In certain chronic diseases or disordered conditions of the blood, such as are found in anaemic and in scorbutic, patients; such as are seen to result from the excessive use of salt food, as in scurvy; and such as follow the long-continued use of potash, as in bread largely prepared with saleratus, the blood is thin and watery, loses its rich color, its fibrine is dissolved, especially by action of the potash, and passive hemorrhages readily make their appearance. This state of the system, resulting in many instances from easily discernible causes, is analogous to the hereditary condition just referred to under the names of constitutional peculiarity and psoric diathesis. In either class of these affections, the abnormal liquidity of the blood favors the extravasation; and it is easily understand that the losses of blood, although replaced as to quantity by the absorption of water called for by the intense thirst so commonly seen after severe hemorrhages, do but still further aggravate the disposition to metrorrhagia.
In certain constitutions there is seen in connection with the catamenia, a remarkable disposition towards violent hemorrhage. And the same thing is equally true in other cases unconnected with the menses. This disposition may be termed a constitutional metrorrhagia molimen, in which, under the influence of appropriate exciting causes, the blood rushes to the uterus, and flows from it; just as sanguineous congestion and haemoptysis result from corresponding excitement of the pulmonary organs. Cases of metrorrhagia of this class are mostly to be seen in persons of a plethoric habit, who are thus almost exactly the opposite of those above mentioned as anaemic, scorbutic and scrofulous.
The alarming, frightful, and sometimes even fatal metrorrhagias, which may arise from even very small polypi, have already been referred to in the description of these forms of uterine tumor. In cancer of the uterus, the metrorrhagia is often periodical, even in those who have long passed the critical age; it is alarming both from its quantity and from the frequency of its recurrence; it may be very sudden and severe from the destruction of some important blood-vessel; it may alternate with a limpid, serous, or extreme fetid discharge; it may form from time to time a sort of crisis in the cancerous disease and congestion; it often augments during the whole course of the case, but may sometimes suddenly cease, leaving the patients entirely free during the latter part of their existence.
The metrorrhagias which arises from placenta praevia, from retained placenta, and from other causes in connection with parturition, will be more particularly considered in the description of the difficulties of Parturition itself.
Those which arise from abortion may be due either to the violence or those causes of the abortion itself, or to the prolonged retention of the ovum and placenta. The latter has been known to have remained for weeks, keeping up a more or less constant hemorrhage during the whole time. But this subject will also be more fully and appropriately discussed in connection with the general subject of Premature Delivery.
Still another most important class of metrorrhagias is found in those which appear after the change of life. These may arise in some instances from disorganization of the tissues of the womb itself; but in most cases the hemorrhage is believed to be due to the real metrorrhagic molimen already referred to, or to the continuance of the same scorbutic or psoric influences in the system, which have been described as producing metrorrhagia in the earlier periods of the female life. In these cases, the hemorrhage may be more or less constant; or it may alternate, in various ways, with a watery or a passed the critical age, a certain amount of periodicity is observable. But the subject will be again considered in the chapter on the Change of Life.
The attendant symptoms, although always to be taken into consideration in prescribing for a case of metrorrhagia, need not here be recited. They are mostly symptoms of debility and prostration in various degrees and forms; it should be borne in mind however that some patients bear very severe losses of blood with comparative impunity, while others suffer very greatly from every slight hemorrhage.
The treatment of metrorrhagia requires the utmost quiet on the part of the patient, and the strictest attention to all the circumstances and conditions, on the part of the physician.
This is not a local affection, but is always constitutional, dependent upon some general disease which, when abated, the hemorrhage is controlled, except in case of actual rupture of the uterus, placenta praevia, and atony or paralysis brought on by too suddenly evacuating the contents of the uterus.
The following remedies, and others mentioned under the titles relating to the different varieties of uterine hemorrhage, should be carefully studied and compared.
Aconite. In active hemorrhage with fear of death and much excitability. She cannot sit up even in her bed. She seems to giddy she falls over. Particularly suitable to females of full, plethoric habit.
Antimonium curd. Uterine hemorrhage, with a distinct pressure in the womb as if something would come out. Somewhat rheumatic. White tongue. Nausea and vomiting.
Apis. Profuse uterine hemorrhage, with heaviness in the abdomen; faintness. Great uneasiness and yawning. Red spots, like bee- stings, upon the skin, and sensation, as if stung by bees, in the abdomen and in different parts of the body.
Argentum nit. Uterine hemorrhage, with much trouble in the head. Confusion, dullness and much pain, greatly aggravated by the least movement. A short time seems very long to her; and every thing done for her seems done so very slowly. She has, for instance, been flowing an hour, and to her it seems hours; we work rapidly for her safety, and she thinks we are so very slow.
Arnica m. In cases from a fall, a shock to the system or a concussion. Blood bright-red, or mixed with clots. Nausea in the pit of the stomach. Warmth about the head and the extremities cool.
Arsenicum. Hemorrhage with lancinating burning pains; in low states of the system, when aphthae appear.
Belladonna. Profuse discharge of bright-red, hot blood, with pressing or forcing (outwards) as if all would escape the vulva; or pain in the back as if it would break. The blood sometimes has bad small. A flow occurs at times between the periods. Sometimes a vascular excitement prevails; throbbing in the carotids; flushed face, red eyes and full, bounding pulse.
Bryonia. Hemorrhage of dark-red blood, with pain in the small of the back and headache as if it would split. Dry mouth and lips. Nausea and faintness on sitting in bed.
Calcarea carb. The history of the case shows that she has always menstruated too often, too much and too long. It seems difficult for her to stop menstruating. Leucophlegmatic constitution. Cold, damp feet. Swelling at the pit of the stomach like a saucer bottom up. Vertigo on stooping, worse on rising again or on going up stairs.
Cantharis. Uterine hemorrhage, with great irritation in the neck of the bladder. Urinating often, smarting, cutting and burning in passing only a few drops.
Carbo veg. Passive metrorrhagia with much itching of the vulva and anus.
Chamomilla. Metrorrhagia of dark, coagulated blood, with tearing pains in the legs, and violent labor-pains in the uterus. Hemorrhage of dark blood with pressure towards the uterus and frequent discharge or colorless urine. Great irascibility.
China. Hemorrhage from the abuse of Chamomilla. Discharge of clots of dark blood. Uterine spasms. Desire to urinate. Colic. Also after miscarriage, or labor, or at any other time when there is much loss of blood. Coldness and blueness of the skin. Twitching and jerking of single muscles. Heaviness of the head, ringing in the ears, loss of sight and fainting; in the most desperate cases of this type, China will speedily cure.
Cocculus. Particularly in pregnant females.
Coffea. Hemorrhage with excessive sensitiveness of the organs and voluptuous itching; she would like to scratch, but there is too great sensibility.
Creasotum. Discharges of a large quantity of dark blood; then for a few days bloody ichor with pungent odor, corrosive itching and smarting of the parts; then the discharge recommences and the same phenomena transpire again.
Crocus. After miscarriage or labor, or from dancing or a long walk during the catamenia, with or without pain, there is a discharge of a dark, stringy blood; it comes away in dark or black strings. Often there is a sense of rolling and bounding in the abdomen; sometimes there is a similar feeling in the stomach.
Ferrum m. Hemorrhage with fiery-red face, and hard, full pulse. After parturition or miscarriage, a frequent discharge of partly fluid and partly black, clotted blood, with violent labor-like pains, full, hard pulse, and frequent short shuddering; headache and vertigo; constipation and hot urine.
