Tokology

Menstruation is the sanguineous flow accompanying the maturation of the ovum in the ovaries. It generally occurs regularly every twenty-eight days, and in temperate climates continues from about the fifteenth year to the forty-fifth.

Physiologists differ as to the cause of this phenomenon. It was for a long time believed to be a cleansing process peculiar to women; that Eve, having through her transgression entailed upon her daughters a curse, they needed more renovation and regeneration than men; and that aside from ordinary depurition this special secretion was given to them.

The theory now prevails that accompanying the maturation of the ovum there is a flow of blood to the generative organs, which in medical parlance is called hyperemia. The exudation of this venous blood from the membrane of the uterus constitutes menstruation; also that this menstruation is a provision of nature for the supply of a superabundance of blood, which during pregnancy is appropriated to the growth of the fetus. Thus is it allied to maternity leading us to regard this function with reverence.

In a normal state the discharge is slight, being from one to three ounces, and lasts two or three days.

Certain physiologists claim that all sanguineous flow is abnormal, that there should be no show of blood in a perfectly healthy woman. It is averred that the squaws of some Indian tribes have no show accompanying either ovulation or parturition.

Menstruation should be entirely devoid of suffering. A woman should have no cognizance of this function, save by the discharge. Could this be the rule, instead of the prevalent exception, the capacity of strength and endurance either for work or pleasure would be increased one hundred fold. The nation not only needs strong men but strong women, strong in physical as well as mental development. This strength is required for prosecuting a persistent warfare against prevailing and existing wrongs, as well as for transmitting health and vigor to the coming generation.

A woman in perfect health need take no especial care and make no change in her manner of life at this period. But under our artificial habits of life, such a woman is the exception rather than the rule, and in most cases some attention must be paid to the recurrence of the menses.

Many young ladies in attendance upon school, feel a need of some indulgence at that time, and are often granted respite from duty. Women following any regular occupation have learned to plan a day of lighter work at the recurrence of the period. Yet on the contrary some have found that congestion and pain are relieved by occupation sufficient to interest the mind, with exercise adapted to increase the circulation.

The disorders incident to menstruation are: Amenorrhea, Dysmenorrhea and Menorrhagia.

Amenorrhea is absence or suppression of the menses caused by cold, a chronic ailment, an anemic condition or some ovarian or uterine affection. It is also often the result of mental conditions, as grief, fright or severe mental strain.

One need not be uneasy about suppression when there is no special constitutional disturbance. Our grandmothers taught that the absence of the menses was always greatly to be feared, the prevailing idea being that serious results would follow to some vital organ. This is a mistake.

Patients during treatment for uterine ulceration and inflammation often gain steadily in health, although the menses cease for months. This has been observed especially in hygienic institutions.

At all events, in treating suppression avoid strong remedies, such as old-fashioned tansy tea, steel filings and ergot. These produce congestion, and may be the source of severe chronic ailments.

See to it that a general condition of health is attained. With plenty of out-door exercise, congenial employment and freedom from care, the young girl may, with rare exceptions, trust to nature for correction of suppression.

Dysmenorrhea, or painful menstruation, is of such frequent occurrence that it deserves especial attention. Most young ladies experience more or less suffering at this time. It may be only nervousness, wakeful nights, a slight headache, some pain in the back or pelvic regions, and a disposition to be alone; or the attacks may be severe, with pain in the back and pelvis, running down into the limbs; the surface and extremities cold, face pallid, with nausea, vomiting or fainting, and perhaps spasms.

This ought not to be, and, in most instances, need not be. With our present knowledge, the conditions for and causes of dysmenorrhea may be removed.

Among causes we find inflammation of the ovaries, oviducts, or mucous membrane of the womb, mechanical closure of the outlet of the womb, or, simply constipation, neuralgia or rheumatism.

With inflammation of the ovaries there is, previous to the recurrence of the menses and throughout its course, a dragging pain in the pelvis with swelling and soreness of the breasts, and more or less mental distress. These symptoms are not always relieved by the flow.

Inflammation of the mucous membrane of the uterus is the most frequent cause of dysmenorrhea. With this the pain begins with the flow and increases as the flow increases. There may be a discharge of shreds of membrane or clotted blood, and sometimes a membrane having the entire form of the cavity of the womb. This is produced by deposits of fibrine, like that of membranous croup.

When there is undue closure of the cervix the pain precedes the menstrual flow, and is relieved as the discharge becomes free.

