26 



OBSTETRICS. 



is much constitutional disturbance, venesection, or cups to the loins, 

 laxatives, baths, and opium to relieve pains. In the chronic form^ if 

 possible, remove the cause: to7iics, aloetics, ^n^ the means above 

 mentioned ; there being but few direct emmenagogues. 



Dysmeriorrhoza. — Painful or difficult menstruation. — This may- 

 be dependent on a faulty condition of the system, upon neuralgia of 

 the uterus, or an inflammatory state of that organ, or it may depend 

 on mechanical constriction of the cervix. The discharge is often 

 scanty, accompanied with great pain in the back, loins, fever, &c. 

 and often with the elimination of membranous or shreddy coagula. 

 The treatment during the paroxysm is antiphlogistic, as cups to the 

 loins, revellents, baths, anodyne enemata. In the interval, tonics, if 

 debilitated ; alteratives, if inflammatory ; and dilatation by the bougie, 

 as recommended by Dr. Mackintosh, if there be stricture of the cer- 

 vix. Females afflicted with this disease rarely conceive. 



Menorrhagia^ is an increase of the menstrual flow either in fre- 

 quency or in quantity, and it may be either active or passive, the 

 former occurring in robust plethoric habits, the latter in the reverse. 

 The most common causes are nervous and vascular excitements, 

 fevers, internal congestions, displacements of the uterus, and ap- 

 proach of the critical period, &c. It may be confounded with the 

 hemorrhage arising from abortion, foreign growths, &c., within the 

 uterus. The treatment varies ; in persons of a full habit venesection 

 may be necessary, rest, revulsives, saline laxatives, astringents, &;c. 

 In the interval, moderate diet, cold baths, &c. In debilitated cases, 

 rest, tonics and astringents, and opium, good diet, &;c. When the 

 hemorrhage occurs about the critical period, it often resists the ordi- 

 nary treatment. Under such circumstances, the ergot of rye often 

 answers a good purpose. It may be given in doses of from 5 to 10 

 grs. twice or thrice a day. All stimulating and hot drinks should be 

 avoided, and the patient kept in a horizontal position on a hard mat- 

 tress. As soon as the discharge is entirely arrested, a blister should 

 be applied to the sacrum, and kept open, and vaginal injections of 

 cold water, or of a solution of acetate of lead, or other astringents, 

 used two or three times a day. In taking the injections, the patient 

 should assume the horizontal position, and endeavour to retain the 

 fluid for a short time. If displacements exist, rectify them, avoid 

 sexual excitement of all kinds, warm clothing, frictions, &c. 



Vicarious menstruation. — Seems a provision to obviate the ill 

 effects of suppressed menstruation, by substituting a similar discharge 

 from some other part. It occurs from various parts of the body, 

 sometimes from the gums, nostrils, eyes, lungs, anus, stomach, or 

 even from an amputated stump. The fluid sometimes resembles or- 

 dinary blood, at others, it has the characters of the catamenial fluid. 

 It may occur at any time, and in any constitution. It is not, how- 

 ever, usually attended by any serious consequences. 



