MIDWIFERY. 
or accidental, arises where there is perfect 
liealth lip to the time of menstruating, and 
the patient tahes cold at the point of dis- 
charge, or even while menstruating, and 
the flow is prevented or suddenly ceases. 
Obstructed menstruation generally de- 
pends upon the application of cold ; this will 
produce a fever which will stop it if com- 
ing on, and arrest its progress, where it has 
already commenced. In all such cases there 
is pain in the head, back, and loins, pain 
in the limbs, with all the symptoms mark- 
ing fever. If we know of this early, we may 
with ease give relief. We may always take 
away blood, and clear the bowels ; rhubarb 
is the best medicine ; then a saline draught, 
with antimonials in such quantity as to 
come short of vomiting, and five or six drops 
of laudanum, or four or five grains of ipeca- 
cuanha every six hours. The warm bath is 
productive of advantage where applied soon 
after the complaint has begun. Where the 
slipper bath is not at hand, the lower part 
of the body may be seated in a volume of 
tepid water in a large tub, or the conveni- 
ent vehicle called a hip bath ; after which 
the patient must be made very dry, and put 
into a warm bed, and use the remedies be- 
fore mentioned ; and the discharge will re- 
turn, or, if not immediately, it will ultimate- 
ly return, and the health remain unimpair- 
ed : but, if the menstruating period be passed 
over, it then becomes a chronic obstruc- 
tion, the symptoms attending which are very 
destructive of female health. 
Of the chronic obstruction of menstrua- 
tion there are also two kinds, which have 
each a distinct set of symptoms ; those of 
plethora, and those of weakness; and chro- 
nic obstruction, depending on plethora, 
may degenerate into that kind depending 
on weakness. The patient will first be 
taken with symptoms which only belong to 
plethora, and after that arise those belong- 
ing to weakness. The young are most 
liable to the first kind, in wliom the quantity 
of blood is much increased beyond what it 
should be, by luxurious habits, and where 
too little exercise is taken for the quantity 
of food ; and even here it will not often 
lead to obstruction, unless the occasional 
cause is applied by taking cold : when this 
does really happen, the attack of fever may 
be so slight as not to be observed by the 
patient. Where we see all the signs of the 
system beirig loaded with blood, we should 
certainly take some away ; where the pulse 
is hard, full, strong, and frequent ; the skin 
dry and hot, more thirst than there should 
be, with pain in the head, back, and loins ; 
where, especially, instead of an active dispo- 
sition, we see a desire to be always by the 
fire, and the girl at the same time liable to 
giddiness. Here the pulse is nearly up to 
too, which being an increase of more than 
twenty beats in every minute, the effects of 
such increased action is, that the strength 
Will be Worn out, and the chronic obstruc- 
tion from plethora be changed into the 
chronic obstruction from weakness ; the 
reason is this, that the action is so strong 
that it niay, by continuing, exhaust the 
powers of life ; nothing indeed exhausts the 
strength of the system so much as increased 
action of the heart and arteries ; for it is 
not the pulsating arteries alone tliat are af- 
fected, but in the same proportion is the ac- 
tion of all the capillary vessels in the body 
increased, so that the whole extent of in- 
creased action is prodigious. It being 
known that the action arises from obstruct- 
ed menstruation with plethora brings on 
weakness, it might be expected that the 
strength of action would be brought gradu- 
ally down fo the point of health ; but that 
never happens ; it sinks below it. This sort 
of obstructed menstruation must be treated 
by evacuation, by bleeding ; but the foot is 
not preferable, as we do not get blood 
enough by opening the vena saphena, un- 
less the foot be immersed in warm water ; 
and if this be done, we are unable to tell the 
quantity we take, uhless we from time to 
time measure the water. The best way, 
then, is to bleed from the arm, and with 
bleeding to use purgative medicines ; the 
patient should take much exercise and little 
sleep, and, on the intermediate day to those 
on which wp give the purgatives, we should 
give saline draughts. The effect of this 
will be, that she will be brought down from 
great and morbid action to the state of 
health ; and it is fifty to one but the men- 
strual discharge returns immediately. 
This species of chronic obstruction pro- 
ceeds from plethora, and plethora may exist 
so as to prevent menstruation eithpr at its 
earliest effort or after it has been long in the 
regular habit of recurring. The term 
chlorosis is generally applied to the first 
kind ; amenorrhoea to the second ; but 
chlorosis, or green-sickness, is a mere re- 
sult, and may result from either ; it is that 
chronic menstruation depending on symp- 
toms of weakness we have already noticed, 
and may result from each as well as from a 
distinct and separate source, because the 
continued action of vessel? exhausts tlie 
