MEDICINE. 



Practice, acute pain, which is generally referred to the pit of the 

 y^' stomach, and is often attended with severe vomiting, 

 and by this operation the obstruction is occasionally 

 removed: the same effect is sometimes produced by 

 brisk purgatives Opium and warm fomentations re- 

 lieve the pain, and likewise the spasmodic contractions, 

 which, as was remarked above, seem to exist in these 

 cases, and lend to aggravate the complaint. There are 

 instances in which the distension produced by Gall- 

 stones is 80 great as to produce inflammation, when 

 bleeding must obviously be had recourse to, at the same 

 time that we may try the warm bath and emollient in- 

 jections. 



SECT. VI. Amenorrhcea. 



Amenor- Ischuria, or a difficulty in the excretion of the urine, 

 rhou. j g perhaps in all cases a symptomatic affection, either 



occurring in connexion with some other more general 

 disease, as Dropsy, or depending upon some obvious 

 mechanical obstruction, as in Lithiasis. We shall there- 

 fore pass on to Amenorrhcea, or the deficiency of the 

 menstrual discharge. It occurs under two forms, that 

 of retention and of suppression : the first, where the 

 discharge does not make its appearance at the proper 

 period of life; the second, where, after it has appear- 

 ed, it does not return at the usual intervals. There is 

 another affection which ought perhaps to be regarded 

 as a mere variety of Amenorrhoea, in which the dis- 

 charge takes place at the proper times, but is in small 

 quantity, and is attended with considerable pain ; this 

 ha* received the name of Dysmenorrhoea. When Amen- 

 orrhsea, in any of its forms, has continued for some 

 time, it produces various constitutional derangements; 

 there are pains in different parts of the body, espe- 

 cially in the neighbourhood of the uterus ; the appe- 

 tite fails, the bowels are torpid, the head is oppressed, 

 Anasarca supervenes, the breathing is short, the pulse 

 is weak, and the whole body becomes languid and en- 

 feebled. In some cases, particularly in those where 

 the discharge does not take place at the proper age, 

 there is a remarkable sallowness of the complexion, 

 from which circumstance the disease has obtained the 

 name of Chlorosis; it is likewise attended with a sin- 

 gular tendency in the patient to take into the stomach 

 various articles of an indigestible nature, which would 

 seem to be the mere effect of caprice, did we not ob- 

 serve this morbid appetite to exist, where we have no 

 reason to suspect this disposition from any other cir- 

 cumstance, and where the stomach is evidently in an 

 unnatural state. The proximate cause of these com- 

 plaints is evidently, in the first instance, the same, a 

 defect of power in the vessels of the uterus, by which 

 they are unable to propel the blood into the capillaries 

 with due force and in the proper quantity. In what 

 way this condition of the capillary vessels produces the 

 general symptoms is perhaps not easy to explain ; and 

 indeed it may be suspected, that at least in a great 

 number of cases, the peculiar state of the uterus is ra- 

 ther the effect than the cause of. the constitutional ir- 

 regularity. 



Treatment. But whatever may be our determination upon this 

 ( fx>int, it does not affect the principles upon which we 



proceed in our treatment of Amenorrheea, which is to 

 excite the system generally, and the uterus in particu- 

 lar, by the use of those means which may increase the 

 action of the arterial system, and especially of the ute- 

 rine vessels. The state of the bowels obviously re- 

 quires purgatives, and those of a stimulating kind; 



such as the resins and more acrid extracts, scammony, Practice, 

 aloes, colocynth, &c. The degree of flatulence which s T 

 is generally present indicates the employment of what 

 have been termed carminatives; and when there is 

 much pain or irregular action of the parts, we may 

 prescribe antispasmodics, of which perhaps tlie most 

 efficacious is assafztida, with an occasional opiate. 

 Exercise, and especially horse-exercise, as much as can 

 be borne without exhaustion, is a necessary part of 

 the regimen ; and the diet should be as nutritive as the 

 patient can bear, without inducing indigestion or any 

 degree of febrile excitement. We have hitherto taken 

 no notice of that class of remedies that are styled em- 

 menagogues, because we are extremely doubtful whe- 

 ther there be any to which this title ought to be ap- 

 plied, except to some substances, the action of which 

 is so violent as not to be admissible into practice ; we 

 consider the savine to be of this description. Perhaps 

 there is nothing which is better entitled to the specific 

 appellation of an emmenagogue than electricity, and 

 this application may be safely tried in conjunction 

 with purgatives, and the other treatment that has been 

 mentioned above. The warm hip-bath, or even warm 

 water applied to the feet, frictions with the flesh-brush, 

 and warm clothing, are generally thought to be ser- 

 viceable. Besides these remedies, which appear to be 

 more particularly indicated by particular symptoms, 

 we often find it necessary to use stimulants and tonics, 

 as the various kinds of bitters, and the preparations of 

 iron ; with respect to the latter medicine it should not 

 be employed until the bowels are rendered completely 

 soluble, and in all cases it may be proper to combine 

 it with aloes, or with some of the purgative resins or 

 extracts. 



CHAP. VI. 



ParamorphicE. Local Structural Diseases. 



Having now, in our five first classes, gone through Paratnor- 

 the different diseases which proceed from primary at- phi*, 

 fections of the systems of the blood-vessels and the 

 nerves, the mental faculties, the organs of nutrition, 

 and those of secretion, we now come to the diseases 

 which are of local origin. These form the two classes 

 of the Paramorphiae and the Ectopise ; the first denot- 

 ing a morbid change of structure, the latter a mechani- 

 cal displacement of the parts concerned. The greatest 

 number of these diseases fall under the province of 

 surgery ; they frequently require the assistance of 

 some manual operation, or of external applications ; 

 and although they are often accompanied by constitu- 

 tional affections, yet these are obviously sympathetic, 

 so that our main attention is to be directed to the topi- 

 cal derangement. 



We have divided our class of Paramorphiae into Phy- 

 mata and Phtharmata ; the first including tumours of 

 all descriptions ; the second denoting an alteration in 

 the substance or structure of the part, as where a mem- 

 brane is converted into a bone, where a suit part be- 

 comes rigid, or a hard part becomes soft and flexible. 

 Of the different genera which compose this order, per- Diseases el 

 haps the only one which can properly be considered the heart- 

 as falling under the province of the physician, is that 

 which consists of the organic affections of the heart. 

 Besides the inflammation of this viscus, which has been 

 already treated of among the Phlegmasia?, it is subject 

 to many other organic derangements ; its valves, uncl 



