MENSTRUATION AND MENSTRUAL DISORDERS.

The first appearance of the menses marks an epoch in the life of the girl which ushers in womanhood. It is the harbinger of the fruitfulness of the maiden, whose limbs now become rounder, and her hips widen out, while the breasts increase in size and the entire aspect undergoes peculiar changes, which all point to the approaching condition of maturity.

The term is derived from the Latin plural menses, meaning month, from moon, and it is an actual fact that the lunar forces seem to influence this physiological function, inasmuch as it recurs every four weeks; most women menstruate during the first quarter, and only a very few during the new or full moon.

During infancy and childhood, the sexual system of the female is inactive. The menstruation begins, in a temperate climate, about the fourteenth or fifteenth year of life, and ceases at the age of forty-five or a little later.

The climate exerts a marked influence in determinating the first appearance of menstruation, which is further influenced by the conditions of life and society in which the child is brought up.

The diversity in the ages at which children menstruate in different countries cannot be laid to any constitutional peculiarities of the races. Observation has established that, when children of the same race and family are brought from a hot to a colder climate, the advent of the first menstruation changes. These girls menstruate not so young as their older sisters, but begin about at the same age as those who are born in the colder climate.

In hot countries, for instance in Africa, the negroes and girls in East India begin to have their periods at the age of ten to twelve years. In Sweden and Norway the average age for the first menstruation is sixteen, while further north, in Lapland, the ages vary from eighteen to twenty years. Next in order of importance, influencing the menstrual epoch, are the surroundings and food.

In the same climate there are differences in the ages of children that are entirely due to these causes. Children who are pampered and who are nurtured in ease and luxury menstruate earlier than those of the poor or even of the middle class, who are brought up in habits of industry.

We observe again a difference in the ages between those who are reared in the country or rural districts and the dwellers in the cities, whether it be in luxurious apartments or in tenement houses. The former grow older and stronger than the latter before the show begins.

The temperament also greatly influences the development of the function; children who are nervous, irritable, and of a sanguineous temperament, menstruate earlier than those of sedate habits.

The color of the hair and complexion are also indices of the respective appearance of the menses in the brunette and blonde. It has been observed that the dark-complexioned girls menstruate sooner under similar conditions than the blondes. Weakly children, who are delicate from some constitutional habit, or whose organism has suffered from disturbances of indigestion or suffered severely from teething in early childhood, menstruate earlier than their stronger and robust sisters.

The quantity of the natural menstrual discharge, as well as the time or duration, varies greatly in health with different individuals. We first notice a slimy discharge, which soon becomes tinged with blood, and after one or two days it is almost of pure blood. The flow generally lasts three or four days, very seldom only one day, and sometimes a week to ten days.

The monthly recurrence of the menstrual periods averages thirty years; in temperate climates it may overreach this figure a little, while in hot climates it comes much below this average.

It does not follow as a rule that because a woman began to menstruate quite young, the change of life will take place earlier. This also depends much upon temperament, habit and mode of life.

Physiologists have established, by carefully-prepared statistics, that the average period of menstruation for women who began to menstruate early is thirty-three years, while those who commenced late have an average of only twenty-seven years.

When a woman is forty-five years of age, we may, however, as a rule, look for the change of life to set in; if she goes beyond this age, she may be taken as the exception.

The cavity of the womb is the principal source from which the blood comes; while the ovaries and tubes are also greatly congested with blood, the amount that comes from them must be very small.

The blood that comes from the womb is not different from blood coming from any other source; the changes and peculiarity of the menstrual show are due to its passage through the vagina, where it becomes contaminated with vaginal secretions.

It is supplied from the blood-vessels of the womb, oozing through the mucous membrane of that organ, just as in a case of nosebleed. The entire womb is more or less swollen, and more especially the mucous lining, so that it corresponds, in many instances, to an inflammatory process, and for that very reason, a sudden check of the menstrual flow will often result in a regular subacute or acute inflammation of the womb. If the discharge of blood from the uterus is in small quantities and a gradual, steady flow, it becomes so altered by the secretions in its passage through the vagina that it does not coagulate, but when it is poured out more rapidly or in larger quantities, the menstrual blood coagulates or congeals in the same manner as if it were derived from other sources.

