The
first indication of the approaching final cessation of the menses
is often irregularity in the menses; and as this period is more
frequently the one at which any latent disease of the uterus shows
itself, it is always looked forward to with much anxiety by the
female.(1) Indeed, so replete
is this period with horrors to some, that we may very justly suspect
it to be the cause of many of the distressing symptoms which sometimes
accompany this interesting process of the human uterus. |
Irregularity a frequent first clue -anxiety
abounds |
The
reason of the discharge leaving the woman at this time of life,
appears to be founded in Divine wisdom and beneficence; childbearing
being thereby prevented beyond that period at which the mother
would be capable of extending her care to her offspring, in the
ordinary probabilities of human life; and thus consequently submit
her child to the doubtful management of strangers, or subject it
to the waywardness and caprice of those who could not feel a parent's
affection, or would not yield a mother's devotion to its many necessities
and wants, at a period at which its helplessness would most require
the kindest offices. |
Menopause
a function of God's wisdom and kindness |
This
change is sometimes so silently effected, that the woman scarcely
takes notice of her altered condition; at others its approach is
so gradual as not to attract observation, until the diminished quantity
gives warning it is about to take its leave forever. |
Some
women are totally symptomless |
For
many ages opinions have been entertained that the final cause of
this evacuation is an outlet for peccant humours [toxins], and hence
the apprehensions of women probably arise; for wherever the discharge
is less abundant than usual, the most serious fears are entertained
lest its retention should excite disease, either in the uterus itself,
or in some other part of the body; hence a diminished menstrous
secretions always more alarming to the female, than an increased
flow. |
Reduced
discharge causes apprehension |
"The
time of life," as it usually called, is without doubt an important
epoch, and care and attention are then particularly called for,
but the vulgar [commonplace] error, that women at this period
are always in danger, is not without mischief to the suffering sex;
for it is doubtful whether they are necessarily more obnoxious [liable]
to disease, at least to severe disease, at this than any other period
of their existence. (2)That they are occasionally liable to disease at this time,
and that disease one of the most terrible of human maladies, cannot
be concealed, we mean cancer of the womb, but this disease is much
more rare in the uterus than in certain other parts of the body,
for example, the breasts; and perhaps we are within the proper limits
when we say that there are three instances of the latter for one
of the former. |
Dangers
much exaggerated. |
If
latent dispositions in the uterus and other parts to disease, become
active about this period of life, it is not because the menses being
about to cease excites them, but because the disease is slow in
developing itself and is kept perhaps in check for a long time by
the menstrual discharge serving as an important evacuation; especially
when the uterus may be the seat of the complaint. In such a case
the foundation of the disease is laid, or originated at a time when
the menses were the most perfect, as regards period and quantity;
consequently; they could have no agency in its production; but,
on the contrary, from its frequently relieving the engorgement of
the vessels, kept it in subjection for a long time. Coincidences
in the human system are so common, that they are frequently mistaken
for cause and effect, the cessation of the menses and the appearance
of scirrhus [hard cancerous tumour] and cancer, or other maladies,
being regarded as cause and effect. |
Coincidence
is not causal |
Our
present concern however, is with the derangement of the discharge
at or about the period of cessation: this will consist in either
diminution of the usual quantity, or an excess of it. With respect
to the first, little need be said, as it is what is expected; but
the excessive flow must be treated, for the most part, according
to the rules prescribed for the management of hemorrhage from the
uterus from any other cause; the indication being - to diminish
the quantity discharging, and to prevent an excessive return. |
Increased
or decreased flow |
To diminish the quantity of blood discharging:The first
of these indications is best fulfilled by rest; cool air and drinks;
cold local applications; by the use of acetate of lead and opium,
no. 21; and by the plug. The patient so circumstanced must be immediately
confined to a horizontal position, and every motion should be strictly
forbidden; cool air must be admitted with freedom wherever practicable,
and no nourishment nor drink be given, except they be cooled. Cold
applications to the belly are frequently useful in excessive discharges
of this kind; the best mode of applying them is by large bladders
not quite filled with water in which there is ice, if it be in summer,
or during hot weather: cold water alone will be sufficient if in
winter. During the use of this, care should be taken to keep the
feet and legs warm. We should also give one of the pills No. 21,
and repeat it in an hour or less and continue it afterwards, if
circumstances call for it. In urgent cases, the acetate of lead
pills not being on hand, the ordinary mixture of sulphuric acid,
alum and infusion of roses, may be taken or Ruspini's styptic. Should these
means not control the discharge after a proper trial of them, recourse
must be had to the plug, - a soft handkerchief may be folded, dipped
in vinegar and water, and inserted quite up the passage. The
insertion of a small piece of ice in the first fold of the handkerchief,
is attended with great advantage, and has often a powerful effect.
The plug should never be allowed to remain longer than ten or twelve
hours at a time, without being removed, cleansed and re-inserted. |
Flooding
and Treatment of heavy flow |
The
discharge of blood at this period of life is occasionally so great
and so rapid as to threaten speedy exhaustion, and then it can be
met only by the most prompt application of the most efficient remedies.
