The attainment of Puberty in the human female is indicated by the establishment of menstruation, and is the epoch at which she fully enters on that general development and growth which terminated in her being capable of bearing children.
Signs of Puberty. Before this functions commences, a striking change is effected in the general system. The pelvic viscera become rapidly developed, and the hips enlarged; the breasts become rounded and full, and establish their connection and sympathy with the womb; the chest, throat, and arms acquire the contour of a mature development, and the whole body becomes more rounded, full, and adipose; the hair grows more luxuriantly; the skin becomes fresh and blooming, the voice full and mellow; and the whole female figure acquires that elegance of symmetry, the complexion that bloom of health and beauty, and each feature and action that play of intellect and emotion., and that indescribable gracefulness of action, which are to be found in women alone.
Corresponding with the external changes coincident with Puberty are internal ones, occurring especially in the ovaries and uterus, which now become more active and more perfectly developed; in short, she has now, as a rule, power to conceive.
The mind, too, as well as the body, acquires a rapid growth; the mental capacity is enlarged, the imagination becomes more vivid, and the nervous system exhibits a heightened sensibility.
Maternal Instruction. As Puberty advances, no prudent mother will neglect to instruct her daughter to expect the change which is common to her sex, so that the first appearance of the menstrual flow my neither be arrested by the alarm naturally felt at something hitherto inexperienced, nor by the dangerous applications to which in her ignorance she may otherwise secretly resort. Some persons view the whole matter with such strong disgust, that they expose themselves carelessly or purposely at the regular time to cold and wet, or use cold baths or other means of suppression, and thus finally bring on disordered menstruation, and permanent ill-health. The mother should keep an account of dates and other particulars, and, for a few days before the expected low, should prevent all unusual exposure to light air, as at balls and evening entertainments; or to the injurious effects of damp men, thin dresses, or wet feet, When the function has once became healthily established, such extreme precautions need no longer be observed.
V. The Function of Menstruation.
The periodical recurrence of the menses, or courses, as they are termed, is one of the most important of the female organization. It consists of monthly exudation of fluid from the womb, the average quantity being from four to six ounces at each period. The duration of a menstrual period varied in different persons, the most common being from four to five days.
This fluid is eliminates from the uterine vessels, and is considered by some as a true secretion, and by others as discharge of pure blood. The latter opinion is the correct one. it is well known that menstrual blood does not coagulate like ordinary blood; and it has been demonstrated that the addition of a small quantity of acetic, or phosphoric, or indeed of almost any acid, to natural blood, will prevent its coagulation, and render it in its properties and appearance similar to menstrual blood.
In cases, however, in which the discharge is so profuse tat a portion of its coagulating constituent-the fibrine escapes without intermixture with the acid secretion, clots are formed. Thus it is proved that true menstrual blood, uncombined with the normally acid vaginal mucus, is like ordinary blood, and equally capable of coagulation; but that being immediately dissolved in the vaginal mucus, it is thus unenabled pass off in an uninterrupted course. And here may be observed one of those wise and beneficent contrivances of the Creator and Preserver of all, which so frequently excite the wonder and admiration of the physiologist. If no such solvent power as that of the acid vaginal mucus existed, the coagulated part of the menstrual secretion would, in consequence of its consistency, be prevented from passing along the vaginal canal, and would thus become a mass of dead and putrid matter, entailing consequence which would be fearful in the extreme.
VI. First Menstruation.
In our climate, from the 14th to the 15th year is by far the occurrence of the first menstruation. In hot climates it commence at an earlier, and in cold at a more advanced age. The occurrence of menstruation in this country earlier than he 14th year-at the 13th or 12th year; and also one or two years later than the 15th year-at the age of 17 or 18-is not sufficiently uncommon to justify any medicinal interference, should the health be otherwise good; although as a rule the former is too early, and the latter is too late. Menstruation commences considerably earlier in cities than in the country. It also occurs in the daughters of the rich, who have every comfort and luxury, everything which enervated and relaxes, and at the same time excites, at least nine months before it does in those of the industrious portions of the community in the most comfortable circumstances; and full fourteen months, on the average, before it appears in the poorest classes.
It is satisfactorily established, that, in every country and climate, the period of menstruation may be retarded in very many cases much beyond the average age, without producing ill-health or the slightest inconvenience. Probably the most successful mode of rearing girls, so as to bring them to the full perfection of womanhood, is to retard the period of puberty as much as possible, at least until the 14th or 16th year. In carrying out this suggestion, it is of the highest importance to discontinue the use of hot-baths, especially with the addition of mustard; also the indulgence in the use of hot, spiced, and stimulating food and drinks; living in over-heated and badly- ventilated rooms; excessive dancing, novel-reading, and late hours; for all these tend to occasion precocity, with frequent or copious or irregular menstruation. It is the duty, therefore, of the mother to enjoin on her daughter the frequent use of cold baths, free exercise in the open-air, or in cool, well-ventilated rooms, to provide plain and digestible diet for her, and to insist on abstinence from hot tea and coffee.
