4. Menorrhagia lochialis, or lochial menorrhagia, from women after
childbirth.
5. Menorrhagia abortus, or menorrhagia with abortion.
6. Menorrhagia nabothi, when there is a serous or watery discharge from
the vagina in pregnant women.
I think it a better mode to treat of menorrhagia according to the
original signification of the term, namely, an immoderate flow of the
menses. I admit it must, from the nature of the case, be often
difficult—indeed impossible—to determine whether a case belongs really
to menorrhagia proper, or to hemorrhage from the womb. But the true
indications of treatment would be the same in either case, so that a
mistake in diagnosis would be of no manner of account in practice. I
shall, then, speak of menorrhagia as a separate and distinct disease. I
shall use the term simply as meaning an immoderate flow of the menses.
Leucorrhea, hemorrhages, abortions, and the lochial discharge, will be
spoken of separately. But I admit it must, after all, be a question,
whether in all cases of immoderate flow of the menses, there is not
actually hemorrhage. It is held by some, that the fluid, or discharge,
in menstruation, is never capable of forming clots; in short, that it is
in no sense common blood. But we know that in a great number of cases
clots are formed. If it is, therefore, true, as some assert, that the
menstrual fluid proper never coagulates, then, in all these cases to
which I have referred, there must be hemorrhage. I am of the opinion,
that the menstrual fluid is capable, in some cases at least, of
coagulating like common blood. For all practical purposes then, it will
be sufficient to understand by the term menorrhagia, all immoderate
menstruation that does not actually amount to a plain and palpable
hemorrhage.
Who are the persons that are most subject to menorrhagia? “Women who
live indolently and indulge in stimulating articles; who use little or
no exercise; who keep late hours; who dance inordinately; who are
intemperate; who have borne many children; who have been subject to
febrile affections; who have much leucorrhea; who are too prodigal of
the joys of wedlock; who are advancing toward the non-menstrual period;
who yield too readily to passions or emotions of the mind, are those,”
says a distinguished author, “most subject to menorrhagia; to which may
also be added, those women whose physical labors are too great, as well
as those who have too little labor, are also subject to this disease.”
Menorrhagia, like amenorrhea, indicates a deteriorated state of the
general health. A really healthy person can never have the disease,
except, possibly, under some peculiar circumstance, for a single time.
Real healthy persons, who have no natural impediments, always menstruate
regularly.
_Treatment._—The general indications of treatment will be inferred from
the character of the disease. Do every thing that may be to fortify and
invigorate the general health. Every thing that tends to this important
object, acts indirectly to effect a cure. This is the only rational
mode.
Daily and habitual bathing in water, tepid, cool, or cold, according to
the patient’s strength, is a means of wonderful advantage in this
disease. The fibers of the system are too lax, so to say; the vessels
open too readily, and thus an unnatural discharge takes place. Imagine
that you have walked a long way in a hot day: you find the veins of the
hands and feet swollen, heated, and enlarged. The tonicity of their
coats has become lessened. If a vein were opened under such
circumstances, the flowing of blood would be much more free than
ordinarily. Now if we wash these parts in which the veins are too much
enlarged, we find that the water immediately strengthens them. The
unnatural amount of blood is driven back, the vessels again assume their
normal condition. Here we find an evidence of the tonic effects of cold
water. Tepid water is also tonic, to a greater or less degree, because
always cooling. It is on this tonic principle that water acts so
favorably in excessive menstruation.
It is to be observed that in menorrhagia there is much less pain than in
the opposite state, namely, deficient menstruation.
DYSMENORRHEA.
I next speak of _dysmenorrhea_, or painful, difficult, or laborious
menstruation. This is not only a very common affection, but one of the
most painful to which females are subject. Many a woman has spent almost
her whole menstrual life with as much pain occurring at each menstrual
period, as though labor itself had been passed through. What untold
sufferings, alas! are women brought to endure in this disease. Can we
for a moment suppose that it is in accordance with the designs of a
benevolent Creator, that woman should thus suffer? I answer
unhesitatingly, it cannot be. Neither can reason, analogy, or the facts
of experience be brought to prove the contrary of my position.
The most prominent and distinctive feature of this disease is the pain.
This is experienced mostly in the loins. There may also be pains in the
uterus; pains, in short that resemble, both in character and severity,
those of actual labor. These become so severe and agonizing, in some
cases, as to cause the patient to faint. This affection is one in which
not only great suffering is experienced, but is also often one of great
obstinacy.
Dysmenorrhea may, for the sake of convenience, be divided into three
species:
1. The inflammatory; which occurs in persons of a full, plethoric, and
sanguine temperament.
2. The neuralgic; which occurs in persons of a highly excitable
temperament, and of a delicate habit of body; and,
3. Where there is a mechanical difficulty to the passage of the
menstrual fluid, as, for instance, a closed, or nearly-closed vagina,
and a too small opening of the womb.
