MENSTRUATION.
Though this is not a disease, but a healthy function, and as, from
various causes, derangement of the function occurs, it is proper that
it should be perfectly understood. Menstruation is the term applied to
the phenomenon that attends the rupture of what is called the
_Graafian follicles_ of the ovaries and the discharge of an ova, or
egg. It is a bloody discharge from the female genitals; not differing
from ordinary blood, excepting that it does not coagulate, and in its
peculiar odor. The blood comes from the capillaries of the womb and
vagina.
MENOPHANIA, OR THE FIRST APPEARANCE
of the menses, is usually preceded by a discharge of a fluid whitish
matter from the vagina, by nervous excitement, and by vague pains and
heaviness in the loins and thighs, numbness of the limbs, and swelling
and hardness of the breasts. The first appearance is an evidence of
capacity for conception. It generally appears about the age of
fourteen, but varies from nine to twenty-four years. In warm climates
women begin to menstruate earlier and cease sooner than in temperate
regions; in the cold climates the reverse of this holds as a general
rule. The manifestations of approaching puberty are seen in the
development of the breasts, the expansion of the hips, the rounded
contour of the body and limbs, appearance of the purely feminine
figure, development of the voice, and the child becomes reserved and
exchanges her plays for the pursuits of womanhood.
More or less indisposition and irritability also precede each
successive recurrence of the menstrual flux, such as headache,
lassitude, uneasiness, pain in back, loins, etc. The periods succeed
each other usually about every twenty-eight days, although it may
occur every twenty-two, twenty, eighteen, fifteen, or thirty-two,
thirty-five, or forty days. The most important element is the
regularity of the return. In temperate climates each menstrual period
ordinarily continues from three to six days, and the quantity lost
from four to eight ounces. The menses continue to flow from the period
of puberty till the age of forty-five or fifty. At the time of its
natural cessation the flow becomes irregular, and this irregularity is
accompanied occasionally by symptoms of dropsy, glandular swellings,
etc., constituting the _critical period_, _turn_ or _change of life_;
yet it does not appear that mortality is increased by it, as vital
statistics show that more men die between forty and fifty than women.
It should be the
DUTY OF EVERY MOTHER
or female in charge of a child in whom age or actual manifestations
suggest the approach of puberty to acquaint her with the nature of her
visitation and the importance of her conduct in regard to it. She
should be taught that it is perfectly natural to all females at a
certain period, and that its arrival necessitates caution on her part
with regard to exposure to wet or cold. The author has made the
acquaintance of the history of many cases of consumption and other
diseases which were directly induced by folly and ignorance at the
first menstrual flow. The child is often kept in extreme ignorance of
the liability of womanhood occurring to her at a certain age, and,
hence, when she observes a flow of blood escaping from a part, the
delicacy attached to the locality makes her reticent with regard to
inquiry or exposure; she naturally becomes alarmed, and most likely
attempts to stanch the flow by bathing or applying cold water to the
part, thus doing incalculable mischief.
This purely feminine physiological function should be well studied and
understood by all females. At least, they should know that the
phenomenon is a natural one, liable to disorder, and that the best
interests of their general health demands care and prudence on their
part to maintain regularity, etc., of the flow. Disregard of such a
duty will surely entail much misery.
DELAYED AND OBSTRUCTED MENSTRUATION.
When the menses do not appear at the time when they may naturally be
expected, we call it delayed or obstructed menstruation. It is,
however, of great importance to know whether a girl is sufficiently
developed to make it necessary for the menses to appear, although she
may have reached the proper age. As long as the girl has not increased
physically, if she has not become wider across the hips, if her
breasts have not become enlarged, and if she experience none of the
changes incident to this period, an effort to force nature is
positively injurious. In this case a general treatment will be called
for. She should be required to exercise freely in the open air, retire
early to bed and rise at an early hour in the morning. She should not
be allowed to be closely confined to school, if attending. Her diet
should be generous but free from all rich food, which will disorder
the stomach. If, however, she is fully developed, and she suffers from
time to time from congestions of the head, breast or abdomen, it will
be necessary to interfere. The following are symptoms which will
generally be found in these cases: Headache, weight, fullness, and
throbbing in the center of the cranium and in the back part of the
head; pains in the back and loins; cold feet and hands, becoming
sometimes very hot; skin harsh and dry; slow pulse, and not
infrequently attended with epilepsy.
TREATMENT.
It is well for the patient, a few days before the period, to take a
warm hip bath or foot bath twice a day, and at night, when retiring,
to apply cloths wet in warm water to the lower part of the abdomen.
