GEN. I. SPEC. I. α P. ob structionis Emansio. the menses. not only in his First Lines, but long afterwards in his Materia Medica, he regards the discharge as pure blood, and, consequently, the economy of menstruation as a periodiRetention of cal hemorrhage. "I suppose," says he, "that in consequence of the gradual evolution of the system, at a certain period of life, the vessels of the uterus are dilated and filled: and that by this congestion these vessels are stimulated to a stronger action by which their extremities are forced open and pour out blood. According to this idea it will appear that, I suppose, the menstrual discharge to be upon the footing of an active hemorrhagy, which, by the laws of economy, is disposed to return after a certain interval."* Sympathetic affection with the uterus at this time often mani From the sympathy prevailing between the uterus and most other organs of the system, we meet not unfrequently with some concomitant affection in various remote parts; as an appearance of spots on the hands or forehead antefested in recedently to the effluxt; or, which is more common, a mote parts. peculiar sensation or emotion in the breasts 1. Catamenia why thrown off monthly rather than at other periods not known. Still a proof of design obvious: and a habit established by repetition. Period of ance va riable: We cannot explain the reason why this fluid should be thrown off once a month or by lunar periods, rather than after intervals of any other duration. But the same re mark might have been made if the periods had been of any other kind: and will equally apply to the recurrence of intermittent fevers. It is enough that we trace in this action the marks of design and regularity: and, after the establishment of a habit by a few repetitions, there is no difficulty in accounting for the intervals being of equal length. The time in which the secretion, and consequently the first appear discharge, commences, varies from many circumstances; chiefly, however, from those of climate, and of peculiarity of constitution. In warm climates menstruation appears often as early as at eight or nine years of age-for here the general growth of the body advances more rapidly than from eight or nine in hot climates, * Mat. Med. Vol. 1. p. 587. 4to. + Salmuth, Cent. III. Obs. 18. GEN. I. SPEC. I. a P. ob in colder quarters, and the atmosphere is more stimulant. In temperate climates it is usually postponed till the thirteenth or fourteenth year, and in the arctic regions till the structionis nineteenth or twentieth. Emansio. intemperate, and nineteen or twenty in arctic re gions. Generally In all climates, however, when the constitution has ac- the menses. to thirteen quired the age in which it is prepared for the discharge, or fourteen various causes, observes Dr. Gulbrand, may accelerate its appearance. Among these we may mention any preternatural degree of heat or fever, or any other stimulus that quickens the circulation. Mauriceau relates a case in which it was brought on suddenly by an attack of a accelerated tertian intermittent: and in like manner anger or any by accidents. other violent emotion of the mind, has been found to produce it as abruptly. The depressing passions, as fear and severe grief, conduce to the same end though in a different way for here there is rather uterine congestion than increased impetus, in consequence of the spastic chill of the small vessels on the surface, which lessens their diameter. Inordinate exercise, or a high temperature of the atmosphere, has in like manner a tendency to hurry on the menstrual tide; and hence its appearing so early in tropical regions. Dr. Gulbrand, indeed, conceives that even an increase in the elasticity or weight of the atmosphere is sufficient to produce a like effect, and refers to a curious fact in proof of this. In an hospital, to which he was one of the physicians, he tells us that a very considerable number of the female patients were suddenly seized with catamenia ; which was the more remarkable because several of these had, for a considerable time, laboured under a suppression of that discharge, and had been taking emmenagogues to no purpose; while others had only been free from their regular returns for a few days. On inquiring into the cause, the only one which could be ascertained was a very great augmentation in the weight or pressure of the atmosphere, the mercury in the barometer having attained a height at which it had never been observed at Copenhagen before though he does not state the point it had actually reached*. It is possible that other general causes may Hence the * De Sanguifluxû Uterino. 8vo. Hafn. Sometimes by a differ- disease sometimes GEN. I. SPEC. I. * P. ob structionis Emansio. said to be epidemical. Much de under which sometimes operate to a like extent; and hence this disease is said, by Stoll and other writers, to be occasionally epidemic*. Still much depends upon the idiosyncrasy: some girls the menses. are of a more rapid growth than others of the same climate; and in some there is a peculiar sexual precocity or prematurity of orgasm that hurries on the discharge before pends on the the general growth of the body would lead us to expect it: idiosyncrasy of which Pecklin gives an example in a girl of seven years pregnancy is of age who, in the intervals, laboured under a leucorrhoeat. reported to And hence chiefly we are able to account for those very early and marvellous stories of pregnancy in girls of not more than nine years old, which, if not well authenticated, and from different and unconnected quarters, might justify a very high degree of scepticism‡. have occurred at nine years of age. Duration of the discharge. Quantity secreted. Ultimate term. Retention Sometimes by constitutional tardiness. The efflux continues from two to eight or ten days; and the quantity thrown forth varies from four to ten ounces in different individuals: the monthly return running on till the fortieth or fiftieth year, and sometimes, as we shall have occasion to observe hereafter, to a much later period of life. It is not always, however, that a retention of the menses to a much later date than sixteen, or even twenty years of age constitutes disease: for sometimes it never takes place at all, as where the ovaries are absent or perhaps imperfect; or where, instead of precocity in the genital system, there is a constitutional tardiness and want of stimulus ; under which circumstances it appeared for the first time, according to Holdefreund, in one instance at the age of seventy§ and in another, that fell under the care of Profirst time at fessor Frank, it never appeared either in a condition of single or married life, nor had the patient at any time any lochial discharge, though she had produced three healthy children.