The remote causes for dysmenorrhea are errors in dress and diet, want of exercise, etc.

To errors in woman’s dress more than any other one thing is the unnatural pain due. Women are burdened with heavy clothing, and every vital organ restricted by bands and bones. It is not unusual to count from sixteen to eighteen thicknesses of cloth worn so tightly about the pliable structure of the waist that actual deformity is produced.

The pelvis and chest are naturally well guarded from intrusion by the ribs and pelvic bones. But just at the point where belts are adjusted there is no protecting wall. Thus these parts are easily deformed, consequently digestion becomes imperfect, the circulation obstructed, the respiration restricted, and what is worse than all, the viscera crowd down upon the womb, the citadel of life.

Thus, by abuse, the maternal organism fails of fulfilling the divine charge committed to it by the Creator. The wonder is that intelligent, educated woman has ordinarily no thought of her relation to posterity, and her responsibility to offspring.

Exercises adapted to develop the muscles of the trunk and abdomen, giving breathing power and room for all the viscera will be found very satisfactory in their results, to women who will arrange their clothing suitably.

The restraint placed upon young girls, according to the usages of society, at the time when they most need exercise and muscular development, is not only mistaken wisdom, but a cruel physical wrong. They must be ladylike! So, perforce, they must not jump nor skip; they must not run up stairs two steps at a time, like a boy. No romping allowed! The physical freedom which is everywhere accorded to a boy, and by which he, all unconsciously fits himself for manhood, is forbidden the girl.

So she grows up without strength of nerve or muscle, and readily becomes a victim to all the ills that woman is heir to.

A very little care and planning devoted to this subject would bring to women both health and happiness. Like Rose, in Miss Alcott’s delightful story, a naturally frail girl may be developed into a hearty and vigorous young woman, and this too without unduly subjecting her to the mortification of singularity.

Neither is it necessary, in order to preserve health, that her thorough education should be neglected. The hue and cry that has been raised against the higher education of woman, on the ground of her physical incapacity to endure severe mental training, is not well founded.

The fact is that girls and women can bear study, but they can not bear compressed viscera, tortured stomachs and a misplaced uterus. The impure air, almost universal in schoolrooms, has much to answer for in the alleged incapacity of girls for mental wear and tear. Given pure air, the Delsarte training, loose and light clothing and unimpaired digestion, and our girls will in due time prove to the world that, notwithstanding a vigorous pursuit of study, “a girl is just as good as a boy.”

Out-door games and amusements are becoming more and more fashionable. Among these lawn tennis, croquet, archery, rowing, bean-bags and tri-cycling are popular and healthful in their tendency.

Next to errors in dress and deficient exercise, errors in diet may be responsible for painful menstruation. How can this be? Once, on inquiring of a class of young ladies the cause of this trouble, I received various replies; as skating, jumping rope, climbing stairs, improper clothing, etc.

A little eleven-year-old girl raising her hand, asked: “Is it not eating too much candy?” The rest of the girls laughed. But I replied, “You need not smile; this young lady has sounded the keynote of your trouble. It is not only too much candy, but you eat too freely of the carbonaceous foods, fats and sweets, without taking sufficient exercise to have them appropriated. Inflammation is the result and hence suffering ensues.”

Treatment for dysmenorrhea must be palliative and curative. No young girl should be allowed to endure this pain. It gives a shock to the nervous system, which sooner or later will act upon her general health, and depreciate her vitality.

In palliative treatment it has been customary to use alcoholic stimulant in some form. Symptoms at first are relieved, the blood being caused to flow to the surface, thus lessening congestion. The patient is made perhaps not actually drunk, but is stupefied. My observation, however, is that menstrual pain removed by this agency, recurs more severely at subsequent periods. The reason of this must be that the alcoholic stimulant increases the already inflamed condition. It is not good treatment.

The application of heat in some form will safely relieve almost any case. A relay of hot lamp chimneys is available in sudden attacks, even if at night; or a hot plate or stove-lid, wrapped in cloths is excellent in an emergency. In more severe cases, use hot fomentations (Page 114) or the hot water bottle.

A hot sitz-bath (Page 184) is the best resort where cramp-like symptoms with vomiting or fainting are experienced, or where the patient is threatened with spasms. Anticipate suffering by this treatment as soon as indicated by premonitory symptoms. Continue the bath until a copious perspiration is induced, probably from thirty minutes to an hour. Then rub off lightly without exposure, keeping wrapped in the blankets, and applying the hot water bottle, lie quietly for some time. Many who ordinarily suffer from three to five days can be relieved in one hour by this means alone. This course will prevent a recurrence of so severe an attack.