Those suffering from the first species of the disease are such as are
generally too indolent in their habits, and partake too freely of rich
and gross articles of food.
The second variety of the disease is often caused by the too free use of
narcotics and stimulants, such as tea, coffee, opium, and, in some
cases, tobacco; though, to woman’s credit, it is to be said this last
article is not much used by them.
The third species may arise from some congenital impediment, or such as
existed from birth. In the treatment of this last, mechanical or
surgical means may, therefore, not unfrequently be resorted to with
benefit.
Females, whether married or single, appear to be equally subject to this
disease. In some cases, marriage appears to cure it; in other cases, it
would seem that it caused it.
A change of air, such as leaving a city to reside in the country; or
perhaps on the contrary, in some cases where persons remove from the
country to the city, the affection ceases.
_Effects of Pregnancy._—Pregnancy appears sometimes to break in upon the
disease, and cure it; but it is far oftener true, that females who
suffer from dysmenorrhea, are incapable of conceiving. Oftener, in this
disease, there is a too scanty flow of the menstrual discharge.
Sometimes, however, it commences with little or no discharge, but ends
in a very copious gushing forth of the menses, which brings entire
relief from the pain. “A membranous substance, or small coagulum, is
discharged; if it be a membranous substance it will be found of unequal
size, sometimes small, at other times large; and sometimes it resembles
the cavity from which it has been expelled; at other times it will be
broken into many fragments. After the expulsion of this substance, the
woman enjoys ease, unless there be a fresh production, in which case it
requires for its expulsion fresh contractile exertions of the uterus.”
Dr. Denman regarded the secretion of this membranous substance as a mark
of barrenness, and says that he never knew a female conceive, in whom it
was formed. This rule, doubtless, often holds true, but not always, as
observation proves.
_Causes._—The causes of this disease are plainly the same, or very
similar, to those which operate greatly to deteriorate the general
health. “It would perhaps be very difficult,” says Dr. Dewees, “to
assign all of its remote causes. The most common are the application of
cold during the flow of the menses; taking cold after abortion; and in
some instances it follows the beginning of marriage; but in other
instances the causes are so hidden as not to be cognizable; the married
and single are alike subject to it.”
_Treatment._—Immense mischief has been done in this disease by the
administration of powerful medicines. A disease so obstinate in its
nature as often to call forth the greatest endeavors on the part of the
physician to cure it, has been combated, in instances innumerable, by
the most potent drugs. Nor are these poor suffering patients backward
themselves to swallow any opiate, anodyne, or antispasmodic, however
powerful and however harmful it might prove to the general system, if
there is any prospect of obtaining present relief.
As this is one of the most painful affections to which human nature is
subject, I will enter particularly into a consideration of the means to
be employed to cure it. We may divide the treatment into two heads:
1. That which relates to the general health; and,
2. That which relates to the time in which pain is experienced.
As to the first of these considerations, all that I have said or can say
in these letters respecting the means and modes of improving the general
health and stamina of the system, should here be brought to mind. The
second of these indications, however—that of relieving pain—I will
endeavor to explain fully.
I must tell you that I have studied and practiced the healing art now a
considerable number of years. I have endeavored to learn the truth in
this important mission of healing the sick. I now, therefore, solemnly
declare to you, that in the whole range of the medical art, so far as I
have been able to learn it, I know of nothing that excites in my mind a
more lively interest, or a more thankful feeling toward the Author of
our being, than the adaptation of cold water as a means of relieving the
pain and agony which often attend the menstrual period. There is, if I
am a judge in this matter, nothing in the whole range of the materia
medica, no, nor in all drug substances combined, that can at all compare
with the power of this blessed element to assuage pain. But of this I
shall speak more, presently.
As a remedy in painful menstruation, Dr. Good recommends “the advantages
of traveling, change of air, and new stimulus given to both the mind and
body by novelty of scene, novelty of company, amusing and animating
conversation, and exercise of various kinds.” “With these,” continues
this author, “may also be combined, in the intervals of the menstrual
season, and particularly before the discharge has appeared, the use of
cold, and especially of sea-bathing.”
Thus it appears that Dr. Good himself entertained the erroneous notion
that cold bathing is a dangerous measure at the menstrual period. He
observes, however, that “an unnecessary apprehension of catching cold by
the employment of this powerful tonic has been entertained by many
practitioners;” that with proper care he had never known it occasion
this effect; and that it should only be relinquished when no reactive
glow succeeds to the chill produced by immersion, and the system is
hereby proved to be too debilitated for its use. But in the
water-treatment, as you all know, we are not obliged to resort to cold
immersion alone; the rubbing wet-sheet is a most excellent application
in those cases where the reactive or calorific force is at a low ebb. We
can also use tepid ablutions of various kinds with great advantage,
under such circumstances—great, not only as regards the patient’s
feelings of comfort and strength, but as to cleanliness, which is also
an important consideration.