|| It is only, therefore, when symptoms take Has occur red for the seventy. Hence retention only a disease when * Rat. Med. P. III. p. 48. Samml. Med. Wahrnehm. 1x. B. p. 401. Schmid, Act. Haller (Gottl. Eman.), Blumenbach. Bibl. 1. p. 558. § Erzäklungen, No. 4. De Cur. Hom. Morb. Epit. Tom. vi. Lib. vi. Part ш. 8vo. Vienna, 1821' GEN. I. SPEC. I. a P. ob place indicating a disordered state of some part or other of the body, and which experience teaches us is apt to arise upon a retention of the menstrual flux, that we can regard structionis such retention as a disease. Emansio. Description system suf fers. These symptoms, as already stated in the definition of the menses. the disorder, consist chiefly in a general sense of oppres-disordered in the body is sion, languor, and dyspepsy. The languor extends over consequence the whole system, and affects the mind as well as the hereof. body and hence, while the appetite is feeble and capri- of symptoms cious, and shows a desire for the most unaccountable and when the innutrient substances, the mind is capricious and variable, often pleased with trifles, and incapable of fixing on any serious pursuit. The heat of the system is diffused irregularly and is almost always below the point of health: there is, consequently, great general inactivity and particularly in the small vessels and extreme parts of the body. The pulse is quick but low, the breathing attended with labour, the sleep disturbed, the face pale, the feet cold, the nostrils dry, the intestines irregularly confined, and the urine colourless. In some instances there is an occasional discharge of blood, or a blood-like fluid from a remote organ, as the eyes, the nose, the ears, the nipples, the lungs, the stomach, or even the tips of the fingers, giving examples of the fourth species. There is also, sometimes, an irritable and distressing cough; and the patient is thought to be on the verge of a decline, or perhaps to be running rapidly through its stages. Patient sometimes thought to be in a de cline. Yet decline does not follow though continue for the disease many years. System accommo dates itself A decline, however, does not follow, nor is the disease found fatal, although it should continue, as it has done not unfrequently, for many years: for if the proper discharge do not take place, the constitution will often in some degree accommodate itself to the morbid circum- sometimes stances that press upon it, and many of the symptoms will become slighter or altogether disappear. Most commonly, however, when the patient is supposed to be at the worst, probably from the increased irritation of the system peculiarly directed to the defaulting organs, a little mucous or serous discharge, with a slight show of colour is the harbinger of a beneficial change, and is soon succeeded by the to the mo morbid condition. Disease sometimes ceases gra dually when supposed to be at the worst. GEN. I. proper discharge itself: though it often happens that the efflux is at first not very regular either as to time or quanstructionis tity. But this is an evil which generally wears away by Retention of degrees, and is diminished with every recurrent tide. SPEC. I. a P. ob Emansio. the menses. disease of debility, which is generally the primary All the symptoms indicate that retained menstruation Manifestly a is a disease of debility; and there can be little doubt that debility is its primary cause—a want of energy in the secernent vessels of the uterus that prevents them from fulfilling their office, till the increase of irritability, from the increase of general weakness, at length produces a sufficient degree of stimulus, and thus momentarily supplies the place of strength. The system at large suffers evidently from sympathy. cause. P. obstructionis Yet menostation may take place from a SUPPRESSION OF THE MENSES after they have become habitual, as well Suppression as from their retention in early life, which constitutes the SECOND VARIETY of the disease. Suppressio. of the menses. Cause mostly that of the preced The causes of this form are for the most part those of the preceding, and consist in a torpitude of the extreme or ing variety. secernent vessels of the uterus produced by anxiety of mind, cold, or suddenly suppressed perspiration; falls, especially when accompanied with terror, or a general inertness and flaccidity of the system, and more particularly of the ovaria. Hence the disease may exist equally in a robust and plethoric habit and in the midst of want and misery. In the last case, however, it is usually a result of weakness alone; and on this account it is sometimes found as a sequel upon protracted fevers. May exist equally in a robust and delicate frame. Symptoms necessarily different from those of the pre As this modification of the disease occurs after a habit has been established in the constitution, its symptoms differ in some degree from those we have just contemplated. ceding vari- And, as it occurs also both in a state of entony and atony, ety, and why. the symptoms must likewise differ according to the state of the constitution at the time. If, however, the frame be at the time peculiarly weak and delicate, the signs will not essentially vary from those of the first variety, only that there will be a greater tendency to head-ache, and palpitation of the heart. Yet not essentially different in weakly habits. Symptoms in an entonic habit. If the habit be plethoric, and, more particularly, if the |