LETTER V.. Of Menstruation.

OF MENSTRUATION.

Tardy and Suppressed Menstruation—Chlorosis—Sudden Check of the Menses.

One of the most important of all subjects connected with the health of females, is that of disordered menstruation.

You will find, as you read medical works on Females, the word amenorrhœa, which signifies a partial or total obstruction of the menses in women, from other causes than pregnancy and old age. You will find, also, the words menorrhagia, signifying an immoderate flow of this discharge, and dysmenorrhea, meaning difficult or painful menstruation.

Before proceeding to speak of obstructed menstruation, I ought to make some remarks upon the too tardy appearance of this discharge.

As I have before observed, the catamenia usually appear at from the fourteenth to the fifteenth years of age. Now, when there is a failure on the part of nature to bring about this state of things, there is not unfrequently a great deal of anxiety experienced on the part of mothers and those most intimately concerned. If, likewise, the girl at this time is attacked with any particular ailment, it is almost sure to be attributed to this cause. Too often, under these circumstances, she is also subjected to various modes of medical treatment, with the view of forcing nature into that sort of work which it is believed she ought to do, but will not. Now, the effect of such a course can be only harmful, as a general fact. To aid nature, it should be remembered that we must increase her powers, and not diminish them, as is almost necessarily the case if a course of drug-medication is practiced.

Please notice, then, that I wish to persuade you that this plan of drugging the system for tardy menstruation is a most unwise and unnatural one. Attend well to nature, and nature will take care of herself. Let me give you a few words from an honest, good man, Dr. Dewees, who years ago went to his long home. He says:

“Our exertions in favor of such patients, should tend to the invigoration of the system in general, and the development of the uterine system in particular. The first should be attempted—First: By the establishment of a regular course of exercise; such as riding on horseback, when practicable; walking in proper weather; skipping the rope within doors, when the weather will not permit exercise abroad; dancing moderately, and with strict regard not to become overheated, and cooling too suddenly. Secondly: By proper attention to dress; wearing flannel next the skin in cold weather, and properly protecting the feet and legs against cold; carefully avoiding damp and wet places, and partial streams of cold air, especially when warm. Thirdly: By a diet of easily-digested substances, both of the vegetable and animal kind; avoiding all stimulating drinks, such as wine, spirits, or beer, etc., under the specious pretext of their being strengthening.”

I give you these words, not that I would altogether agree with every idea advanced, but because of the general worth and correctness of the remarks, and the high authority from which they come. I do not believe it best for any one to wear flannel next to the skin, but I do believe in guarding the body sufficiently against cold, a thing which young ladies too often neglect. Dancing, too, as a general rule, cannot be regulated in the way it should be; and as for animal food, it is not necessary, to say the least.

I do not wish to appear to be fault-finding with your sex; but I must say, in all frankness, that some have taken an unreasonable course in regard to bringing on the courses, when they are tardy. The following case happened to a physician of eminence: The girl was a most amiable and interesting creature, for whom he was requested to prescribe for the expected menses, but who had not one mark which would justify an interference, and especially as she was in perfectly good health. She was fifteen, it is true; and this was all that could be urged by the mother in favor of an attempt to “bring down her courses.” He relied too much upon the good sense of her anxious parent, and freely explained himself to her. She left him apparently satisfied with his reasoning, and he heard nothing of the poor child for six months; but at the end of this time he was suddenly summoned to attend her, as she was said to be alarmingly ill.

When he saw her, she was throwing up blood in considerable quantities from the lungs; she died a few days after from the excess of this discharge. The distracted mother told him, that though she appeared satisfied with what he had said when she left him, she was convinced he was wrong, and that her daughter’s health required the immediate establishment of the menstrual evacuation. With this view, she determined upon the trial of a medicine of much celebrity in similar cases, vended by a quack. She procured it, and gave it according to direction; in a few days her daughter became feverish, lost her appetite, and frequently vomited; her strength failed, and after a short time she was confined to her bed. She called upon the “doctor,” and made known to him the condition of her daughter; he encouraged her to persevere, and told her that the fever, etc., was an effort nature was making for the end proposed. She persevered, fatally persevered, for in a few days she lost her lovely and only daughter. The medicine given in this case proved, on examination, to be the oil of savin (juniperas sabina), a most active poison, and one which, in the smallest doses, has been known to produce disastrous results.

