Part 3

Treatment.

As this disease proceeds from debility, it is evident that the great object to be fulfilled will be to give tone and energy to the system; and if this debility has arisen from a sedentary life, the patient must begin immediately to exercise in the open air, and, if practicable, to change her residence. The tepid or warm bath should be used in preference to the cold. The first medicine given may be the pulverized mandrake root, combined with a little cream of tartar. This, as well as other medicines, should be taken upon an empty stomach: after it has been given, motherwort, pennyroyal, and other herb teas may be freely drunk. After the exhibition of the purgative, which may be occasionally repeated, gum aloes may be taken, combined in such a manner as to prevent the piles. This medicine, from its action upon the uterus through the medium of the rectum, is very useful in retention of the menses. Emmenagogues, or “forcing medicines,” should not be used to bring on the menses, except there be a struggle or effort of nature to effect it, which may be known by the periodical pains and pressing down about the hips and loins. When this occurs let the feet be bathed, and perspiration promoted, by drinking freely of diluent teas, such as pennyroyal, motherwort, and garden thyme. Should considerable pains attend the complaint, eight or ten grains of the diaphoretic powders may be given, and fomentations of bitter herbs applied over the region of the womb. Desomeaux’s Portuguese Pills are now recommended as the best specific, especially if the disease proves obstinate.

The female should be very careful not to expose herself to the vicissitudes of the weather, and not suffer the feet or clothes to become wet: warm clothing must be worn, and particularly flannel. For pain apply a heated brick, covered, to the bowels.

The diet should be light, nutritious, and easy of digestion.

SUPPRESSION OF THE MENSES.

Description.

In this disease there is a partial or total obstruction of the menses in women from other causes than pregnancy and old age. The menses should be regular as to the quantity and quality; that this discharge should observe the monthly period, is essential to health. When it is obstructed, nature makes her efforts to obtain for it some other outlet; if these efforts of nature fail, the consequence may be, fever, pulmonic diseases, spasmodic affections, hysteria, epilepsy, mania, apoplexy, green sickness, according to the general habit and disposition of the patient. Any interruption occurring after the menses have once been established in their regular course, except when occasioned by conception, is always to be considered as a case of suppression. A constriction of the extreme vessels, arising from accidental events, such as cold, anxiety of mind, fear, inactivity of body, irregularities of diet, putting on damp clothes, the frequent use of acids and other sedatives, &c., is the cause which evidently produces a suppression of the menses. This shows the necessity for certain cautions and attentions during the discharge. In some few cases it appears as a symptom of other diseases, and particularly of general debility in the system, showing a want of due action of the vessels. When the menses have been suppressed for any considerable length of time, it not unfrequently happens that the blood which should have passed off by the uterus, being determined more copiously and forcibly to other parts, gives rise to hemorrhages; hence it is frequently poured out from the nose, stomach, lungs, and other parts, in such cases. At first, however, febrile or inflammatory symptoms appear, the pulse is hard and frequent, the skin hot, and there is a severe pain in the head, back, and loins. Besides, the patient is likewise much troubled with costiveness, colic pains, and dyspeptic and hysteric symptoms.

Treatment.

