ANOMALIES OF MENSTRUATION. 163 



emmenagogues is only proper when the amenorrho2a is due solely 

 to feebleness of the uterine congestion. In other cases the conges- 

 tion is to be relieved by local depletion, leeches, or scarification of 

 the vaginal portion, or in virgins by cups applied to the inner side 

 of the thighs.] 



Menorrhagia, or too copious menstrual haemorrhage, has been 

 already mentioned as a symptom of various structural changes and 

 of tumors in the uterus. But it also occurs without perceptible dis- 

 turbance of nutrition, where the escape of blood from the uterus is 

 hindered in heart and lung diseases, etc., as well as in fluxions in- 

 duced by irritation of the uterus from sexual excess, perhaps also 

 by sensual excitement. In very rare cases menorrhagia depends on 

 a haemorrhagic diathesis, being a symptom of scurvy, purpura 

 hsemorrhagica, acute infectious diseases, such as hsemorrhagic small- 

 pox or measles, or of typhus, etc. Where it is due to obstructed 

 efflux or increased afflux of blood to the uterus, it is usually pre- 

 ceded by symptoms similar to, but more marked than, those with 

 which normal menstruation usually begins. Part of the blood 

 passes off in a fluid state, part coagulates in the vagina, forming 

 irregular clots ; rarely it coagulates in the uterus, and there forms so- 

 called fibrinous polypi, such as frequently appear after abortions. 

 Plethoric patients often bear very decided loss of blood without 

 injury ; anaemic patients have the symptoms of increased anemia. 

 The treatment of menorrhagia requires great attention to the origi- 

 nal disease. The occasional application of leeches to the cervix is 

 often of surprising benefit in those cases dependent on chronic in- 

 flammation of the uterus. As soon as the loss of blood is decided 

 and threatens to impair the strength, it is important to prevent all 

 bodily exertion and mental excitement, and to keep the patient in a 

 horizontal position during menstruation. At the same time we for- 

 bid all stimulating food and drink, and order mineral or vegetable 

 acids. It will only rarely be necessary to employ cold water or ice- 

 compresses, or to have recourse to styptics. In some cases, how- 

 ever, the bleeding threatens life, and then it is necessary to act 

 energetically, and even to inject hot-water solutions of chloride of 

 iron, etc., into the uterus. 



[The term dysmenorrhcea is applied to the conditions under 

 which, instead of the trifling disorders which are almost normal, 

 grave and distressing symptoms arise, especially violent pain in the 

 back, belly, groins, and thighs, and sometimes sympathetic derange- 

 ment of remote organs, such as cramp in the stomach, vomiting, 

 diarrho3a, numbness, headache, dizziness, and convulsions. The 

 causes of dysmenorrhoea are numerous. It has been assumed that 



