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MEDICINE. 



Practice. 



SECT. XXVI. Menorrhagia. 



Menorrh*- Whatever may be our opinion respecting the nature 

 f' of the menstrual discharge, or the use which it serves 



in the animal economy, we" can have little doubt, that, 

 when it exists in excessive quantity, it is generally of 

 that kind which we have termed arterial. It is gene- 

 rally attended with pain in the back and loins, and, 

 when it has continued for any length of time, produces 

 a febrile condition of the system, as manifested by the 

 state of the pulse, and the other functions immediately 

 connected with the circulation. The principal danger 

 of Menorrhagia depend, upon the immediate loss of 

 blood, which is often so considerable as to reduce the 

 vital actions to a very alarming state of debility ; but 

 it may be observed, that unless it arises from some 

 structural disease of the organ, or is connected with 

 pregnancy or parturition, when it becomes a sympto- 

 matic affection, it may usually be restrained by the pro- 

 per application of remedies. These are both general 

 and local ; the latter are employed to remove the ur- 

 gent symptoms, and the former to prevent their recur- 

 rence. 



Treatment. In stopping haemorrhage, the immediate object which 

 we have in view is, to produce a coagulum at the mouths 

 of the bleeding vessels, which, in this case, is princi- 

 pally to be accomplished by the topical application of 

 cold. This, partly by its mechanical astringent opera- 

 tion, and partly by its sedative action on the vital 

 powers, seems to diminish the flow of blood along the 

 capillary arteries, and thus admits of the coagulation 

 of the fluid which lies near their termination. Perfect 

 rest, abstinence, and the means which were recom- 

 mended in the other external haemorrhages, are to be 

 pursued in this complaint ; and, in the same manner, 

 we may employ the lancet, or may administer digitalis, 

 where they seem to be indicated. There is often a de- 

 gree of restlessness in this complaint which renders 

 opium necessary. We generally find that acids and 

 neutral salts are prescribed, upon the principle of their 

 being refrigerant ; but this effect we are disposed to re- 

 gard as altogether hypothetical. The former, at least 

 the citric acid, may be useful in quenching thirst ; but 

 the latter we conceive to be always injurious. Astrin- 

 gents and tonics of various kinds have been administer- 

 ed in Menorrhagia, with a view of securing the system 

 against its recurrence. We are of opinion, that it is 

 impossible to produce any astringent effect upon an in- 

 dividual organ through the medium of the stomach ; 

 and, with respect to tonics, we may observe that their 

 operation is of a critical nature. Perhaps, when the 

 system has been much exhausted by the violence of the 

 complaint, or where copious bleeding has been thought 

 necessary to repress it, euch remedies may be indicat- 

 ed ; but we must bear in mind, that their effect is ulti- 

 mately to produce that state of the system which will 

 tend to lay the foundation for the return of the com- 

 pliint In most cases, a suitable attention to diet, and 

 to those circumstances which are calculated to establish 

 the healthy action of the digestive organs, will be found 

 ufficient to recruit the system, and is the safer plan of 

 proceeding. We think it may be questioned how far 

 there is ever an idiopathic Menorrhagia, which pro- 

 ceed* from absolute weakness of the part, although 

 such a state is generally desc ribed by systematic writ- 

 ers ; for it must be observed, that even where there is 

 a general langour of the circulation, still a relative state 

 of activity may prevail in the uterine system. If, how- 



ever, such a state really exist, the stimulating plan Practice, 

 would be improper, or, at least, of doubtful effect, not- ""Y"""' 

 withstanding it might appear to be indicated by the 

 state of the constitution. We must abstain from de- 

 pletion, or employ it with great caution, and arc to 

 trust to topical remedies, with the assiduous employ- 

 ment of those means which may confirm the general 

 health without increasing the activity of the circula- 

 tion. 



SECT. XXVII. 



Venous htemorrfiagies. 

 Piles. 



Htemorrhois, 



Although, considered either in a practical or a theo- Venous 

 retical point of view, there seems no reason to doubt of hoemorrha- 

 ihe actual existence of venous, as distinct from that of 8 ies - 

 arterial hsemorrhagies ; yet they appear, in most cases, 

 to be rather symptomatic than idiopathic affections, 

 being either consequential upon some other disease, or 

 indicating a structural derangement in the organ from 

 which they proceed. This remark, will, we apprehend, 

 apply to the discharges of blood from the stomach, the 

 intestines, the liver, and the bladder, which are, for the 

 most part, either the effect of previous inflammation of 

 these parts, or of actual disease in them, by which their 

 mechanical texture is obviously deranged. The only 

 means of relief, therefore, is to remove the morbid con- 

 dition on which the discharge depends, when this can 

 be accomplished, an object, however, which it is too 

 frequently beyond our power to effect. Various pallia- 

 tive remedies have been employed in these cases, but 

 we conceive without much prospect of relief; deple- 

 tion is not indicated by the state of the system at large, 

 nor do we apprehend that any benefit can be expected 

 from the usual routine of astringents and tonics. Mild 

 purgatives are useful, both from their local and their 

 general effect, and opium may be given to allay irrita- 

 tion and to ease pain ; but beyond these we have little 

 to trust to, except the assiduous application of all those 

 means which strengthen the digestive organs, and 

 through their means tend to establish the general 

 health. 



There is, however, one of the venous haemorrhagies Haemotr- 

 which is to be regarded as an idiopathic disease, and ho ' s - 

 which admits of a more direct and decisive treatment, 

 haemorrhois or piles, consisting of a discharge of blood 

 from the haemorrhoidal veins. This disease has excited 

 a considerable share of attention, as appearing to coin, 

 cide with the pathological hypothesis of the Stab Huns, 

 respecting the salutary efforts of the intelligent super- 

 intending principle, or aiiima. It was supposed that 

 these veins afforded a kind of outlet for the superfluous 

 fluids, when the sanguiferous system was oppressed 

 with too large a quantity of blood, being analogous to 

 the menstrual evacuation of the female, of which this 

 was supposed to be the prime object. We have, how- 

 ever, no hesitation in asserting, that the facts upon 

 which this hypothesis was built were much exaggerat- 

 ed, and that when we view the complaint without pre- 

 judice, we shall find it to be, like many others, in a 

 certain degree useful in restoring the balance of the 

 circulation, when it has been deranged by various cir- 

 cumstances, but, like them, always to be regarded as a 

 disease which we must attempt to remove, and which, 

 if suffered to proceed without restraint, lays the foun- 

 dation for much future inconvenience. 



We shall not in this place inquire into the causes Treatment, 

 which tend to produce congestion in this particular set 

 of vessels ; it will be sufficient to remark, that in cer- 



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