Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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Metrorrhagia, Hemorrhage from the Womh.

We understand by metrorrhagia a more or less profuse flow of blood
from the womb at any other time than that of the menstrual period.

1. It may occur in the not pregnant state of the womh, in consequence
of abnormal fluxion to that organ. Or in consequence of morbid growths
in the womb and desorganizations of the organ, as shown in the pre-
vious chapters, or (and that is, perhaps, its most frequent occurrence)
in consequence of those conditions which lead to the so-called " change
of life" in the female organism ; here it is, perhaps, not always distin-
guishable from a mere profuse menstruation.

2. It may occur during pregnancy. With some women it is almost
a rule, that the menstrual period is repeated several times after con-
ception, without apparent injury to the child. In others, however, a
hemorrhage during the first months of pregnancy is the forerunner of
abortion. Hemorrhages during the second half of pregnancy are often
signs of a placenta previa, or likewise forerunners of miscarriage.

3. It may occur after the expulsion of the child, whether it be full-
grown or not. Such bleedings are generally of great importance.
They are almost always (if not occasioned by mechanical injuries) the
consequence of insuflS.cient contractions of the womb, the causes of
which consist either of protracted or exhausting labors, or a too rapid
expulsion of the child, or a partially-adhering placenta, or large blood
coagula within the womb.

4. When occurring later, during the lying-in time, the hemorrhages
are usually not so profuse, and happen chiefly in women who do not
nurse the child. Sometimes, however, they may be caused by an
inflammatory irritation of the womb.



432 FEMALE ORGANS.

Symptoms.

Metrorrhagia sets in frequently with cliillj spells. The bleeding
is either in gushes, or a continuous flow of bright-red or dark blood.
The face turns pale, the extremities grow cold ; there is anxiety, rest-
lessness, labor-like pains or colic ; sometimes difficulty in breathing ;
vomiting and even convulsions. A great loss of blood brings on the
signs of aneemia : coldness and deadly paleness of the face ; chills ;
cold perspiration ; darkness before the eyes ; ringing in the ears ;
fainting, drowsiness, weak pulse, convulsions.

Therapeutic Mints,

Apocyn. cann., the flow is either continuous or paroxysmal; the
blood fluid or clotted ; there is nausea, vomiting, palpitation of the
heart, great prostration and fainting when raising the head from
the pillow.

Arnica, after difl&cult labor or external injuries; head hot; remain-
ing body cool.

Bell., great bearing down, as if every thing would be pressed out,
or a pain from the sacrum through the pelvis to the pubis ; headache ;
loss of consciousness ; darkness before the eyes ; enlarged pupils ; cold
nose ; oppression, groaning, yawning, jerkings of the arms ; convulsive
clenching of the thumbs.

Calc. c, climacteric period ; chronic ; mixed with leucorrhoea ;
previously always inclined to profuse and protracted menses.

Caulophylium, threatening abortion, and with spasmodic bearing-
down pains ; great vascular excitement ; passive hemorrhage after
abortus or confinement ; tremulous weakness of the whole system.

China, at the commencement or actual presence of the above de-
scribed symptoms of ansemia.

Cham., threatened abortus or actual abortion ; labor-like pains from
the small of the back extending to the genitals ; blood dark and
clotted.

Crocus, dark, viscid, stringy blood, in black clots; feeling as if
something alive were in the abdomen ; nervous excitement ; palpita-
tion of the heart ; fearfulness ; after being overheated, straining and
lifting ; after abortus and delivery ; worse from slightest motion ;
yellowish, earthy color of the face.

Erigeron can., uterine hemorrhage, with violent irritation of the
rectum and bladder ; after abortion, with diarrhoea and dysuria.

Ferrum, partly fluid and partly black, clotted blood ; labor-like and



METEORRHAGIA. 433

colicky pains ; fiery red face ; frequent short shudderings ; lieadaclie
and dizziness ; constipation and hot urine.

Hamamelis, passive hemorrhage, with anaemia.

Hyoc, continuous flow of bright-red blood, with spasmodic jerkings
of the body and great vascular excitement.

Ignatia, after the abuse of chamomile-tea ; after mental excitement
and depression.

Ipec, especially after child-birth or the taking away of the placenta;
the flow is continuous, and the patient gasps for breath.

Kreos., black blood in large quantities and of an offensive smell ;
during the climacteric period.

Kali c, threatened abortus and consequences of it; great weakness
in the small of the back and lower extremities ; pain in the small of the
back as though it were broken ; dry, hacking cough ; obstinate sweat-
ing, with feverish chilliness ; chronic inflammatory state of the womb,
with nausea and vomiting.

Lachesis, climacteric period.