It is not always, however, that puberty advances gradually and normally. The establishment of menstruation may be long delayed, and then excessive languor, drowsiness, violent pain in the head or along the spine, and in the region of the bowels, with a feeling of weight, tenderness or heat, or a bearing-down sanction in the pelvic region, may alternate with feverish reaction, or with nervous symptoms, or even with spasms. In some girls it may be accompanied by derangements of the venous, biliary, or lymphatic systems, and, unless successfully treated at this period, these disturbances may be present, in a greater or less degree, during every subsequent recurrence of the menstrual discharge. The treatment of these abnormal conditions is described in subsequent sections.
Menstruation may occur for the first time prematurely, from a severe fall, violent jumping, great mental emotion, etc. In such cases there may be a considerable discharge, amounting, in extreme instances, to absolute flooding, and lasting for several days. It is important that these facts should be known, so that in such sudden and extreme instances the mother may not only maintain her own composure, and calm any excitement in the patient, but efficiently carry out the following measures.
TREATMENT. A few doses of Aconitum, if resulting from mental emotions, or of Arnica, if occasioned by a fall or any external injury, observing at the same time the following conditions: Rest, in the recumbent posture, light covering, a cool and well ventilated apartment, and cool drinks. These means will often be sufficient to arrest any serious consequences, or at least will suitably precede the more detailed treatment suggested in subsequent part of this manual, or the attendance of a homoeopathic practitioner.
Menstruation and the General Health. If the catamenial function, as it is termed, be well and healthily established, new impulses will be given to every nerve and organ of the body, and the system will acquire superior forces for resisting influences adverse to health. On the other hand, constitutional delicacy, carelessness, or improper treatment, may render this period extremely dangerous in the propagation of new forms of disease, or in the development of any latent disorder which has existed from birth. Hence, the first appearance of the menses should be looked forward to with some care anxiety on the part of the mother or guardian; and when they are long retarded, the general health disturbed, and the remedies and measures suggested in this work appear inefficient in bringing about the necessary change, a homoeopathic physician should be consulted without delay. False delicacy and improper treatment have needlessly undermined the health of thousands.
VII. Delay of the First Menstruation. (Amenorrhoea-Emansio mensium.)
We have before stated, that the period at which the “Change” first takes place varies in different constitutions and under different circumstances, and not active medicinal means should be used so long as the health continues good. But when all the external sings of womanhood have appeared, and menstruation does not occur, but there are aching, fullness, and heaviness of the head, bleeding at the nose, palpitation of the heart, shortness of the breath of slight exertion, weariness of the limbs, pains in the small of the back, in the lower part of the bowels, and down the inside of the thighs: these may be regarded as so many indications that nature is seeking to establish this important function. Under such circumstances, a selection of one or more of the following medicines may hasten the necessary change.
CAUSES. Retention of the menses, giving rise to the symptoms just noted, rarely occurs in healthy and vigorous persons, but usually follows as a consequence of original delicacy of constitution or of some long-standing chronic affection. But it is important that the cause should, if possible, be definitely ascertained.
Occasionally there is original defective formation of the vagina or of the uterine organs; or some mechanical obstruction may prevent the passage of menses (retention mensium). These causes can only be determined and relieved by examination and surgical means. If no such cause exist, the delay is due to want of development at the time of puberty, and may be benefited, or the concomitant symptoms relieved, by the following remedies.
TREATMENT. Pulsatilla. Pains in the abdomen and across the back; hysterical symptoms, alternate laughing and crying, nausea and vomiting, palpitation of the heart, loss of appetite, and indigestion. This medicine is chiefly indicated in girls of light complexion, fair hair, and a timid, easily vexed, yet uncomplaining disposition.
Cimicifuga Racemosa. Delay from deficient nervous energy in the ovaries, with excess in other organs, manifested by extreme nervousness, hysteria, heavy headache, restlessness, sleeplessness, chorea, etc.; pain under the left breast, and in the left side generally, rheumatic pains, etc.
Ferrum. Debility, languor, palpitation, indigestion, sometimes Leucorrhoea, very pale complexion, puffiness of the face and ankles, and other anaemic and chlorotic symptoms (See Chlorosis). Senecio is also a good remedy.