If a woman becomes pregnant, the menses as a rule are suspended during the child-bearing period, and usually remain absent after the child is born so long as the woman nurses the child. I have known one woman who menstruated during her entire pregnancy, and another who had had eight children and never menstruated in her life, yet she was, and always had been, in perfectly good health: thus we see, that there is no rule without exceptions.

An essential part of the menstrual function is that in which the ova or female germ cells ripen and are expelled from the ovary. The menstruation is only a reflex or side issue, to a more important part that is going on in the female generative system; this is termed ovulation, or the ripening and expulsion of the human egg from the tissues of the ovaries. In the physiological process that operates in the economy of nature for reproduction, the ovaries are the principal organs. The other organs are simply accessory, and indeed many of the lower animals have no other organs than the ovaries for the perpetuation of their species.

In the human female, the ovaries consist of a tough fibrous tissue, between whose meshes are little cysts, which are called Graafian vesicles, and these little vesicles serve as the nests in which the ova or little germ cells mature.

These ova which are imbedded in the Graafian vesicles are so small that they can only be seen by a high magnifying power.

The activity of the ovaries begins at puberty, and ceases with the change of life, or menopause.

The approach of the menses is signalized by a certain group of symptoms, which clearly indicate a congestion of the pelvic organs.

There is generally a drawing sensation in the back and thighs, and a sensitiveness upon pressure in the regions of the ovaries and the womb. There is a feeling of lassitude and weakness of the limbs, sometimes hot flushes changing off with chills, and often a feverish condition, which will last until the flow is fully established.

Professor Dalton says: “In many birds, for example, the plumage assumes at this period more varied and brilliant colors; and in the common fowl the comb or ‘crest’ enlarges, and becomes red vascular. In the American deer, the coat which, during the first year is mottled with white, becomes in the second year of a uniform tawny or reddish tinge. In nearly all species, the limbs become more compact and the body more rounded; and the whole external appearance is so altered, as to indicate, that the animal has arrived at the period of puberty, and is capable for reproduction.”

In the human subject, the child now becomes conscious of the sexual instinct, however chaste or virtuous her mind, for we must not dull our intelligence with the idea that the sexual function is unholy; it is no more so than to say our prayers; so that an additional duty is now incumbent upon mother or guardian.

The child must be made to know that she must be more reserved and guarded in her relations with the male sex; that she no longer can romp or play on the knees of male friends or visitors, and that it is dangerous and unbecoming to be left alone with them. A little later on, she must be apprised that she too may become a mother, and that that would be a great disgrace for one so young and not married. The child thus learns to protect herself against the insidious smiles and snares of the seducer, for he is ever abroad, and often family friend and trusted adviser.

There are beings who are men in form only, but at heart are black villains, and selfish brutes. When the mischief is done, then it is too late to repent of a mother’s negligence, or to bewail a child’s disgrace and man’s perfidy; the three combined make one of the most distressing scenes that it has ever been my misfortune to behold.

Successive crops of eggs ripen, and are discharged by the adult female at each menstrual period.

I have already said that the ovum is contained in the Graafian vesicle, in which it grows and matures, as the fruit ripens on a tree, so the Graafian vesicle gradually ripens for the expulsion of the ovum, which gradually makes its way to the surface of the ovary. Within the Graafian vesicle the serous fluid accumulates, so that it ruptures and discharges its little ovum, which is taken up by the fringed extremity of the Fallopian tube, and carried along the oviduct into the womb, from which it escapes into the vagina, and is lost, provided conception has not taken place.

Investigations have been made as to the number of ova certain mammalia discharge, and it has been found to correspond with the number of young that the animal produces at birth. Where a litter consists of from three to twenty, as in the bitch and the sow, a similar number of eggs ripen, and are discharged at the period of oestruation.

In the cow or mare, and in the human female, as a rule, only one egg is discharged at each period of ovulation.

