The next sort of menorrhagia does not depend on general, but local weakness, arising from the woman having borne a great number of children, and the weak ened state of the uterus. This effect is sometimes dependent on excessive vene ry ; hence we account for the violent at tacks of menorrhagia prostitutes arc very subject to. It may arise from blows on the abdomen. This is a more unma nageable case than the others; because the weakness is local, and any strength ening remedies applied constitutionally increase the strength of both parts at the same time ; so that there still is the same difference between the system and the uterus in point of tone, because they are both equally raised; injecting :old and astringent solutions into the vagina is the best remedy. Though now and then • case occurs, in which the opposite means succeed, where every cold application has failed, and throwing up tepid water has put a stop to it.
The worst state of relaxed uterine sys tem is, a great local weakness of the ute rine vessels, which cannot be acted upon through the medium of the constitution. Since the hemorrhage will be increased by whatever increases the strength of ac tion in the heart and arteries, it would be more an object to lower the constitution ; and the best measure is, to leave it alto gether, only attempting to stop the he morrhage by local means. But the cold application, so often recommended, will fail ; a piece of ice has been in the vagina a whole day without stopping it. In these cases, the most likely thing to succeed is, to introduce an injection into the uterus itself ; to do which a tube must be care fully passed up into the uterus, like a male catheter. We must withdraw the wire from the tube, and insert the nose of a small syringe into the tube, and press forward a little of some astringent injec tion; as soon as it produces pain in the back, the pipe must be taken away, be cause a very little of the solution will be enough ; if there be thirty drops in the uterus, it is quite sufficient. In the very worst case that has been known to hap pen, this method was completely effectual in the cure. The acetate of lead has been employed in the suppression of uterine hemorrhage with great success. It may be given in doses of two or three grains, every four or six hours.
PainfulMenstruation. Dysmenorrhara, or painful menstruation, is a complaint in a state of nature unknown; but it hap pens among those who do not marry at the time of life nature intended; for which there are many reasons in the present day, and among the rest the difficulty of maintaining a large family ; consequently women are thrown out of a state of na ture, not doing that which nature intend ed. The patient, when first attacked with
this disease; feels hardly any pain, or if she feel pain, it is only very slight in the lower part of the back, which is from the consent of certain nerves with the uterus; but in four or five years it becomes esta blished pain in the back, as violent as grinding pains in labour. Such a woman will afterwards bear labour very well, and declare that she would rather bear a child, than experience the pain of difficult menstruation once a month. In this man ner the pain increases, but the menstrua tion goes on very imperfectly for some time and when at length it becomes more plentiful in quantity, the pain les sens, and the last two days of the accre tion is not attended with any pain.
The appearance of the fluid in thisdis ease, is not that of menstruation, as it usu ally occurs. There are coagula of various sizes, and if what is discharged be ex amined carefully, flakes of coagulable lymph will be perceived. 't his state arises from interruption of the functions of the uterus, and it is a situation in which the uterus is much less liable to become impregnated; but if it do, the patient may go on to menstruate without any pain to the end of her life, or perhaps with less than she suffered before. This complaint is more frequent in large towns than in the country.
The first object in regard to treatment is to remove the inflammation, for there can be no difficulty in supposing inflam mation present at the time the pain is so violent ; one strong proof of which is, the coagulable lymph being thrown out. The patient for this purpose should leave off animal food entirely, if possible, at least partially, should avoid all liquors, live as simply as she can, and keep the bowels in such a state, that the stools may not be hard. If she be strong and plethoric, we may bleed once ; but it is a bad principle to bleed young people, as it lays the foundation for a larger quantity of blood being formed than ought to be. Between one period and another, the parts about the pelvis should occasionally be immers ed in the tepid bath, and afterwards rub bed, and as soon as the pain comes on should, be put in a warm bath : this may even be done the night before. The ;d ria Doveri should also be given to assist perspiration, which is always an object in the present case. Pursuing this plan, the habit will be broken, and the patient may go for years without menstruating with pain ; but when it returns, the same ground must be gone over again. It is often entirely relieved by marriage ; so that it may sometimes be useful to recom mend this change of state to the consi deration of the parents.