Phosphorus. For delicate constitutions, with sensitive lungs, and a predisposition to disease of those organs. Sometimes, in such cases, instead of the menstrual discharge, expectoration of blood in small quantities occurs, with cough, and pains in the region of the chest. See also Bryonia, further on; and the section on “Vicarious Menstruation,” p.43.
Calcarea Carbonica. Scrofulous patients, with chronic indigestion, heartburn, enlarged glands, etc.
Arsenicum. Poor appetite, great prostration and emaciation, swelling of the ankles, feet, or face, etc. Sepia, Iodium, Sulphur, or Secale, etc., may also be required.
For the concomitant symptoms:
Nux Vomica. Congestive morning headache, constipation, frequent acute indigestion, spasms, etc. This remedy is well suited to patients of dark complexion, energetic, vehement, and irritable disposition, and who take too little out-door exercise.
Bryonia. Bleeding from the nose and spitting of blood instead of the menstrual discharge, with hard, dry cough, stitches in the chest, and constipation.
Veratrum. Cold hands and feet; hysteric and fainting fits; nausea, vomiting, and tendency to diarrhoea.
Administration. As a general rule, the selected remedy should be administered in the morning on rising, one or two hours before dinner, and on retiring to bed. When the symptoms are acute, hourly, or every three or four hours.
ACCESSORY TREATMENT. It is very important that the feet be kept warm and dry, and that comfort rather than fashion should determine the arrangements of the entire clothing. It is especially necessary that the abdomen be kept warm; the necessity of wearing drawers, to protect it from cold, must therefore be obvious. Too studious and sedentary habits should be corrected; exercise taken out of doors, particularly in the morning; walking, running, thee games of battledore and shuttlecock, trundling the hoop, and other exercises, are powerful auxiliaries for obtaining health of body and vigour of mind. These exercises are likely to be much more efficacious if practiced in the country, in suitable weather, and where the air is pure and bracing. If pleasant company can be added to the charms afforded by diversity of views and landscapes, the advantages will be yet greater. All these means should be aided by a carefully selected diet, consisting of easily digestible animal and vegetable food. Made-dishes, high seasoning, and spices, also the use of tea and coffee, and all stimulating drinks, are to be avoided.
Cocoa forms a suitable and nourishing beverage. The nibs should be soaked in water over night, and the next morning boiled briskly in the required quantity of water, for two hours, strained off, and the liquid served up with boiling milk. The common practice of stewing the nibs detracts from the otherwise pleasant flavour.
AMENORRHOEA AND GENERAL ILL-HEALTH. It is most important to recognise the connection, as cause and effect, between general deranged health and the absence of menstruation. The function of menstruation, like the other functions of the body, is best performed hen the system is in health. Now health is not promoted by redundancy or excessive action, any more than by debility or enfeebled action; consequently, the exhibition of stimulants will not hasten the menstrual function, even in cases of debility, unless attention be paid to the restoration of the general of the patient.
With these views we have prescribed Pulsatilla, Ferrum, Phosphorus, Cimic., etc., not as mere emmenagogues, but rather as efficient and well-tried agents for aiding to remove that defect, in the health, or general functional inactivity of the body, which is the real cause of the evil The experience of all homeopathic physicians proves that the effect of our treatment in cases of delayed menstruation is the improvement of the general health and spirits of the patient, and that Amenorrhoea at length disappears as evidence that the cure is complete.
CAUTION. And here let it be observed, once for all, that the attempt to remedy any defect in menstruation by spirits, decoctions of herbs, by the pills which are procured with such fatal facility at druggists’ shops, or by any kindred means, deserves the strongest reprehension. The practice is fraught with life-long danger to the system, and is therefore emphatically to be condemned. It must be distinctly understood that unless it is abandoned the patient must be prepared for an ultimate increase in the very suffering from which she thus vainly seeks relief.
VIII. Suppressed Menstruation. (Amenorrhoea-Suppressio mensium.)
When the menstrual flow has fairly been established as part of the economy, it is yet liable to be suppressed.
CAUSES. The cause may be a physiological one, such as pregnancy; frequently, however, it is consequence of weakness, resulting form excessive loss of blood, chronic and acute disease, sexual excesses, and mechanical obstructions; or it may occur suddenly during the flow from exposure to cold and damp, as by getting the feet wet, or eating ices; or from violent emotions of the mind, such as anger, terror, etc., or from any other cause which abruptly shocks the system. Perhaps the most common and dangerous cause of sudden suppression is exposure to cold and damp air, sitting upon the grass or ground, immersion of the feet, hips, and body in cold baths when, over-heated, or leaving off any accustomed garment.
