Those comprising the first of these two classes are weak, pale, delicate young women; spare and thin, or fleshy and leucophlegmatic; in either case, having feeble circulation, as evidenced by general chilliness and sensitiveness to the cold; imperfect nutrition, as shown by their indifference to or disgust for food, or still worse, imperfect assimilation, as shown by their insatiable appetite. Those composing the second class, on the contrary, show all the appearance of perfect and robust health; they are plumb; their cheeks red, their complexion florid, and their habit plethoric. In the former of those classes of amenorrhoea, the sufferings are more chronic, and more generally diffused over the entire system; in the latter they are more acute and severe, and more concentrated in the form of local congestions. “In both, the attempt at menstruation may be made each month, accompanied by shiverings, pain in the back and loins, weight at the lower part of the abdomen, aching down along the thighs, general lassitude and uneasiness, and sometimes pain in the thyroid gland. These symptoms, after continuing a few hours or a day or two, pass away without any menstrual secretion, to be repeated each succeeding month. “But the effects of this abortive effort are not so temporary;, severe headaches occur occasionally, sometimes with intolerance of light and sound, the patient complains of throbbing and a sense of fulness in the head, pain is felt in the side, the stomach and bowels become irregular in their functions, the countenance pale and the strength much reduced. Paroxysms of dyspnoea and hysteria, and hysteralgia come on; and the patient has the appearance of confirmed ill-health; is sometimes said to be going into decline. There is general chilliness, or disposition to attacks of fever, according to the plethoric or lymphatic temperament of the patient; pain in the chest; and if the patient be of the florid constitution, her case may easily terminate in quick consumption; while if leucophlegmatic, the same fatal termination may be reached by a somewhat more tedious course.
A careful study of the different remedies mentioned at the close of this section will enable the physician to determine upon the medicine to be administered. And in most of the emansio mensium form of amenorrhoea, when we have described as amenable to and requiring medical treatment, a single dose only should be given, waiting until after the return of the next menstrual period; or even longer, if signs of improvement should appear.
Suppressio Mensium constitutes the second form of amenorrhoea, in which the menses having made their appearance have subsequently ceased.
This may be sudden in its onset, violent, accidental suppression; or it may come on in a gradual manner. In the former case it may lead immediately to severe and dangerous forms of disease; in the latter, it may precede the development of some profound constitutional disorder, such as phthisis; or it may result from organic derangement of the uterus, or of the ovaries themselves.
Causes. Acute Suppression of the menses may result from exposure to cold, and wet, or both, immediately preceding the appearance of the menses or during their flow; from violent shock to the nervous system, as in cases of fright; from sudden and severe mental distress; or from any profound disturbing influences, whether physical or moral received during the menstrual period.
Chronic Suppression of the menses may result from any slowly operating debilitating influences, from too close sedentary confinement, as in young girls at school; from too severe mental application; from lack of sufficient nourishment; from leucorrhoea; and, as already stated, from the development of some constitutional dyscrasia, such as consumption, &c., or from scrofulous or other affections developed in the ovaries and other of the sexual system.
Symptoms. The more sudden the suppression and the more severe and profound the causes which produce it, so much the more violent will be the resulting symptoms. In most there is more or less fever; headache, hot skin, quick pulse, nausea, and other indications of general constitutional disorder. Or the ill effects of the suppression may be developed in local inflammation, as in inflammations of the lungs, uterus and ovaries. And in cases of nervous temperament, and scrofulous diathesis, there is often a remarkable disposition to be attacked with inflammation of the brain, from the menstrual suppression. In such cases the return of the menses would usually be followed by a subsidence of the cerebral symptoms. The appearance of the menstrual flux in other severe illnesses, where there had been no previous suppression, is regarded as constituting a very grave complication.
Hysterical affections, or even neuralgic sufferings, in other instances, may result from suppression of the menses; and these may successively attack the head, lungs and stomach. Sometimes the more profound consequences of nervous debility and disorder, such as fainting, loss of vision, amaurosis, apoplexy and even paralysis, make their appearance in connection with such suppression. And the more violent disorders that follow acute, sudden suppression of the menses, are very apt to terminate fatally.