The discharge of ripened ova does, however, occur in exceptional cases without any sign of the menstrual show, and the person may be susceptible to conception, so that we may reasonably infer, that ovulation constitutes the most important function of the menstrual period.

MENSTRUAL DISORDERS.

These are designated by different terms, not because each name signifies a particular disease, but simply an indefinite symptom of a diseased condition. In other cases menstrual disorder may produce symptoms that are common to widely different diseases. In other words, the phrase menstrual disorder, without being qualified as to its particular cause, means, from a practical standpoint nothing upon which a treatment can be intelligently based. Not any more than a cough which is simply an irritation of the bronchial nerves, and may be due to a bronchitis or pneumonia, or it may not be due to any pulmonary affection at all, as, for instance, in the case where an aneurismal tumor presses on the bronchial nerves, and excites severe paroxysms of coughing. A great many menstrual disorders are due, not to any disease of the generative organs, but to an affection of the nervous system.

Menstruation may be precocious in some girls, and if the discharge is not accompanied with the usual symptoms of backache and some of the other symptoms that characterize the normal appearance of the menses, or if the girl is otherwise not fully developed, and has in this climate not reached her twelfth or fourteenth year, it constitutes a sign of a disease. If, however, the show recurs at certain intervals, it is not to be considered with the same degree of apprehension that it would be if it recurred at irregular intervals.

The sanguineous discharge which shows itself at the genitals during an acute attack of an infectious disease, has no relation whatever with the menstrual function; this may take place in children at any early age.

We often see girls who are not yet thirteen, who still wear short clothes and go to school, that menstruate regularly, but with this precocious menstruation there is also a corresponding development of the body which gives them a womanly appearance. Such girls should not be permitted to expose themselves to the inclemency of the weather, because they are much more liable to take cold, which may result in inflammations, than girls in whom the menses have not appeared.

Girls of a scrofulous taint or other hereditary habits of constitution, often begin to menstruate prematurely; outdoor exercise and cod liver oil with cold sponging on retiring at night are the proper resources for building them up.

AMENORRHŒA.

This term is employed for the purpose of designating an absence of the menstrual flow in persons who are old enough to menstruate, and in whom there is no physiological reason for its suppression, such as being too young, after the change of life, or during pregnancy and while nursing the child on the breasts.

We find this disorder of the natural function of menstruation more among the women of the rich and affluent whose lives are spent in indolence and luxury; this is to be ascribed to lack of sufficient exercise to stimulate the nervous and sanguineous systems to the performance of their healthy functions.

The amenorrhoea, or a retarded menstruation in young girls, is oftener the result of a general debility than of a disease of either the womb or ovaries. We have here again about the same causes playing their pernicious role as in precocious menstruation in weakly children; that is, that the same causes produce directly opposite results. The scrofulous and hereditary taints always interfere with the proper and healthy development of the system; in amenorrhoea they appear to be a hindrance to the formation and growth of the red blood corpuscles. In some girls the suppression of the courses appears to be a wise conservative provision of nature, because the girls are already so weak and bloodless that even the loss of a very small amount would only increase the anÆmia, so that in these cases it is not so much a question of “bringing on the courses” as of building up the constitution, and enriching the blood in order to bring about the desired result.

Chlorosis, or the green sickness, is not simply an anÆmia or a bloodlessness, but a physiological incapacity of the system to prepare the required blood cells for the sanguineous fluid, and this is, indeed, the most frequent cause of the disorder under consideration. Chlorosis is a disease that is peculiar to the female sex, beginning as a rule at the age of approaching puberty, between the fourteenth and twentieth year, so that there appears to be a physiological relation between the blood genesis on the one hand, and the development of womanhood on the other.

In some cases we can trace the impoverished condition of the blood to unhealthy dwellings, impure air, want of exercise, improper diet, nervousness, the reading of exciting, amorous novels, and the practice of masturbation or self-abuse. On the contrary, the disease is often developed under the most moral and exacting discipline and hygienic surroundings.