Wearing thin-soled shoes is a most fruitful cause of the decay of female beauty, and the decline of female health; the injury from tight-lacing, although considerable, being nothing in comparison with that resulting form wearing thin-soled shoes in all kinds of weather. A large number of girls are apt to have “a check” from the slightest chill or exposure during the monthly period. Happily, the effects of some at least of these causes may be diminished by the frequency of their occurrence, so that those accustomed to bathe may go into the sea during menstruation with perfect impunity; habitual exposure to the casualties of life necessarily diminishing their injurious impressions. Sudden suppression during the period occasions the most acute suffering and may develop alarming symptoms in the nervous or circulatory systems, or in both; but chronic is far more serious, as it points to deeper constitutional cause
TREATMENT. 1. Sudden Suppression during the flow. The patient should be immediately placed in hot hip-bath, and afterwards retire to a warmed bed. The free action of the should be promoted by a few doses of Aconitum, at short intervals, and by frequent droughts of cold water. The success of this treatment, however, depends on the promptness with which it is adopted. Pulsatilla, Cimic., or Dulcamara may be required; the last if suppression be the result of damp, with a concomitant eruption on the skin.
2. Suppression from fright. Aconite, Opi or Verbascum
3. From mental emotions. Chamomilla or Coloc. (anger); Ignatia or Hyoscyamus (grief); Coffea or Opi. (excessive joy).
4. Chromic cases. Coni., Senec., Sepia
5. Gradual suppression. See the remedies under “Delayed Menstruation.” This is generally associated with some deep constitutional disease, such as Consumption, and should be placed under the care of a physician without delay.
Aconitum. Suppression attended by a rush of blood to the head, producing pain, redness of thee cheeks, faintness or giddiness on rising from a recumbent position, weight in the loins; cold relieves but heat aggravated thee sufferings; there is also heat aggravates the sufferings; there is also heat, thirst, and a general feverish condition.
Cimicifuga. Intense headache, pain in the aye-balls, back, and limbs, especially of the left side; palpitation, depression of spirits, and nervousness.
Pulsatilla. This is a chief remedy, especially in females of mild, timid, and amiable disposition, who are easily excited to tears or laughter; also when there is languor, pain across the small of the back and lower part of the bowels, palpitation, nausea and vomiting, sensation of fullness in thee head and eyes, and disposition to general coldness, frequent urination, and Leucorrhoea.
Sepia is also important remedy, and may follow the last medicine particularly in females of a delicate constitution and sallow skin; the sufferings are often mitigated by exercise, and aggravated by rest; bearing down in the lower parts of the abdomen and pains in the loins, melancholy mood, and morning headache.
Belladonna. In addition to the Aconitum symptoms, there are sparks before the eyes, dizziness, confession of the head, aching pains in the eyeballs and sockets, shooting pains in thee eyeballs and sockets, shooting pairs about the womb and ovaries, bearing down, with heat and dryness of the vagina.
Bryonia. Vertigo, bleeding of the nose, stitches in the sides and chest, dry cough, confined bowels, severe pressing pain in thee stomach, irritability of temper.
Opium. Useful in recent cases, attended with great heaviness of the head, dizziness, lethargy, and drowsiness, especially if there be also obstinate constipation and retentions of urine.
Conium. Very efficacious in retarded or suppressed menstruation of long standing, when not depending on constitutional causes.
Administration. A dose thrice daily at the commencement of the treatment; afterwards, as improvement ensues, night and morning. The remedy may be continued for ten days or a fortnight, if doing good, or earlier changed for a more suitable one.
ACCESSORY MEASURES. The cause of the suppression should be found out and removed if possible. All physical or mental depression, or undue excitement, night air, late hours, stimulating drinks, and highly=seasoned food, should be avoided. Meals should be taken with regularity, the stomach never over- loaded, the food being simple and nourishing. The drink should be cocoa, black tea in great moderation, not oftener than once a day, and pure water. Green tea, coffee, and all stimulating drinks must be abandoned. Out-of-door exercise, useful employment, and agreeable company or books will greatly aid recovery. While hoping for a return of the menstrual discharge, the exercise of patience is sometimes necessary, as the general health is often greatly improved before this crowing evidence of cure is obtained.
Caution-See page 33.
IX. Too Scanty, Short-lasting, Deficient Menstruation. (Menstrua exilia.)
This condition, like :Delay of the First. Menstruation,” is often due to constitutional causes, and must be treated accordingly. At the same time, if the patient enjoy good health notwithstanding the scanty flow, no medicinal interference is justifiable. If, on the other hand, sufferings are present during the monthly period, and there is a general derangement of the system, medicinal and general means must be adopted to correct the morbid condition.
TREATMENT. Pulsatilla. Pale, scanty and watery menses, preceded and accompanied by cutting pains in the loins, dejected mood, chilliness, etc., in patients of light complexions and mild disposition.