EFFECTS OF WATER-TREATMENT.

There is one remarkable fact concerning the effects of water-treatment, as affecting menstruation, which should here be spoken of. Where a vigorous course of hydropathy is practiced for chronic disease, the menstrual function, in some cases, ceases for months, and even a whole year or more. I had first to learn this fact for myself, no other practitioner ever having promulgated the doctrine, so far as I know. And it is a remarkable fact, that in such cases no injury arises from the circumstance; but the individual’s health grows, month by month, in all respects better. No inconvenience is experienced from the suppression, nor need the slightest alarm be felt. The probable reason why menstruation thus ceases is, that a vigorous action of the skin is caused by the water process; elimination, or the throwing off of the waste, morbid, and impure matters, is made to go on so rapidly and vigorously, that there is no need of the purification of menstruation at the time. This doctrine, however, is conjecture and mere speculation, and one that does not appear to be susceptible of positive proof. That the occurrence does takes place, and that women have, at the same time, been remarkably benefited in health; cured, as we may say, of long-standing and most obstinate chronic diseases, we know to be a fact.

But whenever retention of the menses occurs, and is not caused by pregnancy, or by the age of the individual, at which the function ceases naturally, or by a course of water-treatment, we are to suspect some derangement of the general health. This is a natural function, and if we find it ceasing when it ought to go on, we may safely conclude, that the efforts of nature are by some means thwarted; otherwise she would do her work.

CHLOROSIS.

Retention of the menses is very often attended with what is technically termed chlorosis.

The word chlorosis signifies a greenish, or greenish-yellow hue of the skin, and might, therefore, be applied to certain affections belonging to both sexes; but the term is “generally confined to that modification of amenorrhea, which is attended by a dingy-pale, or greenish color of the skin.” Chlorosis also goes often under the name of green sickness.

In this disease there is “heaviness, listlessness of motion, on the least exercise palpitations of the heart, pains in the loins, back, and hips, flatulency and acidity in the stomach and bowels, a preternatural appetite for chalk, lime, and various other absorbents, together with many dyspeptic symptoms.” In the progress of the disease the face and lips become pale, and after a time assume a more yellow hue; there is great general debility, flaccidity of the muscles, and not unfrequently, swelling of the feet and lower limbs; there is, in short, a great variety of symptoms, varying more or less, endlessly, as we may say, in different cases, and such as denote a very depraved state of the constitution generally.

This disease is sometimes cured spontaneously. The simple force of nature, acting also, perhaps, in consequence of favorable circumstances as to air, exercise, diet, clothing, occupation, etc., is often sufficient to effect a cure. Menstruation is brought on, and thus the individual becomes well; but in other cases the affection is of a very obstinate nature, and leads to disease of some important organ, as the womb, bowels, lungs, etc., and ends at last in death.

Chlorosis has been sometimes mistaken for tubercular consumption. When the patient has been cured, it has been said she was cured of that disease. Thus it is that more persons are said to be cured of this dreadful malady than actually have been. Chlorosis, as a general fact, is by far oftener curable than consumption is. It is, in fact, generally curable if taken in season, which, alas! cannot be said of that most formidable disease, consumption of the pulmonary organs.

Causes.—The causes of chlorosis are as numerous as the causes of depraved health generally. Any thing which tends to lower the tone of the system generally, during the period at which chlorosis ordinarily comes on, may act as a cause, either directly or indirectly, of the disease.

I will here give you a case which may serve to throw some light on the subject.

A physician was called to visit a young lady of the city of New York, of a wealthy family, in which, the mother being present, something like the following conversation occurred:

DOCTOR.—Well, Miss, how are you to-day?

PATIENT.—Not very well, I am sorry to say.

D.—Do you attend school at present?

P.—Yes; I am at Mrs. ——’s seminary, in —— street.

D.—How long have you been there?

P.—Four years, including now and then a vacation of a few weeks.

D.—What have been your studies?

P.—Composition, Rhetoric, Mathematics, Philosophy, Chemistry, Botany, French, Spanish, Music, and Drawing.

D.—Do you like your studies?

P.—Yes; some of them very much.

D.—How do you like the study of English composition?

