Of all medicines, bark is the worst here ; it requires a good stomach to di gest it; it increases every difficulty of breathing that may have existed previous to its use. Now and then a gentle eme tic will be useful: we may for that pur pose give five grains of ipecacuanha eve ry half hour till it operates. After the bitters have impaired the tone of the sto mach, this gentle action will restore its strength, and render them as efficacious as before : when the stomach is strong enough, we may begin with steel, the best form of which is called draughts, but it is the most nauseous mix ture that ever was made, as originally pre scribed ; and we should therefore prefer some one of the numerous modes in which this medicine has of late years been revised. By these means the weak patient will be raised up to that state which is nearest health ; while the ple thoric patient is lowered down to the same point. These two patients being now brought to that same point which is most favourable to menstruation, it re mains to discover the best means of get ting back the secretion. Having brought down the plethoric, and raised the low and weak patient, so that both are on a par, we may now begin with the emme nagogue remedies.
All medicines called emmenagogues are stimulating; we muct never use strong stimuli where the ,constitution is yet weak, or we shall only exhaust the sys tem, and where there is a tendency to plethora, we shall produce hemoptoe these then must not be begun upon till the constitution is amended. Some em ploy hellebore, which has sometimes cer tainly evinced great power, for which reason we may give forty drops of the tincture, though, most commonly, the menses will return without giving any thing. Madder is recommended from its supposed deobstruent quality. - Instances of its wonderful powers are related in Dr. Home's practice. Now and then electricity has been useful, when the patient all but menstruates. Friction of the lower extremities is good as exer cise. Issues have been recommended; dancing, air, exercise, are the real, the natural, and only effectual remedies It is merely necessary to determine to the part ; we well know that a mother, di rectly as she takes the child in her arms, feels the draught of the milk come into her breast, even before the child is put to it.
Profuse Menstruation. We now proceed to consider the opposite state to obstruct ed menstruation, which is profuse men struation, or menorrhagia; this is where it returns too often, though there -may not be too much lost in each time; or, it may be, there is twice the quantity lost at the regular time : in short, in whatever manner the secretion is increased, so as to weaken the constitution, it is called menorrhagia. Whether there be too
much or too little tone in the vessels, they may be,inactive, allowing their con tents to escape as ;hey do in petechial fever, both into the cellular membrane and into the urine.
Profuse menstruation may depend on increased action of the heart and arteries; or on too much food, drink, or stimuli, in any shape. And the symptoms which ap pear in the constitution from such causes will be just those of plethora ; of the chest, heat and thirst, concurring with this profuse menstruation; and the same treatment of the constitution will remove it : this is the simplest sort of menorrha gia, and requires least discussion. We must prohibit the use of animal food, and keep the bowels in a state of purging with Epsom salts. What we want isnot a vio lent purging, but a gentle increased ac tion of the bowels; by this we pall the ap petite, which is another object gained ; and it does not allow the food to remain so long in the stomach, while part of the circulating fluids is evacuated by the in creased secretion we have produced into the intestines. if this treatment be not sufficient, it will be necessary to apply those local remedies prescribed in flood ings.
The next state of increased menstrua tion is, from relaxation of the system. This will sometimes arise from increased action, which we have said will occasion ally degenerate into a weakened state; for the effect of great action is the pro duction of great weakness. Where there is a weak pulse, flabbiness of the muscles, and all the symptoms of weakness and relaxation of vessels, a very small force of action in the heart will be equal to the forcing of blood through an open vessel. All the strengthening medicines as well as astringents will be necessary here ; alum and bitters : and where there is no thing of a vibrating feel in the pulse, steel may be given. But, sometimes, when the profuse discharge depends on relaxa tichi of vessels, steel will increase the dis charge ; yet, where there is no fever, it is one of the best remedies. Next come the cold bath, and moderate exercise in a pure air. In regard to steel, it must be given very gradually at first, as in the mi neral waters which are so famous. The stomach will frequently not bear it less diluted. It is very beneficial to recom mend patients to some mineral spring in the country, even from a secondary de sire to get them out of town, where they may rise early, and enjoy the benefit of a country air. The patient goes with hope and expectation of relief; her mind is amused, and her health repaired by drinking the water, though in the water there should be no virtue at all.