I have known girls who lived in the country, enjoyed horseback riding, ate nutritious and wholesome food, and whose solitary moments were beyond suspicion, yet at the age of puberty they commenced to fade in color, and fail in strength, gradually growing paler and weaker, until they became chlorotic and bloodless. This can only be explained on the theory that the period in which nature was preparing the system for the purposes she had in view, caused a shock to the nervous system, which so disarranged the functions that the sanguineous system did not respond to the growth of the generative system.

Then there is another class of cases, where girls menstruate before they are old enough, and without their bodies showing any visible evidence of developed womanhood, who belong to the most obstinate cases for successful treatment.

The relative diminution of the red blood cells to the healthy standard is in some cases truly alarming. In the average healthy blood, there are, in one thousand parts of blood, one hundred and thirty parts of red blood cells; this falls to sixty, and even forty parts in the thousand in the chlorotic patient.

It is one of the peculiarities of this disease, that while the muscular tissue wastes away, the fatty tissue is not only preserved, but it sometime increases, so that in a family of several girls, the chlorotic girl is considered the ‘most fleshy,’ but as fat is not flesh, the appearance is deceptive.

When we stop to think a moment, that the red blood corpuscles are the messengers which absorb the oxygen in the lungs during the respiratory movements, and carry it to the different organs and tissues of the body, without which all tissue change would cease. And that the same red blood cells must return again to the lungs for exhaling the carbonic acid, one of the waste products of tissue growth, then the diminution of the red blood cells in the proportion above given, must affect the entire system very injuriously.

This is indeed the case; the natural respiratory movements are insufficient on the slightest exertion, so that patients tell us that when they walk a little fast, go up the stairs, or even sweep the room, they feel a shortness of breath.

There are other symptoms that point to carbonic acid poisoning, which it will be interesting to review. A great majority of these symptoms are to be found in every case of chlorosis. The muscles become weak at first, because their nutrition is interfered with, and they waste away, and secondly they become irritable from the poisonous presence of the carbonic acid, and so are often very painful. The patients are easily tired out; some, indeed, feel tired all the time, getting up in the morning as worn out as when they retired at night.

The nervous system suffers as much, because the principal nerve food is oxygen, and if there is no blood, there can be no oxygen; a starved nerve is a painful nerve. We find neuralgias, affecting the different parts of the body, the rule; when these are located in the external muscles, they are easily recognized, but when located in the deep organs, as the ovaries or the womb, they are generally mistaken for something else. The nerves of these individuals being in such an irritable state, it is natural to infer, that hysteria is often to be found as one of the complications, so that habitual sadness, and abnormal longings after chalk, lead pencils, and other indigestible articles are prominent symptoms.

The circulatory system suffers derangements that are characteristic of chlorosis. Palpitation of the heart is a prominent symptom; this is partly due to the irritation of the carbonic acid on the cardiac nerves, and partly to sensitiveness of the patient, owing to a morbidly-increased sensibility of the whole body. Chlorotic patients blush up at times, only to be followed by a green paleness that is peculiar to the disease. Pain in the region of the heart, and disturbances of the digestion, are sometimes prominent symptoms. There is no feeling of hunger; eating is not so much from hunger, but more from a sense of duty to keep up the strength. A heavy or full feeling is often experienced after a meal, and a sourish eructation will give relief to the oppression, because the walls of the stomach are relaxed and in sympathy with the general debility.

But in all cases of chlorosis the sexual functions are the seat of the greatest disturbance; amenorrhoea or the suppression of the menses is the most prominent symptom. The ovaries no longer seem to expel ripened ova, for there are no indications that point to their activity, because there is not only an absence of the show, but also an absence of the other signs that were noted when we considered menstruation and ovulation.

There are a great many other diseases of which amenorrhoea is a prominent symptom; these will be referred to when separate diseases become the subject of special inquiry.