As to the second indication of treatment in these cases, suppose the
pain is already upon you. You ask, “What are we to do?” I answer, there
are many things, among which are the following:
The _rubbing wet-sheet_, with a good deal of rubbing and faithfully
applied—many times in the whole day if you find need—is one of the best
applications.
The _wet girdle_, likewise, should be kept constantly about the body,
and changed as often as the pain requires. Wet compresses about the
thighs and below the knees, or about the calves of the legs, are also
useful.
The _sitting-bath_, cold, and sometimes alternating with warm, is also
to be employed. If, at the same time, some one rubs the back well with
the wet hand, the relief will be more speedy. In very bad cases, when
the pain amounts really to a great agony, sitting in a wash-tub, with a
couple of pails of cold water in it, at the same time having two or more
persons to aid in rubbing the whole surface, if properly persevered in,
must sooner or later quell the pain. Possibly, in some cases, it might
require an hour or more to effect the desired object. If the patient
becomes too much fatigued to continue the half-bath a long time, she can
recline in a folded wet-sheet to rest herself, and then afterward
proceed again to the bath. Frictions with the wet hand upon the surface,
generally have great effect in assuaging pain in these cases.
The _folded wet-sheet_, that is, a common double sheet of linen,
although cotton answers tolerably well, folded once each way, half of it
being wet, and applied about the trunk of the body from the arms
downward, is a very soothing application in these cases. Applied in this
way, two thicknesses of the sheet next to the surface are wet, and the
two outer thicknesses are dry. This is a very convenient application,
and one great advantage in using a sheet in this way is, that we can
open it in front of the body and rewet it, by sprinkling water upon it,
without the patient being obliged to rise. If she is able to get up at
the time of rewetting the sheet, it is better to do so; but if she is
not, it can be done without. A patient may remain many hours in this
folded sheet if there is need, a whole night, for example; but she
should not allow herself to become too warm in it, as that would weaken
the body. According to the season of the year, it should be rewet more
or less often, and the patient should have more or less covering as she
may feel a need.
The _clyster_ is also a great help in subduing pain in the womb and
back. The tepid, or lukewarm, as a general thing, answers best. We use,
sometimes, gallons in succession, until the object is brought about.
The _foot-bath_ is likewise a useful remedy. If the feet are cold, they
should be put in warm water, the old-fashioned way; but if otherwise,
cold answers the purpose best.
Now, it may occur to you, that this kind of treatment, which is so
opposed to the old notions, is to be considered as a dangerous one. You
know how afraid women are of cold under such circumstances, and how
dangerous it is, in fact, to chill the body at certain times. But
remember I am speaking of extreme cases of _pain_. Cold does not injure
the body at such times; but, on the contrary, does a great amount of
good. You know that if the discharge gets well started in these cases,
the pain ceases. Now the cold, instead of checking the discharge, does
actually help it to come. The pain, the undue heat in the uterus, the
inflammation, as it might almost be styled, is the cause of the
discharge not appearing. The application of cold puts a stop to this
pain and undue heat, and thus the discharge is helped to come forward.
You will, then, perceive that cold, under circumstances of fatigue and
exhaustion, must have a very different effect from what it does when the
body is in great pain. In the former case it is highly dangerous; in the
latter, highly useful.
But good as cold water is to relieve pain, do not, I beseech you,
neglect the means of restoring the general health under these
circumstances. It is very foolish, as well as inconsistent, to allow
yourselves to go on in habits which your own better judgment must tell
you, can only tend to make you worse at the menstrual period. Do not
think, that because you have so good a remedy as cold water always at
hand, that you can do as you like in regard to self-indulgence.
LETTER VII.
SIGNS OF PREGNANCY.
Importance of the Subject—Difficulties of ascertaining Pregnancy in some
Cases—Means by which it is to be Known.
There are some circumstances in which a knowledge of the signs of
pregnancy is of very great importance. Dr. Rigby informs us that “there
are numerous cases on record where a false diagnosis in women convicted
of capital offenses, has led to the most lamentable results, and where
dissection of the body after death has shown that she was pregnant.”
Baudelocque, a French writer on the subject, relates the case of a
French countess, who was imprisoned during the Revolution, in
consequence of being accused of carrying on a treasonable correspondence
with her husband, an emigrant. She was ordered to be examined by two of
the best midwives in Paris, and they declared her not pregnant. She was
accordingly beheaded upon the guillotine, and her body taken to the
School of Anatomy, where it was opened by Baudelocque, who found twins
in the fifth month of pregnancy.
