MENORRHAGIA. OR PROFUSE MENSTRUATON. By this is meant menstruation, characterized by excess in quantity or in frequency. There are two kinds; one, in which there is merely the natural secretion in excess, and the other in which pure blood is discharged by the uterine vessels. The latter variety is recognized by the presence of clots of blood in the discharge, or by its stiffening the linen, which appearances are not seen in the normal menstrual fluid. the majority of severe cases, there is this direct uterine bleeding. In The symptoms of the disease are the following. The flow of blood at the menstrual periods becomes much more profuse than natural, continuing for several days longer than it should do. The menstrual periods are also frequently approximated, so that menstruation occurs every three weeks, or every fortnight. Thus in many cases the woman is almost always menstruating; one lengthened period being scarcely over, when another begins. In the menstrual intervals there is usually profuse leucorrhoea. In some cases, especially in women who have had children, the discharge comes on suddenly in gushes, unlike the slow dropping exudation, that characterizes the natural secretion. The constitutional effects are those which are produced by a drain on the system, or by loss of blood from any other part. At first languor and weakness in the loins; then severe aching in the loins and back, coming round to the thighs and groins; acute headaches, often confined to one spot, as if a nail were driven into the head; ringing in the ears, dimness of sight, giddiness, and sometimes the sensation as if a clock were ticking in the head; increasing pallor and debility, derangement of the stomach and bowels, palpitation of the heart; melancholy and nervousness, at times almost to insanity; dropsy of the eyelids and feet, from the increasing thinness of the blood; also sometimes prolapse of the uterus and vagina from relaxation. If the disease occur in a plethoric married woman who lives freely, it is often of an active and more violent character, while in the delicate (among whom it is much more frequent,) it is rather of a passive kind. In the former case it is often caused by the application of cold during menstruation, which, if it do not arrest the discharge suddenly, as we have seen it often does, may on the contrary, produce a profuse flow, attended by feverish symptoms: and the habit of profuse menstruation continues at subsequent periods. In these cases menstruation is preceded by a feeling of tension and fulness in the pelvis, with weight and throbbing in the womb. The discharge is often emitted with pain and expulsatory throes, the flow lessening during a pain, and increasing on its subsidence. The passive form of the disease is of frequent occurrence, and is generally found among delicate and nervous women. In it there is frequently little or no local pain during the flow, but extreme debility and exhaustion is often produced. Although a fatal result is very rare, yet life is often reduced to the lowest ebb by the great losses of blood. The disease also frequently occurs about the period of menstrual decline. This takes place in many women about the age of 44, but in the greater number from 47 to 50. This period is in many cases attended with great losses of blood from the womb. These continue long, often for several years, and are sometimes very excessive. The bleeding sometimes continues for weeks, or even months, without complete cessation, and the prostration of health may be extreme. Fear of organic disease, such as cancer, is often excited by these protracted bleedings, and life is sometimes lost from mere exhaustion. These hemorrhages may continne for from one to four years, and yet terminate in health, and the decline of the function. The As the forms of menorrhagia are various, so are its causes. essence of the disease consists in an over-excited state of the ovaries, which discharge too rapidly immature eggs; and in a congested and irritable state of these organs, as well as of the womb, which gives rise to the profuse attendant menstrual discharges. When once morbid and excessive action has been excited in these parts, it is kept up by habit; and the discharge of eggs and of blood at last assume a passive and habitual character. As chlorosis and amenorrhoea are frequently the effect of insufficient stimulus to the ovaries, so menorrhagia often proceeds from their over stimulus. Excessive venery is very apt to produce it, especially where the sexual organs have been unaccustomed to the venereal stimulus. Thus in women who have married late, even a moderate amount of venereal excitement might induce it. The same may be said of delicate and susceptible girls, who take little exercise, and therefore all whose organs are in a habitually weak and excitable state. But the over stimulation of the organs by too frequent child-bearing is also a most important cause of the disease. This, together with over lactation, often causes menorrhagia. Abortion frequently causes, or is caused by, previous menorrhagia; for this is really an ovarian abortion. The eggs are cast off by the ovaries every fortnight or three weeks, prematurely, just as the child is cast off by the womb before the proper time. An inflammatory state of the ovaries, and ulcers of the womb are frequent causes of menorrhagia, as of the other diseases of menstruation. Cold, especially during menstruation, is another frequent cause, producing congestion and disorder of the secreting organs. Dr. Ashwell says moverover, that the form of the disease, which occurs at menstrual decline, is caused more frequently than is supposed, by the avoidance of complete sexual intercourse, and the consequent derangement and congestion of the ovaries and MENORRHAGIA. OR PROFUSE MENSTRUATON. By this is meant menstruation, characterized by excess in quantity or in frequency. There are two kinds; one, in which there is merely the natural secretion in excess, and the other in which pure blood is discharged by the uterine vessels. The latter variety is recognized by the presence of clots of blood in the discharge, or by its stiffening the linen, which appearances are not seen in the normal menstrual fluid. the majority of severe cases, there is this direct uterine