Part 4

In no instance which has come under my knowledge, where the hemorrhage was in consequence of a laxity of the uterine vessels, have these pills failed in producing the desired effect.

In those cases where the hemorrhage is profuse, or of long continuance, and resists the means already pointed out, it will be proper to inject into the uterus from a gill to half a pint of a strong decoction of oak bark, in which one or two drachms of alum have been dissolved, or as much of the saturated solution of alum in water, in order to constringe and strengthen the vessels of the womb. This may be repeated twice or thrice a day, according to circumstances.

When symptoms of an increased action in the vessels of the womb are observable, the tincture of foxglove, in doses of twenty drops every four hours, constitutes the best remedy.

When there is reason to suppose the hemorrhage proceeds from a scirrhous or ulcerated state of the womb, all that can be done, is to afford temporary relief by giving opium in large doses. Indeed, opiates may be given with advantage in every case where there is considerable pain or anxiety, and the patient much exhausted. Under these circumstances, from one to two teaspoonfuls of laudanum, or from two to four grains of opium, according to the urgency of the case, will be useful not only in giving a check to the discharge, but also in preserving the strength, and abating nervous irritation. In most cases it is preferable to give opium in the form of injections to allay the spasmodic pains of the womb; and, when administered in this way, clysters of thin starch or gruel, in each of which two teaspoonfuls of laudanum are added, should be given every two hours until relief be obtained. (See Abortion and Flooding.)

Regimen.

The diet, at the time of excessive discharge, must be light and cool. The drink must always be cold, as ice-water, lemonade, or tamarind beverage. Port wine, in such cases, is too frequently resorted to, which uniformly does harm by increasing the circulation.

Prevention.

To prevent a recurrence of the attack in those who are subject to it, the patient must necessarily avoid the causes by which it has been produced.

When it is evident that the discharge is in consequence of a full habit, it will be proper to reduce the system by living sparingly, by keeping the bowels rather in a laxative state, and by rising early, and taking through the day regular but frequent exercise; and, after the plethora is removed, by strengthening the vessels which have been over-distended, by the use of the cold bath.

In a greater number of cases, however, we meet with a delicate constitution and spare habit, with pale countenance: this state requires the use of sea bathing or the shower bath, and the vessels of the womb are particularly strengthened by pouring cold water daily on the back and loins.

It will be advisable to use a generous nutritive diet, with wine, and to have recourse to some of the tonic medicines, as advised under the head of obstructed menses, to strengthen the system generally. At the same time the bowels must be attended to, and invigorating exercise taken daily; whilst on the other hand, fatigue, and especially exposure to relaxing heat, must be carefully avoided.

DECLINE OF THE MENSES.

The nearer a woman approaches her forty-fifth year (cæteris paribus), will be the risk of some irregularity in the menses; and as this period is more frequently the one at which any latent disease of the uterus shows itself, it is always looked forward to with much anxiety by women. Indeed, so replete is this time with horrors to many, that we may very justly suspect apprehension to be the cause of some of the distressing symptoms, which sometimes accompany this interesting process of the human uterus.

Delicate women, and especially those who have lived idly, have this period of life arrive earlier than those of a contrary constitution, and opposite habits. We have already noticed, in our section on Suppression, that this change sometimes takes place at a very early period of life, and this without leaving any injurious consequences behind it; and, on the other hand, we find many cases on record, where this discharge had continued with regularity to a much longer period than the ordinary one. Gardien mentions a case which fell under his own notice, where this evacuation continued with great exactness, until beyond the seventy-fifth year; others, still more uncommon, are mentioned by various writers.

This change is sometimes effected so silently, that the woman scarcely notices her altered condition; at others, its approach is so gradual, as not to attract observation, until the diminished quantity gives warning that it is about to take its leave for ever; while, again, the irregularity, both in period and quantity, may be such, as justly to give alarm, as well as to produce the most serious danger.

But, as a general rule, it may be observed, that when the woman arrives at about her forty-fifth year, she finds her menses to become irregular, both in the quantity of fluid evacuated, and in the periods they observe; being sometimes in advance, and at others, not appearing until long after the accustomed time. The woman also finds some alteration has taken place in her general health; she becomes pale, debilitated, and nervous; arising, however, for the most part, from the too frequent returns of this discharge, or its too great abundance.

At this time, also, the woman sometimes becomes the victim of a strange illusion, should the menses not have returned for several periods; for she now supposes herself to be pregnant, as her abdomen enlarges, as do the mammæ; her appetite becomes capricious, or she has strange longings, &c., the whole of the rational signs of this condition being present, in her imagination, even to the motion of the child. This delusion is most common to women who marry late in life, and who are very desirous of offspring. Now the breasts lose their intumescency; the morning sickness vanishes; the swelling of the abdomen subsides; the imagined stirrings of the fœtus cease, or the sensation becomes so unequivocal as to satisfy that it arises from the movement of wind; and, to put everything beyond hope, the menses return in overwhelming quantity. It is highly proper, that practitioners, and especially the younger part of them, should be put upon their guard in respect to this condition of the patient, and not too easily yield credence to all her wishes may dictate, or absolutely to treat as an impossibility, a circumstance of which there is occasionally an example.

