se-

246
eretions,

LEUCORRHCEA,
the

symptoms

will

generally prompt the

In such, there will

patient to seek immediate relief.

be

rigors,

from sympathy with the uterus, heat of

surface, a quick pulse, and white tongue, pain in the

loins

and hypogastric region, heat and pain about the

cervix uteri and neck of the bladder, affecting also

the vagina, urethra, and external parts, distressing ar-

dor urinae, and strangury.

These symptoms may conunder the idea of

its

tinue one or several weeks, according to the treat-

ment and

its

success.

If,

be-

ing a " weakness," tonics and stimulant injections

are early exhibited, the discharge will probably be-

come more
effects

excessive,

purulent or muco-purulent,

thin and watery, or ichorous, and the constitutional

more aggravated.

If,

on the contrary,
in quantity,

anti-

phlogistic and

soothing treatment be adopted, the

morbid secretion will diminish

and the

general derangement will disappear.

stances, the cure
is

In
;

many

in-

quickly effected
is

but in some,

even where proper treatment

sued,
it

early and fully pur-

lasts

long,

proves very troublesome, and

eventually passes into a chronic and inveterate state.

It

need scarcely be said that the discharges

in the va-

rieties

now

pointed out, originate in increased action

of
the
different
parts.

of the

vessels

Females,

therefore,

of plethoric habit, possessing more than

are are

ordinary vigor of constitution,

more
feeble

liable

to

such attacks than

strong.

those

who
is

or

less

And

as the former

not so numerous a

class as the

latter, it

may

be affirmed that leucoris

rhcea, attended

by weakness,

the

more common

LEUCORRHGEA.
form.

247
fe-

Yet

it

must be remembered that some

in

males indulge

the

pleasures of the table, and

drink too freely of malt liquor,

In

wine, or

spirits.

many

affections thus produced, the cares of

family or a business, or more frequently the disinclination

to

exercise,

or

eventually the want of

its

strength sufficient to bear

inconveniences, almost
cor-

compel a sedentary

life.
;

Hence they become

pulent, but not strong

is

a larger quantity of blood

generated, vessels scarcely to be seen before bevisible, the pulse is full, the respiration is

come

em-

barrassed on slight exertion, and the functions of

the bowels and the kidneys are badly performed.

In these

examples, and they are not very uncomthe middle period

mon,

particularly about

of

life,

menstruation often becomes profuse, and the leucorrhcea excessive.

Great care

is

required in the treat-

ment

for if these

undue secretions are suddenly

liver,

stopped, apoplexy, inflammation of the

of the

stomach or bowels may supervene and the patient

be quickly destroyed
:

in

the section on treatment

full

these circumstances will receive their

attention.

share of

In the various degrees

is

now

pointed out,
;

leucorrhcea
difficult

common

sexual malady

nor

is

it

to

believe,

from the complication

of

of

its

causes, the susceptibility

women,

the

frequent

neglect of

all

treatment, and the

injudicious

man-

agement so often adopted, that every variety of case

shall arise.

Second, Chronic and aggravated leucorrhcea.

It is

in this form,

not in the preceding, that the

248
cure
cases
is difficult.
is

LEUCORRHCEA.

The
;

history of these

more

serious

instructive

because

it

generally reveals

early neglect or improper treatment.

Some
as

females,

however, seem to be almost naturally the subjects

of discharges,
character.

unusual

in

amount

well

as

in

In

many

instances,

amongst the out-

patients of Guy's, these leucorrhceal discharges are

so habitual, that complaints of congestion in other
parts,

about the head or chest, pains in the limbs,

or neuralgic pains of the

abdomen, are almost

in-

variably complained

of for some

weeks
at all

after

the

excessive and morbid secretion has been entirely or

even partially cured.

Nor

is

it

uncommon,
without
its

when many remedies

uncontrolled.

have

been

tried,

benefit, that the disease is

allowed to take
results

course

The

frequent

are

sterility,

from anemia of the reproductive organs, especially

of the ovaria, prolapse and procidentia of the uterus,

and not unfrequently of the vagina and bladder.

It

need scarcely

be added

that

pallor,

partial

emaciation, or rather thinness of person, indigestion,

impaired

appetite,

and constipation, languor, and

weakness, are the constitutional accompaniments.

In

some instances

(vide cases), the continuance and

is

aggravation of the leucorrhcea

practitioner.

the fault of the

Uterine or general plethora has been

the morbid state of the cervix or

overlooked

body

of the uterus

has been

disregarded

abrasion or

ulceration affecting these

parts or the vagina,

may

not have been discovered because an examination by

the speculum, or the finger,

has not been

made.

LEUCORRHCEA.

249
some time, a case

Thus what was

at

first,

and

for

of aggravated and chronic leucorrhoea only, becomes,

in the progress of the

morbid action, an example of

its

the symptomatic form, and requires for

cure a

much more
rative

local

application of stimulant and alteI

remedies.

have

known two examples

where severe and primary attacks of leucorrhoea,

were rendered chronic and aggravated by an unnatural heat of the external parts,

produced and

maintained by the constant wearing of thick napkins, to secure the

patients against the discomforts

of large discharges, which were, by this measure

alone, rendered
still

more excessive and constant,

leucorrhoea

(vide cases),

a greater supply of blood being thus

the
is

induced.

Where
it is

is

chronic

and

aggravated, there

great variety in the discharge.

Sometimes

glutinous, transparent, and colorless

the
is

natural

secretion in excess

at other

times

it

decidedly purulent, muco-purulent, or watery, the

result of inflammation
parts.

changing the action of the

less

Nor

is

the color

variable

a green or

brown tinge may

blood

indicate excessive irritation,

and

mingled

with the

discharge

will

probably

result from

abrasion or rupture of the capillaries of

it

the uterine surface, or

may announce
it

the approach

of the catamenial period.

After these observations,

that the general

will

be understood

health

may be

fearfully

and some-

times, although very rarely, fatally broken

down by
exist in

chronic and inordinate

the young, or in those

leucorrhoea.

If

it

who have

scarcely passed

32

250

LEUCORRHCEA.
chlorosis,

twenty years of age, amenorheea and

their

with

numerous

evils,

and ultimately

phthisis,

may

occur.
ing, if

Nor would

these results appear so astonish-

by accurate inquiry the quantity of mucus,

constantly secreted,

was

really

known.

It

would

then scarcely surprise us that a

girl,

delicate perhaps

from

birth, or

who,

at least,

may never have enjoyed

latent tendency, after

good health, should eventually die from consumption

to

which she may have had a

a drain of blood for months and years, sufficient to

furnish an ounce, or several ounces, of leucorrhceal

secretion daily.
in

Nor is it more to be wondered at women, that menstruation should be long married

suspended, and that conception should be prevented

during the exhaustion produced by these discharges.
It

cannot,

think, with

truth

be
in
it

affirmed, that

changes of structure never occur

protracted leucorrheea, although
satisfactorily proved, that

connection with

may

probably be

malignant lesions are not

Softening

within the scope of

of parts and
partial

its

morbid powers.

disorganization of the uterus

may, according
take place.
I

to Andral,

and

my own
may
is
its

observation,
soften,

know

that a brain

and

purulent deposit be found in

effect of

substance, as the
clearly

undue

lactation,

and there

no
leu-

reason

why some

similar effect should

not happen

to the uterus from

excessive and

protracted

corrheea.

Patients often think because the pain and

heat,
fre-

and constitutional disturbance continue, or are

quently repeated,
that formidable

uterine

disease

LEUCORRIKEA.

251

must
tinge

exist.

This opinion

is

strengthened by the

acrimony and odour, and the occasional sanguineous

of
the

discharges.

Doubtless,

under such

circumstances, examinations by the speculum and

finger ought to be

made;

but, even in their omission,

a hasty conclusion should not be formed, as these

symptoms often occur

and protracted case.

in

a functional but severe

There must be noticed

also a form of the malady,

for

by some authors denominated the passive, but

which a better appellation, judging from

nency, would
instances
it is

its

perma-

be habitual

leucorrhcea.

In

many

the consequence of acute and inflam;

matory attacks

but in

still

more of constitutional
generative

and

local

weakness.

The

organs

of

most leucophlegmatic females, are habitually relaxed,

and there are not a few where a very small quantity
of mucus seems naturally to exude from the surface
of the genital fissure.

To
and

this

condition

have

already alluded as one not generally deserving to be

regarded

as

morbid,

only

requiring

for

its

control careful

and repeated

ablutions.

But

this

habitual and trivial discharge dependent originally

may become morbid by its excess especially when it co-exists with amenorrhcea and chlorosis. Nor must it be forgotten that it has been cured, when of
on constitution, climate, and
temperament,
;

long standing, by marriage, and by the re-occurrence

of menstruation.
It
is

rare in the young,

to

and

common

in

married

women,

whom

there

belong the general condi-

252
tions

LEUCORRHCEA.
already
described,

and whose strength has

excess,

been

weakened

by

sexual
;

menorrhagia,

abortion, or

over-lactation

these

having perhaps

induced displacement and prolapse of the uterus.

The symptoms
local irritation.

are slight, and there

is

scarcely any

The
;

discharge

is

generally white,

stiffening

the linen
it

and

if

there

be a neglect of
abrasion

cleanliness,

may produce inflammatory

of the upper part of the thighs and heat of the labia.

The

constitutional effects are trifling

and yet such

of

a patient will often

by pallor of face and darkness

languor

round

the

eye-lids,

and

incapability

exertion, afford sufficient indications of the existence

of a weakening

malady.

Occasionally, where the

disease has been long unchecked, and

where the

discharge

is

on the increase, there will be emaciabowels, and depraved appetite and

I

tion, constipated

indigestion

and

have often known such patients

complain of pain in the stomach, when empty, of a

desire for food, without being able to
least with relish,
in

take any, at

and of dragging and heavy feelings lumbar regions.

icterode,

the abdominal and

is

The comand several

plexion

often sallow and

times

have had great

difficulty in

curing eruptions

about the face and forehead, which have long existed in connection

with

this

form of leucorrhcea.

Third, The symptomatic leucorrhcea.

To

a certain extent
is

all

that has

been heretofore

advanced

applicable

to

the

symptomatic form.
will exist

Most of
here
;

the

symptoms already pointed out

but with great variety as to their causes and

LEUCORRHGEA.
relief.

253
mucous
dis-

For
is

example, a

transparent

charge

equally an attendant of prolapsus uteri, as

:

of inflammatory uterine catarrh

but the accompa;

nying symptoms are widely different

nor can the

cure be accomplished by the same means. a muco-purulent, or purulent secretion,

Again
result

may

not only from acute inflammation of the uterine

mu-

cous lining, but from a cancerous or submucous tu-

mor.

The

cure in the one case

:

may

be

effected

with comparative ease

in

the

other relief only,

and that not without

expected.

difficulty

and delay, can be

of the disease
;

The symptomatic form

it

is

therefore deserving of especial

notice

but,

as in

subsequent parts of the work,

must be the subject

of remark, in connection with the structural lesions

of which
it

is

so frequent an

accompaniment,

it

is

not necessary at present to

make more than

these

few observations.

The
finger

importance of accurate examination by the

is

and speculum, where the leucorrhoea

sus-

pected to arise from lesions of an organic kind, can

scarcely be too strongly urged.
forgotten, that

Nor ought

it

to be

more than one such inquiry may be

first

required, as an affection at
limits of functional

confined within the

in its progress ac-

disease,

may

quire a totally different character.

There
allied to

is

a peculiur form of leucorrhoea

somewhat

hydrometra, inasmuch as the contents of

the uterus in this latter disease are not always serous, but

sometimes albuminous and muco-purulent

254
secretions.

LEUCORRHCEA.
In this variety the discharge does not

consist of a limpid glairy fluid like

nor does
corrhcea
;

it

come away
but the fluid

gradually as in
is

common mucus, common leuif

often entirely purulent, or

so closely resembles pus, as to be with difficulty,

at
all,

distinguished from

it,

either in color, viscidiin the uterine

it

ty, or

odor

and having accumulated

In these particulars

cavity to four, five, six, or

more ounces,
it

comes
widely
I

away by

gush.

differs

from ordinary leucorrhcea, and in one example

thought from the suddenness of
similarity of the previous
its

escape, and

the
dis-

symptoms, that the

charge must have been the result of abscess.

opinion, however,

This
obser-

was not confirmed by subsequent

events.

