Absence of the Menses. Amenorrhoa.
The absence of the menses is divided into two kinds, retention. and suppression. It is retention when the monthly flow has never appeared; suppression, when, having been established, it is, by one cause or another, stopped.
Retention Explained. The ovaries, as we have before said are the centre of the female sexual system. It is the swelling or ripening of an ovum or egg, every four weeks, which causes the large flow of blood to the parts, and the consequent menstrual discharge.
But it sometimes happens that the ovaries are not developed at the usual time of life. The monthly evacuation does not then appear. There is retention. There may be retention, too, from other causes, after the ovaries are matured. Costiveness may sometimes occasion it; so may a degenerated and low state of the blood.
There may be mechanical causes of retention. The mouth of the womb may be entirely closed, or the neck may be so constricted as to close the passage through it, leaving no outlet for the monthly accumulation. The hymen, also, may have no opening through it. When these mechanical obstructions exist, there are sometimes large collections of fluid in the womb, which cause enlargement of the body, and in some instances, painful suspicions that the sufferer has committed imprudence’s, and is in the family way. Physicians should be on their guard against falling into such errors, and lending the sanction of their name to these blasting mistakes.
Suppression Explained. Suppression a stoppage after flow has been once established maybe caused by inflammation of the ovaries, the blood, in this diseased condition, being drawn so entirely to these swelling and germinating bodies, that the accustomed flow from the womb does not take place.
Inflammation in the neck of the womb may also cause a stoppage. So may a fright, as from a fire occurring in the neighborhood, or a cold taken by being caught in a shower. Girls sometimes, in their utter thoughtlessness or ignorance, dip their feet in cold water, when their courses are upon them, and bring on a suppression of a most dangerous character. The most lovely and innocent girls have done this for the purpose of attending a party; and, in some instances, the stoppage induced has ended in death within a few hours. The profound ignorance of their own mechanism, and of the laws which govern it, in which girls are kept who are just budding into life, is a serious reproach both to parents and physicians.
Suppression may be induced by whatever reduces the quantity or quality of the blood, as consumption, or by great depression of spirits. With some rare exceptions, women have not their turns while in the family way.
Treatment. Before anything can be done in the way of treatment, the case must be thoroughly investigated, and the specific cause of the disease searched out.
If it prove to be retention, and arises from a bloodless condition and an undeveloped state of the ovaries, iron is the proper remedy (61), (73), (74), (75), with a generous diet and exercise out of doors. If caused by an inflammatory state of the uterine neck or ovaries, the proper treatment has been already indicated. If from costiveness, relief may generally be found from prescriptions (5), (9). The mechanical causes alluded to above, when found to exist, must be removed by gently dilating the mouth of the womb or the uterine neck, with bougies, beginning with the smallest, and increasing the size, or by puncturing the hymen, as the case may require. Permanganate of potash, in capsules of 2 grains each, after meals, is one of the best remedies.
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