MIDWIFERY, 
strength. Usually, however, the complaint 
depends on improper food, living in bad 
air, or want of exercise, and, added to these, 
want of communication between, the sexes ; 
for a certain state of the ovaria predisposes 
to it. One symptom in this kind of ob- 
structed menstruation is, there being a 
mark perceived round the ancle at night 
where the edge of the shoe reaches ; another 
is, a fullness and puffiness of the fece and 
eyelids in the morning ; so tliat, after sleeps 
the whole countenance looks too big ; while 
in tlie course of the day, this size and ap- 
pearance goes entirely off. These last 
effects are evidently those of oedema, be- 
cause during the day the water lodged in 
the cellular substance about the face sub- 
sides, and the cells below are progressively 
filled ; so that by night the ancles are 
swelled : during the night again, the gravi- 
tation of the fluids diffuses tlie appearance 
of swelling over the fiice. 
The upper extremities partake at last in 
this appearance, becoming swelled about 
the hands at night. In short, the whole 
skin is swoln and stretched, and assumes a 
soft pappy feel. To these symptoms there 
is now added a very great derangement of 
stomach, the appetite goes quite away ; 
sometimes tire patient has an inclination for 
improper food, a vehement fondness for 
cinders, candles, or pipe-clay ; this does 
not seem to belong to any sort of instinctive 
impulse from nature, but depends on a de- 
rangement of stomach alone : all these evi- 
dences are further pi-oved by flatulency 
and a sense of weight at the stomach after 
eating ; great irregularity of the intestines. 
Sometimes costive, and at others lax ; vege- 
tables undergoing their acid fermentation ; 
and animal matter its putrefaction ; both 
known by eructation, both dependant on 
the impaired state of the stomach : to these 
succeed difficult respiration, either on walk- 
ing or going up stairs ; and this does not 
arise from ordinary weakness where a per- 
son could rest, because she was tired ; but 
in chlorosis she stops because she loses her 
breath : w’ith this there is palpitation at 
tire heart ; the pulse is frequent, small, and. 
hard ; and there are hysterical symptoms, 
veiy often, where the obstruction has been 
of long continuance. This complaint, how- 
ever, is easily cured where it lias been of 
.short duration, and the menstruation is not 
permanently interrupted. 
The treatment will depend on the form 
which all the symptoms take on when com- 
bined. TUpugh cases of this obstruction 
differ from ordinary weakness, yet the treat- 
ment we should pursue will be applicable 
to most cases of weakness. It is right to 
keep the bowels clear, by an occasional 
dose of rhubarb ; we should then begin the 
use of bitter medicine, remembering that in 
proportion as the weakness is greater, the 
medicine should be weak ; for it is an error 
to suppose that the stronger a medicine of 
tliis kind is, the more efficacious it must be. 
In all cases of weakness, we must consider 
the lightest bitters as the most proper ; at 
first, a dram of the bitter tincture to an 
ounce and a half of peppermint water ; or 
an ounce of the bitter infusion instead of 
tlie tincture. But at the same time we 
must recollect, tliat the stomach is still a 
weakened organ : the. powers of digestion 
must be still weak, consequently digestion 
will not be so quick, nor will the food be 
pushed forward from the stomach so soon 
as it is in health ; and tlie second meal will 
be ill digested, because the whole of the 
first has not left the stomach : for the.»e 
reasons, a gentle purgative must be joined 
with the food. A good medicine is bitter 
pills, foimed with such materials as will al- 
low the stomach to act on them without 
much difficulty. 
Of all medicines, bark is the worst here ; 
it requires a good stomach to digest it ; it 
increases every difficulty of breathing that 
may have existed previous to its use. Now 
and tlien a gentle emetic will be useful ; we 
may for that purpose give five grains of ipe- 
cacuanha every half hour till it operates. 
After the bitters have impaired the tone of 
the stomach, this gentle action will restore 
its strength, and render them as efficacious 
as before : when tlie stomach is strong 
enough, we may begin with steel, the best 
form of which is called Griffiths’s draughts, 
but it is the most nauseous mixture that ever 
was made as originally prescribed j and we 
should therefore prefer some one of the nu- 
merous modes in which this medicine has of 
late years been revised. By these means 
the weak patient will be raised up to that 
state which is nearest health ; while the ple- 
thoric patient is lowered down to the same 
point. These two patients being now 
brought to that same point which is most 
favourable to menstruation, it remains to dis- 
cover the best means of getting back the 
secretion. Having brought down the ple- 
tlioric, and raised the low and weak pa- 
tient, so that both are on a par, we may 
now begin with the emmeuagogue reme- 
dies. 