In

ail

the instances falling under

my

vation, and they are comparatively rare,

lent

muco-puru-

leucorrhcea had long existed previously,

it

and

although

was suspended during an accumulation

it

going on

in the uterine cavity,

returned immediIt is

ately after the escape of the purulent gush.

true,

nevertheless,

that

the

symptoms assume a

character distinct from any other form of the malady, as the time for the eruption approaches, (vide
cases).

There

is

fulness about the hypogastrium, a

sense of constriction and weight about the neck of

the

bladder and along the course of the rectum,

heat, general

dysuria,

uneasiness, and

sometimes
In one

acute pain with forcing about the uterus.

instance the patient

was
to

so distressed by these, that

for several

she

was compelled

keep her bed

days

LEUCORRHtEA.
prior to the escape of the pus.
suffers

255

The
this

general health

from the repetition of

series of

morbid
usu-

actions.

Sometimes there
where widows were
red.

is

emaciation, and there

the cure.

is

ally great difficulty in

its

In two instances
disease disap-

subjects, the

peared after marriage, pregnancy having soon occurI

have several times examined prior to the

;

escape of the fluid

the

uterus has been generally

;

but not greatly enlarged

slightly tender,

the

cervix

swollen and
In no

and the os partially closed. and

none that

case has an examination revealed subsequent structural mischief,

in
I

have seen has the

it

uterus been
all

sufficiently
it

voluminous to render
have never seen

at

probable that

should be mistaken for an ordiI

nary case of hydrometra.

affection
in

this

young females.
widows, or those
in

Married women, and

particularly
tive

whom

the reproduc-

organs having been employed are so no longer,

to be its

seem
I

most frequent subjects.

prevalent disease, without adopt-

have thus attempted to elucidate the history and

this

symptoms of

ing the division into vaginal and uterine leucorrhcea.

Independently of symptoms,
difficult to distinguish

it is

allowed to be very

what portion of two continuseems much

ous membranes of identical structure are morbidly

furnishing a nearly identical secretion
easier
rest
;

it

and more rational that the diagnosis should

diffi-

on the severity of the symptoms, and the

It is

culty of cure.

known

that the vagina

is

much

more frequently the

seat of disease than

the cavity

256

LEUCORRHCEA.
it

of the uterus, and, in the majority of instances,

yields
is

more readily to remedies. Thus where there marked aggravation of symptoms and consideraconstitutional derangement, the uterine
is

ble

memand

brane

probably implicated

but where, on the

are locally

contrary, the whole of the

constitutionally slight and

symptoms

easily cured, the vagina

will generally be found to be the seat of the disease.

The

frequent implication of both the vaginal and

uterine secretory surfaces,

and the

difficulty

even

where one only

ing which
it

is

morbidly affected, of distinguishwill

is,

often perplex the diagnosis,

whatever divisional arrangement be adopted.

Causes.

These

are numerous, and, according to

in the

their nature,

have a distinct influence

produc-

tion of the different varieties of the disease.

The first form, which I have denominated the common leucorrhoza, and which is more idiopathic
than the others, owes
cate and strumous
its

origin,

especially in deli-

females, to causes inducing in-

creased action, and sometimes inflammation in the

secretory surfaces and glandular apparatus of the
genital organs.

These

are, the

application of cold

or moisture, frequent excitement resulting in debility

from excessive sexual intercourse, abortions, from

which the patient has only imperfectly recovered,

quickly
recurring
labors,

puerperal

hemorrhages,

menorrhagia, profuse menstruation, and undue lactation.

The

irritation of a pessary, or of stimulant

injections on the vaginal surface

and the cervix

uteri

belong

also to this

class.

There are other causes

LEUCORRHCEA.

257

which

act only indirectly,

out,

and these, with the agen-

cies already pointed

may

lead,

where the com-

mon, mild, and more idiopathic disease is uncured, These operate to the chronic and aggravated form.
through the medium of the nervous system and by

sympathy.

Thus

in

amenorrhoea, where the func-

tional or organic

nerves of the uterus are affected,

is

a leucorrhceal

secretion

frequently

set

up,

not

only from the vaginal but likewise from the uterine

mucous
els,

surface.

Intemperance

in

eating and drink-

ing often induces derangement of the stomach, bow-

and

liver

by sympathy with these, morbid ac-

tions of the

uterine

system may be induced, and

leucorrhcea will often be the result.

tion of the spinal
ration.
I

lately

Nor must irritamarrow be omitted in this enumesaw an example where leucorrhcea

morbid affection of the chord
in

might be traced

to

the sacral region, as evidenced

these parts were pressed.

by tenderness when

Here there was an un-

usual degree of lumbar and sacral pain,

much more
is

than could

be fairly attributed to the quantity or

In such, a cure

continuance of the discharge.

tained by rest, leeches,
tions

ob-

and stimulating embrocaStill,

I

about the loins and sacrum.

it

do not

wish

to be

understood that dorsal, lumbar, and

inguinal

pains, are the

concomitants of leucorrhcea

of this kind alone.

I am quite aware that symptoms are attendants on cases of leucorrhcea, where there is no such remote and influential

For

these

sympathy. Symptomatic leucorrhcea,

33

as

its

name

implies,

258

LEUCORRH(EA.

being the consequence of other and distinct diseases,

may

be attributed to any causes which shall produce

irritation.

uterine or vaginal

Amongst these must

polypi of various kinds,

be mentioned relaxation, prolapsus, and the other

displacements of the

womb,

affecting the uterus, vagina, or urethra, hard or soft

tumors of the reproductive organs, ascarides, a pessary,

and other bodies intentionally introduced into

the vagina.

Pathology.
rhcea

There can
origin to
first,

be no doubt that leucordistinct

owes

its

two

and dissimilar

conditions.

The

a state of hypercemia or in-

creased action of the vessels of the secretory surfaces,

and the second,

debility,

either original or
state.

produced by the continuance of the former

By

some authors nearly all the cases are supposed to depend on weakness, excepting such only as are accompanied by symptoms of inflammatory action.
There
is

truth in this opinion if the examples be infirst

cluded where the leucorrhcea having been of the

kind originally, has, by

in

its

continuance terminated
it,

the opposite state.

it

Let

however, be remem-

bered, that

does not necessarily follow because

is

the system generally

delicate, that the uterus

in a

and

vagina must of necessity be

state of

anemia.

Local and long continued inflammation often produces constitutional

weakness,

and certainly the

progress of the malady, the irritation and pain, and

the

increased secretions, point to inflammation as

its

one of

essential primary conditions.

Nor must
leu-

we

forget

that delicacy
Still,

often exists without

corrhcea.

original

or acquired feebleness of

LEUCORRHCEA,

259

system may give increased efficacy to the various

exciting causes of this prevalent malady.

Probably
lining

in

all
is

the instances

where the uterine

membrane

implicated, particularly in those

is

where leucorrhcea
morbid discharge.
pathology
is

vicarious of menstruation, the

fluid

vessels elimating the catamenial

furnish

the

In

the symptomatic forms, the

different,

necessarily

as

displaced

uterus, a prolapsed vagina, hard tumors, and various

other structural growths and deviations, produce the

disease.

Diagnosis.

This

is

frequently difficult, and be-

tween some forms of the disease and gonorrhoea

nearly impossible.
correct distinction
Still

in

numerous instances a
ought
to

may
is

be drawn, and where differit

ence of treatment
tempted.

involved,

be

at-

In mild leucorrhcea

it

may

be assumed, that the

muciparous glands at the entrance of the vagina and

membrane of the canal are alone affected. Where the symptoms are decidedly severe, the uterine lining membrane is often interested. The diagthe lining
nosis will be aided

by an inquiry into the following

circumstances

If the discharge
;

was
was

first

observed

after abortion or delivery

if it

prior to, or has

partially or entirely superseded menstruation; if there

be much pain in the hypogastric or lumbar regions,

with nausea and vomiting, or uncomfortable sensations about the stomach, liver, or head, these point

to an affection of the uterus, rather than of the va-

gina.

With

the latter,

we know

that the constitu-

260
tion

LEUCORRHCEA.
sympathizes but
little,

while with the uterus,

its

by means of the organic nervous system, pathy

is

symto be

most intimate.

It

has been proposed to

test,

use a piece of sponge as a local

which

is

introduced into the vagina, so as to plug the os

uteri, in the

on going to bed

and

if,

when

it is

removed

morning, there be no more discharge adhering

to

it

than would occur from the natural mucus of

the canal, the discharge

which takes place by day

If,

must be regarded as uterine.

the

on the contrary,
the

sponge be thoroughly moistened,

as

vagina

must be considered

implicated in the
is

mischief.

But
ble.

it

is

evident that this test

not unexceptiona-

If the discharge

be uterine only, but exces-

sive, the

sponge will be much wetted with the abuterine cavity being so small in
it

sorption, the

its

normal

state, that

cannot contain more than a

vaginal surface

few drachms.
thus made.
afford

If the

be also se-

creting in excess, no satisfactory diagnosis can be

Nor
if it

will an examination
;

by the finger

unerring information

as

in

merely vaginal

leucorrhcea,

be profuse and of long standing,

there will

be a similar relaxation and softening of

is

the cervix, as
affected
;

found where the uterine surface

is

and

in

most instances of either form, the

in

os

will

be open, or

at

least a dilatable state.

Thus we
tions

are compelled

to

depend on the indica-

previously stated, except where

we

are per-

mitted to use the speculum, the only certain means

of diagnosis.
result of

The

following account comprises the

researches with this

M. Marc d'Espine's

LEUCORRHOEA.
instrument

261

on

the

subject of

leucorrhoea.

They
for

were extracted from the Archiv. Gen. de Med.

February, 1836.

M. d'Espine
fore or just

notices

its

continuance during the

its

menstrual intervals, and also

after the

occurrence just be-

menstrual evacuation.

The
with
it.

climate of the middle and north of France appears

most favorable

to

its

production, and

women

very light or very dark hair seem most

liable to

The
tle

character of the constitution exercises very

lit-

influence.

Out of nineteen women

and four weakly.

subject to

whites habitually, six were robust, nine were moderately strong,

An
iice

examination with the speculum gave the

fol-

lowing; result in

193

cases.
in

In

23 the uterine

ori-

was found

dry

40
in

there

was just

a drop of

discharge in the orifice

130 the discharge was

be quite healthy
it

abundant.
red

The

orifice

may

pale

or

bright red, and

occasionally

was granu-

lated and bloody.

The
1

following table will exhibit the character of

the discharge and the state of the uterine orifice, in

11 cases.
Orif. deep red

Orifice healthy.

Orif. reddish,

and granulated

Aqueous discharge, Albuminous transp. discharge, Album, semi-transp. discharge,

.

7
.

3 6

30

6
10

streaked blue, grey or yellow,

13

19

Opaque discharge, streaked,

7 35

53

23

Doubtless where there

os, the leucorrhoea,

is

pregnancy with a sealed

severe,

however

must be vaginal.

262

LEUCORRHCEA.
leucorrhcea, the

From

consequence of structural

or malignant disease, the diagnosis will be

made by

the accompanying symptoms, and by examination

of the vagina and rectum, not only by the finger,

but by the speculum.

From inflammation
of the cervix
;

of the glands in the interior

by the presence of the white creamy

discharge

and by the peculiar tenderness of the

cervix on pressure, the adjacent parts being quite

sound.

From

fluids,

which very

rarely

find

an outlet

through the vagina, after the bursting of an abscess

or cyst in the ovary, uterus, or surrounding organs
;

by previous

indications, such as local pain, swelling,

&c, which do

not occur in leucorrhcea

by the sudodor and

its

denness of the escape, and often by some marked

quality of the discharge, as
its color,

its

offensive

being often mixed with blood, and

ex-

treme viscidity or acrimonious tenuity.

From
and
in

gonorrhoea the distinction

is

often difficult,

some instances impossible.

The

character

of the individuals, and particularly of the husband,

and the previous and present habits of both,

if

they

be highly moral, will go far to negative suspicion.

Even

in

doubtful cases,
is

it

must be remembered that

far infec-

leucorrhcea
tious, as to

sometimes purulent, and so

produce from the male urethra a discharge

which,
toms,

in its
is

appearance and accompanying symp-

not easily distinguished from gonorrhoea.

in the

Generally the secretion

is

male

is

mild, and there

but

little

of that excitement, heat, and ardor urinae

LEUCORRH(EA.

263

so constantly attendant on the real infectious gonorrhoea.

It is said, too, that
it

is

quickly cured, and

that

it is

rarely or never succeeded by gleet.

These
they

observations are in the main correct, but

require

still

some

qualification.

