MENORRHAGIA.
An increased loss at the menstrual epoch may take the form either of a prolongation of the normal period of ltmorrhage, a more profuse discharge while the period lasts, a shortening of the normal interval or of a combination of these. In the worst cases the normal periodicity is masked and the bleeding comes irregularly, the interval being shortened or practically absent (metrorrhagia).
No treatment of the condition is satisfactory which does not take account of the cause and aim at its removal, and there are few complaints in which the routine use of a stock remedy, before a proper diagnosis is made, is so likely to lead to disappointment and discredit to the prac titioner. It should be always remembered that uterine hmmorrhage may be due, not to any fault in the uterus or pelvic organs themselves, but to interference with the venous return, as in mitral disease with back pressure or in hepatic disease such as cirrhosis with portal obstruction. Anwmia, scurvy, phthisis and the infectious diseases may cause excessive menstrual loss. The treatment of any of these conditions, which will be found under the appropriate headings, is, of course, much more important than the treatment of the menorrhagia, and really includes it.
In most cases, however, a local cause is to be found for excessive menstrual loss, and in considering the treatment I propose to group these cases as follows: r. Menorrhagia in Puberty and Adolescence.—Excessive loss in young women just after puberty may he due to defective development of the uterus associated with chlorosis, or in rare cases to an excess in develop ment of the uterus. Later on the hxmorrhage may be caused by some form of endometritis, either a hypertrophy of the endometrium associated with dilatation of the capillaries (hxmorrhagic endometritis) and often with erosion, or less commonly a thin and atrophic endometrium. A mucous polypus may be present, or the ovaries may be the seat of follicular or lutein cysts or of a dermoid cyst. The possibility of the hemorrhage being due to an abortion or to an extra-uterine pregnancy should not be lost sight of.
In treating menorrhagia at puberty the practitioner should be warned against being too hasty in making local examinations or in applying local treatment. One of the most important remedies is rest, and the patient should be warned to abstain from all violent exercise, dancing, bicycling, long walks or active games for two or three days before the period is expected. If this measure does not restrain the she should rest in bed for two or three days, beginning, if possible, before the onset of the flow. Such treatment continued for six months to a year often results in cure. Proper hygiene in regard to food, clothing and sleep should be insisted on, and measures should be taken to insure a proper evacuation of the bowels every day. For this purpose nothing is better than a saline aperient mineral water first thing in the morning, or, what is much cheaper and as efficacious, Epsom or Rochelle salts in a tumbler of warm water. The dose should be gauged so as to give one free motion per day. As regards drug treatment, Iron should be avoided, as it does not suit these cases. Arsenic, Quinine and Strychnine are valuable remedies. They may be combined as in the "Tabloid ": 1. Quin. Sulph. gr. j.
Acid. Arsenics. gr. :A Strych. Sul ph. gr.
Signa.—" One three times a day after meals." Ext. Viburni Prunifolii in drachm doses is a useful drug. Styptol is recommended in grain doses thrice daily during the intermenstrual interval, and in 4-gr. doses every three hours during the period itself. lodal in i gr. doses three times a day may be given. Calcium chloride seems likely to be of service in cases associated with chlorosis; it may be given in 5-gr. doses thrice daily during the interval and more frequently during menstruation. Ergot and Ergotin are not very suitable for these cases and are best avoided. The injection of Pituitrin (1 c.c.) has been highly recommended, and in cases associated with obesity small doses of thyroid gland extract may be tried. Injections of normal serum up to 200 c.c. have been given with good effect.