bleeding. In The symptoms of the disease are the following. The flow of blood at the menstrual periods becomes much more profuse than natural, continuing for several days longer than it should do. The menstrual periods are also frequently approximated, so that menstruation occurs every three weeks, or every fortnight. Thus in many cases the woman is almost always menstruating; one lengthened period being scarcely over, when another begins. In the menstrual intervals there is usually profuse leucorrhoea. In some cases, especially in women who have had children, the discharge comes on suddenly in gushes, unlike the slow dropping exudation, that characterizes the natural secretion. The constitutional effects are those which are produced by a drain on the system, or by loss of blood from any other part. At first languor and weakness in the loins; then severe aching in the loins and back, coming round to the thighs and groins; acute headaches, often confined to one spot, as if a nail were driven into the head; ringing in the ears, dimness of sight, giddiness, and sometimes the sensation as if a clock were ticking in the head; increasing pallor and debility, derangement of the stomach and bowels, palpitation of the heart; melancholy and nervousness, at times almost to insanity; dropsy of the eyelids and feet, from the increasing thinness of the blood; also sometimes prolapse of the uterus and vagina from relaxation. If the disease occur in a plethoric married woman who lives freely, it is often of an active and more violent character, while in the delicate (among whom it is much more frequent,) it is rather of a passive kind. In the former case it is often caused by the application of cold during menstruation, which, if it do not arrest the discharge suddenly, as we have seen it often does, may on the contrary, produce a profuse flow, and relieves the pain, while it lessens the flow. An injection of assafœtida and opium into the rectum, is also excellent in quieting the uterine irritation. To prevent this disease, its various causes must be extirpated. It occurs much more frequently in delicate and irritable women; and these, as Dr. Ashwell says, 66 are a much more numerous class than the robust." Until therefore, the general strength of the sex is greatly elevated, we cannot hope satisfactorily to prevent this disease. The prevailing habits of sexual abstinence, which render the sexual system weak and irritable, and prone to over-excitement, must also be changed before adequate prevention is possible. Venereal excesses and masturbation should be carefully avoided, and only a moderate amount of the natural sexual stimulus used. Frequent pregnancy can be borne with impunity only by very robust women; and is full of danger to the delicate, and to those whose life is not a very healthy one. Over-lactation is very weakening to the general health, and especially to the sexual organs, between which and the breasts there is so intimate a sympathy. Sudden arrest of the secretion of milk is often the cause of inflammation of the ovaries; and an unnatural prolongation of suckling may readily make the ovaries irritable and enfeebled. Ulceration of the womb and ovarian disease must also be prevented. The avoidance of complete sexual intercourse, mentioned by Dr. Ashwell, as a frequent cause of the menorrhagia of advanced life, is a very important subject, of which I shall speak afterwards. Menorrhagia is also greatly favoured by a prevalent idea among women, that copious menstruation is a healthy sign; just as it is a common idea among the poorer classes, that it is healthy to pass much urine, a belief which favours the progress of diabetes. This belief often induces women to neglect the disease in its commencement. The amount of the natural discharge varies in different women, in some being more abundant than in others; but each woman should judge by what is natural to herself in health, and if menstruation become more abundant, than it has been, should not neglect this indication LEUCORRHEA. By this is meant the various non-venereal and non-infectious discharges of mucus, pus, &c., that proceed from the vagina, and are popularly called "the whites. Of all female diseases, none is so common as this. "Few married women, especially mothers, escape it," says Dr. Ashwell. The delicate and middle-aged are more prone to it, than the young and robust, and it is commoner in the married than the single, like all other inflammatory diseases; thus contrasting with the nervous functional diseases, which are far more common in the single. The disease is found in all varieties of severity, from the very mild, to the most aggravated form. The discharge is caused by an inflamed or congested state of the mucous membrane of the vagina, vulva, or womb. The symptoms of an acute attack are, a feeling of heat and tenderness in the parts, followed by a mucous or muco-purulent discharge. There is also some sealding in making water, and more or less febrile reaction. If the disease be not cured, it may gradually become chronic; the pain, heat, and scalding disappear, but a copious discharge continues; and in this chronic state, the disease has a tendency to prove very obstinate, and to exhaust greatly the strength. The pain, heat, and scalding, often last also indefinitely in a subdued form, and are very easily re-excited. The great cause which renders this disease, as well as other inflammations of the female sexual organs, so very chronic and obstinate, is the periodical return of menstruation. This congests these organs, and thus at every monthly period, fans anew the flame of their inflammatory diseases. Thus these white discharges, when once well established, often last for a great part of life, and gradually produce the most serious impairment of health. The constant drain breaks down the system, producing pallor, debility, pain in the back, palpitations, dyspepsia, &c. and all the train of symptoms more quickly induced by menorrhagia. In the young, chlorosis, amenorrhoea, and consumption, are apt to be induced by it. Prolapse of the womb and vagina, and also sterility, are not infrequently caused by it. In most cases however, the disease is of a milder nature, and produces only a certain amount of weakness and pallor. Many women, except |