"Where by the specu-

lum, erosions or ehancrous sores can be perceived

on the os and cervix, the syphilitic character will

be
established.
If,

also,

there be tumefaction of

the inguinal glands, pain during coition, and a dis-

charge from the urethra, with a burning pain along

its

course, and

tenderness and inflammation at

is

its

orifice,

gonorrhoea
it is

probably
difficult

present.

Lisfranc

says, " that

very

to

ascertain

whether
thinks

these white discharges are or are not contagious,

w hether
r

they are or are not venereal.

He

that a white discharge

real

disease,

especially

may communicate the venewhen the former is conis

nected with small ulcerations of the vagina or urethra, a case

more common than

usually thought,

but which

may

be ascertained by examining with a

the slightest erosions of which

glass those parts,

easily escape the

naked eye."

(Vide Lectures pubI

lished
this

in

the Lancet, Nov. 30, 1833.)

presume

singular

statement

is

not intended to convey

the idea, that the venereal disease can be

communi-

cated by

common and
if less

unspecific ulcerations, merely

to exist
is
;

because they happen

on the cervix uteri

meant, there
is

and
if
is

still,

than this

little

any point
a

in the

passage

because the statement

mere truism, that

syphilitic erosions or chancres

can produce the syphilitic disease.

The

perplexity,

264
therefore, of these

LEUCORRHCEA.
cases,
is

fully

admitted
are

and

it

will often happen, that

where we
events,
it

most anxious
shall

to arrive at a positive conclusion,

we

be least

able to do so.
tioner to

At

all

behoves the practi-

be extremely tenacious of the reputation

It
is

and happiness of parties thus circumstanced.

always

his

duty to cure the disease, but rarely to

its

venture upon an exposition of

positively affirm
that
it is

nature.

If he

can

of simple origin, let

;

him
is

do

so, if suspicion

has been aroused

if not, it

better

to

avoid any distinct allusion to the matter.

is

One
table

thing

quite true, that in

is

women

of indispu-

purity, leucorrhcea

sometimes so acrimoni-

ous, as

not infrequently to produce discharge and

;

abrasion in the husband

sions,

and on one or two occaalmost confident, that

after

abortion,

am

eruptions and decided ulceration have been amongst

the results of intercourse.

In these examples the

shadow of suspicion

did not rest on the female.

Prognosis or terminations of leucorrhcea. Acute leucorrhcea, if treated promptly, is usually

of short duration.
side,

The symptoms
is

gradually subregained.
If,

and the tone of the parts

is

therefore, there

a leucophlegmatic habit, and a

constant excess of moisture about the genital apparatus,

it is

not improbable that an inflammatory at-

tack, under such circumstances,

may
in

glide into the

chronic form, and

males,
health,

may
to be

long continue.

Some

fe-

indeed,

except

when
free

unusually

good

seem never
nor does
it

from habitual leucor-

rhcea

appear seriously to affect them.

LEUCORRH(EA.

265

But

where the discharge is so profuse and protracted, that the same results are There is a realized as in excessive raenorrhagia.
there
are
cases,

quick and feeble pulse, a cadaverous countenance,

impaired appetite, and emaciation.

be married, (vide case,)
sterility is
if

If the patient

not an

uncomand

mon consequence
supervene.
I

and

single,

chlorosis

amenorrhcea, and possibly dropsy or phthisis

may
be

do not affirm these greater

disease
;

evils to

the frequent sequel of the

tioner

but the practi-

should
in

be on his guard, more particularly

where,

the

unmarried, emaciation, amenorrhcea,

exist.

and

chlorosis

cough,

fever,

morning
soon

perspiration,

and pulmonary

affection,

may

follow.

Treatment.

This must of

necessity be different.
differ so

The
cases

various forms of the

malady

widely

from each other

in degree, that

while in the slighter

all
is

scarcely any treatment at

it is

required, in

the inveterate

often most puzzling to find any

remedy.
inveterate

Thus
is

the

mild

form easily yields, the

;

cured with great difficulty

and the
till

symptomatic leucorrhcea cannot be restrained

the removal of the affection,
if

that be possible, of

which

it

forms a

part.

But

to

be more precise
is

In ordinary cases, where there

only hyperemia

or simple vascular injection of the secretory

mem-

brane, and
in

where
still

the discharge, although increased

retains
its

quantity,

transparent

mucous
if

character,

rest,

abstinence

from

intercourse,

married, animal food and wine, mild aperients, and

34

266

LEUCORRHCEA.

the employment, as a wash, of the Liq. Plumb.

or the Liq.

C,

Alumen. C,

or the tepid

poppy water,

will usually, in the course of a

few days or a week,

cure the disease.

In the inflammatory form, which comparatively

we do

not often see, where the secretion has

become
;

purulent,

where the pulse

is

is

quick,

full,

or hard

where there

heat, increased action,

and inflamslight

matory congestion of the secretory surfaces,

swelling of the genitals, and pains in the loins and

hypogastric region, the antiphlogistic treatment must

be
the

at

once commenced.
in

Blood may be drawn from

loins

arm

moderate quantity, or from the

by

cupping.

Leeches

to the

hypogastrium, groins, or
;

perineum, must be promptly employed

vaginal

and
be

if,

by a

examination,

the

cervix

shall

found

swollen, shining, red, and tender, leeches, or

what
I

much have now

are

better,

scarifications,

may

be used.

several times scarified, not punctured the

neck of the uterus by a common lancet, mounted on

a piece of whalebone, with

marked
trifling

benefit.
;

The
is

pain of the incision

is

most

there

no

ulceration nor suffering afterwards, and in twentyfour hours, the cervix generally
free

seems

to be entirely
I

from congestion.

In the winter of 1839,

was asked by
of his
at

the late Mr.

Fenner

to visit a patient

Islington,

suffering

from

inflammatory

leucorrhcea.
;

She had not been confined more than

that of her

two months her own reputation, and the husband, were above all suspicion
;

severity of

the

pain

in

micturition,

and the

profusion

and

LEUCORRHCKA.

267

acrimony of the discharge, would have induced the

belief that
it

was gonorrhoea.

An

examination by

the speculum showed that the cervix

red,

and extremely tender

glands

but there

was congested, was no dis-

charge from the urethra, nor any swelling of the

inguinal
;

aided by the speculum tube, the

was scarified, and at least four or five ounces of blood were abstracted, the operation not lasting more than a quarter of an hour. The hip-bath, as
cervix

advised
salines,

at

page

165, mild

aperients, spare

diet,

and occasionally narcotics, will be required.

in

Astringents are not included

this

enumeration,

and

if

they are used during the

first

few days of the

disease, while the

inflammatory stage continues, or

before the discharge has

become thinner and more

abundant, pain and aggravation of symptoms will

often ensue.
I

know

there are cases easily cured

injection, or

by the compound alum

lotion only.

some
is

spirituous

In

such, the affection

probably the

common and
or
if
it

mild, not the inflammatory leucorrhcea;

be,

and a cure

is

obtained, the

patient and

the practitioner will not censure this empirical plan,

nor trouble themselves about the precise nature of

the affection.
If there

be swelling of the labia, or

heat, tenderness,

of the parts within, redness,

and

throbbing, and pain on examination, with a purulent

discharge, there
is

inflammation, and the soothing,

plan

not

the

astringent

ought

first

to

be

tried.

These acute symptoms, however, soon subside, but

the excessive discharge continues
;

and at

this point

the use

of injections,

regarded

by many as

the

268
specific

LEUCORRHCEA.
treatment for
leucorrhoea,

must be com-

menced.

For

this

purpose the various stimulants

and astringents are employed, and often by sponging

the parts externally, and within the genital fissure,

but more frequently by throwing into the vagina,

several times daily,

two

or three ounces, (following

the directions given at page 209), aided by sto-

machics or tonics, mild aperients and

unpleasant affection
tions are
cold,
is

rest,

this

cured.

Generally the injecdischarge

is

but
the

occasionally the

increased,

and

inflammatory

symptoms
I

are

reproduced by cold in any form.

have known

many
hot

patients cured

by tepid, and two by almost

injections.

Dr.
says,

Gooch

(at

page 35 of

his

Compendium)
rhoea
gents,
is

" that the treatment of leucor-

to a

great extent empirical.

Cold

astrin-

among

the rational practitioners, are in the

;

most general use

beneficial.

but tepid ones are often equally

Practitioners

have exhausted

all

the

cold astringent remedies, and then, having recourse

to tepid

ones, the patient has been cured immedi-

ately.

The

liquor plumb, acetat.

tepid,

is

now used

at

the

Middlesex Hospital,

and with general

be hereafter

success."

The
In

various formula? will

this

mentioned.

way examples
;

of the inflamit

matory form are cured

but thus far

is

presumed,
is

that they are not very severe, nor that there

any-

thing to prevent the beneficial operation of medicines, either in the

constitution or

in the

habits of

the patient.

But we do not always possess these

Sometimes, where the best means

advantages.

LEUCORRHCEA.
have been
long

269
employed,
the
If

and

judiciously

leucorrhoea continues, and the health declines.

the

discharge be only small in quantity, and

if

the

patient has

been originally robust, months and even

elapse without any serious results
last.
I
;

years

may

but

they come at

have often wondered to find

the pallor, anemia, and other indications of debility,

so extreme,

where the discharge was scarcely more

it

than by drops, although

had been more excessive.

These examples remind us of passive menorrhagia, where there is a continual sanguineous draining
from the uterus, attended by a cadaverous countenance,

weak

pulse, coldness of the extremities,

and

excessive nervousness.

Indeed, these cases are not

only similar in their nature, but they are almost

invariably
benefited, and

sometimes cured, by one

peculiar remedy, viz. the injection of three or four

ounces of tepid, or (after a time) cold water, into

the

rectum, night

and

morning.

Sometimes the

effects of chronic leucorrhoea are so distressing, the

discharge so excessive, and the cure apparently so

distant, that

not

only the patient,

but the practi-

tioner also, inquires,

what
In

further treatment can

be

adopted, and on what circumstances does this want

of benefit depend
?

some

instances, there

is

no

doubt, that the delay arises from the difficulty of

restoring to the secretory
action.

membranes

their
this

healthy
point,

Mr. Hunter fixed attention on

by

the following remark, that

its rise

" a gleet seems to

take

from a habit of action which the parts

have contracted; and as they have no disposition to

270
lay aside
this

LEUCORRHCEA.
action,
it

is,

of course, continued."

Thus

a vaginal discharge

may

be perpetuated by a
but at the

" habit of action," most

difficult to alter,

same time,
also

satisfactorily explaining the

pathology of

passive or habitual

leucorrhcea.

Protraction

may

depend on

specific or organic

disease, such as

gonorrhoea,

hard

or

submucous tumors, ulcerated

cauliflower

carcinoma,

polypi,

excrescence,

&c.

The

reply,
is

then,
to

to

the

question,
?

what

further

treatment

be employed

will

depend on the
inquiry,

results of examination

by the finger or speculum, as

best answer to the

these will furnish

the

what
will

is it

that prevents the cure ?

If the existence

of structural

maladies be discovered, the attention

be directed to these as the source of the local

for

symptoms,

leucorrhcea

is

then only symptomatic

if,

of these graver diseases.

ascertained, the individual
or

But
is

so far as can be

free from

any

specific

organic affection, recourse

must then be had

either to fresh

remedies, or the treatment already

adopted must be differently and more perseveringly

pursued.

English

practitioners
in

do not frequently
;

examine per vaginam

in

leucorrhcea

and although

the

majority of cases such an inquiry

it is

may be
certainly

dispensed with, in dubious instances

requisite.

So long

as the

discharge

is

muciform,

even

if

it

be excessive, without smell and not sanit

guineous,

may

be presumed to be functional

but
has

where, having long retained these properties,

it

become

acrimonious

and
like

offensive,

watery

and

greenish, or

brown

the grounds of coffee, or

LEUCORRHCEA.

271
is

decidedly streaked and mingled with blood, there

strong reason for a different opinion, and an examination

tea,
is

absolutely essential.

Injections of green

solutions

of alum, the sulphates of zinc and

the

copper, iodine, sulphate or tartrate of iron, and

carbonates of soda and ammonia, decoctions of bark,

logwood, the ergot and catechu, and others (vide

formulae),

may

all

be employed.

