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.[5]
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.[6]
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.