“Suppressed menstruation, either sudden or gradual, is not unfrequently followed, even when uterine inflammation is not developed by serious general symptoms, obstinate vomiting, severe hysteria, and sometimes by the establishment in the economy of a supplementary hemorrhage, to which the name of vicarious menstruation has been given. The mucous membrane of the nasal fossae, of the lungs, stomach, and bowels, are the most ordinary seat of this hemorrhage, which takes place in some instances with the regularity of normal menstruation, and in others at irregular periods. All the other mucous membranes, and also the skin itself in various regions, have been the seat of vicarious menstruation. It has not unfrequently been observed from the surface of wounds or sores..–Bennet.
This so-called, vicarious menstruation constitutes a form of hemorrhage in general less grave than that from other sources. Where it attacks the lungs, for instance, it does not like other haemoptysis, indicate the presence of tubercles, but rather a state of the system which may sooner or later lead to them, if not remedied. The manner in which the chronic or gradual form of suppression takes place, should also receive consideration. The suppression may not occur all at once; but be first preceded by more or less irregularity of menstruation in respect of time. One or more periods may be passed over, the menstrual flow returning again in a diminished quantity, and then finally ceasing. Or the irregularity may be more with regard to quantity alone, the menses with each preceding month becoming less, until they disappear altogether. Or the discharge for some time before its total suppression may have been growing more and more light colored, this is said to be the most frequent manner in which chronic suppression occurs. The menses being supplanted by a perfectly white discharge; or they diminish in quantity, become of a paler color and with shorter intervals; then a menstrual period arrives in which the fluid excreted, is perfectly colorless, while the next period may be characterized by discharge of the natural color. Or again, as mentioned in a preceding chapter, the leucorrhoea, which so often causes amenorrhoea, encroaches more and more upon the menses, both in the time and in the quality of the discharge, until it finally completely replaces the menstrual flow.
The same gradual diminution of the menses may lead to their premature cessation, and this may be in reality the period of the change of life. In such cases, nature, after a few years of rest of the sexual organs, sometimes restores their activity; and women who had supposed themselves to have finally passed the critical age, are surprised to find a full and complete return of the menstrual flow. All this but serves to show that the amenorrhoea, from whatever cause, or combination of causes it arises, is not in itself a disease or even necessarily a morbid condition; as during pregnancy and after the change of life, the menses are wanting from causes which although perfectly natural; are entirely opposite, the person remaining in perfect health. In other cases, however, the disappearance of the menses indicates a disordered state of the whole system, which may be unimportant and temporary, or deep-seated and severe, according to the nature of the influences which produced it. There are, however, cases of suppression of the menses, which, arising from influences comparatively slight, do not so profoundly affect the system; and in which, even without particular treatment, the menses may spontaneously return after missing but one or two periods.
And in all cases, the treatment must be governed by the causes, as in cases of suppression from wet, from fright, &c., and by the totality of the symptoms. In the acute form of the suppression, the appropriate remedy may be repeated oftener, according to the violence of the symptoms and the severity of the suffering, taking care to allow the first dose to exhaust its action before giving the second. While in the chronic form, the remedy, chosen for its adaptability to the whole case, must be allowed to act for weeks, or even months, undisturbed in its action by a second dose, so long as improvement can be traced. If no improvement appears, the dose may be repeated, or anew prescription made, according to the circumstances of the case. The proper treatment of the gradual, chronic from will result not only in the restoration of the menstrual flow itself, but also in the removal of the constitutional disorder, of which the suppression was but the forerunner; and in the radical cure of the local, organic affections of the sexual organs by which, in other instances, the suppression may have been produced. And the same will be found true of the complications, such as leucorrhoea, haemoptysis, or other severe affections which may arise in connection with the amenorrhoea. Let the diet and hygiene of the patient be properly attended to; and then the less the attention paid to external treatment, the sooner will the recovery be complete. Give the proper Homoeopathic remedies, in the proper manner, in these cases, and all the paraphernalia of hip-baths, foot-baths, tonics, stimulants, and misnamed emmenagogues may be dispensed with as worse than useless. The real object being not so much to compel the return of the menstrual flow, as to cure the patient of that disordered condition of her system which led to its suppression.