The curative measures employed must accord with the pathological condition of the patient. For local ailments, treatments must be that indicated for them; neuralgia and rheumatism will demand their own suitable remedial agents.

A lady, thirty-five years of age, had been for a long time a great sufferer at every menstrual period, five or six days being spent in bed each month. There was apparently no uterine disease. Ordinary treatment proved ineffectual. A casual inquiry at length disclosed the fact that she had long been afflicted with rheumatism, not confined to any locality. This gave a clue to her case, and a short treatment for this affection resulted in entire recovery from both that malady and the distressing menstrual attacks. The thermal bath (Page 118) was mainly depended on in her cure.

Local treatment or remedies will seldom be found necessary, if the whole system is kept in the best hygienic condition. A young woman had for nine years been a martyr to dysmenorrhea, spasms attending every period, often continuing for days. Like the woman in Scripture, “She had suffered many things of many physicians, and had spent all that she had, and was nothing bettered, but rather grew worse,” having had in all nine doctors, one of whom had performed a severe operation. Although still young, she was almost a perfect wreck. She had no strength for manual labor, often being unable to walk across the room. Her mental condition was equally deplorable, being scarcely able to do for herself. She was very sensitive to the cold, and consequently wore much heavy clothing suspended around her hips.

In her case few remedies were used. She was induced to make a radical change in her dress, and put upon a thorough course of exercises adapted to develop and invigorate the muscles of the abdomen, and insure a healthy action of the viscera. She was also encouraged to assist daily in light housework, with much free exercise in the open air.

The change was marvelous. Upon the recurrence of her next period, a hot sitz-bath was administered at the first symptoms of distress, and relief was speedy. Her improvement steadily continued; she was no longer agonized with pain and subject to convulsions. Before the three months of her treatment had expired, she was entirely restored to health.

The alteration in her appearance was great, buoyancy of manner and vivacity of expression taking the place of the look of dumb hopelessness which had been hers. The leaden load of physical suffering was lifted from her brain, and a new mental life began. No patient could evince or express more hearty and grateful appreciation of the great change which had been wrought.

This is only one of many instances illustrating the efficacy of simple hygienic methods. The cases are infrequent that will fail to respond favorably when nature is given an opportunity to rally her forces.

Menorrhagia, or profuse menstruation, accompanies inflammation, ulceration, polypus and other uterine diseases. It is not unusual to find it with dysmenorrhea, as it may be induced by the same causes.

The general treatment and remedies are similar in both disorders.

Aconitum, crude tincture.—This is one of the first remedies to be sought in any kind of hemorrhage, especially where there is throbbing pulse, with cold hands and feet. Dose:—Two drops in half a glass of water, tablespoon doses every ten to thirty minutes, according to severity of case. It is important to remember that aconite is a number one remedy in the first stages of hemorrhage from any organ. One can hardly go amiss in giving it. It has a specific effect in controlling the heart’s action, and thus relieves congestion and hemorrhage. An old lady had for twenty years been subject to frequent attacks of hemorrhage of the lungs. She never allowed herself to be without her bottle of aconite, and was always able to check an attack by using it promptly.

Aconitum, 2d.—Is also indicated in cases of inflammation or congestion of the uterus or ovaries, especially if attended with febrile symptoms.

Cimicifuga, 2d.—Heavy, aching pain in the back, extending to limbs, restlessness, cannot keep still. Rheumatic or neuralgic dysmenorrhea. It is also valuable for preparatory treatment, taken two or three doses a day for ten days previous to the recurrence of the period.

Belladonna, 2d.—Congestive enlargement of the uterus or ovaries, bearing down pains, and heat in the vagina.

Pulsatilla, 2d.—Vomiting, fainting, scanty menses, chilliness, moving pains in abdomen, mental depression, hysteria. Discharges bright in color.

Caulophyllum, 2d.—Painful menstruation, with a normal discharge. May be used as a palliative during the menses, and as a curative agent meanwhile.

Ergot, 3d to 6th.—Very severe, cramp-like pains, can not be endured. Discharge dark, clotted and fetid; surface and extremities cold; features pinched.

Dose:—In each of the above remedies ten drops in eight spoonfuls of water. Take one spoonful every half hour.