The bowels should be kept open by some mild catharsis, as castor oil
or a pill of aloes. If there is pain and fullness of the head during
the discharge, or before it, use the following:
Tincture of aconite leaves, Two drams;
Tincture of belladonna, One dram;
Tincture of cantharides, One dram;
Morphia, Three grains;
Simple syrup, Quarter ounce.
Mix. Dose: One teaspoonful three times a day. If the pain is severe it
may be taken every two hours.
Between the monthly periods, if the system is weak, the following may
be taken:
Precip. carbonate of iron, Five drams;
Extract of conium, Two drams;
Balsam Peru, One dram;
Alcohol, Four ounces;
Oil wintergreen, Twenty drops;
Simple syrup, Eight ounces.
Dose: Two teaspoonfuls three times a day. Shake the mixture before
using.
CHLOROSIS, OR GREEN SICKNESS.
This disease generally occurs in young unmarried females who are weak
and delicate. It manifests itself about the age of puberty, and is
accompanied by feeble appetite and digestion. There is no menstrual
discharge, or else it is very slight.
It is caused by innutritious food and residence in damp and
ill-ventilated apartments. It may be hereditary, all the females of
the family being liable to the same disease. Those who drink largely
of tea, coffee, diluted acids, bad wines, and indulge in tight lacing;
are predisposed to this disease. Among the exciting causes may be
mentioned disturbing emotions, unrequited love, homesickness,
depression of spirits, etc. When we take into consideration the fact
that the cause of the disease is impoverishment of the blood, the
treatment will not be difficult.
TREATMENT.
Exercise freely in the open air; protect the body from chilliness with
warm clothing and plenty of it. The patient should sleep on a mattress
in a well-ventilated room. The diet should be nourishing without being
stimulating. It is important that the habits should be regular, and
the mind kept cheerful by society and innocent amusements. Before the
medical treatment is commenced the exciting causes of the disease must
be removed. A complete change must be made in the existence of the
patient. If she is confined closely at school, she must be removed; if
she is inclined to confine herself to the house, send her to the
country. Picture to her the danger she is in by the continuance of
such a life; give her plenty of outdoor exercise. The mental and moral
causes are the most difficult to remove, but a change of scenery and
new friends will do much towards it. For those who are shut up in
factories, or who work all day in a stooping position, a change of
employment must be made. A bath of tepid water in the morning,
followed by a brisk rubbing, will be beneficial; also the frequent use
of the sitting-bath, and the sponge bath in the evening. Active
exercise should precede and follow all baths. During menstruation all
applications of water should be omitted. The following remedies are
recommended by a famous Philadelphian doctor. They are to be taken on
alternate days; that is, take No. 1 one day, No. 2 the next day, etc.:
No. 1.--Precip. carbonate of iron, five drams; extract of conium, two
drams; balsam Peru, one dram; oil cinnamon, twenty drops; simple
syrup, eight ounces; pulverized gum arabic, two drams. Mix. Dose: Two
teaspoonfuls three times a day, every other day, after meals. Shake
before using.
No. 2.--Tincture of nux vomica, one dram; syrup iodide of iron, one
ounce; simple syrup, four ounces. Mix. Dose: One teaspoonful three
times a day, every other day, after meals.
Another treatment is as follows:
Clear the bowels with the following mixture: Sulphate of magnesia, one
ounce; nitrate of potash, ten grains; extract of liquorice, one
scruple; compound infusion of senna, five and one-half ounces;
tincture of jalap, three drams; spirit of sal volatile, one dram. Mix.
Dose: Two or three tablespoonfuls at a time, at intervals of two hours
until an effect is produced. This is to be followed by sulphate of
iron, five grains; extract of gentian, ten grains. Make into three
pills and take a pill twice a day, with the compound aloes or rhubarb
pill every night.
PROFUSE MENSTRUATION--MENORRHAGIA:
By menorrhagia we understand an immoderate flow of the menses. There
is no fixed amount of blood which is lost at the menstrual period, but
it varies in different women. It will average, however, from four to
eight ounces. The quantity discharged may be estimated by the number
of napkins used. Each napkin will contain about half an ounce, or one
tablespoonful, so that eight napkins would contain four ounces;
twenty, ten ounces; etc. In some females the discharge may be
excessive without impairment of the general health.
Some females are predisposed to uterine hemorrhages, from a relaxed or
flabby state of the texture of the uterus. Frequent childbearing,
abortion, high living, too prolonged and frequent suckling, may induce
flooding. Among the exciting causes we may mention overexertion,
dancing, falls, lifting heavy weights, cold, and mental excitement.