P.—I can hardly say; we have to do every thing in French; address our teacher in French when we go to school in the morning; speak French in our exercises; in short, it is nothing but French all day.

D.—On the whole, you say you like your studies?

P.—Yes, when I am well; but latterly I have been so ill and low-spirited I could not enjoy any thing. I like study when I am able to perform it—like it very much. I used to succeed well; but latterly I am discouraged, and do not accomplish any thing at all.

D.—Well, now let us know all about your health, and see if we can find out what the matter is, and what it is proper to do. Here you have a fine, airy residence, an abundance of the best things to eat and drink, and to wear; good baths, good walks, and every thing about you to make you happy and comfortable.

MOTHER.—She has never been regular, doctor, in her whole life.

D.—Does she take her regular baths?

M.—No; she won’t bathe hardly ever, and as for taking an injection, she would die first.

P.—No, mother; I do bathe two or three times a week; but then it chills me and makes me tremble so, I don’t get over it all day.

D.—But don’t chill yourself, use the water milder; but take your bath every morning, or at least some time during the day. You cannot be as clean as you should be in a dusty city like this, unless you wash the body every day.

M.—The rest of us take a cold bath every morning, and it does us a great deal of good; we would not do without it on any account.

D.—How much does your daughter walk every day?

P.—Walk! why! mother won’t let me walk. I only go to school and come back, that’s all.

D.—You only go to school and back. Let’s see how far that is; about a quarter of a mile there, and a quarter of a mile back. Then you walk a half mile each day.

M.—She sometimes goes up and down stairs dusting off the furniture in the house.

D.—That is all very good, so far as it goes. Does she ever make bread?

M.—No; we get the bread at the baker’s.

D.—And rather poor stuff at that. Does she ever wash?

M.—Well, no; the servants attend to that. She has too many studies you know, doctor, for that, and then—

D.—How is the patient’s appetite?

P.—Not very good; sometimes I eat a great deal too much, but the most of the time I relish nothing. I am often wanting what I cannot get; and food always distresses me, gives me acid stomach and heart-burn, and so on.

M.—Yes; she likes chalk, charcoal, slate pencils, vinegar, and all such things. She has always an appetite for these.

D.—This is a morbid, diseased appetite. Do not blame her, she cannot help that; if you or I had just such an appetite, and felt in all respects as she does, we would very likely gratify it to as great an extent. How does the patient sleep?

M.—Not very well; the bed is never right; sometimes we put on a feather bed, and then she gets fidgety and says she cannot sleep; then again we put the hair mattress over the feather bed; but this is either hard, rough, or uneven—there is always some kink in her head about the bed; it’s never right.

D.—Does she have her window open?

M.—No; she’s afraid of taking cold.

D.—What kind of pillow does she sleep on?

M.—Feather pillow, of course.

D.—Of course—a great many people are getting to sleep on hair pillows—and some on harder ones even, such as palm leaf, corn husks, straw, etc.; and some young ladies won’t have any pillow at all; it makes them crooked not to lie straight. For my own part, I like to have one pillow, stuffed with hair, moss, corn husks, or straw—something that is clean, without smell, and cool. One pillow, and one only, that is just thick enough, so that when I lie upon the side, as I think persons who can ought, it is just comfortable. There is a great deal of truth in the old maxim, “keep the feet warm and the head cool!”

M.—I had not thought of that; I suppose the head does keep warm enough of itself.

P.—O yes; you know, mother, my head is always burning hot, and aches most dreadfully too.

D.—At what time of day does it ache most?

P.—It aches all the time; it’s never right.

D.—How do you feel in the morning when you get up?

P.—Very badly; I never sleep well; I feel heavy and weak, and my head aches.

D.—How do you feel when you walk out in the open air?

P.—Well, I can hardly say; in fact I don’t feel as if I could walk. It is as much as I can do to get up and eat breakfast and fix off for school.

D.—Did you ever go to the country in the summer?

P.—O yes, to Massachusetts.

D.—How did you feel there? Could you walk?

P.—O yes; we had walking parties, rides, visitings, and a great many things to take the attention; and I, in fact, either forgot all my ailments, or else had none, I don’t know which. I have been to the country a number of times, and whenever I go all my headache leaves me, my appetite becomes good, and I am soon able to bear as much exercise as any one need.

D.—Do you have any headache?

