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.
LETTER VI.
OF MENSTRUATION.
Menorrhagia and Dysmenorrhea—Their Nature and Treatment.
In the present letter I propose giving you some thoughts concerning two
other forms of disordered menstruation—I refer to _menorrhagia_—an
immoderate flow of the menses, and _dysmenorrhea_, by which we
understand painful or difficult menstruation. There are few subjects
connected with health, which deserve more particular attention, or which
are of greater interest to you, than these of which I am now to speak.
Menorrhagia, from two Greek words signifying the menses and to break
out, implies, according to common acceptation, either an immoderate flow
of the menses, or uterine hemorrhage, which is often a very different
thing. It is generally characterized by pains in the loins, small of the
back, and abdomen, similar to those of labor. There is always a
preternatural flux of either blood or menstrual fluid from the vagina in
what is termed menorrhagia.
Dr. Cullen reckoned six varieties of this disease.
1. Menorrhagia rubra, or bloody menorrhagia, from women neither with
child nor in childbirth.
2. Menorrhagia alba, or white menorrhagia, which is, in other words,
leucorrhea, fluor albus, or the whites.