SECTION VIII. DISTURBANCES OF THE MENSTRUAL FUNCTION. CHAPTER XLVIII. Amenorrhoea Menorrhagia Dysmenorrhoea. SECTION IX. DISTURBANCES OF THE REPRODUCTIVE CHAPTER XLIX. Sterility: Abortion: Retroflexion of the Gravid Uterus. L. Extra-uterine Gestation. Causes. CHAPTER XLVIII. AMENORRHOEA: MENORRHAGIA: DYSMENORRHŒA. THE three subjects to which this section is devoted are not diseases, but are symptoms of a large number of the more or less well-ascertained pathological conditions already considered. Theoretically, therefore, they should not come up for special consideration; practically, however, it is of use to the practitioner to summarize the conditions causing these symptoms, and to give some special hints as to their treatment. AMENORRHOEA. This means cessation of menstruation during the period between Puberty and the Menopause. It is normal to have Amenorrhoea during pregnancy and lactation. Amenorrhoea may be caused by the following Local conditions : Congenital . : Absence or incomplete development of uterus. and annexa, atresia of the genital canal (with or without accumulation of the menstrual blood), state of Cretinism; Superinvolution, simple atrophy of uterus, cystic ovarian disease, extensive inflammatory conditions of uterus and ovaries. Constitutional conditions-such as phthisis, chlorosis, pre-maturity of menopause also cause amenorrhoea. Acquired The local conditions have already been fully described under the various heads; we give here only a few hints as to the investigation of the causes of this symptom. When the patient complains of never having menstruated and there is no constitutional cause for the amenorrhoea, the question of examination should always be entertained; abdominal pal pation and rectal examination are employed to ascertain that there is no retention from atresia. To ascertain the condition of the uterus, a vaginal examination may be necessary. Sudden cessation of the menstruation in a girl neither phthisical nor chlorotic is usually due to pregnancy; early sickness, mammary and other signs should be looked for. Nothing is a sure sign of pregnancy except the characteristic increase in the size of the uterus, agreeing with the number of periods passed. In cases where amenorrhoea is due to chlorosis, Blaud's pills are Treatment. indicated. These contain sulphate of iron and carbonate of potash made up as undernoted; as the result of the combination, the carbonate of iron is formed. Nine pills must be taken per diem continuously for six to eight weeks, by which time a complete cure usually results. Before the pills are given, the state of the tongue and bowels should be looked to. If the tongue is foul and the bowels constipated, we may give the following: B Magnesiæ sulphatis Quiniæ sulphatis Acidi sulphurici dil. Tincturæ capsici Aquam ad zi. 3iij. 3j. žvi. Sig. Tablespoonful twice or thrice daily. This is taken for a week. The Carlsbad salts or Friedrichshall water may be substituted. This hint as to the preliminary purgation is a good one, and is given by Milner Fothergill; if not attended to, the result will be disappointing as the iron will not be so readily absorbed by the intestinal mucous membranes. Note. The original composition of Blaud's pills is as follows:-Sulphate of iron, carbonate of potash, of each half-an-ounce; marshmallow root thirty grains; gum tragacanth q.s. to make 120 pills. The following are the proportions in the pill as made by Messrs. Duncan, Flockhart and Co. of this city: Ferri sulph. siccat. 15, Potass. carb. siccat. 15, Pulv. gum. acacia 3, Syrup. simp. 9; Divide in 5-gr. pil. Blaud's pill gives a ferrous carbonate and a potash salt, the decomposition taking place after the pill is swallowed. In Vallet's pill, which is popular on the continent, the decomposition is effected first and the carbonate of iron thus freshly formed is used to make the pill. The quantities taken to make Vallet's pill are as follows:-Protosulphate of iron (in crystals) 10, Carbonate of soda (in crystals) 12, White honey 3, Sugar of milk 3; Divide in 5-gr. pil. Ringer recommends Permanganate of potash. The following is a good formula: B Potassæ Permanganatis. Causes. These pills should not be made with any excipient containing glycerine or with an oxidizable substance. MENORRHAGIA. Menorrhagia is the term applied to excessive hæmorrhage at the The causes of menorrhagia are the following:- Local Hæmorrhagic diathesis, scorbutic conditions; It should not be forgotten that we may have menorrhagia in cardiac disease, and also in hepatic congestion (Matthews Duncan, Warner). Treatment. The treatment of menorrhagia is the treatment of the condition producing it. In cardiac disease we give digitalis; and in hepatic disease we may try chloride of ammonium, euonymium or iridin. In cases where there is menorrhagia due to a simple congested condition or to a flabby state of the uterine muscle, we may give the following at the menstrual periods :— Note that it is well not to write "at the menstrual period" on the prescription, but to put "as directed." When the practitioner is con |