Amenorrhea in the presence of anemia, chlorosis, tuberculosis, or Bright's disease, is not a symptom calling for local treatment by electricity or otherwise, but is rather to be regarded as a symptom which strictly contra-indicates local measures for instituting the flow. The amenorrhea is here, in truth, conservative, for these patients have not the blood to lose. In case of anemia and chlorosis stimulation of the pelvic organs should only be resorted to after the general state has been improved and the blood has been made richer by such constitutional measures as sug gest themselves. In case of organic diseases which of themselves under mine the system and sap the strength, we question the utility of resort to any measures which tend to restore or to awaken function in organs which are quiescent to the very advantage of the patient.
We have left for consideration, then, that large class of cases where the amenorrhea is said to be dependent on lack of nerve force or tone, the so-called atonic amenorrhea in which latterly the bin-oxide of manganese has often proved of such marked utility. It is in this class that elec trization is most effective and gives the most brilliant results. The patients vary very markedly in their characteristics. At times it is a young girl who presents herself, of eighteen to twenty years of age, that is to say, one who has passed the average pubescent age, of good local and general development, free from constitutional disease or taint, with a history of marked molimina recurring each month, neither anemic nor chlorotic and yet amenorrheic. At other times the woman has previously menstruated normally and with regularity, but has ceased to do so as the result, apparently, of sudden, intense nervous shock, or else on change of residence—a type so constantly met with in emigrants. In both these instances there seems to be lacking the normal stimulus to menstruation, at least such is the hypothetical explanation which we are forced to fall back upon. At other times, finally, the woman, previously regular, notices a gradual decrease in the amount of discharge at the periods and a lengthening in the intervals, until menstruation ceases altogether, and concomitantly with these phenomena there occurs rather rapid develop ment of adipose –that is to say, the stimulus requisite for the regular and proper function of the genital system is apparently diverted towards mak ing fat.
From this rapid survey of the main varieties of amenorrhea, which has seemed essential in order to make clear in what instances electricity is likely to prove of value and in what not, it is apparent that before resorting to the agent strict differentiation of the probable cause of the amenorrhea, is requisite. In brief, the statements may be made that:
where there is considerable lack of development of the sexual organs and complete absence of molimina we cannot hope for any result from elec tricity; in the presence of anemia and of chlorosis resort to local electri zation, at any rate, is strictly contra-indicated until the impoverished blood has been made richer; certain constitutional diseases (tuberculosis, Bright's) associated with amenorrhea, are per se barriers to local electriza tion; where simply nerve tone is lacking or nervous stimulus is misdirected we can be quite confident of obtaining marked results from persistent, local and general electaization.
Seeing now that those forms of amenorrhea, which may suitably be subjected to electrization, are in general dependent on lack of general or local nerve tone, it is evident that it is on the faradic current that we should place our main dependence. Mechanical effects, not chemical, are essentially called for, and, as we have seen, it is the faradic current which furnishes us these mechanical effects. Such, indeed, is the aim of other methods which are popular in the routine treatment of amenorrhea. The repeated passage of the uterine sound, the application of stimulating agents to the eudometrium, the insertion of tents and of stem pessaries, these means all aim at irritating the uterus, at causing congestion, and thereby leading to development and function. There are instances, how ever, where something more than mere stimulation is called for, where the local nutrition is at fault, and here galvanization, or preferably galvano-faradization, answers a better purpose than faradization alone. Where there exists imperfect development of the uterus and its append ages, cases which test our patience to an extreme degree, there is required, in particular, resort to both forms of electrization. Cases of amenorrhea characterized by the presence of molimina, and instances of relative amenorrhea, where there exists a scanty and irregularly recurrent flow, should by preference be subjected to electrization at the time of the molimina, and for a few days preceding their appearance. It is then that the essential sexual organs are endeavoring to fnnctionate or are imper fectly doing so, and stimulation at this time tends to assist the effort. Where excessive development of adipose is a concomitant factor of the amenorrhea, it is self-suggestive that together with stimulation of the sexual organs means should be taken to correct this tendency to adipoiesis by diet, exercise, etc.