It will be necessary, in the treatment of this disease, to remove urgent symptoms if they are present. If the patient is in severe pain, give the diaphoretic powders, and at the same time let a strong infusion of garden thyme and pennyroyal be freely given. Immerse the feet in warm lye water, and rub well with coarse flannel. If relief is not obtained in the course of an hour, or in a very short time, a strong decoction of bitter herbs should be thrown into a proper vessel, and the patient steamed fifteen or twenty times, as long as she is able to bear, or until perspiration is produced; immediately after which let her be put in bed, covered warm, and the herbs be enclosed in flannel or muslin, and applied to the lower part of the abdomen or belly. This process will almost immediately relieve the urgent symptoms. After this our next object will be, to regulate the menstrual discharge, by a proper course of strengthening medicine; that recommended under the head of chlorosis, or a retention of the menses, may be taken with advantage. Inasmuch as both proceed from debility, it is evident that it must be removed in order to effect a cure; and, therefore, that medicine and treatment which strengthen and invigorate the system, will invariably benefit the patient. The skin, stomach, and intestines, all seem concerned in the production of this disease, and hence our attention should be directed to a restoration of their proper offices: the stomach and bowels should be cleansed and stimulated to a healthy action; perspiration must be promoted, and, in short, every secretion and excretion of the system. If the stomach is in a morbid condition, let an emetic be occasionally given, and afterwards a dose of mandrake; both of which may be repeated as occasion requires. The patient may then take the following tonic bitters: Take prickly ash bark, two ounces; wild cherry tree bark, two ounces; Seneca snake-root, one ounce; tansy, one ounce; gum socotrine aloes, half an ounce; devil’s bit, two ounces: pulverize; to every two ounces of the powder add half a pint of boiling water and one quart of Holland gin, and half a wineglassful taken three or four times a day. This may be continued while it agrees with the patient, or as long as benefit is derived. About once a month there will generally be felt more or less symptoms preceding a catamenial discharge; considerable pain will be felt through the lower part of the abdomen, hips, and loins, showing that there is a strong effort or struggle of nature to return the menses. Our principal object, when this occurs, should be, to aid her salutary efforts, as directed in the Retention of the Menses. The patient should sit over the steam of bitter herbs for ten or fifteen minutes, retaining the steam by means of a blanket, to concentrate it upon the lower part of the body; at the same time the feet may be bathed, and tansy tea freely drunk. The abdomen should also be fomented, as before directed. It will not be necessary, however, to use these means, except there is an obvious indication to return the menses.

It must be recollected that when the patient labors under some other disease, there is such debility that there is not superfluous blood sufficient to keep up the menstrual discharge; and in this case our attention must be directed to the primary affection, without any regard to such symptoms; it is also very necessary to bear in mind the fact, that the menses are often suppressed from pregnancy. By a proper attention, we can always discriminate between a suppression of the menses and pregnancy; and the principal diagnostic symptom is, that in the former complaint there is a pain or affection of the head, attended with dizziness.

PAINFUL AND IMPERFECT MENSTRUATION.

Description.

Besides the two deviations from the usual course of nature already mentioned, there sometimes occurs a third, viz. where menstruation, although not wholly suppressed, is nevertheless somewhat difficult, and accompanied with severe pains in the back, loins, and bottom of the belly. This disease is owing to a weak action of the vessels of the uterus, or spasm of its extreme vessels, and is to be obviated by tonics, warm bathing, both local and general, together with the use of anodynes, which should be employed as soon as the symptoms which denote its approach are apparent. This complaint is a common, and generally an extremely harassing, affection. It may occur at every period during the menstruation stage of life; but it appears to be most common between the twentieth and thirtieth years of age, and in subjects of an irritable and sanguineous temperament. In many instances severe pains are experienced in the back, loins, and lower part of the abdomen for five or six hours previous to the appearance of the menses. This, however, soon ceases, and an immediate aggravation of the torturing pain follows. Sometimes the catamenia begin to flow moderately, with little or no previous pains; but in an hour or two, they become suddenly arrested, at the same time that violent pains come on in the hips, side, loins, back, and thighs, with a distressing sensation of forcing or bearing down. Occasionally a very slight menstrual discharge continues uninterruptedly for three or four days, accompanied throughout with extremely severe pains in the abdomen; and in some rare instances the catamenial evacuation, although attended with great suffering, is sufficiently copious and prolonged in its course, and may even exceed the regular duration and quantity of an ordinary healthy menstruation.

Treatment.

Since it is well known that a derangement in the uterine functions must generally proceed from a check of perspiration, astringing the minute ends of the uterine vessels, or in some manner deranging their functions, causing debility, &c., it will appear clear that our first attention must be directed to the skin. Cold appears to be the cause of the disease, and heat seems to remove it; therefore, when these periods of distress occur, let the patient sit over a strong decoction of bitter herbs, such as tansy, hoarhound, wormwood, catnip and hops, while a blanket is thrown round the waist of the patient to confine the steam to the lower parts. After the diseased person has been thus steamed and the feet bathed, let her be put into a bed, warmly covered, and diluent drinks given, such as tansy, thyme, pennyroyal, &c. At the same time let fomentations of the same herbs, enclosed in a flannel bag, be applied to the abdomen, as before directed. This will produce perspiration and afford immediate relief; and when these distressing symptoms are removed, and the patient becomes comfortable, a course of treatment must be adopted to prevent a recurrence of these symptoms, or to produce a natural flow of the catamenial discharge; and similar to that recommended under the preceding complaints. Herbs may be freely drunk.

