DISEASES OF THE TJTERUS. 



ment, accompanying ovulation, under the influence of which bleed- 

 ings may take place at points predisposed to it, both when the 

 menses are absent and when they are present. 



The direct treatment of amenorrhcea by emmenagogues has un- 

 dergone great limitation of late years. Many of the ancient physi- 

 cians (mistaking cause and effect) were disposed to ascribe divers 

 disorders to amenorrhcea as a cause, and to consider the reestablish- 

 ment of the menstrual flow a matter of great importance ; where- 

 as, in many a broken-down subject, it is rather to be wished that 

 she may not be still further prostrated by loss of blood. Some- 

 times, however, in exhausted, bloodless patients, the growth of the 

 Graafian vesicle is arrested, and the periodical ovulation with its 

 uterine hyperaemia does not take place. Such amenorrhceas, arising 

 from defective nutrition and anaemia, can only be successfully 

 treated by allaying the main disease by tonics, iron, strengthening 

 diet, fresh air, and the like. All the different emmenagogues pos- 

 sess in common the property of inducing hyperaemia of the pelvio 

 organs, and especially of augmenting a congestion which already 

 exists, and thus of producing a haemorrhage. This object is most 

 certainly obtained at the time when the menses should naturally 

 return. This period is not, however, invariably one of twenty- 

 eight days ; for it may vary by several days in the same woman. 

 Accepting the results of recent researches, that menstrual flow does 

 not proceed from engorgement alone, but is also the effect of a fatty 

 degeneration and exfoliation of the uterine mucous membrane, it 

 becomes impossible to admit that the flux can be induced by em- 

 menagogues at any other time' than that of nidation. 



Artificial induction of the menstrual flow may be called for 

 when certain disturbances (pain in the back, local congestion, and 

 the like) which normally accompany menstruation indicate a con- 

 gestion of the pelvic organs, and that the haemorrhage which should 

 promptly relieve them has failed to arise. Measures calculated still 

 further to augment the hyperaemia of the womb may then be re- 

 sorted to to bring on the bleeding. These are irritating foot-baths, 

 warm sitz- or full-baths, dry cups or mustard-plasters to the thighs, 

 a hot or even a cold douche to the sacrum, clysters of aloes, or direct 

 irritation of the womb by irritating vaginal douches. More rarely, 

 painting the os with iodine, passage of a sound, or electricity may 

 be tried ; but we should be slow to resort to the internal exhibition 

 of aloes or of savin, on account of their undesirable secondary ef- 

 fects. We must bear in mind, too, that, if we fail to induce the 

 flow by these means, we may nevertheless so augment the uterine 

 congestion as to aggravate the existing distress. Hence the use of 