Lycop., partly black, clotted, partly bright-red blood, and partly
bloody serum, with labor-like pain, followed by swooning ; distention
of the abdomen in different places, changing localities ; pain in the
small of the back, extending into the thighs ; worse in the afternoon
from four o'clock, commencing with chilliness ; restless sleep ; dreams
of falling down from a height ; especially for women who habitually
menstruate profusely.

Merc, frequent fainting ; profuse cold perspiration on the face ;
collection of slime in mouth and throat; external swelling of the
genitals.

Nitr. ac, after miscarriage or confinement ; diarrhoea, with cutting
pain in the rectum after stool; urine of an intolerably strong smell.

Nux vom., during the climacteric period, and especially if such
persons have been drugged previously by allopathic nostrums; or
have used much coffee or alcoholic drinks, or too highly-seasoned
food ; if they lead a sedentary life ; complain much of costiveness
and headache; suffer with piles, &c.

Phosph., between the menses and during pregnancy; lame and
bruised feeling in the small of the back ; dry cough and tightness in
the chest, worse before midnight; great heat on the top of the head;
a great deal of vertigo; chronic looseness of the bowels, worse in the
morning, or else chronic constipation, with dry, narrow stools.

Platina, during pregnancy ; after confinement; after great mental

emotions ; dark, thick, not coagulated blood ; pressing pain from the

28



434 FEMALE ORGANS.

small of the back downward upon the pelvic organs, as though they
would come out, with great sensitiveness of the external organs,
and nymphomania ; sometimes a feeling as if limbs and body were
growing larger.

Plumbum, during the climacteric period; dark clots, alternating
with fluid blood or bloody serum, with a sensation of fulness in the
pelvis, and slight bearing-down pains from the small of the back to
the front; skin dry, pale, yellowish; here and there "liver-spots;"
great debility, short breath on going up stairs ; depressed spirits.

Poisoning with lead brings on abortion.

Pulsat., dark, coagulated blood emitted in paroxysms; worse in the
evening, with labor-like pains ; habitual looseness of the bowels ;
ordinarily rather scanty menses; yielding disposition.

Rhus tox., bright red blood ; threatening abortus, induced by strain-
ing or lifting; trembling sensation in the middle of the chest; con-
tractive pain around the hypochondria; drawing, tearing in the back,
loins and hips; cramp-like contraction of the thighs; aching all over,
worse during rest ; heavy, unrefreshing sleep, full of dreams.

Sabina, blood bright red or dark, also in clots, sometimes alternat-
ing, now dark, coagulated, and then, again, thin and bright red;
flows mostly in paroxysms, which are brought on by the slightest
motion ; drawing, cutting, pressing pains from the small of the back
to the genitals and into the thighs ; women who menstruate early and
almost always profusely ; gouty diathesis ; when the patient feels
better in cool and worse in warm temperatures; threatening abor-
tus; after miscarriage and confinement.

Secale, atonic hemorrhages during the critical age ; after confine-
ment; dark, seldom coagulating blood, sometimes fetid; no pain, or
only slight bearing-down ; flooding, worse from the slightest motion ;
trembling, convulsive jerkings of the limbs; cramps in the calves of
the legs ; general coldness.

Sepia, climacteric age, or during pregnancy, especially during the
fifth and seventh months; congestion of the head; fulness and pressure
in the chest; spasmodic contractions in the abdomen, with terrible
bearing-down; induration of the womb; varicose veins; yellow,
sallow complexion. Such patients are very irritable, and faint from
any little exertion.

Sulphur, in chronic cases, when other remedies do not prevent its
return; psoric taint of the system; eruptions here and there, or
previously-suppressed eruptions; looseness of the bowels early in
the morning, or else great constipation; fits of gnawing hunger



MENORRHAGIA. 435

before dinner; the patient complains of great heat, or flushes of heat;
has sleepless nights, seemingly without cause, or on account of a
tormenting itching all over the body; itching about the anus and
genitals; chronic leucorrhoea, &c.

Menstrual Anomalies.

I. Menorrhagia

Is, like metrorrhagia, a profuse flow of blood from the womb ; only
with the difference, that it occurs at the time of the menstrual period.
This period may keep regular time, or it may come too soon, or it
may last too long ; in some cases the menses are too profuse, too early,
and lasting too long. Its causes are various. We may trace it to
different structural changes and morbid growths of the uterus ; to
•stagnation of the blood in the uterine veins, depending upon heart
and lung diseases; to fluxions to the womb, brought on by sexual
excesses, or sexual excitements by loose literature, or onanism ; to
hemorrhagic diathesis, as in scurvy, purpura hemorrhagica, hemor-
rhagic small-pox, measles, typhus, &c. Such cases, however, are of
rare occurrence. The blood is either fluid or coagulated, and may
difiFer greatly in color and character. Strong plethoric women may
endure menorrhagia for a long time ; weak, feeble women soon show
signs of anemia.