The treatment of amenorrhoea is, indeed, in the great majority of cases, the treatment of chlorosis, and that should be conducted on common-sense principles. If the child has vicious practices, they must be corrected, and everything else that has been mentioned as a cause must be abandoned. Children who were once robust and strong require electrical treatment, while those who were naturally weak require nourishing food and tonics. If there is in the entire pharmacopoea a remedy that deserves the name of a specific, it is to that one which I suggest in amenorrhoea due to chlorosis or anÆmia. Iron preparations are very numerous; every physician has his favorite prescription; some are to be praised more for their elegance and flavor than for any virtue that they possess. If in these cases any positive and decided result is to follow the administration of iron, it must be given in such a mild form that it can be taken in great quantities without irritating the stomach or interfering with digestion. If the contents of the whole alimentary canal are saturated or impregnated with the ferruginous medicine, there will be astonishing curative effects.

I have often observed chlorotic cases who have made the rounds of the different iron springs, and who have taken the numerous and various fancy elixirs, without the slightest perceptible effect, bloom up, after being fed, so to speak, on some harmless iron preparation, which was astonishing to themselves and surprising to their friends. The following is my favorite prescription for chlorosis or anÆmia:

NO. I.

Mix with sufficient water to make into a hard mass and divide into one hundred and fifty pills, and roll in powdered cinnamon.

Take three pills three times a day and after three days increase to four pills at one dose three times a day, then after another three days increase to five pills as many times a day as before; if these doses are not at first borne, begin with less, and if there is no costiveness or tendency thereto, omit the aloes.

If there is reason to believe that the impoverishment of the blood is partly or wholly due to scorfulous taints, then it is advisable to take fresh, pure cod liver oil in conjunction with the iron pills; three boxes of pills are, as a rule, necessary to effect a cure.

It happens quite often in chlorosis or anÆmia that there is a distressing dyspepsia or indigestion with loss of appetite. In these cases I would first advise to put the stomach in order; this is done by first avoiding all indigestible food, such as cakes, pies, and puddings, and taking the following medicine:

NO. II.

Take a tablespoonful three times a day, and if the bowels move freely take less.

Hygiene in the treatment of every disease is to be an important factor; all vicious habits must be abandoned.

DYSMENORRHŒA.

Difficult or painful menstruation is the definition of the above word; all painful menstrual disorders that take place either before or during the menstrual flow come under this designation.

The seat of the pain, when of a colicky nature, is in the uterus; when a continuously dull ache is in the small of the back, it is located in the nervous plexus in the small of the back. The pain is very often in the ovaries and in that portion of the peritoneal membrane which folds over all the pelvic organs and extends on the sides of the womb, constituting the broad ligaments; when the pain is confined to these structures, it is principally felt below the stomach and over the lower part of the bowels.

Painful menstruation is a prominent symptom of a great many diseases, and it often strains the ingenuity of the most clever specialist to trace the symptoms to their real cause.

Obstructive dysmenorrhoea, as its name implies, is due to some hindrance or obstacle to the escape of blood from the cavity of the womb. The obstruction may exist in the neck of the womb, at its mouth, or in the vagina. When the obstruction is in the neck of the womb, it may be congenital or date from birth. The constriction or narrowness may be due to an acquired inflammation of the lining membrane of the neck of the womb. Every inflammation causes a swelling of the tissues, and if the inflammation continues, the swelling becomes permanent and a stricture is the result.

Such strictures are often the result of the applications of strong caustics and meddlesome tampering by the ignorant specialist and abortionist. The application of the electrical current by means of the uterine electrode is the most modern and effectual method of treating these cases successfully.

Flexion of the womb is understood to be a condition in which the uterus is flexed or bent upon itself at a sharp angle, just as a rubber hose that is bent sharply on itself becomes compressed at the kink so as to shut off the flow, in this manner the flow of blood from the cavity of the womb is partly shut off, and the obstruction is the cause of the painful menstruation.

In some women who have flexion or a bent womb there is no obstruction, because the probe passes the canal freely; in these cases dysmenorrhoea must be traced to some other cause. If it is clearly established that flexion is the cause of the obstruction, the most successful treatment is the electrical current. I have often had cases where little mucous growths no larger than a small marble, grew in the canal and obstructed the free escape of blood; after these were removed, the dysmenorrhoea ceased at once.