P.—Strange as it may seem, not the least.

D.—Do you study your books much in the country?

P.—No, very little; we go for relaxation and amusement; we read, perhaps, a little, but do not undertake hard study.

D.—How much do you walk or ride in the day?

P.—Well, I can’t tell; we go sometimes in one direction and sometimes in another. We even walk to neighboring villages; we go some days, I should think, in all ten miles on foot; and I think, indeed, sometimes twice that distance.

D.—Does this give you fatigue?

P.—It does at first, sometimes; but somehow my mind becomes so interested with the country, I forget all my aches and pains; you know I have always lived in the city, and the country seems to me a new life; I seem to feel as happy as the birds.

D.—How do you sleep at night?

P.—It’s a rude place you know, and it is fashionable in the summer there to sleep on straw beds. But it is no matter; we get so tired as to be very glad to sleep any where. We could sleep on the floor, or sitting up in a chair if necessary; when we get so tired sleep we must.

D.—How long do you stay in the country?

P.—Six weeks, and sometimes more.

D.—What kind of food do you eat?

P.—Plain food, such as the country people have. I generally take bread, vegetables, berries, and milk. They have hams, pork, all sorts of meat, and things of that kind; but you know father does not wish me to eat meat; nor have I any particular relish for it. I sometimes eat a little fresh butter along with my brown bread; I suppose I would be just as well off without even that; I enjoy the bread, berries, and milk very much.

D.—Does food agree with you in the country?

P.—Generally very well.

D.—How do you feel after you get back to the city?

P.—Very well for a time.

M.—I guess you would think so, doctor. She acts like a perfect romp; there is no keeping her any where.

D.—It is natural for healthy girls to romp, as you call it. What would a boy be worth, if he were not allowed plenty of exercise? Girls must have their plays and sports, otherwise they will suffer in health. Thus you perceive when your daughter goes to the country, takes plenty of exercise, eats plain food, avoids excess in study, and lives mostly in the open air, she very soon becomes well. Some, perhaps, might tell you that all this is merely the result of a change; but, I ask, if it is merely a change that makes her so much better in the country, why does she not grow still better even when she changes back to the city? The truth is, it is not so much a change, as it is the healthful influence of air, exercise, diet, and freedom from excessive study, which work so great a benefit to her health. You perceive, also, it is not medicine your daughter needs. What has your family physician said about this?

M.—Well, be sure, Dr. K—— used to give a great deal of medicine, but lately he has changed; he says, in such cases it is not of much use. All he ordered was some iron pills, as he called them; and he did not seem to make much reckoning of these, either.

D.—I suppose not. He is an intelligent man—a man of great experience; and he knows well that all well-informed physicians have given up the idea of emmenogogues, or medicines, which have a specific effect to bring on the monthly periods. The pills of iron are supposed to be tonic; that is, they invigorate the system somewhat for the time being; but these, even, soon wear out. You have to take more and more of them, until at last they lose their effect altogether; and worse than that, they in the end become debilitating. That is the way with all medicines, not excepting even tonics. Physicians are in the habit of thinking that they must order something from the apothecary’s, even if it is nothing more than bread pills, colored a little, to make them look like medicine. They think they must do something, or else it would not be fair to charge for their visit. Medical men, you know, must live by their profession; and people have not been in the habit of thinking they must pay, unless the doctor does something. For my part, I think that physician deserves the most pay who does the least; that is, who will teach people to cure themselves, and to keep well without medicine.