Therapeutic Hints.

Compare the preceding chapter on Metrorrhagia, and likewise those
which treat of its causes as stated above.

Ammon. c, premature and very copious flow, especially at night,
when sitting or riding, and after a ride in the cold air; with spas-
modic pains in the belly and hard stools, with tenesmus ; cholera-like
symptoms at the commencement of the flow.

Arg. nitr., congestion of the uterus; cutting pains in the small of
the back and groins ; cramp in the stomach ; great debility of the
lower limbs ; vertigo and enlarged feeling of the head.

Bryon., menses premature and too profuse; dark-red blood; tear-
ing in the limbs ; splitting headache from the least motion, even on
moving the eyes; white-coated tongue; great thirst; bilious vomit-
ing ; tearing in the limbs ; constipation ; stools as if burnt ; or di-
arrhoea in the morning.

Caic. c, profuse, too early, and lasting too long; anaemic symp-
toms and congestion of the head and chest ; leucorrhoea afterwards ;
scrofulous diathesis.



/



436 FEMALE ORGANS.

Calc. phos., menses every two weeks, black and clotted ; before
their appearance, griping and rumbling in the bowels ; leucorrhoea ;
stitching pains in the left side of the head ; sleepiness during the day.

Cham., profuse discharge of dark, almost black coagulated blood,
with drawing, clawing pains from the small of the back to the os
pubis ; greatly excited state of mind ; fainting spells, cold extremities.

Cimicifuga, profuse and too early ; dark, coagulated blood ; aching
in the limbs ; . severe pain in the back, down the thighs, and through
the hips, with heavy pressing down ; weeping mood ; nervousness ;
hysteric spasms ; great pain in the head and eyeballs, increased by
the slightest movement of the head and eyeballs.

Cocc, profuse and too often ; when rising upon the feet, it gushes
out in a stream ; paralytic feeling of the lower extremities.

Collinsonia, menorrhagia in connection with constipation and piles.

Crocus, profuse, and lasting too long, but coming at the right time ;
dark, clotted, stringy blood ; wretched, pale, yellowish color of the
face ; palpitation of the heart on going up-stairs ; great debility.

Digitalis, venous, passive congestion, with pale or livid color of the
face ; coldness of the skin ; swelling and painfulness of the feet ; all
in consequence of some cardiac anomalies.

Erigepon, profuse and too frequent, with violent irritation of the
rectum and bladder.

Ferrum, profuse, too frequent, and lasting too long ; with a fiery-
red face, whilst at other times the face is pale and earthy looking.

Gelsem., almost continuous flow, without any pain.

Hyosc, profuse, with delirium ; convulsive trembling of hands and
feet; silly manners, rage.

Ignatia, profuse, too frequent and lasting too long; after great
mental troubles, grief or fright ; empty feeling in the pit of the
stomach ; great sensitiveness of mind without complaining.

Ipec, very profuse, with heavy breathing ; constant nausea.

lodium, profuse and too early ; ovarian region painful, or sensitive
to pressure; emaciation, notwithstanding a good appetite; chronic
catarrh of the lungs.

Kreosote, profuse and last too long; great distention of the
abdomen before the menses, so that she appears as though she
were pregnant ; blood offensive ; leucorrhoea between the menstrual
periods.

Lycop., profuse and lasting too long; sadness and melancholy
before the menses; yellowish color of the face; frequent jerkings of
the limbs ; incarcerated flatulence.



AMENOREH(EA. 437

Nux vom., profuse and too early ; great sensitiveness of tlie nervous
system ; can't bear light or noise ; is put out of patience when spoken
to ; gets angry and violent without any provocation ; is headstrong
and self-willed ; or gets frightened easily, and is almost beside herself
from the least thing that may happen ; she shuns the fresh air. After
coffee, liquors, high-seasoned food, drugs, sedentary life.

Phos., profuse, too early and lasting too long ; or too late, but very
copious ; afterwards great weakness, blue rings around the eyes ;
losing of flesh and great fearfulness; tender, sensitive women, with
frequent heat in the back, and cold legs.

Platina, profuse, too frequent and long lasting; dark blood; press-
ing-down pains ; excited sexual desire.

Secale, profuse, dark, without pain, lasting too long, being aggra-
vated by the slightest motion or mental emotion.

Sepia, profuse, either too early or at the right time, venous con-
gestion of the head ; one-sided headache, with nausea and vomiting ;
loathing of all food; pot-belliedness after confinement; constipation;
yellow spots on the face.