A writer on this subject thus remarks, “This case of painful menstruation deserves particular attention, because it impairs the health of patients by its present effects, and seems to render them less prolific in future. Dr. Fothergill has afforded relief to several by the following process: Let the patient have near her a few pills, consisting of opium, gr. i. each, made soft with a little of any kind of conserve. She is to take one of these pills the moment the pain attending this discharge comes on. A pill may be taken every hour till the pain ceases: more than two will seldom be required; yet they must be taken in quantities sufficient to mitigate the pain. Let the patient keep either in or upon the bed, or at least in a recumbent posture, drink moderately of any diluting liquor, as herb teas, weak whey, or thin broth. When the time is past, a course of chalybeate bitters, in small doses, may be continued, till within a few days of the return; and the bowels should be kept open with some proper laxative. This excruciating pain seems to be spasmodic, and to proceed from the extreme irritability of the uterine system.” The diaphoretic powders will be found very useful. Diet and exercise are important. A hot brick or salt, enclosed in flannel wet with vinegar, and applied to the bowels, soon relieves the pain.

IMMODERATE FLOW OF THE MENSES.

This alarming complaint may occur under two different states of the constitution. In the one, the woman is of full habit, and often of a ruddy countenance. In the other, she is pale, delicate, and easily fatigued.

Symptoms.

In plethoric habits it is often preceded by headache, giddiness, or difficult breathing, and is afterwards attended with pain in the back and loins, universal heat, and a frequent, strong, and hard pulse. But when it arises from general debility, or in consequence of a laxity of the organ, paleness of the face, chilliness, lassitude of the body, oppressed breathing on the slightest effort, pains in the back on remaining any length of time in an erect posture, and coldness of the extremities, together with a long train of nervous complaints.

Causes.

A variety of causes may produce this troublesome disease. Some of these are general, such as a state of great weakness, or of too much blood; others are local, such as debility of the uterus, occasioned by tedious labor or frequent miscarriages. It may also be produced by accidental circumstances determining the blood more copiously and forcibly into the uterine vessels, as violent exercise in dancing, much straining at stool from great costiveness, contusion on the belly, excess in venery, or strong passions of the mind, particularly at the menstrual period.

Treatment.

In the management of this disease we have two objects: first, to moderate the discharge and procure present security; and, secondly, to prevent a return.

The first thing to be done when the hemorrhage is sudden or profuse, is instantly to remove the clothing which may occasion the least interruption to the free circulation of the blood, and to put the patient to bed, lightly covered with clothes. So long as this discharge continues, it is of importance to keep her in a recumbent posture, as cool as possible, and perfectly at rest, both in body and mind. Cloths, dipped in cold vinegar and water, and renewed as often as they become warm. These cold applications have a powerful effect in restraining uterine hemorrhage, and ought never to be omitted where the discharge of blood is profuse.

If the patient be of a full habit, attended with severe pain in the head or back, and febrile symptoms, it will be proper to give the antimonial, or febrifuge powders, or mixture.

The state of the belly must be attended to. It can be kept gently open by the cathartic mixture, sulphur, or any mild laxative medicine. Stimulating purgatives or clysters, under such circumstances, are improper, from their tendency to increase the discharge.

When no symptoms indicating an increased action in the vessels of the womb are present, astringent medicines should be employed. And, in cases where the discharges have not continued long, and the strength not much impaired, it is often sufficient to arrest the disease by giving fifteen or twenty drops of elixir vitriol, or six or eight grains of alum dissolved in a glass of cold water every hour; or, what is preferable, alum whey, sweetened to the taste, in doses of a small cupful, as often as the stomach will receive it. But, if the discharge be obstinate, we should have recourse to pills of sugar of lead and opium.