Thus, you perceive, I advise your daughter to take no medicine. If there were any medicine in the wide world which I thought would do her the least permanent good, I would advise it; but I do not believe there is any such in her case. Correct her habits of life throughout, and then, in due time, nature will of herself make all right. I advise, then, a course something like the following: take your daughter at once from school, no matter if she loses a year from her books. She can practice music somewhat, the best of all her studies, except, perhaps, reading and writing her mother tongue; but I would not have her practice music too much; a half hour or an hour at a time, perseveringly employed, and this two or three times a day, would be sufficient. And if you choose to take up with my plain advice, let her try her hand at the bread-trough and wash-tub. She is getting to be quite along in her teens. Now let her imagine that she were to become the wife of some honest, intelligent countryman—a physician, merchant, or perhaps, best of all, a farmer—no matter what, so that he be a good, honest, industrious, and worthy young man. Suppose, now, that she really loved him, as I am sure she would, although he is not rich, but in moderate circumstances; now, I say, let her imagine that she is going to be a housewife, as well as wife; let her suppose that she is to make his bread, cook his food, clean his house, and do his washing, at least so far as her health would permit, never further; at least we will suppose that she is to understand all of these matters, and that she will habitually oversee them, and take some part therein—we cannot suppose that a house-servant, however good and faithful, will feel so deep an interest in so important a matter as making the family bread, as the wife would. As the wife loves the husband better than all the world besides, so she is the one who is naturally expected to take a deeper interest in all that pertains to his happiness and comfort, and general good. Now, I say, let your daughter practice all these things; for every good and intelligent young lady looks forward—and that with solicitude—to the day when she shall become a wife.

Let her imagine, then, if you please, that she is to be married, and that the husband of her choice is actually poor; and you know every wise and good parent will not ask their daughters, in forming connections of this kind, “Is he rich?” No; but rather, “Is he honest?”—“Is he respectable?”—“Do you love him?” That is all. Leave other matters all to herself. And then, another thing, riches, as we are told, often take wings, and fly away; so that it is better for every one to be independent, and know how to do for themselves. Let my daughter know how to make a living by teaching music, or painting, or drawing, or any thing that is useful and proper; but, first of all, let her know how to make her own clothes, her own bread, and do her own work. Teach these things first to your daughter, and then as much more of science and the fine arts as you can—the more the better, only do not let it interfere with health.

And now, if, in connection with what I have said, I were to advise your daughter a course of water-treatment, physiological treatment, or hygienic treatment, or whatever you please to call it; or what I consider actually best for her case, it would be something like the following: Let her take a packing-sheet, for twenty minutes, early on rising; then a good bath; then a walk, but not too much at first. Let her repeat the same process in the afternoon. Let her walk a great deal in the open air, that she may have the influence of air, the exercise, the light, and the mental impressions caused by a change of objects combined. Thus may she gradually regain her health. And let her, in connection with this, observe all good rules of which I have spoken.

There can be no doubt that retention and suppression of the menses often occur from precociousness—from precocious education and precocious habits. Parents are, I fear, too often in the habit of wishing that their daughters should become young women early. The daughters are often, no doubt, put forward a great deal too much. I have known numbers of instances where little girls, five, six, or seven years of age, have been sent to dancing schools; and are we to suppose that these early imitations of older persons have no injurious effects? True, children are fond of jumping, skipping, and dancing, in their own way; but this being sent regularly to a dancing master, and being allowed to dance with persons much older than themselves, and of the opposite sex, too, will no doubt have an effect in rendering them precocious. I have known such young girls often become very feeble in general health; and when severe disease attacks them they are found much less able to resist it than those who have not been reared in this doll-baby, fashionable style.

I do not deny that young girls should be allowed to indulge freely in their natural and healthful sports. The restraints of womanhood should not be put too soon or too strongly upon them; nor should their minds be overtaxed during the tender age. This is far too common a practice nowadays everywhere. If people but have the means, they seem to vie with each other in endeavoring to make their children precocious, so far as learning is concerned, while the physical training, which, before ten years of age, is far the most important, is almost wholly neglected. Chlorosis and other forms of amenorrhea are, beyond doubt, caused by these unnatural habits in which children are too often reared at the present day.

A sudden suppression of the menses is often caused by taking cold, as we say. A young woman is in the habit of being much confined within doors, and perhaps in poorly-ventilated and overheated rooms; she dresses too tightly, sleeps perhaps on a feather bed and feather pillow; she drinks freely of tea and coffee, as people generally do; eats superfine bread, gravies, flesh-meat, and other forms of stimulating food, and thus she becomes nervous, irritable, variable in her feelings, and highly susceptible to changes of temperature. Now, a young lady living in this manner is invited to an evening party. We will suppose it is in the fall or winter time. In dressing herself for the entertainment, she puts on her thinnest clothing, and in place of her firmer stockings and thick shoes, she puts on very thin and light ones. The party is continued late in the night, for hours beyond the usual bedtime; the room becomes overheated, and in consequence of the numbers present, the air is rendered very foul. At length refreshments are handed around, such as cakes, tea and coffee, nuts, and the like articles, and of these she partakes freely; and among the other excitements, she perhaps, before going home, engages in the dance; she becomes overheated, overexcited, and perhaps starts for home in a perspiration. She is certainly very liable, under such circumstances, to take a cold, which, in many instances, if it does not result in any thing worse, causes a sudden suppression of the menses.

