Spongia. Violent drawing in the upper and lower extremities during the menses.
Stannum. The malar bone is painful to the touch before the menses, and during their flow it is painful event to move the muscles of the face. Dysmenorrhoea with terrible headache, the pain gradually increasing to hits highest point, and, after remaining for a time, as gradually declines.
Stramonium. Excessive loquacity during the menses. Drawing pains in the abdomen, upper and lower extremities.
Sulphur. The menses are thick and black and so acrid as to make the thigh sore. Every evening, just before the menses, she always has a cough. Pain in the abdomen during the menses, as if the intestines were strung up in knots by threads. She has to take a sitting posture for relief. Flushes of heat on the top of the head, cold feet, &c.
Sulphuric acid. She always gets a distressing nightmare before the menses.
Tart. e. Pain in the groins and cold creepings just previous to the menses.
Thuya. Terribly distressing pain in the left ovarian and iliac regions with scanty flow. She has to lie down, the suffering is so great.
Veratrum. The sufferings during menses are attended with thirst for icy cold drinks, nausea, vomiting and diarrhoea, or simply diarrhoea. Cold sweat on the forehead from the pain. Great exhaustion.
Zincum. During the menses, heaviness of the limbs with violent drawing about the knees, as if they would be twisted off. Sore eyes. Sudden oppression of the stomach; she was to loosen her dress.
MENORRHAGIA is the term now employed to signify an increased or immoderate flow of the menses, or profuse menstruation. Formerly it was understood to embrace uterine hemorrhage in general; but it is now very properly restricted as above; while by the term Metrorrhagia are designated those hemorrhages from the uterus which are not connected with the catamenia.
The following very general division of the varieties of menorrhagia with simplify the whole subject, and at the same time render our brief description more clear and comprehensive.
I. functional Menorrhagia; in which the flow is increased in quantity, or in frequency, or in both.
II. Organic Menorrhagia; in which the flow appears in connection with some positive disorder of the sexual apparatus.
III. Sympathetic Menorrhagia; in which the flow appears in connection of with severe forms of general disease.
In Functional Menorrhagia, the flow may be perfectly natural, except in its quantity and in the frequency of its return; or it may be occasionally mixed with the clots of blood. In either instance, the causes of this affection are to be found in the more or less plethoric condition, habits of life, or even in the various anomalies of the blood itself. These, and similar influences, some of them deeply seated and constitutional, may combine to produce such profuse discharge at the monthly periods, or even oftener, without the intervention of any distinct disorder either of the sexual apparatus in particular. Only the earlier or milder forms of menorrhagia can be included in this class, those which have not been preceded by any actual disease, and in consequence of which no organic lesions have as et arisen. And many cases which in their initial stages would be classified here, subsequently become so complicated as to belong rather to the second class. In this same class of functional menorrhagia, must also be included, all those cases which arise from general debility without positive disease; as in persons who fall into this “weakly way” from having too many children, or from over- suckling them to prevent the too rapid increase of the family. And cases arising from excessive coition or any other form of over-exertion; or from some inherent constitutional weakness (especially in this respect) which may be aggravated and developed by various provoking influences, are all to be included in this class.
In Organic Menorrhagia, the flow appears in connection with some positive disorder of the sexual apparatus. In the order of time, this flow may precede or follow the appearance of the organic disease; but in either case there is such an established connection of the menorrhagia itself with other disorders as renders the case very different from what is described under functional menorrhagia. Nor is the reality of this connection at all affected by the view we may take as to the question whether, in any given instance, the menorrhagia is due to the disease which may have preceded it, or to the structural change which, in another case, may have followed it. Thus in some instances the threatened onset of some organic disease is preceded by congestions which, greatly aggravated at the menstrual period, render the flow abnormally frequent and profuse. So the actual presence of structural disorganization of the uterus, or of any os its appendages, even when out not very far developed, may produce such menorrhagia. And finally, these d forms of profuse menstruation, whether too frequently or more rarely recurring, may sometimes not only be caused by some hitherto undeveloped change in the interior organism, but they may also remain persistent as consequences of former diseased conditions of the various of the sexual apparatus. In the first of these three categories might be enumerated a very great variety of the disorders of the female organism, the majority of which are in many instances at least, preceded by increased catamenia; in the second, might also with equal propriety be mentioned almost the entire range of such diseases, from simple uterine congestion of up to polypoid and cancerous tumors; while in the third, the simple mention of the profuse menstruation which, unattended with any other disorder, sometimes appears after the period of the change of the life, may supply all that is needed in the way of illustrative example.
Some forms of uterine disorder are preceded or even caused by entire amenorrhoea; but it is easy to see that the deep-seated physiological tendencies toward active disease of the uterus and its dependent organ must to a certain extent consist in congestion, which cannot but be greatly aggravated by the menstrual nisus, and which consequently leads to a more profuse menstrual discharge. The same is still more plainly true of the actual presence of structural disease in any of these organs, the constant congestion must necessarily be seriously enhanced by the added influence of the catamenia; and from this combination of pathological and physiological conditions, a more than normal flow results. And in those cases in which structural disorders have existed formerly, but have now subsided, to all appearance, the proofs of their former existence still remain, in many instance, in the form of chronic congestion, which is capable of producing menorrhagia, often of the severest form, and even of keeping it up and reviving it after t he change of life.
We make these statements, not from any desire to give undue prominence to pathological views, but to show the importance, the necessity of most carefully studying all the symptoms, those preceding as well as those attendant, in order to prescribe correctly in such cases. The menorrhagia, which we are called upon to treat, is by no means such a hemorrhage as that from an open wound, which may be stopped as soon as convenient; we have, in fact, something to do very different from arresting an active or even a passive hemorrhage; we have a sick person to cure. And just as fast as by our prescriptions, of advice and medicine, her general health improves, just so fast will she find her catamenia approaching the normal standard. Nor when we have done for our patient in such cases all that our art admits and science requires, shall we have merely “set her courses right; “we shall have so restored her health that her courses will come right and remain right, since by curing the patient herself we shall have removed the causes of the menorrhagia.
It is not intended to assert that all this can always be accomplished; but nothing less than all this should always be the aim of the physician. And even of he should not succeed in restoring his patient to perfect health, he will have gone to work in the right way to do it; and if his success be but partial and incomplete in a given case, even if it should disappoint both his own hopes and the expectoration of his patient and her friends, how much greater will it not be than if he had gone to work in some other than the best possible method? How great is the difference, in chronic cases especially, between even a small improvement and a positive change for the worse?
In Sympathetic Menorrhagia, the flow appears in connection with severe form of general disease. Examples of this variety of profuse menstruation are seen in some cases of variola; morbilli, especially rubeola nigra; scarlatina; erysipelas; typhus; cholera; and during the course of these diseases, especially when they determine a draining of the mass of the blood, the courses are often suppressed; still a great number of observations have proved that when the flow persists, it may become so copious that it completely exhausts the already feeble forces of the patient and may even hasten a fatal termination. This is especially the case with the exanthemata. We have often observed that the appearance of a very copious menstrual hemorrhage during the course of these diseases, is almost always the precursor of a fatal dissolution of the blood. Sanguineous discharges form the skin, the nose, the rectum, etc., soon supervene, and death occurs sometimes even in a few hours after the startling cerebral symptoms have come to complete the picture represented by the rapid decomposition of the blood. Scanzoni.