Nor must
it

it

be

forgotten that each of these, good though

loses its effect.
I

be, soon

have cured

many
1

cases of passive

leucorrhcea more

quickly than
this

should otherwise
:

have done, by acting on

of one injection.
acting
In the

suggestion

week

being often long enough to wear out the good effects

employment of measures
secretory organs, the
into

thus
is

locally
to

on

the

intention

convert a morbid

healthy

function, and of course

constitutional

means, such
chalybeate
are

as good

air

and

diet, iron,

quinine and

waters, with a regulated system of aperients,

not to be excluded.
in operation at the

Both

classes of agents

may

be

same

time, without determining,

to

what

is

often

difficult

decide,

whelher the
;

leucorrhcea

be a
fact,

primary or secondary affection

it

whether, in

has arisen from constitutional

delicacy, or whether the constitutional

weakness

is

the sequel of the local disease.

Where

the dis-

charge

is

habitual and inveterate, and where, with-

out disorganization of structure, the secreting surfaces have

taken on a permanently unhealthy and

all

disordered action, the nitrate of silver surpasses

other remedies in
its

restorative power.

Its

benefl-

272
cial influence

LEUCORRH(EA.
has been fully tested in affections of

the mucous tissues of the

mouth and
its

throat,

and a

similar good effect will accrue from

use in chronic

and inveterate leucorrhcea.

the profession

Its

exhibition will be

explained hereafter, (vide formulae.)

is

To

Dr. Jewel

indebted for a succinct and comits

prehensive account of

properties.

Through

the

medium
tinuity,

of the great sympathetic nerve, and by conthe

reproductive or sexual are intimately

connected with the urinary organs, and hence have

been suggested copaiba, turpentine, cubebs, cantharides,

and the

tinct.

benzoin, comp.

(vide for-

mulae), for the treatment of the chronic and inveterate

form.

Turpentine and

cantharides

have

given, often advantageously, and a good

many times
remedy
not

with curative
of Dr.

effect.
;

The

latter is the great

Dewees
water,

and, beginning with thirty drops in

three

sugared

times
to a

daily,

he

does

hesitate to

mount up

dose of two hundred,

three times in the twenty-four hours.

ful, if

He

is

care-

there

be plethora, that

it

shall

be removed

prior to giving the tincture.

"

We

cause the patient," he informs us, " to be

;

well purged
diet,

confine her to a milk and vegetable

;

and sometimes order her to lose blood

is

when

the pulse
if

sufficiently

reduced by these means, or

the pulse be in a proper condition without them, the

cantharides,

we commence

&c."

It
if

need
stran-

scarcely be added, by

w ay
r

of caution, that
to be left off.
first

gury appear, the tincture

is

" Should

the complaint withstand the

strangury,

we

are

LEUCORRHCEA.

273

not discouraged, but re-commence the remedy at the

original dose of thirty drops, fore until a difficulty in

and increase
is

it

as be-

making water

again ex-

perienced

it

rarely,

however, withstands the second

In hospital, and in pri;

irritation of the

bladder."

vate practice,
I

have secured these conditions

its

but

cannot report, as

author does,

" that

when
in, it

properly conducted, or sufficiently persevered

rarely fails to effect a cure."
in this practitioner
is

Still,
I
:

so great, that
tried

my confidence am anxious his

in other

remedy should be extensively

it

hands

may

be more successful than in mine.

Attention to the general health cannot be neglect-

ed without detriment to the patient.

a case

Lately

saw
for

where the discharge, which had been

excessive,

w eeks
r

w as
T

restrained

by giving

five

or

six

doses of blue

pill,

followed by an aperient of
first
;

senna

and

salts

the

motions

were highly

offensive

and scybalous

aftenvards they became

healthy, and with no other treatment than ablution,

and a removal into pure, dry, and mild

adoption of good diet and
function of the skin
pleted.
If the

air,

and the

exercise,

by which the

was

restored, the cure

was com-

reader will turn to page

in that

43

of this work,

he will find

and the succeeding pages, direcof anemiated patients,

in

tions relative

to the health

which may be advantageously followed

leucorrhcea.
It
is

chronic

scarcely necessary to state, that

is

menstrual irregularity

one of the frequent conse-

quences of the disease when protracted.

35

Leucor-

274
rhcea may, indeed,

LEUCORRHCEA.

become

vicarious of menstruation
;

altogether (vide page 144)

and certainly, although

amenorrhcea induces leucorrheea, the converse of

this

position

is

equally true.
is

Whenever, then, the

general health

so far impaired by excessive dis-

charge, as seriously to have deranged the catamenial function, constitutional

as well as

local

treat-

ment must be pursued.

tic

sea voyage, travelling

abroad, the air of the sea-coast, foreign and domes-

chalybeate spas and iron, constant exercise out

air,

of door, living in fact in the open

ures on which

are the meas-

we must
in

principally rely.

The

use

of wine and spirituous liquors, strong tea and coffee,

is

recommended

habitual or passive leucorrheea.

strict

Doubtless such advice requires

still

limitation, but

in certain districts,
it

and controlled by medical

I

authority,

is

beneficial.
in

recollect

ago an old practitioner

of Lincolnshire,

the fenny and

that

who

said

the

many years damp part disease w as

7

almost endemic in his neighborhood during certain

parts of the year, and
that he combated, and often
coffee.

cured

it,

by bark, wine, gin, tea and

loaded with moisture, and

In
at-

Belgium and Holland, and round Berlin, the

mosphere
prevalent,
clothing.
is
it is

common
is

to attempt the cure of leucorrheea,

which
and

very

by spirituous liquors,
Solid animal food
if

tea,

flannel

may

be eaten twice in

the day, and

paired,

the digestive powers are

much imBut,

hot water,

w ith
r

a third

or

fourth part of

brandy or rum, may be the dinner beverage.

after

what has been

said at page 43,

need only

LEUCORRHCEAe
refer to the directions there given.

275

patient, suf-

fering

from

habitual

leucorrhcea,

without organic

disease, should not sleep on a soft bed, nor frequent

heated rooms and crowded assemblies.

The

excite-

ment of music, the

be exchanged
riding
for

theatre,
air

and

late

hours, should

country

and exercise, moderate

on horseback, and the simpler habits and

life.

scenes of rural

In these cases, almost every-

thing depends on the improvement of the general

health,

and

this

cannot

be accomplished without

attention to the chylopoietic organs.

Let healthy

digestion be restored, and the leucorrhcea will gra-

dually disappear.

It

is

not always safe to cure an

inveterate leucorrhea, without increasing for a time

the action of the liver and the intestines, or putting

the patient on a spare diet.

This
first

is

particularly im-

portant where the discharge

appeared on the
as,

suppression

of
7

some customary evacuation,

for

example,
after

w here

menstruation has become sparing

previous excess, or where an eruption having

long existed, has at once or gradually disappeared.

In these instances,
necessary.

some moderate drain

it

is

often

Without

plethora,

and

its

injurious

consequences,

may

occur.

An

issue or seton ought

occasionally to precede any curative attempt.

the

In

young and middle-aged, spare

will

diet, purging,

and
full

exercise

mostly
to

suffice

but in

women

of

habit, addicted

the
is

pleasures of the table,

often required.
in

this

more decided drain

organs are probable,

At a more
the different
patients

advanced age, when congestions

and where the

are

276

LEUCORRHCEA.
is

strumous and feeble, peculiar watchfulness

site.

requi-

After the cure of habitual leucorrhoea, abluat

least, if

tions of cold water,

not injections into

;

the vagina, should be daily practised

avoiding their

use for a few days before and subsequent to menstruation.

In Dr. Balbirnie's digest of the practice in Female

Diseases, of several eminent French physicians

book deserving

attentive

perusal,

the fears

have

expressed of injecting the uterine cavity are said to

be, in the great majority of cases, " totally unfounded,

and the mere remnant of ancient prejudice."

Lisfranc
first

M.

injects

simply fresh water, then

decoctions, or astringent injections or styptics, the

strength of which

is

to be increased

by the addition
"

of a few drops of concentrated acid.

elastic tube, introduced

A gumand

with circumspection, serves

fluid,

as a

means

for

conducting the injected

we

are thus enabled to cure white discharges which

resist

obstinately

every

other

method."

(Vide
I

Lectures

in

the

Lancet, Nov. 30, 1833.)

shall

append
in the

to this

chapter one or two cases, occurring

practice of

M.

Tealier,

where
or

injections of

soot and
tive

water into the uterine cavity were producbenefit,

of

without
It

pain
is

any

apparent

evidences of hysteritis.
the contradictory
results

right thus to contrast

of a

similar

treatment.

Further
success
tion.

experiments,

which

these

examples of

may

justify,

may

establish a correct deduc-

In the

French hospital cases, reported by

Dr. Balbirnie, " narcotic injections" were ordered

LEUCORRHCEA.
by the physician
especial mention
;

277

and as immediately afterwards

is

the private cases

that the narcotic

made of M.

of " uterine injections" in

Tealier,
it

is fair

to

infer,

injections referred

to above,

were
that

merely vaginal,
throwing

thus

establishing

the

fact,
is

fluids into the cavity of the

womb

by no

means
indeed,

a general but a rare treatment.

Further on,

M.

Lisfianc says,

" that sometimes these

uterine injections stop the discharge suddenly, as in

the

male,

or

they

act

more slowly,

in

general
other

requiring

twenty or twenty-five days.

(and these,
the
I

On

occasions "

fancy, are not infrequent)

" they convert

acute one,"

chronic

inflammation

into

an

(an event replete with danger, where

is its

the uterine

mucous surface treatment must be modified

cure."

seat,)

" hence the

to the case,

and usually

twenty-five to thirty days are sufficient for a perfect

" As

exceptions, there

are

two cases
ancient,"

in

which we should proceed with more

reserve, viz.,

when
remedy

these
in

discharges

are

very

(the

examples
is

which, by-the-bye in England, such a generally thought of,) " then they become

habitual and necessary to the

economy

and

it is

frequently impossible to supply their place," (this

is

a wise and extensive interdiction of uterine injections) "

and imprudent

to attempt

it

more
to

espe-

cially if the

woman

be old, feeble, or have any tenIntermittent

dency

to

scrofula.

discharges

also
their

require the

same precaution, with respect

uteri.

suppression, as uterine flooding."

Inflammation of the cervix

As

this afTec-

278
tion
is

LEUCORRH(EA.
confined to the glandular part of the uterus,
it
is

and as

attended by a peculiar discharge which

rarely forms a part of the

tion,
it

common
it

leucorrhceal secreIt is

is

entitled

to

distinct consideration.

not always easy to distinguish

from inflammation

of the surrounding parts, particularly when, having

ceased to be an acute,
ady.

it

has become a chronic malsecretion,

its

Here the white opaque

be partially,
if

distinclost,

tive sign, will

its

not entirely,

by

mixture with the thinner and more transparent

In addition also, the local pain and ten-

secretions.

derness on pressure, will be so

much

less than in

the inflammatory stage, that the peculiar characters

of the malady will be nearly destroyed.

In recent
Sir Charles
first

and marked cases,

Clarke
is

its

diagnosis

is

easy.

entitled

to the

praise of having

de-

scribed the

symptoms and treatment.

Judging from
cannot
times,

the record of cases amongst the in and out-patients

at Guy's, as well as

from private practice,

regard

it

as a very

common

disease.
in the

Many

from the pain which patients

plained of low

ward have comhave thought

down about

the sacrum and coccyx,

I

and deeply seated behind the pubis,

that there must have been inflammation of the cervix,

and yet on examination, although the finger has

been covered by a white secretion, there has been no acute suffering from pressure on the neck of the
uterus.

Out

of nearly one thousand cases of sexual

I

disease, treated at Guy's,

find

inflammation of the
It

os and cervix has

happened only twenty times.

rarely occurs in single females, or before twenty,

LEUCORRHCEA.
and
is

279
age and the period

most

common between
It is

this

of cata menial decline.

liarity

not dependent on pecu-

of constitution
its

the

plethoric

and robust being

as frequently
I

subjects, as the delicate and irritable.

it

have several times observed

soon after marriage.

dis-

Its

pathognomic symptoms are the opaque white

at the

charge and pains behind the pubis, and

lowest

part of the back and sacrum, aggravated by the

lar efforts
els

muscu-

necessary for the evacuation of the bow;

and the bladder

in short,

by any circumstance
in the pelvis.

which causes pressure centrally

constitution
is

The

rarely affected, if judicious treatment

has been early adopted.

Where, however, there

it

has been protracted neglect,

will

probably have

passed into a chronic state, and, in connection with

inveterate leucorrhcea,

may have induced

excessive

anemia.