EFFECTS OF DRUG-TREATMENT.

And now, to follow out our imaginary case, how is this young lady to be treated? Do not people generally set at work in such cases with hot drinks, hot baths, and, in short, the heating means generally? And what is the result of such treatment? If it be at all persevered in, the individual is rendered more weak. Such treatment may occasionally succeed; but any and every means of debilitating the system must necessarily render it more liable to a similar attack. But it is also to be observed that such treatment generally fails of its object, and thus, in the end, the patient is certain of being made worse for it.

How came this delusion? How does it happen that people are so much afraid of the cooling and tonic means? It is from a wrong understanding of the nature of the case. In the first place, a cold was taken. This is literally true; cold made a more powerful impression upon the system than it could bear at the time without harm. As a secondary effect, inflammation is the result. In all cases of acute, but sudden suppression of the menses, I conceive that there is more or less inflammation of the womb; and wherever there is inflammation, which always consists in increased heat, the natural discharge cannot go on. Now here, where there is a cold, as we say, which means heat and inflammation, should we apply hot things? Certainly not; but rather cold. And yet I would not use cold too much; never more than the individual can safely bear.

This, then, is the plain treatment for acute suppression of the menses: do all that may be in fortifying the general health of the individual.

If at any time there is shivering, or rigors, apply the rubbing wet-sheet, rubbing briskly over it, and then let the patient go and exercise in the open air. Let her bathe, at least daily, in water tepid, cool, or cold, accordingly as she can bear. A tepid-bath, that is, water from 70 to 80° Fah., is always cooling in effect, it being much cooler than the blood, which, in its natural state, is 98° Fah. She should also wear the wet girdle constantly, changing it at least four times in the twenty-four hours. She should walk out daily and often, but not too far at a time. She should, in short, pursue just such a course as we would in any similar case of debility; and, if necessary, take a full course of water-treatment, such as is suited to the particular case.

I am sorry that some of my younger friends of your sex are in the habit of checking the menstrual discharge for some particular object; but if they could know the great hazard they run in doing so, they would not, I hope, do it. Let me say a few words to them on this subject.

Frank mentions the case of a young lady who put her feet several times in cold water during the flow of her menses, because she expected her lover, which quickly arrested them. An inflammation of the womb followed, and she was brought dying into the hospital, at Vienna.

One of his relatives, of fine health and rare beauty, who, after dancing all night with her menses on her, left the ball-room in full perspiration; she would not wait for a carriage, but proceeded home, which was not far off. She was attacked with inflammation of the womb, and died on the fourth day.

Mr. Brown, a writer in the Edinburgh Medical and Surgical Journal, gives the case of a lady of about forty years of age. She had become very much heated by a long walk in hot weather. At the end of her walk, the menses appeared, but which were entirely suppressed by a drink of cold water. This was followed by headache, oppression, and amaurosis of the left eye. In about six months, Mr. Brown succeeded in restoring the menstrual discharge, at which time, also, her sight fortunately returned to her. The eyes are particularly liable to affections of this kind, arising from a sudden stoppage of the catamenial function; and some have been made blind for life in this way. I hope, therefore, that those for whom I write, both young and old of your sex, will hereby learn to be very cautious in regard to checking the monthly discharge. You see how dangerous it is, and how easy, by carelessness or design, it is to cause it. But, beware!

Shall I again speak of the water-treatment? If you bathe habitually every day; if you are careful to avoid overheated rooms, and becoming too fatigued; if you exercise daily in the open air, and keep yourselves actively engaged in some useful employment, you will have little to fear from the evils of which I have been speaking. But, after reading what I have said, if any of you will persist in taking such a course as will tend to the suppression of the catamenia, or, what is worse, if any of you should dare to put a check to this discharge, when it interferes with your pleasure or convenience, the evil must be upon yourselves, and not upon me. But I hope for better things of you, and that no one will be guilty of designedly or wantonly doing that which can only end in harm.