A great many mistakes of this kind have been made, first and last, in
the medical world. Not many months ago, in this city, two eminent
practitioners—one of them in particular being one of the most celebrated
in the world—had a patient whom it was declared had an internal tumor,
from which it would not be possible for her to recover. The physician
who attended principally in the case, went often to visit the lady, _to
crowd up the tumor_, as it was called. After a time the physician was
sent for early in the morning, to visit the case, as the lady was
suffering a good deal of pain. He said he would make it his first visit
to see her. On arriving, what must have been his surprise to find his
patient already delivered of a fine boy!
The signs of pregnancy, that are very difficult to understand; or, in
other words, to ascertain whether a woman is really pregnant in a given
case, may be a very difficult matter, if not absolutely an impossible
one.
You will agree with me, I am confident, that the old custom of
impanneling a jury of twelve matrons, where a court of justice wished to
ascertain whether a woman was quick with child or not, was not a good
one. If the most experienced physicians and midwives are liable to great
mistakes in these matters, how much more so those who have paid little
attention to the subject.
But it is my purpose in the present letter to speak of the ordinary
signs, changes, and appearances which will usually be found to be
accompaniments of this state; and that you will feel a deep interest in
the subject, I am already fully aware.
Suppression of the menses, as you well know, is not necessarily a sign
of pregnancy. As a rule to which there can be but few exceptions,
menstruation and pregnancy do not go on together. Indeed, many writers
contend that there can never be menstruation in connection with
fecundity. Others assert the contrary. But the rule is, pregnancy and
menstruation cannot be present at the same time. But, as we have seen
elsewhere, there is often suppression of the menses from various other
causes than the one we are now considering.
Nausea, and vomiting in the morning, constitute one of the most common
signs of pregnancy; but it is to be remembered also, that, in a
considerable proportion of cases, no stomach-sickness, whatever, is
experienced. On the other hand, likewise, many persons have nausea and
vomiting arising from other causes than pregnancy.
If the child dies in the mother’s womb, it is believed that nausea and
vomiting, for the most part, cease immediately.
An irritable state of the stomach is one of the most common symptoms in
the early part of this period. The breasts often, at first, grow
smaller; after two or three months, they enlarge, and sometimes become
painful. A fluid, somewhat resembling milk, only more watery, is not
unfrequently observed to ooze from these parts during the early months
of gestation. The nipple is seen to be surrounded by a brownish circle;
this is at least true in many cases. In the beginning of pregnancy, the
abdomen does not necessarily grow larger, as might at first be supposed.
Indeed, good authorities assert, that in the commencement of the period,
it becomes rather flatter than formerly; and that when it does first
increase in size, it is rather from inflation of the bowels,
particularly the colon, than from expansion of the uterus. An
enlargement of the abdomen may arise from such a variety of causes as
the obstruction of the menses, dropsy, diseases of the ovaries, or of
the womb. This sign must necessarily always be looked upon with caution,
especially in those cases where there is a strong desire for progeny.
I remarked that a fluid resembling milk, is sometimes one of the signs
of pregnancy. When this secretion takes place, it is looked upon by many
of those who are not well-informed on the subject, as being a certain
sign of this state. But it should be remembered, that not unfrequently
when the menses cease from some other cause than that of pregnancy, a
milky fluid is secreted in the breast. This has been known, likewise, to
take place in women who had passed the child-bearing period, in young
girls and infants, and even in men. Dr. Dewees gives us a case which is
well calculated to impress upon us how careful we should be in forming
our judgment in cases of this kind. It is as follows:
“I once knew a considerable quantity of milk form in the breasts of a
lady, who, though she had been married a number of years, had never been
pregnant, but who, at this time, had been two years separated from her
husband. She mentioned the fact of having milk to a female friend, who,
from an impression that it augured pregnancy, told it to another friend,
as a great secret, who, in her turn, mentioned it to another friend; and
thus, after having enlisted fifteen or twenty to help them keep the
secret, it got to the ears of the lady’s brother. His surprise was only
equalled by his rage; and in a paroxysm he accused his sister, in the
most violent and indelicate terms, of incontinency, and menaced her with
the most direful vengeance.
“The lady, conscious of her innocence, desired that I should be sent for
forthwith, and insisted her brother should not leave the room until I
arrived. Some time elapsed before this could be accomplished, as we were
several miles from each other, during the yellow fever of 1798. During
the whole of this time she bore his threats and revilings with almost
exemplary patience and silence. I at length arrived; and, in the
presence of the brother and a female friend, she informed me of what I
have just stated, and said, her object in sending for me was, to submit
to such an examination as I might judge proper to determine whether she
were pregnant or not. She would not permit her brother to leave the
chamber, and I conducted the examination without his withdrawing. This
thing turned out as I had anticipated, from the history given at the
moment, of her previous health. I pronounced her not pregnant; and she
died in about eight months after of pulmonary consumption, in which
disease obstruction of the catamenia is not an unfrequent occurrence.”