These symptoms

during intercourse
tinuance,
and,

and,

if

married, pain
;

first

excite attention

their con-

as concomitants,

irritability

of the

bladder and rectum, constitute the disease.

rally

Gene-

menstruation
is

is

not deranged

occasionally,

however, there
menial
flow.

dysmenorrhcea or a scanty catarecovery

takes
place

Sometimes
;

without any treatment

symptoms gradually disappear, and the glandular structure again becomes sound. At other times the malady continues, notwithstanding the treatment and some authors supthe
;

pose, that from this chronic

inflammatory action,

tubercular deposit and

their

cancerous disease
serious
is

may have
probably,

origin

but such

results,

never occur, except where there

a latent tendency

280
to structural
is

LEUCORRHCEA.
and malignant disease.
In that case
it

easy to understand

how

repeated inflammation

may

induce morbid activity.

Causes.
or local

Circumstances

either of a constitutional,
irritability,

kind,

which augment

and pro-

duce

in

the cervix increased

action.

Cold, inor-

dinate exertion, either physical, sexjal, or mental,

highly-seasoned food, late hours, and

excitement,

and amenorrhcea suddenly induced.

Diagnosis.

The
it,

local pain

(pressure on the cer-

vix producing

while similar pressure on the imis

mediately contiguous vagina,

suffering),

borne without any

and the white opaque discharge, enable

form a correct opinion of the
I

the

practitioner to

disease.
it

In reference to the latter

may

add, that

differs

widely from the transparent colorless mucus

leucorrhcea, and
is

of

common

not likely to be con-

founded with the watery, or purulent secretions, so

frequently occurring in mixed and symptomatic cases.
Sir Charles Clarke characterizes the discharge " as opaque, and perfectly white." This is its

usual color, but in undeniable examples

it

have seen
resembles,

of grey

tint.

He

further says, " that

it

in consistence, a

mixture of starch and water made

It
is
;

without heat, or thin cream.

easily

washed
is

from the finger after an examination

ble of being

and

it

capait

diffused through water,

rendering

turbid."

Of

the latter part of the statement there

facility of

can be no doubt, and the

water,
certainly

mixture with

constitutes
it,

ready

and

true

diaguosis.

Let

however, be remembered, that

LEUCORRHCEA.
this

281
copious and free
in

creamy discharge

is

rarely

from admixture, except on rising from bed

the

morning, the time which ought to be chosen for the

vaginal examination.

Treatment.

The

abstraction
is

of

blood,

in

the

more
at

serious attacks,

a primary measure.
this

And
part

as the best

methods of doing
the reader

are

pointed out
to
this

page

167,

must
will

refer

of the work,
for

where he

also

find directions

the

bath and

injections,

which may be beneis

ficially

followed where the inflammation

not so

severe as to require the loss of blood.

The poppy

hip-bath used for an hour, twice a day, soothes the

pain and irritation better than any other remedy

and where

this

cannot be obtained, half a pint of

warm water, or gruel, starch water, or poppy tea, may be thrown into the vagina several times daily

its

the prescribed precautions being taken to prevent

immediate return.

As

aperients, castor
in
is

oil,

or

any of the mild forms prescribed

be employed.
tion about the

chapter 5,
so

may

Sometimes there
times
daily,

much

irrita-

bladder, that an opiate, or ten drops,

two

or

three

of the

mist,

morphiae

acetatis (vide page 186,)

may

be administered, or an

opium, or a belladonna suppository

It is

may

be used.

occasionally necessary to

empty

the bladder by

the catheter;

and

rest

in

the recumbent position

and spare and unirritating diet must be adopted.

36

282

LEUCORRHCEA.

Case

34.

It is

unnecessary to narrate any cases of

common

leucorrhcea, either of the mild

or acute kind, as
all-

these are so

numerous

as to be familiar to

INVETERATE LEUCORRHCEA.
July
10th, 1835.

Mrs.
she

J.

aged 26, residing near

Guy's Hospital, has been married six years, and has borne
three children.

Prior to her

first

confinement

immediately,
;

indeed, after marriage

had leucorrhcea
was adopted.

but as

it

was

attributed to the excitement of pregnancy, and ceased soon

after

delivery, no treatment

During both the

subsequent pregnancies the discharge returned, and disap-

peared after recovery.

She imputes
occurred

the

present attack

to-

over-nursing, having suckled her last

infant nearly sixteen

months.
this time,

The weaning
now

in

January, 1834, and since

has never been free

a year and a half, she

from excessive discharge.

Prior to the lengthened nursing

she was remarkably healthy, " en bon point," and active; but
for the
last

nine months her weakness has been extreme.

pallid,

She

is

anemiated and

emaciated, and incapable of any

sits

exertion.

She has

lost

her former animation, and

sofa.

or lies

nearly the

whole day on the

Pulse 94, and feeble,

skin cool and

clammy

urine scanty, and of straw color

appetite most capricious, and frequent vomiting after taking

food.
if

Sleeps well

at night,

and would do so nearly

all

day,

she were not frequently roused by her mother and children.

in

Cough, pain

the side, and morning perspiration are absent,

phthisis.

and none of her family have died of

The
is

legs are

cedematous, and the skin of the face and eyelids

extended

and flabby.

On

the whole, there

is

more exhaustion, more

LEUCORRHOEA.
complete prostration, than
I

283

have ever before witnessed as

the consequence of leucorrhoea.

On

inquiry about the treattried,

ment,

found

that

many remedies had been

and

although injections had been carefully used she had frustrated

their

beneficial

effects,

by always (day and night) wearing

the

two thick napkins.

stantly heated

Thus

generative organs were con-

by the thickness of the covering, and increased

It

discharge was the result.

was with

difficulty

she was per-

suaded to use any further means, she was so determinately

convinced that nothing could do her any good.
sented, however, to take the muriated
diet,

She congood

tincture of iron,

and

ale, to

use nitrate of silver injection three times

all,

daily, and,

above

to

leave off the napkins.

;

The
viscid,
It

dis-

charge was usually thin and watery

occasionally, for a few

sometimes

and

weeks together, purulent.

blood
;

had, on

several occasions, been streaked with

but there had

never been any offensive odour.

abstained from intercourse.
quantity, and
as
it

She had

for

many weeks
its

was curious to ascertain

to use six

was quite necessary

napkins

in

the twenty-four hours, she must, at least, have lost several

ounces daily.

It is not, therefore, at

all

surprising, after so

protracted a drain, that her constitutional

ingly impaired.
scantily,

power was exceed-

Menstruation occurred every month, but so

slightly

and so

sanguineous, that the leucorrhoea

might

justly

have been considered as vicarious of the function.

On

examination, internally, by the finger, the vagina was

found to be capacious, and so relaxed that there were

folds partially filling
its

many

up

its

canal, and a thin secretion bathed

entire

surface.

The

cervix was large, but not tender,

the os patulous with

thickened edges, and the whole of the

parts exceedingly moist

and

soft.

The body
as

of the uterus,

examined by the rectum

as well

by the vagina, appeared

to the

more voluminous than

os externum.
I

natural,

and approached nearly

could not discover any ulceration, although

284
at the

LEUCORRHCEA.
upper and posterior part of the vagina the surface was
day by day, or even week

rather rough, uneven and pulpy.

It

would be tedious

to narrate,

by week, the

effects of the remedies.

The

principal benefit

seemed

to

be derived from the various preparations of iron,

nitrate

and the frequent use of injections, particularly of the

of
silver.
;

These had
but as he

been employed
at

by

her

previous

attendant
their use

had seen her only

to.

distant intervals,

was not steadily adhered

was more
to

fortunate,

as

visited

her very frequently on

the

my way

Guy's, and

insisted, as

condition of
strictly

my

attendance, that the treat-

ment should be
compelled
to

pursued.

At one time we were

give up

the injections for a (e\v days, as they

produced soreness, and

another, the iron

she

was

tired
laid

of their
aside,

use.

At

was temporarily

quinine and
local salt

gentian, or zinc and hop, being substituted.

The

shower-bath over the

beneficial,

abdomen and

hips

was extremely
on finding that
its

and she expressed great

satisfaction

she was gradually acquiring tone and strength from

use.

daily

At
;

first

it

was employed tepid and subsequently quite

cold

and she was rubbed dry afterwards by towels impreg-

nated with bay-salt.

The lower

part of the

body acquired 60

warmth by these
to

frictions,

and her whole appearance began

improve.

The

injection

was ultimately used,

at

grains

of the nitrate to Sxvi. of distilled water.

entirely

The
In

napkins were
ablutions

and most beneficially abandoned,

linen

frequent

and

clean

being

their

substitutes.

chronic and

inveterate leucorrboea, the wearing a protection of this kind,

and sometimes a pad, which

disease.

is

still

worse, perpetuates the

I

And now,

in

every case,

am

particular

in

my

inquiries on this
this

point.

At the expiration of
her former
in

eight

months

patient had

menstruated
of

healthily three times, and she

health.

had regained

much

She

visited

Brighton for several weeks, and

about twelve months from

LEUCORRHCEA.

285
I

my

first

seeing her, she had

perfectly recovered.

hear

that she has since borne another child.

This

is

an instructive, because

it

is

not a very

rare case of aggravated leucorrhcea.

Over-lactation

and frequent pregnancy are almost sure, sooner or

later, to

be succeeded by excessive mucous secretion.

it

"Whether

shall

be protracted to exhaustion, will

greatly depend on the attention and influence of the

practitioner.
If he

regard

it

as a

matter of

little

moment,

it

will be allowed

to persist,

and eventually,
occur
;

similar results to those

pointed out, will

sufficient

if,

on the contrary, he have

consequences,

weight
its

to con-

vince the patient of her situation and

if

certain

the discharge continue, then reme-

dies will be promptly and efficaciously administered,

and the disease

will be either cured or relieved.

Case

35.

chronic leucorrhcea, attended by accumulations

of purulent fluid.
August, 1835.

Mrs.
up
to the

aet.

38, a widow,
to

and

for-

merly an out-patient of Guy's, was sent

me by Mr.
is

Morgan, one of the surgeons.

follows
:

The

history of the case

as

She

has,

commencement of

the

disease

(nearly three years since), enjoyed

girl

excellent health.

As a

she was always vigorous, menstruated regularly, and was

capable of great exertion.

Subsequent

to

her marriage, in

her twenty-fourth year, she was robust and plethoric, having

children
quickly, nursing
in strength.

them without

difficulty,

and im-

proving

She has now (1835) been a widow

286
four years, and
rhoea.

LEUCORRHCEA.
for the
first

last three,
it

has suffered from leucor-

When
It

noticed,

occurred a few days before

till

menstruation, and was not present again

the return of the

catamenia.

was so

slight,
it

that

no

means were used.

Occasionally

Subsequently, however,

continued throughout the month,

and soon became excessive and acrimonious.

it

has

been
In

purulent,
July,

often

muco-purulent,

and
to

slightly

odorous.

1834, the discharge began

thicker, to use

lessen in

quantity, and

became
a

her

own

words, " like

matter."
entirely to

In

few

days

more, the

leucorrhoea

seemed
there

have disappeared, but not

satisfactorily, as

was pain and

fulness about the lower part of the

belly,

and

especially about the neck of the

calls to

womb.

She had frequent

urinae,

empty the bladder, there was ardor

and

feel-

ings of tension and weight within the pelvic cavity.

The
;

greater

number of these occurrences was

entirely

new

for,

although she had frequently,

lent, suffered

when

the discharge was puru-

from vaginal

irritation, heat,

and pain, yet the

symptoms
saline

just described

were so

different, that her attention

in

was painfully excited.

The

surgeon then

attendance gave

aperients, enjoined

rest

and spare

diet,

and recom-

mended

the

warm

hip-bath.

On

one occasion, a few weeks

felt

afterwards,

when she was

getting out of bed, she

some-

thing suddenly give

way

within

her,

and there immediately

escaped from the vagina a quantity of offensive matter.

fainted, but

She

was quite relieved.

The
usual

discharge continued
thin

purulent for a week,

leucorrhcea
returned.

when
This

the

and
been

mucuous
repeated

process

had

several times prior to

my

first visit,

August 10, 1834.

She
good

was then recovering from one of these escapes of purulent

matter,

and was feeble and altogether

and wine were allowed
;

ill.

Tonics,

diet, porter

and

in a

few weeks the

secretion had again

sive than formerly.

become muco-purulent, but more excesAt

this

period

examined, but there

os

was no

trace of altered

structure.

The

was more than

LEUCORRHCEA.

287

usually patulous, and the whole of the parts within reach of

the finger were softened, probably by the constant discharges.