It seems that the apprehensions of this period of life have arisen mainly from the notions entertained of the final cause of the menses; namely, that it gives vent to peccant humours. But females should be made to know, that all this is purely the theory of the vulgar; as the menstrual blood is formed from the general mass; and, consequently, if that be pure, the other will be; therefore, the idea is altogether ill-founded. But unfortunately, whenever this discharge is less abundant than usual, the most serious fears are entertained, that there will be a retention of a portion, which will cause disease, either in the uterus itself, or in some other part of the body; hence, a diminished menstruous secretion is always more alarming to the female, than an unusual flow. But it may be well to remark, that there is a great difference between the cessation of this discharge, and the suppression of it. In the one instance, it is an event which nature has designed should take place, and is effected altogether by arrangements of the system itself; and, of course, one of its natural processes: in a word, as much so as its commencement; but the suppression, from some morbid agency, is in direct opposition to the intentions of nature, and will, of course, be followed by some baleful consequence, if it continue beyond a certain period.

The vulgar error, that “women at this period of life are always in danger,” is replete with mischief to the suffering sex; and I feel it a duty to declare, that they are not necessarily more obnoxious to disease at this, than at any other period of their existence. That they are sometimes liable to a disease at this time; and that disease one of the most terrible in the long list of human infirmities, I admit; but must, nevertheless, insist that Cancer (the disease to which I allude, and the one so much dreaded) is more rare in the uterus than in certain other portions of the body; for instance, the mammæ; and, perhaps, I am within the truth, when I say, that there are three instances of the latter for one of the former. If latent dispositions to disease, either in the uterus or other parts, become active about this period of life, it is not because the declining menses excite them; but because the disease is slow in developing itself, and is, perhaps, kept in check for a long time, by the menstrual discharge serving as an important evacuation; especially when the uterus may be the seat of the complaint. In such instances, the foundation of the disease was laid, perhaps, at the time when the menses were the most perfect, as regards period and quantity; consequently, they could have had no agency in its production; but, on the contrary, from its frequently relieving the engorgement of the vessels, served to keep it in subjection for a long time; not as a specific discharge, but as a mere depletion; or, in other words, that if an equal quantity of blood could have been by any other means as certainly abstracted from the uterus, the same favorable result would have followed. Coincidences in the human system are so common, that they are frequently mistaken for cause and effect; hence the cessation of the menstrual discharge, and the appearance of scirrhi and cancers, are considered as cause and effect.

At this period of life, nothing will so effectually secure the woman against injuries which may arise from the irregularities of the menstrual discharge, as a well-regulated regimen. By regimen, in this place, we would wish to be understood, not only eating and drinking, but exercise of both body and mind, including the proper government of the passions; in a word, everything which relates to both moral and physical existence.

A well-ordered course of exercise in the open air in well-selected weather, and great simplicity of diet, is of the utmost importance to the female at this period of life, and should never be neglected, if it be possible to indulge in them. By these means, the nervous, muscular, vascular, and lymphatic systems are all preserved more certainly in equilibrium with each other, since they are the best calculated to ensure a reciprocation of their respective offices; and, consequently, to maintain that condition of the system, termed health. Hence, the justness of the remark, that the women who live in the country, and who exercise freely in the open air; who have fulfilled their duties scrupulously as mothers, by suckling their children, agreeably to the views of nature; who do not goad their systems by over-stimulating food and drinks; who do not relax their bodies by too long indulgence in bed, have but little suffering at this period.

From this it will follow, that a milk and vegetable diet, together with pure water as a drink; regular exercise, not carried to fatigue; keeping the bowels well open, by well-selected food, as the fruits of the season in proper quantities: the bran bread if necessary; but not by medicine, unless absolutely required; governing the temper; restraining the passions, as well mental as animal, will largely contribute to the safety and comfort of this period. All that we have just recommended, is calculated to place the system in a condition by which it shall preserve its various forces; have its irritability diminished; its sensibility moderated; and pretty certainly prevent that condition of the blood-vessels, most decidedly unfriendly to the general health at this time, called plethora. And, though last, not least in fair estimation, is an attention to cleanliness. The external organs should be washed with lukewarm water at least twice a day, and the whole body once a week, by going into a lukewarm bath. In using the bath, care should be taken to come out of it as soon as the purposes of cleanliness are answered.

Our next concern is with the derangement of the discharge at or about the period of cessation: this will consist, 1st, in a diminution of the proper quantity; and, 2dly, in an excess of it. As regards the first, we have already said enough when treating of the suppression of the menses; and, with respect to the second, it must be treated according to the rules prescribed for the management of hemorrhage from the uterus from any other cause, that is, first, to diminish the quantity discharging; secondly, to prevent an excessive return.

CONCEPTION; OR, PREGNANCY.

CONCEPTION.

In order to procreate the human species, there is a periodical discharge of blood from the vagina of every female, termed the catamenia, or menses. The secretion of this fluid commences at that period of life termed puberty, which occurs at different ages, according to the climate. In some latitudes it commences as early as eight or ten, and in others not until fifteen. As soon as conception or pregnancy commences, this discharge ceases, and goes to support the fœtus, or the child.

The manner in which conception takes place has ever been a fruitful subject of inquiry, but we are unable to account for this change precisely. It is, however, pretty evident that the semen of the male is introduced into the uterus, while the semen of the female is discharged from the ovaria by means of the Fallopian tubes, the fimbricated extremity of which closely embraces that organ.

These tubes, by a kind of peristaltic motion similar to the intestines, convey the semen of the female into the uterus, where it unites with the semen of the male; and it is these united fluids which constitute the rudiment of the fœtus, and which often give to the child the appearance and dispositions of their parents. Sometimes one trait is inherited, sometimes another; at other times a new compound or character is formed (like a chemical union), which does not partake of the nature of either of the former.