This species of chronic obstruction pro. ceeds from plethora, and plethora may exist so as to prevent menstruation, either at its earliest effort, or after it has been long in the regular habit of recurring.
The term chlorosis is generally applied to the first kind ; amenorrhcea to the se cond : but chlorosis, or green-sickness, is a mere result, and may result from either ; it is that chronic menstruation depending on symptoms of weakness we have already noticed, and may result from each, as well as from a distinct and separate source, because the continued action of vessels exhausts the strength. Usually, however, the complaint depends on improper food, living in bad air, or want of exercise, and, added to these, want of communication between the sex es; for a certain state of the ovaria pre disposes to it. One symptom in this kind of obstructed menstruation is, there be ing a mark perceived round the ancle at night where the edge of the shoe reach. es; another is, a fulness and puffiness of the face and eyelids in the morning; so that, after sleep, the whole countenance looks too big ; while in the course of the day this size and appearance goes en tirely off. These last effects are evident ly those of (edema, because during the day the water lodged in the cellular sub stance about the face subsides, and the cells below are progressively filled ; so that by night the ancles are swelled : dur ing the night again, the gravitation of the fluids diffuses the appearance of swelling over the face.
The upper extremities partake at last in this appearance, becoming swelled about the hands at night. In short, the whole skin is swoln and stretched, And assumes a soft pappy feel. To these symp toms there is now added a very great de rangement of stomach, the appetite goes quite away; sometimes the patient has an inclination for improper food, a vehe ment fondness for cinders, candles, or pipe-clay ; this does not seem to belong to any sort of instinctive impulse from na ture, but depends on a derangement of stomach alone : all these evidences are further proved by flatulency, and a sense of weight at the stomach after eating ; great irregularity of the intestines, some times costive, and at others lax ; vegeta bles undergoing their acid fermentation, and animal matter its putrefaction ; both known by eructation, both dependent on the impaired state of the stomach : to these succeed difficult respiration, either on walking or going up stairs ; and this does not arise from ordinary weakness, where a person could rest, because she was tired ; but in chlorosis, she stops be cause she loses her breath : with this there is palpitation at the heart; the pulse is frequent, small, and hard; and there are hysterical symptoms, very often, where the obstruction has been of long continuance. This complaint, however,
is easily cured where it has been of short duration, and the menstruation is not permanently interrupted.
The treatment will depend on the form which all the symptoms take on, when combined. Though cases of this obstruc tion differ from ordinary weakness, yet the treatment we should pursue will be applicable to most cases of weakness. It is right to keep the bowels clear, by an occasional dose of rhubarb ; we should then begin the use of bitter medicine, re membering that, in proportion as the weakness is greater, the medicine should be weak ; for it is an error to suppose that the stronger a medicine of this kind is, the more efficacious it must be. In all cases of weakness, we must consider the lightest bitters as the most proper ; at first, a drachm of the bitter tincture to an ounce and a half of peppermint water; or an ounce of the bitter infusion instead of the tincture. But at the same time we must recollect, that the stomach is still a weakened organ: the powers of digestion must be still weak, consequently diges tion will not be so quick, nor will the food be pushed forward from the stomach so soon as it is in health ; and the second meal will be ill digested, because the whole of the first has not left the sto mach : for these reasons, a gentle purga tive must be joined with the food. A good medicine is bitter pills, formed with such materials as will allow the stomach to act on them without much difficulty.