Other obstructions may be due to a stricture of the vagina or some deformity of the hymen; a very slight surgical operation will permanently relieve both of these hindrances.

There is a much larger proportion of cases that suffer from painful menstruation in whom the uterine organs are perfectly healthy, but who are systematically injured by dishonest or hungry specialists, by being subjected to local treatments. I have had cases of this nature fall into my hands very often. They had made the rounds of the specialists and had been made the innocent prey of avaricious professional competition, so that it is of the greatest importance to distinguish this class of cases from those in which the pelvic organs are the seat of the difficulty.

Nervous and congestive dysmenorrhoeas are particularly adapted for the hygiene of home treatment. Nervous or neuralgic dysmenorrhoea is very often overlooked, and treated as a local lesion of the womb.

The psychical exaggeration which many women experience at the approach of the menses is abnormally heightened in dysmenorrhoea. The pains in the back, in the hips, and in the lower part of the abdomen disturb the normal operations of the mind. The irritation of the nerves of the womb is often reflected to distant organs, and pain is felt in remote regions. Some women suffer only just a day or two preceding the flow, while others suffer severely during the entire period, so that they are forced to keep to their bed the greater part of the time.

Professor William Goodell, one of the most profound and original female specialists in America, has this to say in a recent publication: “I have learned to unlearn the idea— and that was the hardest task of all—that uterine symptoms are not always present in cases of uterine disease; or that, when present, they necessarily come from uterine disease. The nerves are mighty mimers, the greatest of mimics, and they cheat us by their realistic personations of organic disease and especially of uterine disease. Hence it is that even seemingly urgent uterine symptoms may be merely nerve counterfeits of uterine disease. I have, therefore, long since given up the belief, which, with many, amounts to a creed, that the womb is at the bottom of every female ailment.

“Nerve strain, or nerve exhaustion, comes largely from the frets, the griefs, the worries, the carks and cares of life. Yet although the imagination undoubtedly affects it, it is not a mere whim or imaginary disease, as all healthy women and physicians think; but it is the veriest of realities. When some flippant talker or some slipshod thinker scoffs at nervousness as a sham disorder, I say to him: ‘Can the bribe of a principality keep you from blushing when you are ashamed, or from blanching when you are afraid?’ Under the flitting sense of shame or of fear these vasomotor disturbances are momentarily beyond your control; and so they are in the nervous woman, whose vital organs are, as it were—not transiently but—perpetually blushing and blanching under deficient brain-control over the lower nerve centers.

“Strangely enough, the most common symptoms of nerve disorder in women are the very ones which tradition and dogmatic empiricism attribute to womb disease.

“They are, in the order of their frequency, great weariness and more or less of wakefulness and inability to walk any distance, a bearing-down feeling, headache, nape-ache and backache, scant, or painful, or delayed, or suppressed menstruation, cold feet, and irritable bladder, general spinal and pelvic soreness, and pain in one ovary, usually the left, or in both ovaries. The sense of exhaustion is a remarkable one; the woman is always tired, she passes the day tired, and she goes to bed tired, and she wakes up tired, often, indeed, more tired than when she fell asleep. She sighs a great deal, she has low spirits, and her arms and legs become numb so frequently that she fears palsy or paralysis.

“There are many other symptoms of nerve strain, but since they are not so distinctly uterine, and, therefore, not so misleading, I shall not enumerate them. Now, let a nervous woman with some of the foregoing group of symptoms recount them to a female friend, and she will be told that she has womb disease. Let her consult a physician and ten to one he will think the same thing and diligently hunt for some uterine lesion. If one be found, no matter how trifling, he will attach to it undue importance, and treat it heroically as the offending organ. If no visible disease of the external organs be discoverable, he will lay the blame to the invisible endometrium, or on the unseeable ovaries, and continue the local treatment. In any event, whatever the inlook or the outlook, a local treatment is bound to be the issue.”