TREATMENT.
The patient must lie down on a hard bed, and abstain from all
stimulating food and drinks. The room should be cool and she should be
lightly covered with bedclothes. Soak the feet in warm water, and if
the flowing is excessive apply cloths wrung out in vinegar and water
to the lower bowels. The hips must be elevated higher than the head.
Only in extreme cases should plugging be resorted to. This may be
done by pieces of linen, about four inches square, thrust into the
vagina until it is full, and a bandage applied between the legs. Cold
hip baths and vaginal injections of cold water will be beneficial when
the hemorrhage is slight.
Use also the following:
Diluted sulphuric acid, Two drams;
Syrup of orange peel, Two ounces;
Cinnamon water, One ounce.
Mix. Dose: A teaspoonful in a wineglassful of water two or three times
a day.
If there is much pain administer the following every two or three
hours:
Morphia, Quarter grain;
Cayenne, Four grains;
Rosin, Four grains.
Mix. Give in blackberry syrup.
PAINFUL MENSTRUATION--MENSTRUAL COLIC--DYSMENORRHEA.
Dysmenorrhea means a difficult monthly flow, and is always preceded by
severe pains in the back and lower part of the abdomen. It is caused
by taking cold during the period; fright, violent mental emotions,
obstinate constipation, sedentary occupations, smallness of the mouth
and neck of the womb. Females subject to this trouble are generally
relieved by marriage. The symptoms are severe bearing-down pains in
the region of the uterus, like labor pains; restlessness, coldness,
flashes of heat, with headache; aching in the small of the back, lower
part of the abdomen, and thighs; the discharge is scanty, and contains
shreds of fiber and clotted blood.
TREATMENT.
The patient should immediately go to bed and cover up warmly.
Stimulating food and drinks should be avoided. Use a warm foot bath
and sitting-bath, with hot poultices of hops or cloths wet in hot
water applied to the abdomen.
In the interval of the menses, take active exercise, with a tepid hip
bath three nights in the week, injecting some of the water high up in
the vagina. Keep the bowels open by a pill of aloes and myrrh, and
take a small teaspoonful of the volatile tincture of guiacum three
times a day, in water. On the approach of the period, take the
following at night:
Calomel, Three grains;
Opium, One grain.
In the morning a dose of caster oil, and on the appearance of the
menses, the Dover's Powder and mixture as before. Repeat this
treatment, in each interval, until permanently relieved.
The following is recommended by an eminent physician, to be taken a
few days before the period:
Acetous tincture of colchicum, Three drams;
Magnesia, One dram;
Sulphate of magnesia, Three drams;
Distilled mint or cinnamon water, Four ounces.
Mix. Dose: A small wineglassful every two or three hours until it
operates. This should be preceded the night before by a small dose of
blue pill.
SUPPRESSION OF THE MENSES--AMENORRHOEA.
By suppression is meant a disappearance of the menses after they have
become established, and may be either acute or chronic. It is caused
by cold caught during the flow, by exposure to night air or by wetting
the feet; fear, shocks, violent mental emotions, anxiety, fevers and
other acute diseases. Chronic suppression may be either a consequence
of the acute, or caused by delicate health; also, from diseases of the
ovaries or womb. It may also be occasioned by an imperforate hymen, in
which case it must be cut open by a physician.
TREATMENT.
When the suppression is caused by some disease in the system, that
disease must be cured before the menses will return. For sudden
suppression, use the warm sitting-bath or foot bath. Apply cloths wet
in warm water to the lower part of the abdomen, and drink freely of
warm water. If the suppression is chronic and the patient is delicate,
in the interval between the menses use the shower or the full bath of
cold or tepid water, rubbing the body briskly with a coarse towel,
especially around the abdomen, loins, and genital organs.
As soon as the discharge has ceased, a warm hip bath will generally
bring it on. If there is much inflammation of the uterus give the
following:
Tincture aconite leaves, Two drams;
Sweet spirits of nitre, One ounce;
Simple syrup, Three ounces.
Dose: One teaspoonful every two or three hours.
If the discharge cannot be brought on, wait until the next period. A
few days before the term the bowels should be freely opened and kept
open until the period for the discharge has arrived. A pill of aloes
and iron is one of the best that can be given. Give from one to three
pills daily. If there is no evident reason for the discharge not
appearing, such as pregnancy, inflammation of the neck of the womb,
and the woman is suffering from the suppression, use the following:
Caulophyllin, One dram;
Extract aconite, Eight grains;
Aloes, Ten grains;
Sulphate of iron, Ten grains.
Make into forty pills. Dose: Two or three pills, taken night and
morning.
