MIDWIFERY. 
and astringent solutions into the vagina as 
tlie best remedy. Tlioiigli noVv and then a 
case occurs, in which the opposite means 
succeed, where every cold application has 
failed, and throwing up tepid water has put 
a stop to it. , 
The worst state of relaxed uterine system 
is, a great 'local weakness of the uterine 
vessels, which cannot be acted upon through 
the medium of the constitution. Since the 
hemorrhage will be increased by whatever 
increases the strength of action in the heart 
and arteries, it would be more an object to 
lower the constitution ; and the best mea- 
sure is, to leave it altogetlier, only attempt- 
ing to stop the hemorrhage by local means. 
But the cold application, so often recom- 
mended, will fail ; a piece of ice has been 
in the vagina a whole day without stopping 
it. In these cases, the most likely thing to 
succeed is, to introduce an injection into 
the uterus itself; to do which, a tube must 
be carefully passed up into the uterus, like 
a male catheter. AVe must withdraw the 
wire from the tube, and insert the nose of a 
small syringe into the tube, and press for- 
ward a little of some astringent injection ; 
as soon as it produces pain in the back, the 
pipe must be taken away, because a very 
little of the solution will be enough ; if there 
be thirty drops in the uterus, it is quite 
sufficient. In the very worst case that has 
been known to happen, this method was 
completely eifectualin the cure. 
Painful Menstruation. Dysmenorrhoea, or 
painful menstruation, is a complaint in a state 
of nature unknown ; but it happens among 
those who do not marry at the time of life 
nature intended ; for which there are many 
reasons in the present day, and among the 
rest the difficulty of maintaining a large 
family ; consequently women are thrown 
out of a state of nature, not doing that 
which nature intended. The patient when 
first attacked with this disease, feels hardly 
any pain, or if she feel pain, it is only very 
slight in the lower part of the baek, which 
is from the consent of certain nerves with 
the uterus ; but in four or five years it be- 
comes established pain in the back, as 
violent as grinding pains in labour. Such a 
w'oraan will afterwards bear labour very 
well, and declare that she would rather 
bear a child, than experience the pain of 
difficult menstruation once a month. In 
this manner the pain increases, but the 
menstruation goes on very imperfectly for 
some time ; and when at length it becomes 
jjiore plentiful in ([uantity, the pain lessens. 
and the last two days of the secretion is not 
attended with any pain. 
The appearance of the fluid in this disease 
is not that of menstruation, as it usually oc- 
curs. There are coagitla of various sizes, 
and if what is discharged be examined care- 
fully, flakes of coagulablelymph will be per- 
ceived. This state arises from interruption 
of the functions of the uterus, and it is a si- 
tuation in which the uterus is much le.ss 
liable to become impregnated ; but if it do, 
the patient may go on to menstruate with- 
out any pain to the end of her life, or per- 
haps, with less than she sulFered before. This 
complaint is more frequent in large towms 
than in the country. 
The first object in regard to treatment is 
to remove the inflammation, for there cfm 
be no difficulty in supposing inflammation 
present at the time the pain is so violent; 
one strong proof of which is, the coagulable 
lymph being thrown out. The patient for 
this purpose should leave off animal food 
entirely, if possible, at least partially ; 
should avoid all liquors, live as simply as she 
can, and keep the bowels in such a state, 
that the stools may not be hard. If she be 
strong and plethoric we may bleed once ; 
but it is a bad principle to bleed young 
people, as it lays the foundation for a larger 
quantity of blood being formed than ought 
to be. Between one period and another, 
the parts about the pelvis should occa- 
sionally be immersed in the tepid bath, and 
afterwards rubbed, and as soon as the pain 
comes on should be put in a warm bath : 
this may even be done the night before. The 
■pulvis Doveri should also be given to assist 
peixpiration, which is always an object in 
the present case. Pursuing this plan, the 
habit will be broken, and the patient may 
go for years without menstruating with 
pain ; but when it returns, the same ground 
must be gone over again. It is often en- 
tirely relieved by marriage ; so that it may 
sometimes, be useful to recommend this 
change of state to the consideration of the 
parents. 
Fluor (dims — AThites. This is another 
and very common complaint. Most wo- 
men conclude it leads to disease, and some 
are much alarmed at its appearance. In 
procidentia uteri, it arises mechanically; 
for its cure, which is sometimes very tedi- 
ous, the cold water bath is the best remedy 
of any that we know of ; cold water may 
be injected into the vagina, and if this be 
not sufficient, an astringent may be added. 
The case is most unmanageable, when aris- 