Whether this malady shews itself in the rapid expenditure of fluid
blood, or in the repeated expulsion of large coagula [clots] it
must be opposed by the same remedies - these two conditions present
no difference of indication, nor any essential difference in the
complaint itself; the former, however, generally requires more prompt
interference than the latter as more blood is expended in a given
time. |
clots |
To
prevent an excessive return of this discharge. This second indication must be fulfilled by cautious blood-letting;
purgative; alteratives; hemlock, and tonics. In those cases where
there is an immense loss of blood at this period of life, there
is an almost continual draining off of this fluid, after the violence
of its issue is much abated; hence we sometimes find a greater or
less discharge almost always present, which renders the woman not
only very feeble, but keeps her mind in a state of extreme apprehension
from one period to another. These two causes - the excessive discharge
and mental anxiety, - keep the system in a constant state of excitement:
and if the pulse be examined, it will frequently be found to be
quick and tense. We are, therefore (unless the patient is constitutionally
delicate and debilitated) under the frequent necessity of abstracting
a few ounces of blood, especially towards that time which the disease
has assumed for its movements - say in about every three or four
weeks. |
Treating flooding
by bleeding the patient |
To
aid the vessels to contract, we should confine the patient to a
strictly vegetable diet, or to a diet of milk, if this agree with
her; all kinds of liquor and spices should be forbidden and exercise
absolutely prohibited. The patient should sleep on a mattress, and
should be directed to repose herself upon it, or a sofa, as often
as she may feel a little weakened or fatigued by sitting up. The
feet and legs should, however, be kept warm. |
Treating
flooding by diet and rest |
It
is great importance that the bowels should be kept freely open,
by the regular exhibition of some mild purgative, as No. 5, 9 or
19. Aloes is generally considered to be bad medicine in these cases,
but the hiera piera
(it is a mixture
of aloes and white canella bark) long the old woman's remedy, has
certainly been serviceable. The following case may be given as worthy
of some notice - A lady, aged forty-two years, for whom almost all
the known remedies for this hemorrhage had been prescribed, with
very little benefit, was told by some old woman that the hiera piera
was a certain cure of her complaint; as this woman cited the cases
of two or three ladies known to the patient, who had been benefited
by it, and who, on application being made to them, strongly recommended
it, she was allowed to make use of the old woman's prescription.
This was half an ounce of hiera piera to a pint of gin, of which
a wine-glassful was to be taken at bedtime: It was taken and the
lady was completely intoxicated all night and very sick the next
morning. Thinking the effects would next night be less severe, she
again ventured it with similar result. She was now determined to
abandon it, unless some less objectionable mode could be adopted
for its exhibition - it was prescribed in the following manner:
Take
of hiera piera, two drachms; oil of cloves, ten drops; castile
soap, twelve grains; syrup of rhubarb, a sufficient quantity
to form the mass - to be divided into forty pills.
One of these
was directed every morning, noon and evening, unless they should
prove too purgative; which did not occur, as the patient was of
an extremely costive [prone to constipation] habit. She soon
perceived, after she began to use this medicine, a diminution of
the discharge, and by the time she had finished the pills prescribed
above, it was so much reduced in quantity, as to give no further
uneasiness. This and a few other cases of a similar kind,
prove the importance of gentle purging in this condition |
Purging
necessary in cases of flooding |
The
extract of conium (hemlock) is often a useful medicine in this disorder,
especially where the discharge is chiefly by coagula. It may be
given in pills in the dose of three to six grains, or more, twice
or thrice a day, and is serviceable in allaying irritability and
relieving pain. I think the addition of a small quantity of
blue pill, and tartarized antimony (as in the form No.22) will often
be more serviceable than the latter given alone, especially where
there exists symptoms of great functional disorder in the liver
and bowels |
Use
of hemlock for clots |
When
the condition of the patient is very much improved by these means,
and debility remains, we may venture cautiously on a more generous
diet, gentle exercise daily in the open air, and a little of the
mildest kind of tonic, as infusion of cascarilla, gentian or calumba. |
Convalescence |
But
what we have previously said refers only to the severe form of this
complaint.; and we will now add a few words as to the management
of the more ordinary cases. Commonly little or nothing is required
beyond attention to keep the bowels open by means of beaume de vie, or one of the mild aperients No.
9 or 19, taken every or every other night, No. 22 or Plummer's pill;
or the alterative pill No. 91 in the DOMESTIC MEDICINE, sometimes
answers remarkably well. Together with these means, the exercises
must be attended to and the diet should be nourishing, but rather
less in quantity than usual. |
"Ordinary"
cases of increased flow need little attention |
When
a great many days are employed giving issue to a discharge, or,
as the women term it, being almost constantly unwell, yet where
the aggregate quantity may not greatly exceed the common monthly
evacuation, some tonic and a mild alterative are indicated, also
bathing the parts in cold water, abstaining from much exercise especially
in the house, and from all stimulating food. Two drachms of rhatany,
thrice a day in a wine-glassful of water, is very useful; or the
infusion of cascarilla, as in No. 16, may be advantageously taken
In conjunction with these measures, a single pill of the acetate
of lead, No. 21, or one pill taken now and then is likely to be
of great service, particularly if the discharge appears disposed
to increase in quantity. |
Constant
spotting |
Many
women at the period of the final cessation of the menses, although
they do not suffer from a profuse discharge or hemorrhage, yet are
much troubled with rheumatic or flying pains, head-ache, hot flushes
and other troublesome symptoms. It is too common for such persons
to go on along time unrelieved, and to be told that these feelings
being necessarily produced by their state, there is little to be
done but bear them patiently. This, however, is a mistake,
for I have found an alterative pill at night, similar to Plummer's
pill, or No. 91 in the DOMESTIC MEDICINE, with sarsaparilla and
rhubarb in the day, to be almost a sovereign remedy, provided the
patient is careful of her diet, and attentive to her bowels and
to exercise. In prescribing an alterative pill in these cases, we
should vary the combination according to circumstances, sometimes
giving half a grain of calomel, or less, in each pill, and sometimes
adding a little Dover's powder, whereby its soothing effects are
promoted. The kind of combination, and the doses, will of course
make a great difference in the effects in different cases |
Other
symptoms warrant sympathy |