The remedies should always be taken a few days before the period
arrives for the menses. If the chronic suppression is the result of
any acute disease, the health must first be re-established, otherwise
it would be wrong to force the menses. When this has been done,
immediately before the return of the period a warm hip bath should be
taken every night for six nights, and one of the following pills taken
three times a day:
Fresh powdered ergot of rye, Fifty grains;
Barbadoes aloes, Twelve grains;
Essential oil of juniper, Twelve drops.
Make into twelve pills with syrup or mucilage, washing down each pill
with a cupful of pennyroyal tea.
CESSATION OF THE MENSES--CHANGE OF LIFE.
By the phrase, "change of life," or, the critical period, we
understand the final cessation, or stoppage, of the menses. It usually
takes place between the ages of forty and fifty, although in some
cases it may occur as early as thirty, and in others not until sixty.
However, we can expect the change about the forty-fifth year.
The symptoms will vary according to the constitution of the woman. In
some the change occurs by the discharge gradually diminishing in
quantity; in others, by the intervals between the periods being
lengthened. A woman may pass this period without having any more
unpleasant symptoms than an occasional rush of blood to the head, or a
headache. Others, however, may have very severe symptoms arise, which
will require the care of an intelligent physician. These disagreeable
sensations should receive a careful consideration and not be hushed up
with the reply that these complaints arise from the "change of life"
and will vanish whenever that change takes place. The foundation of
serious trouble may be laid which will make the remainder of her
existence a burden and cut short a life which might have been
conducted to a good old age. While this change is in progress, in
probably the majority of cases there is more or less disturbance of
the health. It is sometimes quite impossible to say exactly what is
the trouble with the patient, except that she is out of health. The
following are some of the symptoms which may arise: Headache,
dizziness, biliousness, sour stomach, indigestion, diarrhoea, piles,
costiveness, itching of the private parts, cramp and colic of the
bowels, palpitation of the heart, swelling of the limbs and abdomen,
pains in the back and loins, paleness and general weakness.
TREATMENT.
Eat and drink moderately; sleep in airy, well-ventilated rooms;
exercise daily in the open air, either by walking or riding; avoid
violent emotions; shun exposure to wet, stormy weather, wet feet, etc.
Keep the bowels regulated with the following:
Mercurial pill, one grain; ipecac powder, one-half grain; compound
rhubarb pill, three grains. Mix for a pill to be taken every night.
Or, one ounce of hicra picra, or powdered aloes with castella, mixed
in a pint of gin, which should stand for four or five days, after
which a tablespoonful in a glass of water may be taken every morning
or second morning, as the case may be.
If the patient is large and fleshy, of full habit, the following is
recommended:
Sulphate of magnesia, one and one-half ounces; compound infusion of
roses, five ounces; cinnamon water, one ounce. Mix, Dose: Two
tablespoonfuls once a day.
If there are nervous symptoms prominent, give valerianate of zinc,
eight grains; tincture of valerian, two drams; orange flower water,
three and a half ounces; syrup of red poppies, two drams. Mix. Dose: A
tablespoonful every six hours.
FALLING OF THE WOMB
_(Prolapsus uteri)._
Falling of the womb is simply a sinking down of the organ, and may be
so slight as not to be noticed or so great that the organ will
protrude between the legs through the external opening. It is not a
disease of the womb itself, but of some of its supports.
So long as the vagina retains its natural size and the ligaments are
but two and a half inches long the organ will not be displaced.
Whatever tends to relax and weaken the system may cause the complaint.
The muscles of the abdomen which support the intestines being weakened
from any cause will allow the intestines to press down upon the womb
and its ligaments, and, in consequence of this constant pressure, they
give way. Another cause is too early exercise after childbearing.
Flooding and leucorrhoea, or whites, if allowed to continue for a
long time, will produce it; in delicate females, continued running up
and down stairs, also tight lacing, dancing, leaping, and running,
particularly during the period of menstruation, when the womb is
increased in weight by the blood contained in it. The use of medicines
to loosen the bowels, which is very common among many, is still
another cause of the disorder.
Most females who are troubled with falling of the womb think that it
is necessary to a cure that they should wear some kind of a support to
the abdomen. These supporters, however, do a vast amount of harm, for
by being worn tightly around the abdomen they increase the pressure on
the bowels, thus forcing down, more and more, the womb and its
appendages. All that is necessary is to raise up the womb to its
natural position, and use an instrument that will keep it in place.
This instrument is called a pessary. This pessary is a ring or hollow
cup-shaped globe, made of gold, silver, ivory, wood or gutta-percha,
and is placed in the vagina or birthplace, thus supporting the womb.