In a
little

more than three months, (Nov. 20, 1835.) menhaving been suspended eight weeks, re-accumula-

struation

tion again took place,

and on examination,

was struck with

the increased bulk of the uterus. the touch, and

The

cervix was tender to

;

the os was more closed than natural

it

still,

at

the lower, (whatever

might have been

it

at the

upper part of

the channel of the cervix,)

was not completely occluded.

neck, as
the vagina was rather

There was, however,

hot, although

a firm, tense condition of the

well as of the body of the

still

womb, and

moist and painful on pressure.

There was

considerable febrile excitement, and the patient was in bed.

few days afterwards the gush occurred, and by measure,

it

was

ascertained, that seven ounces of fluid, possessing all the pus, not at
all

characters of true

streaked

with blood, had

escaped.

Twice afterwards

this series
1

of morbid actions was

gone through, and on one occasion

matter escaped.
tainly
fetid.
It

was present when the

amounted
general

to

half a pint, and

was cer-

Her

health

had improved, and the

Iron in
I

leucorrhoea in the intervals had slightly diminished.

various forms and doses had

been given, and once

to
affect

pushed
gentle

the

blue

pill

sufficiently

far

the

gums,

salivation being
silver in solution

kept up for several weeks.

The
though

nitrate
it

of

had appeared sometimes

as

would

entirely cure the affection, but the

discharge again and freI

quently returned.
the
injection
in

Under
the

these
It

circumstances,

proposed

of

uterus.

was carefully done, by

throwing

some portion of an ounce of warm water, with

three grains of the sulphate of zinc.

diate
effects
;

There were no immehours, there

but
in

in

about six

or seven

was
but

agonizing pain
ness

the uterine region and internally, tendernearly

;

on

pressure
its

over

the

whole

abdomen,
;

especially at
all

lower part

a quick, hard pulse

and

in fact

the

symptoms of

hysteritis.

The measures

described at

288

LEUCORRHCEA.
;

page 234 were pursued

ble
result,

but

was

so fearful of an unfavora-

that

fifteen

ounces of blood

were abstracted,
full

calomel and colocynth purges, and subsequently a

opiate,

were given.
subsided, and

After these
I

measures the sympt'oms

slowly

bad the

satisfaction to find, in

two or three

weeks, that she had scarcely any remnant of the disease.

This apparent cure was but of short duration.

discharges again returned, and she
left

The same

town

for the sea-side.

She resided
and married.

there

many weeks, was

considerably improved,
I

Pregnancy quickly occurred, and when

had not suffered any return of

last

heard of her, she

tressing malady.

this

dis-

Case

36.

leucorrhcea, accompanied with purulent discharge,

reported by

dr. joseph ridge.

Marianne B
stature,

aged 19, of

florid

complexion, ordinary
in

and sanguineous temperament, was admitted

July,

1836, into Petersham Ward.

She had been

the

in service,

and

had enjoyed good health,

began
to

until

eleven weeks since, when she

in

complain of uneasiness
in

hypogastric region,

with severe pain

the right

groin, increased a thick,

towards night.
very fetid
present

This was accompanied with

vaginal discharge, which
time.

yellow, and

has continued
not

up

to the
;

The catamenia have

general
health

been arrested

and they

appeared

a fortnight before admission.

Her

has

suffered
is

she feels

weak, and

indisposed to exertion.

There

a profuse

purulent secretion,
exertion.

which comes on

at

intervals, especially after

On

getting out of bed, or in

endeavoring to evacuate the bladder

or rectum,

it

passes per vaginam, by gushes, being preceded

for

by a cessation

some hours.

Occasionally,

it

continues

LEUCORRHCEA.
for

289
until
its

two or three days together

is

and then ceases,

accumulation
pain, and

relieved

by
a

sudden flow.

She has lumbar

and

occasionally
in

distressing

sense of fulness

bearing-down

the uterine region.

Sometimes the pains

and

are severe and lancinating, extending to the pubes and groins:

bowels costive
moderate.

tongue slightly furred

pulse rather

full,

These symptoms continued

partial
vals,

for

several

weeks, with but

at
in
;

amelioration..

The

purulent secretion was,

afterwards
recurred,
periods

inter-

diminished

but soon

equal

quantity.

She passed over two catamenial

and the

discharge appeared to

be intimately mixed with

the sangui-

neous flow.

Some

shreds of

membrane were

discovered,

being preceded by more than usual pain.

The

treatment consisted

in

the exhibition of laxatives,

with occasional topical bleeding, and sedatives to allay constitutional

irritation.

An opium

suppository was used, with

Injections of an astringent

a belladonna plaster to the loins.

kind, variously modified, with the

hip-bath, were employed,

but with

little

advantage.
disease, and

The

obstinacy of the
it,

the

marked

debility

accompanying

determined Dr. Ashwell

to inject the cavity

of the uterus with tepid water.

This was effected by

intro-

ducing a gum-elastic catheter with an open mouth, the edges

being smooth, within the cervix, and
propelling
the
fluid

through

its

tube.

Considerable pain over the pubes followed,

which was relieved by anodyne fomentations.

greatly abated, and
a

The
and

discharge

second injection was ordered.

severe

This

was

followed

by

more

symptoms,

marked

evidence of hysteritis; which was relieved by bleeding, both

general

and

local,

purgatives,

fomentations,

and

strict

antiphlogistic regimen.

The
in

discharge ceased with the cure

of the

hysteritis

and

few weeks she was presented,

feeling quite well.

37

290
I

LEUCORRHCEA.

was

not prepared for so alarming an attack of

inflammation, as the consequence of the injection

merely of
ces,

warm water
in

although in several instanthe

and especially

somewhat

similar

one
fol-

already related,

hysteritis

of marked severity

lowed the use of a weak solution of the sulphate of

zinc.

The remembrance
It

of this induced
is

me

to

em-

ploy tepid water only.

well

known,

that in

extensive uterine hemorrhage, cold water, and water

variously medicated,
in

may

be safely employed.

But
is

most of these cases, as already observed, there

at least

no evident and probably no real disease of

the lining

membrane.

Case

37.

This, and the following case, are extracted from

Dr. Balbirnie's work, page 129

and

present

them

here to convey to the reader an accurate idea of the

way in which uterine injections are employed by M. Tealier, and perhaps in French practice generally
:

they are described in the work of this physi-

cian on Cancer of the

Womb.

Considerable tumefaction, without induration of the neck

of the

womb

dilatation of its orifice

injections into the cavity

of

the

womb

profuse leucorrhcea
cure.

Madame
irritable,

aged

thirty
is

years,

having

had

two

children, of which the youngest

four years old, lively and

that

experienced

since

year

she

had

quitted

LEUCORRH(EA.
Geneva, her native country,
toms of uterine catarrh
the
able
loins,
:

291
Paris,
all

to

live in

the

symp-

dull

pain in the hypogastrium, in

and

in the groins,

where she experienced disagreefor

draggings

when she stood

some time

a weight on

the perinaeum, which rendered long walks painful, and some-

times impossible

a continual

and abundant discharge from

the vagina of a thick, yellowish brown mucus, or of a glairy

matter,
like

the

white of egg,

on which

were remarked

sometimes spots of blood.

Painful and habitual constipation

;

loss of flesh

febrile pulse

the menses having experienced

no derangement.
voluminous
;

To

the touch the neck

orifice,
;

appeared
dilated,

soft

and

and the uterine

much
all

admitted

easily the point of the index finger

tinea?

the surface of the os

was covered with a thick mucus, which, when wiped

color, contrasting

away, presented a greyish white

red
tint

with the

of the uterine orifice

in the

slight lineary excoriations

were

observed

direction of the cavity.

On

pressure being

exercised with the speculum on the

considerable
orifice

body of the womb., a

issued

quantity of thick

mucosities

from

its

painful

the neck was an inch above the perinaeum.

pressure

with

the

finger

and

the

speculum was

Bleeding from the arm, to the extent of eight ounces, was

practised; and, during eight days, injections of the decoction

of the mallow-root, and poppy-heads, baths, a mild regimen,

and

rest,

were prescribed.

When

the pains of the

a

womb

were calmed, these emollients were replaced by

of a handful of soot
in

decoction

pint of water, with

which, each

morning, three or four injections were made into the uterine

cavity,

by means of a gum-elastic
its

catheter, introduced
injections

by

one of

ends into the

facility,

orifice.

These

were perAfter

formed with

and without occasioning pain.

having withdrawn the catheter, a pledget of charpie, imbibed

in the

same decoction, was

left

upon the neck

until

next

day.

This treatment was continued during

fifteen

days, after

292

LEUCORRHCEA.
in

which they were then stopped,

of the discharge
:

order to ascertain the state

Injections,

it

had almost entirely ceased.

nevertheless, were continued every two days during a month.

The

patient then no longer experienced any of the

all

symptoms
health of
a

mentioned, and

treatment was suspended.

The

Madame R
succeeding to
this

has not been treatment.

deranged anew

for

year

She experiences some leucorher a diseased

rhoea from time to time, to which she has been subject from

her infancy, and which

state.

does not constitute

in

Case

38.

Soft engorgement of the neck of the

womb, bleeding on

the slightest

neck largely

habitual opened
pressure

leucorrhoea

orifice

of the
lip.

superficial erosion

on the posterior
state,

Infecundity, the consequence of this morbid

removed

by

its

cure.

Madame L

aged

thirty,

of good

constitution,

and

having had only one child, ten years ago, was tormented
with an habitual leucorrhoea, with a feeling of weight
at the

womb, and some

pierce
it.

occasional darting

pains,

which seemed

to

Eighteen months ago, eight days

after the cessa-

tion of the

menses, there commenced an oozing of blood by

the

vagina,

which

was very

inconvenient to the
several months,

patient.

The
aid

discharge had continued

to, in

when medical

was had recourse

the

month of August, 1S34.

This lady had been

from certain
painful

for

some time the prey of sadness,

circumstances, and under the influence

of which her indisposition had

made

sensible progress.

On

examination, the belly was found voluminous, and painful, on

pressure.

The

pain was especially

;

felt

behind the pubis, in

;

the groins and loins

it

was

dull

and deep

at times

it

had

LEUCORRH(EA.
the lancinating character
:

293

the uterus was enlarged, sensible

beyond the vaginal

insertion,
;

and

descended
to the

to

within two

inches of the os externum

the neck

touch

was

soft

and spongy.
instrument,
it

Seen by the speculum, and compressed by the

allowed
to

exude from
;

all

its

surface a
its

great

number of drops of blood

tumefied,
existed
a

the
;

edges of
on
the

orifice
lip

were
there

and of a lively red

small
ulceration,

posterior

somewhat deep.

yellowish

white discharge, proceeding from the uterine cavity, impregnated

all

these

parts,

and contributed

to

keep up the

soft

flaccid state of the tissus that

was present.
period, and

The

patient being
all

removed from the menstrual

presenting

the appearances of a strong constitution, blood

to the extent of
after,

was immediately drawn from the arm

ounces.

twelve

This bleeding, renewed three days

;

stopped

the discharge of blood

in great

but the

leucorrhoeal

flux continued

abundance.
last

Injections with soot water

were carried,

as in the

case, into the

uterine cavity
at

they were con-

tinued

during three weeks,

the

end of which time the

:

leucorrhoeal discharge had almost entirely ceased

the

womb

was returned

to its

normal

state.

During these three weeks

there had not appeared a single drop of blood.

The menses

flowed then regularly

and

after their cessation, the os tincae

was found
blood;
its

firm,
orifice

and permitting no more the exhalation of

was sensibly contracted, and the leucorrhoeal

discharge almost gone.

M.

Tealier has informed us that this lady,

who had been

barren from this cause for nearly ten years, immediately

afterwards

became pregnant.

294

LEUCORRHOEA.

Case

39.

leucorrhoea, diagnosis difficult from gonorrhoea.

occurring in the practice of mr. tracy of cork street.

May, 1840.

Mrs.

set.

twenty-three, has been marfirst

ried three years,

and since the birth of her

child,

now

eighteen months ago, her health

has always been delicate,

and

six

months since leucorrhcea appeared.

in

She

visited

Cheltenham

February,

1840, and

after

an absence of

some weeks, during which her health was

she returned home.

greatly improved,

The

discharge was at this time watery

in quantity.

and

thin,

although diminished
its

Intercourse was
all

resumed, and, as

consequence, the husband had

the

symptoms of gonorrhoea.
parties

In this case the reputation of both

still

was undoubted; but

the secretion from the male

urethra continued for ten weeks, notwithstanding persevering

and active treatment.