The nervous variety of painful menstruation is frequently due to impoverishment of the blood, which, as we have learned, is often the direct cause of irritable nerves. The same treatment as for chlorosis will give the desired relief: the treatment with iron pills. If the stomach is deranged from dyspeptic disorders, then my dyspeptic mixture, No. II, is to be given. But there are cases that are purely neuralgic without any apparently serious lesion of the blood; cases in which the neuralgia of the womb or ovaries is probably due to exposure to cold or some other indiscretion; here the following recipe will effect a cure in the course of several months:

NO. III.

Mix. Take a teaspoonful in a tumblerful of milk three times a day, between meals.

Congestive dysmenorrhoea is oftener in the nature of an acute or sudden attack, except when it is due to a chronic inflammation of the lining membrane of the womb. It is often brought on by a sudden or inadvertent exposure, just at the time when the menses should make their regular appearance.

Persons of a plethoric habit and those who have been the subjects of inflammations either of the womb or in the tissues surrounding the womb, are more liable to this form of dysmenorrhoea than others. It will often be ushered in with a chill, followed soon with fever. There is headache, the skin becomes dry and hot, and often there is considerable irritability of the bladder, straining of the rectum and diarrhoea. Unless the pain is due to an obstinate displacement, it yields to proper treatment. For the straining and irritable bladder a hot sitz-bath should be employed for ten to fifteen minutes. In the absence of a suitable vessel for a sitz-bath an ordinary bathtub can be used by filling it six or eight inches with water, at a temperature of 104°F., and while sitting in the bath allow the boiling water to run slowly into it, so as to keep the temperature up. These sitz-baths should be taken several times a day, and after each bath the patient should rub herself thoroughly dry and wear flannel next to the skin. The extremities and feet should also be kept warm by wearing woolen hose.

Towels wrung out of hot water should be carefully folded and applied to the lower region of the abdomen and then covered over with a thickly folded flannel cloth so as to retain the heat and moisture; when the towel has cooled off repeat the dipping in hot water.

The Femina vaginal capsules are of inestimable value in this class of diseases. They relieve congestion of the womb by allaying the irritation. The best time to use one is just before retiring, and after taking a sitz-bath, or a vaginal injection of hot water, or both. Persons who are of a costive habit should pay particular attention that, about the time their monthlies come around, their bowels act freely, and to accomplish this purpose the Femina laxative tablets should be taken, one each night for several nights before the courses are expected.

MENORRHAGIA AND METRORRHAGIA.

By menorrhagia is meant, as the composition of the term implies, an excessive flow of blood at the regular monthly period; by metrorrhagia, a flow of blood from the womb at any time irrespective of the regular menstrual periods. Neither of these forms can be called a disease, as they are solely the symptoms of several kinds of uterine affections. In the course of our investigations, we will find that one of the most prominent and common symptoms of different womb diseases is hemorrhage of the womb.

If the hemorrhage is the result of general debility from protracted nursing, the child must be weaned, and recipe No. I, with a nourishing diet, will effect a cure.

Hemorrhage may be due to the presence of a fungoid inflammation, tumors, or affections of the mouth or neck of the womb, or congestion of the ovaries.

It is very often due to a “bad getting up” from confinement, where the womb has never returned to its original size. Sometimes it is due to a portion of the afterbirth that was retained in the cavity of the womb. It is also a symptom of cancer. As I have already said, it may be the symptom of so many different diseases that the proper course to pursue is to find an honest and competent physician to make a thorough examination, for the purpose of deciphering the real cause, and when that is discovered, it is as a rule, an easy matter to remove it and thus afford the patient permanent relief.

There is no remedy which on the whole is so effectual in controlling hemorrhage, no matter from what cause, as:

NO. IV.

Dose: a teaspoonful in a little water every four hours until the flow ceases, or until a physician is consulted to diagnose the case. In pregnancy, the administration of ergot is not admissible; cold water compresses are also useful in checking uterine hemorrhage, and the utmost quietude should be observed.

Nervous exhaustion from protracted confinement, or mental worry from the loss of a child or the death of a friend, may also cause uterine hemorrhage. The ergot is useful in these cases, with a change of air and scenery.