The cold hip bath should be used once a day, at the same time
injecting cold water into the vagina with a syringe. Lie down as much
as possible, and avoid becoming fatigued. Apply cold bandages to the
abdomen on going to bed.
If the womb has descended to the external orifice it is often
necessary to restore it to its natural position by pressing it upward
and backward by a finger or two pressed into the vagina. If the
process be accompanied with pain, the vagina should be well washed by
injections of thick flax seed or slippery elm bark tea for a day or
two before the astringent washes are used.
Avoid tight corsets and heavy skirts, suspend the under-garments from
the shoulders and not from the waist, as is usually done. Use plain
vegetable diet, and avoid tea, coffee, spirituous drinks, and all
sensual indulgences. Allow the clothes to be loose. These things must
be attended to closely. The diet should be plain and nourishing, but
not stimulating.
Use an injection of an infusion of white oak bark, geranium, or a
solution of alum, in the proportion of one ounce to the pint of water.
If there is inflammation of the womb, this must be subdued before
using the pessary. Give tincture of aconite, compound powder of ipecac
and opium, with injections of an infusion of hops and lobelia, or an
infusion of belladonna.
If there is heat and difficulty in passing water, drink an infusion of
marsh mallow and spearmint. If the patient is weak, give the following
tonic:
Sulphate quinine, twenty-five grains; citrate of iron (soluble),
thirty-five grains. Make into twenty-four powders. Take a powder three
times a day, after each meal, in sweet wine.
LEUCORRHOEA--WHITES--FLOUR ALBUS.
The word leucorrhoea is derived from two Greek words, and means
literally a "white discharge." It is also known as "flour albus,"
"whites," and "female weakness," and consists of a "light colorless
discharge from the genital organs, varying in hue from a whitish or
colorless to a yellowish, light green, or to a slightly red or
brownish; varying in consistency from a thin, watery, to a thick,
tenacious, ropy substance; and in quantity from a slight increase in
the healthy secretion to several ounces in the twenty-four hours."
This discharge generally occurs between the ages of fifteen and
forty-five, seldom during infancy or old age. When it occurs in young
female children, it will not infrequently be produced by the presence
of pinworms in the vagina, which make their way there from the rectum.
There will be intense itching of the parts, and the worms can be
removed with a small piece of cloth, after separating the lips.
This disease may be either acute or chronic. The acute form generally
results from taking cold, and is simply a catarrhal inflammation of
the mucous membrane lining the vagina. The chronic form is but a
continuation of the acute, and is generally caused by the acute stage
having been neglected or improperly treated. Ulceration of the neck of
the womb sometimes results. There are two forms of leucorrhoea:
Vaginal leucorrhoea, when the discharge comes from the walls of the
vagina; and cervical leucorrhoea, when the discharge proceeds from
the neck of the womb.
Causes: Taking cold from sitting on the ground, or exposure of the
neck and shoulders; over sexual excitement, and sexual intercourse;
tight lacing; piles, miscarriages, and abortions; displacements of the
womb; purgatives, improper articles of diet; warm injections, or
injections of any kind; late hours, etc. It may also be hereditary.
TREATMENT.
The treatment, to be successful, requires that the patient should
first be placed in a favorable condition. Anything which tends to
excite the disease must be avoided, as dissipations, late suppers,
etc. The diet must be plain and nourishing without being stimulating,
and be taken regularly. Exercise, short of fatigue, will be
beneficial. The clothing should be warm and worn loosely, especially
about the waist. Water is of great importance in the treatment of this
trouble. The sitting-bath may be used every day, and injections of
cold or tepid water should be used three or four times a day,
according to the severity of the discharge.
An injection of weak green tea will be found good in some mild cases,
as also sweet cider or a weak solution of alum.
One of the best tonics is the muriated tincture of iron, of which take
twenty or twenty-five drops in half a tumbler of water three or four
times a day. An excellent injection is made by taking three drams of
tannic acid and an ounce of alum, dissolving in a quart of water, and
inject one-third three times a day. The bowels should be kept open by
Rochelle or Epsom salts, or seidlitz powder. When there is great
debility of the organs, or when the disease has been brought on by
exposure to cold, pregnancy, abortions, etc., the following will be
found very successful:
Tincture of aloes, two ounces; muriated tincture of iron, four drams.
Mix. Dose: Thirty-five drops in water three times a day. At the same
time use the following injection: Sulphate of zinc (white vitriol),
two drams; sugar of lead, two drams. Mix in one quart of water, and
use one-fourth for each injection.