Southern Medical and Surgical Journal - Georgia Regents University

414 Healthy and Morbid Menstruation, [July,constitutional state of the patients suffering from menorrhagia,but they also greatly sinaplify treatment. The haemorrhagebeing in reality nearly always the result of local disease, thelatter is in most cases, the real element to be attacked and subdued.Instead, therefore, of an intricate and complex system oftherapeutics, founded on a host of indications, the practitionerhas, generally speaking, merely to bring to light and treat thedisease which causes the mischief. By so doing, he removesthe morbid condition which keeps up the haemorrhagic state,and menstruation spontaneously returns to a natural state.In those tbrms of menorrhagia in which the absence of anylocal disease is evident, or at least to be presumed,— at the beginningand termination of the menstrual function, for instance,or when the haemorrhage occurs in an accidental manner fromsome easily assiojnable cause, mental or bodily,—very littlemedicinal treatment is, generally speaking, required. If thepatient is kept at rest in a horizontal posture, and the cause beremoved, the haemorrhage \v\\\ generally subside of itself,without leaving any trace in the general health beyond temporarydebility, w'hich quiet and a moderately nourishing dietarysoon remove.This is not, however, always the case ; the haemorrhage may,even under these circumstances be so severe and so prolongedthat it would be imprudent to trust to the unassisted efforts ofnature. When such is the case, the indications are, to moderatethe activity of the circulation by the means of sedatives,such as opium, hyoscyamus, digitalis, hydrocyanic acid, Indianhemp, and other medicinal agents similar in their action ; tomodify the plasticity of the blood by the administration ofvegetable and mineral acids; and to exercise a revulsive actionon the intestinal canal by the means of saline purgatives. Theapplication of cold to the lower abdominal region, and the injectionof cold astringent injections into the vagina, may also beresorted to, should these means fail. It is as well, however, toW'ait, unless the haemorrhage be excessive, until the normal durationof the menstrual flux in the patient have y)assed, lest theimpression of cold should suddenly arrest the excretion of bloodwhilst the physiological flux towards the uterus is still in force,as extreme congestion, and even inflammation, might ensue.This appears to me a desirable precaution, and one which Iusually adopt, although the direct impression of cold to theuterine organs during menstruation, does not appear to be inreality as dangerous as it is usually considered.In this the most simple form of menorrhagia, it is seldom necessaryto resort to those medicinal agents which have a directinfluence upon the uterus, such as ergot of rye and savine. . It