Eventually he was cured by

liq.

steel

and

a mixture of copaiba mucilage and

potassas,

with the

oxy muriate

injection.

CHAPTER

VIII

OF THE DISORDERS ATTENDANT ON THE DECLINE OF

MENSTRUATION.
It

is

impossible, within

a reasonable

space, to

give a correct definition of these important affections

in
;

although

it is

by no means

difficult to furnish

detail
I

an

accurate and
therefore,

condensed account of
after a
in

them.

shall

few preliminary

observations, describe

them

something like the

order of their frequency, beginning with the more

common, and concluding more dangerous deviations.

eral

the
It

has

summary with the become too genis

an opinion, that the decline of this function

illness
;

must be attended by
error
;

but this

surely an

women, who pass over this time without any inconvenience, and many whose indisposition is both transient and slight. That this does not more constantly happen, arises
for there

are healthy

from the

fact, that

nature and health are often sacI

rificed to fashion

and luxury.
in

have already ex-

plained

(at

page 42),

reference to the physical

education of female youth,

how

injuriously the na-

tional practices affect the establishment of the function.

The
and

almost entire neglect of out-of-door exsports, the substitution of prolonged in-

ercises

296

DECLINE OF MENSTRUATION.

door studies, by which both mind and body are pre-

maturely exhausted
instead of an
diet
;

farinaceous and

vegetable,

easily digested

and nutritious animal

cli-

clothing inappropriate to our changeable

;

mate

and many other circumstances, too numerous

produciive of results in early
hurtful.

to be recounted, are
life,

conspicuously inauspicious and

this

Only

let

enumeration

be completed

by the subse-

quent histories of marriage and child-bearing, and

we

shall

be convinced, that the

ills

attendant on

catamenial decline, are attributable not to necessity,

but mainly to habits, unwisely begun, and
still

more

unwisely continued.

Females themselves anticipate

dodging time," " the
it

this
it

period as excritical

tremely eventful, denominating

" the

or

turn of life," &c.

Nor can
reason
of this ex-

be denied, that they often

have

sufficient

for their anxiety.

With

the extinction

traordinary secretion, the reproductive faculty dies

an event of
of a

itself

of sufficient magnitude in

the

life

woman,
life,

to give to this

epoch an emphatic

in-

terest.

The consequences may

where even a
;

be injurious at any
is

time of

slight evacuation
it

sud-

denly stopped
sive

for all

hough

was

originally exces-

and morbid, such a process eventually becomes

it

so habitual and necessary, that

cannot be safely

done away, without either preparatory antiphlogistic

treatment, or the institution of some compensating
drain.
1

have,

in

an appended

note, for

which

am

indebted to Dr. Stroud, given an extraordinary

illustration

analogous

occurring in

the other sex.

DECLINE OF MENSTRUATION.

297

There are few

females.*

practitioners

who

could not verify

the statement from their

own

observation amongst

We

cannot,

therefore,

be surprised, especially

where luxury and

tion of

dissipation, or

penury and disease

have already injured the constitution, that the cessa-

two such prominent functions of the female

shall

economy, as menstruation and reproduction,

the nervous, vascular, and
it

be sometimes accompanied by serious changes in

digestive systems.

Let

be remembered, also, that these are the distinc-

tive functions of the sex, exerting for

many

years a

marked
to their

influence over their health, and giving even

disorders a peculiar character

decline.

not

lost

till

after their final

And

yet

it

must not be
is
;

supposed, that the effect of these great changes

always morbid.
for there are

Sometimes

it is

quite the reverse

women who
suffered

have never been vigorous

their lives,

and well during the middle period of

and

some who have

from protracted

illness or

* Case of Frederick P

young man subject

to plethora,

and
for

to large discharges of blood

from the nose every spring, having

some time labored under mental vexation and anxiety, missed, He became somnolent, morose, and dejected, and at length, after some bodily exertion, fell Under the direction of Mr. Symes of into a sort of fainting fit. Tavistock Square, he was largely bled, with apparent relief. Having been placed in bed, he lingered for some hours, with a sense of
during last spring (1840), his usual epistaxis.

weight and oppression about the heart, which gradually terminated

in

death.

On-inspection of the body, about three pints of partially

coagulated blood were found in the pericardial sac, having been

discharged from a ruptured aperture in the superior cava, which

would admit the

finger.

With

this

exception, there was no other

disease, either in the heart or elsewhere.

38

298

DECLINE OF MENSTRUATION.

chronic uterine maladies,

who

after this time acquire

what they term, " a settling of the constitution,"

and good health.
If the affections

accompanying catamenial decline

to

be classed according
probably be
little if

their frequency, there can

any doubt, that

Functional derangements of the brain and nervous

systern, are the

most numerous.

Next in amount are the cases of increased action and congestion of different organs. And, happily, among the least common, are lesions of structure and malignant disease.

train

of symptoms, fairly to be denominated

hysterical,

nervous

or

so

often

accompanies the
accomplished,

change, even
that
it

when most
little

favorably

excites but
or

attention, if

some

single

symptom
severity.
irritability

the

entire
a

affection is not of unusual

Timidity,

dread
a

of

serious
to

disease,

of temper,

disposition

seclusion,

impaired appetite and broken sleep, with physical

weakness and inquietude, are common

indications.

Women

are

aware that such symptoms may be exin

pected to occur, and they are

to their approach.

consequence alive
Occasionindividual

Of
it

course the cessation does

not always take place

ally,

in the
is

same way.

but very rarely,

sudden.

The

having arrived at the usual age, anticipated menstruation

illness.
is

prevented by cold,

fright, or

by some

These circumstances,

in earlier life,

would

have been followed, on

the discharge; but
it is

their removal,

by a return of Nature seizes

not so now.

DECLINE OF MENSTRUATION.
this

299
function

opportunity to
I

put

an

end

to

the

altogether, and

have known

several patients thus

dealt

with,

who

never had afterwards one hour's

inconvenience.

But a gradual extinction

is

much
is is

more common.
a return
;

One

period

being missed, there

elapses,
;

a longer time then

and there

perhaps

an

excessive

return

afterwards

some

months may pass away without any appearance,

then there
the
is

a sparing secretion

and

in this

way
to

discharge, sometimes

amounting almost

flooding,

and again being so scanty and so slightly

have already,

sanguineous as scarcely to attract notice, altogether

disappears.
I

at

page 214, mentioned

nearly impossible

(he different ages at which the cessation takes place;

and as
to

to the

time occupied,

it is

afford

any precise information.

Some
I

females

pass over the period in a few months, others are

irregular for a

much

longer time, and

have known

instances where several years have intervened be-

tween the beginning and completion of the change.

Hysteria,
exists,

of
in

marked

intensity,

not

infrequently

and

two

patients formerly under

my

care,

a stranger, seeing the extent of mental aberration, might, without careful investigation, have concluded,
that

they

were
a

really

insane.

In
in

one of these

instances,

physician

attending

my

absence,
Soothing,

strongly

urged

restraint

and

removal.

temporising treatment, however, must be adopted in

these cases.
Irritability is their
is

prominent feature
it

and as the cessation

important
that
its

a process of nature,

is

completion

should

neither

be

300
hastened
ment.

DECLINE OF MENSTRUATION.
nor

delayed

by inappropriate

manage-

The examples
decline.

are not rare,

where increased action

result

and congestion occur

as the

of caiamenial

We

do not expect

to find delicate

women

thus suffering, but those

who have been

plethoric

and healthy,

who have
it

indulged in good diet and

wine, or malt liquor, are exceedingly prone to such

affections.

Nor must
after

be forgotten that the ten-

dency often continues

for

for

months, and sometimes

disappearance
of

years

the

entire
at
all

the

secretion.

Every one

observant of female

diseases,

must know that

women who

have been

healthy prior to this change, often become corpulent

after
its

completion, and are more than usually liable

to attacks of apoplexy, paralysis, pulmonary obstruction,

and cough.

Thus

affording

an illustration of

the remark,

the correctness of

which cannot be
another series,

doubted, that while certain morbid conditions of the

cerebrum produce emaciation, there

is

amongst which the influences in question must be Headplaced, which induce repletion and obesity.
ache then, sensations of fulness about the cerebrum,
throbbings of the carotids, and visible distension of
the superficial veins of the temples and neck, ought

always

to excite

watchfulness

if

not apprehension.

Cases of

partial

apoplexy and paralysis do occur as

life
;

the result of neglected amenorrhcea in earlier

and several times

have been struck with the relief

afforded to affections of the brain, at this period, by

an excessive return of the catamenial discharge.

Affections of the skin, too, very difficult of cure,

DECLINE OF MENSTRUATION.

301

and sometimes almost permanent, are by no means

rare.

Evanescent eruptions

about

the

face

and
is

upper part of the body are common.

scarcely any organ or
part of

But

there

the

body, and the

statement

is

particularly true of the uterine system,

suffer

which may not

great

from acute or chronic inflamthis

mation as the direct or remote consequence of

change.

Hepatic

derangement,

and

even

disorganization, have
this

been frequently attributed to

cause.

cannot, from

my own

observation,
I

confirm the latter part of this statement, although

have known the

liver, in

common with

the

other

chylopoietic viscera, seriously disordered.

very few remarks will suffice on the treatment

;

of these various sympathetic affections

and

first, I

must be allowed
take can

to state, that

no more serious mis-

be committed, than to attribute any of

them, without the most accurate inquiry, to debility

rather than
to

repletion.

Let
is

it

be remembered

that an accustomed

evacuation
;

about to cease, or

has finally disappeared

that the patients have been

previously healthy, and that the probability therefore

is,

that the

weakness

is

apparent not
is

real.

If,

for

instance, because there

languor and inactivity, a

slow pulse, torpid bowels, and depression of mind,

stimulants

and generous diet are allowed, some

important organ will become congested

or the lungs

the
;

brain

and either suddenly

occur.
I

fatal or structural

disease

may

know

not

how

often,

but

certainly very frequently, such errors

it is,

happen

and

therefore, the

more necessary

to urge especial

caution.

302
There

DECLINE OF MENSTRUATION.
are instances

where too large bleedings

In such, and

have been practised, and where the antiphlogistic

treatment has been too long pursued.
in

others,

where the active symptoms have been

where from the commencement the
been of

subdued, or
disease

has

mixed

character,

modified

measures must be adopted.

duce anemia, and extreme

Further loss of blood

will
in-

and the continued exhibition of cathartics

irritability,

while a sudden

and

injudicious

alteration

of the

treatment
or

may
part.

irretrievably injure

some weakened organ

apparent
that
I

Hence,

it

will

be

middle

and

cautious course must be chosen.

have

now under

my

care a lady

who

has ceased to menstruate for

three or four years, and who, by the adoption of a

spare and vegetable diet, and the almost daily use

of purgatives throughout the whole time, has be-

come gradually
that her
life is

so exhausted, irritable and neuralgic,

a burden.

Many months

of watchful

treatment will be required ere she can return again

to

animal

food,

on which

the restoration of her

health really

depends.

these important points.

thora continue

More need not be said on Where symptoms of plewhere on even

or
local

and

there are cases

the poorest diet patients will

fatten purgatives or
general

mild

aperients, occasional
exercise,

small

bleedings,
spirits,

and

abstinence

from

wine,

and malt

liquor,

must be

strictly enjoined.

On

setons and issues great stress

was formerly

laid,

but they are not often necessary.

Where

patients

cannot

be induced to live appropriately, but will

DECLINE OF MENSTRUATION.
gratify the appetite, at

303
where the

whatever

risk, or

brain

is

evidently the seat of frequent congestion,

and serious symptoms are constantly present, such

remedies are most desirable.

Other measures of a
with

derivative kind will naturally suggest themselves, as

mustard hip-baths,

and pediluvia,
the

frictions,

stimulating embrocations, and

flesh

brush, the

continuance of sexual intercourse, and the encour-

agement, by any gentle means, of the catamenial

flow.

At page 213,
rhagia, the

in the section

on congestive menoris

probability of pregnancy

mentioned.

Nor must
sionally

it

be forgotten that conception does occa-

occur

when

the

process

of

catamenial

cessation seems to be nearly complete.

titioner will not, therefore, suppose, if the

The

prac-

symptoms
fal-

of gestation arise, that they must of necessity be

lacious.
is
I

grant that spurious or mistaken pregnancy

;

more

likely
to

and many men have exposed themby erroneous opinions on

this

selves
difficult

ridicule

matter.
in

More than
" diagnosis

this

need not say

from
fully

here,

as

the

of

pregnancy
will

disease"
discussed.

the

distinguishing

marks

be

Lesions of structure

and malignant

disease.

There more
time.

is

an almost universal impression that organic

especially of the

maladies,

breast and uterus, are

likely to take
I

place at this than at any other

it is

doubt whether catamenial decline, as

process, has anything
;

a natural
original

to

do with their
that the

production

but

certainly think

304

DECLINE OF MENSTRUATION.
to disorganization

development of a latent tendency

may

accrue from the derangement, especially where

the uterus becomes congested, either as a conse-

quence of a superfluity of blood

for

which there

is

no adequate
its
I

outlet, or as the

result of a neglect of

proper local abstraction.

Under such

conditions,

can easily understand that tubercular or cancerous

deposit, either in the uterine or

shall

mammary

structures,

receive a

stimulus of growth,

which may,

unchecked, lead to rapid development.

It is

scarcely requisite to urge a frequent inquiry

state of

as to the
easily,
if

these organs
exist,

the breast

may
and
of
the

any suspicion
there

be

examined
in

although

may be

obstacles

the

way
if

vaginal investigations, they will readily yield

necessity to the patient's safety be urged as their

justification.

CHAPTER
FORMULA
The

IX.

OF REMEDIES.

following prescriptions are selected from

are generally used, and
to

many which

which

have

been long accustomed

employ

in the diseases of

menstruation, characterized hy pr6fusion or excess,

and

in leucorrhcea.

[For the aperients and purgatives reference must be made to page 179.]

STOMACHICS AND TONICS.

I

shall

add only two additional formulae

Form. 46.

Mistura Tonka cum Acido.

Sir

James Clark.

R. Acid. Sulph.

dil. 5iv.

Syr. Aurant. iss.

Aquae Cinnamomi

j.

M.

ft.

Mist.

Take one
full

teaspoonful
If
it

three

times a day in a wine-glass

pill

of water.

be advisable, a

containing one or two

grains either of the sulphate of iron or quinine, with or with-

out a narcotic,

may be
39

given with each dose.

306

FORMULA OF REMEDIES.
Form. 47.

Mist. Ferri Tartratis.

3j.

R.

Ferri Tartratis

Ammoniat.
j.

Tinct. Aurant.

Tinct. Card. C. 3iv.

Aquae

destillatae v\jss.

M.

ft.

Mist.

Take one
daily.

tea, dessert, or tablespoonful three or four times

SALINES WITH PURGATIVES.

Form. 48.

Mist. Salina cum Acido,

R.

Infus. Rosae C. gviij.

Magnes. Sulph.
Acid. Sulph.

5iv. vel. Sviij.

B'i. vel.

Pulv. Potassse Nitrat.

9ii.

dil. 5ss. vel. 3j.

Tinct. Digitalis oiss.

M.

ft.

Mistura.
If
it

Two
so take

tablespoonfuls three times daily.

be necessary

the following
it

pill

frequently, the menorrhagic loss

being excessive,

should be swallowed half an hour or an

hour before the mixture.

By

this

arrangement a considerabe exhibited, without

ble quantity of the acetate of lead

may

the diminution of

its

beneficial,

and

free

from the risk of

its

injurious properties.

Form. 49.
R. Plumb.
Acetatis gr.
vel.
i.

ad.

ii.

vel.

iii.

Micae Panis

Confect. Rosac Gallicae

q. s.

Ft. pilula.

ASTRINGENTS.

Form.
R.

50.

Mistura Secalis Cornuti.

Siij.

Tinct. Secalis Cornut.

Pulv. Potass. Nitrat.
5j.

Aquae Menth. Pip.

vss.

M.

ft.

Mist.

FORMULAE OF REMEDIES.
Take one
more
case.
or less
tablespoonful, one

30?
or

and a
;

half,

two

table-

spoonfuls, every two or three hours

the dose being repeated

frequently,

according to the urgency of the

Form.

51.

Dr. Dewees.

R.

Spir. iEther. Sulph. C.

Tinct. Opii. aa

gtt.

xxx.
5vij.

Aquae Menth. Pip.

M.

ft.

Haust.
(in cases

One draught

to

be taken every hour,

of alarming
pill*

Menorrhagia or profuse menstruation) with the following

R. Pulv. Opii.
gr. i.
gr.
ij.

Plumb. Acet.

Cons. Rosa3 Gall.

q. s.

Ft. pilula.

Form. 52.
Dr. Dewees.

R.

Infus. Rosae. C.

ij.

Elixir Vitrioli ^Ixx.

Magnes. Sulph.

oiss.

M.

ft.

Haust.

One

draught to be taken every six hours with or without

the lead.

Form. 53.
R.
Spir. Terebinth. C.

Mist. Terebinth. Comp.

nxv,
M.

xx, ad.

xl.

Mucil. Acaciae
Spir.

5vij.
5j.
ft.

Lavand. C.

Haust
I

One
this

draught every four,

six, or eight hours.

have given
loss
is

with marked benefit

in

menorrhagia, where the

occurring
in

not excessive, but leucorrhoea

;

protracted,

connection with

a few drops of tincture of

opium may be added-

308

FORMULA OF REMEDIES,
Form.
Mist. Copaibce Comp.
|j.

54.

R. Balsam.

Copaibse

Mucil. Acaciae.
Sp. Lavand. C.
Mist.

ij.

3ij.

Camph.

v.

M.

ft.

Mist.

One
daily.

or

two tablespoonfuls

to

be taken three or four times

is

The

efficacy of this mixture

increased,

if

it

can be

borne on the stomach, by the addition of one or two drachms

of the powder of cubebs.
tharides,

The
;

tinctures of cubebs,

can-

and capsicum, are frequently beneficial

menorrhagia

in protracted

or

dropping

and

in

chronic and

inveterate

leucorrhoea, fifteen

or twenty drops of each

may be adminan ounce of

istered three or four times daily in water, or in

mucilage.
in

have

lately used

the Extractum Haematoxyli,

;

doses of fifteen or twenty grains, three times a day

;

con-

tinued for several weeks

it

must be suspended

in

water or

mucilage, for
will pass

if

given

in

pills

they become so hard that they

effect.

through the body unchanged, and without

It is

scarcely necessary to give the

more common
I

astringent lotions and injections, although

do not
I

wish
think

it

to

be inferred from the omission, that

of
their
efficacy.
is

lightly
if

The compound
;

alum wash,

well used,

one of the most valuapossess

ble remedies of the kind

we

but there are

tedious examples of leucorrhoea,

in

which more

powerfully astringent and stimulant means must be

employed.
Form. 55.
R. Decoct.
Injectio Astringens.

Secalis Cornut. |xiv.

gr. xx.
gij.

Argenti Nitrat.
Tinct. Catechu

M.

ft.

Injectio vaginalis.

FORMULA OF REMEDIES.
Four ounces
of the secale
is

309
The
decoction

to
to

be used three times a day.

be prepared by boiling one ounce of the

bruised rye in a pint and a half of water,

down

to a pint.

Form. 56.

Injectio Astringens.

Dr. Copland.

R.

Inf.

Quercus

iv.
5ij.

Pulv. Gallarum gr. xxx.

Ft. Injectio vaginalis.

Tinct. Catechu

To

be used once, twice, or three times daily.

Form. 57.

Enema

Astrlngens.

Dr. Mackintosh.

R. Plumb.

Acetat. gr. xv, xx.

giv.

Aquae purse

Ft.

Enema.

To

be used by the rectum once or twice daily.

Form. R. Argenti

58.

Injertio

Argenti JVitrat.

Nitrat. gr. xv. ad. 3j.

xvj.

Aquae Rosse

M.

ft.

Injectio vaginalis.

Three

or four ounces to be used three or four times daily.

In cases where an unhealthy condition of the vagina or cervix

has been ascertained to exist by the speculum, or where, in-

dependently of such
stronger solution
is

state, the discharge

is

inveterate, a
this

much

sometimes required, and with

parts

by the

aid of the tube, the diseased

may be

directly touched,

or

washed once
for the

or twice

daily,

a camel-hair

pencil

being

used

purpose.

In a protracted

example of leucor-

rhoea lately under

my

care, the nitrate of silver

was thus

used, and with curative effect.

it

Of

all

the mineral astringents

it

is

the

best.

Dr. Jewell remarks, " that by some

is

thought, that the checking of a vaginal discharge

prejudicial.

must be

This opinion," he says, "is

at variance with

my

310
own experience

FORMULAE OF REMEDIES.
;

but
a

would employ the

nitrate of silver,
to

not merely with

view of arresting the discharge, but

in

produce a perfectly new action, or new excitement,

part from which

the
I

the secretion

has

its

origin.

The mode
in

have adopted
to conceal
stricture,
it

in

the application of this agent, has been either

it

in a silver tube, as

is

employed

cases of

(except that the tube should be adapted to the size

argenti nitras,')
or
in

of the

'

the form of a solution, in the

proportion, generally, of three grains to the ounce of distilled

water, the strength

soft
lint

being gradually increased.

piece of

may

be moistened with the solution, and introduced

into the vagina, for a short period, several times in the day, or

a bit of sponge, firmly and neatly tied to the end of a slip of

whalebone, and well

saturated

with

the solution,

may be
This

passed into the vagina, up to the os and cervix uteri.

can easily be effected by the patient

that

herself.

It is

necessary

the

application
benefit

should

be frequently repeated, or no
expected.
solution,
it

permanent
requisite to

can

be

Should and
to

it

become
it

employ
or

a strong

apply

to

certain

part,

ulcerated surface,

can be accomplished

with a great degree of nicety, by means of a camel's hair

brush introduced through the speculum or dilator."

Form.

59.

Injectio Ferri Sulphat.

3j.

R.

Ferri Sulphatis 9i, 9ii. vel

Aquae

distillatae Sxvj.

M.

ft.

Injectio vaginalis.
I

Four ounces
have of
injections
far
late
;

to

be employed three or four times daily.

discontinued the use of syringes, for vaginal

bottles, fitted

india-rubber
there
is

with ivory tubes, are

better

less

difficulty in their

employment, and

they are not so apt to get out of repair.*

* Patients should be told that the two any linen which they may happen
stain.
last

forms (58, 59) will spoil

imprinting an indelible

to soil,

FORMULA OF REMEDIES.
Form. GO.
Injectio Soclcc Carbonat.

311

Dr. R. D.

Thompson.
vel 5j.

R.

Sodae Carbonat.

3'\, )ii.

Aquae Purse

xvj.

M.

ft.

Injectio vaginalis.

Four ounces three

or four times daily.

Dr.
tical

Thomson

is

said

by Mr. Jones,

in his

" Practo

Observations on the Diseases of

ascertained,

Women,"

have

by repeated

experiments,

that

inflammation of mucous membranes always engenders a free acid on their surface,

which

acts there as

an

irritant

increasing inflammation.

To

neutralize

this,

he makes use of the alkali.

Mr. Jones con-

firms this opinion

by

stating, that

whenever litmus

paper has demonstrated the presence of a free acid,

almost immediate relief has been obtained by the

use of the alkali.

So

far

as

my

exhibition of this
certainly in
it

remedy goes,

it

supports these views;

several examples of acrimonious leucorrhcea,

has

quickly relieved, and several times cured the malady.

Form. Gl.
R. Succ. Limon.

Injectio Succ.
j.

Limon.

recent.

vel ij.

Aquae Purae xv.

vel gxvj.

M.

ft.

Injectio vaginalis.

To

be used either warm or cold, as directed above.

in

Acetic acid

the proportion of half an ounce to a pint of

muriatic acid, ten, twenty, or thirty

water

nitric, or

minims

to a pint of water,

may

be advantageously used

in

protracted

leucorrhoeal discharges.
or

Their

effects will be either sedative

stimulant

in

proportion to their strength.

In

diluted

312

FORMULAE OF REMEDIES.
;

form, they will often soothe

whilst in greater intensity, they

will not only stimulate, but induce excessive irritation.

The

sulphate of copper 9i. vel

decoct, secalis,
is

5j.

to
;

pint of water, or the

often beneficial
or

nor must the injection of

forgotten.

the

black

wash,

the

oxymuriate lotion be

Electricity, dies
;

and a
I

blister to the

sacrum, are valuable reme-

and

am

anxious to give a place to the following

:

excellent combination of Sir Charles Clarke

R.

Infus. Cascarillae j.

Aquae Pirnentae
Syr. Zinzib 3j.

gss.
3j. 3iss. vel 3ij.

Tinct. Sabinae C.

Ft. Haust.

To

be taken three times daily.

Date Due

Demco

293-5