Trillium, menses every fourteen days, lasting seven and eight days;
in the intervening time profuse leucorrhoea of a yellowish color and
creamy consistence. The blood is at first bright red, but owing to
anaemia, grows pale.

Veratrum, profuse and too early ; commencing with vomiting and
diarrhoea ; sensation upon the top of the head, as if ice lay there ;
nose, hands and feet cold ; irritable, weeping mood.

2. Amenorrhoea

Consists in the absence of menstruation in women between the ages
of puberty and climaxis, with the exception of the periods of preg-
nancy and nursing. The non-appearayice of the menses at the age of
puberty has its cause chiefly in chlorosis, scrofulosis, tuberculosis
and rhachitis. Earer are those cases in which it depends upon a
degeneration of the ovaries ; more frequent those depending upon
chronic infarcts or catarrhal processes of the womb in consequence
of the above-stated constitutional diseases. It has been observed,
likewise, as a consequence of spinal diseases, imperforation of the
hymen, and closure of the os uteri.

The cessation or suppression of the menses is usually a consequence
of inflammatory processes, the causes of which have been detailed
under the head of Metritis.



438 FEMALE 0EGA3SFS.

Vicarious menstruation is that peculiar anomaly of the menstrual
function, bj which, at the regular monthly period, hemorrhage takes
place, not through the -womb, but by means of some other mucous
membranes, (nose, lungs, bowels, eyes, ears,) from wounds and from
telangiectasias. The reality of such abnormal action is established
beyond any doubt, although the reason of its occurrence is still a
matter of conjecture.

The symptoms of amenorrhoea consist chiefly of headache, espe-
cially on the top, or on one side ; heaviness of the feet ; dyspnoea ;
dyspepsia; lassitude; sadness; sleepiness in the day-time; oedema;
palpitation of the heart; epistaxis; haemoptysis; hgematemesis;.
swelling of the veins on the lower extremities, in combination with
all the constitutional signs upon which the whole disturbance rests
as a basis.

Oriierapeutic Mints.

Aeon., during puberty frequent bleeding of the nose ; great palpi-
tation of the heart ; congestion of the head.

Apis, in young girls, who are constantly busily engaged in this or
that, but do nothing right ; who let every thing fall out of their hands
or break it, and laugh over it ; also great congestion of the head,
and even delirium ; oedematous swelling of the lower extremities.

Apocynum, in young girls, attended with bloating of the abdomen
and extremities.

Bell., hsematemesis instead of the monthly discharge.

Bryon., bleeding of the nose instead of the monthly flow.

Calc. c., in young girls of a plethoric habit, or a scrofulous
diathesis, with different complaints, as if the menses would set in,
but do not ; suppression of the menses from working in water, with
anasarca.

Carbo veg., at the time the menses should appear, violent itching of
old tettery eruptions.

Caust., epileptic fits during the time of puberty.

China, after suppression by chagrin; secretion of milk in the
breasts.

. Cimicifuga, in suppression from a cold, mental emotions and febrile
symptoms ; when rheumatic pains in the limbs, or intense headache,
or uterine spasms are present.

Coceulus, instead of the monthly flow : cramps deep in the abdo-
men; pressure in the chest; dyspnoea; groaning and moaning; great



AMENOERHGEA. 439

weakness, so tliat the patient is scarcely able to speak : paralytic
feeling in the lower extremities.

Cyclamen, chlorotic state; great dizziness and headache.

Cupr., typical paroxysms of the most violent cramps in the abdo-
men, extending up into the chest, with nausea, retching and vomiting;
convulsive motions of the limbs, with piercing shrieks.

Digitalis, age of puberty; dark red, bluish color of the face; dis-
tended veins on eyes, ears, lips, and tongue ; constant yawning; irregu-
lar action of the heart; suffocating feeling in bed; frequent desire to
urinate; leucorrhoea; painful and swollen feet and limbs, with paralytic
feeling in them.

Graphites, after Pulsatilla; congestion of the head and chest; dark
redness of the face; constriction of the chest, when lying, with anxiety;
itching between the fingers, and tetters; nails grow thick and crooked;
the limbs upon which she lies go to sleep.

Hamamelis, vicarious bleeding from the nose or stomach, with great
constipation and varices on the legs.

Kali c, age of puberty; spasms of the chest; swelling of the face,
especially over the eyes; stiffness and pain in the small of the back ;
dryness of the skin; is easily frightened; sleepless after 3 o'clock a.
M., feeling worse in all respects at that time.

Lycop., suppression from a fright; great agitation of the blood in
the evening, or a feeling as though circulation had ceased; great
desire for sweet things; sour belching; great fulness in the stomach
and bowels; liver spots on the chest.

IVlercur., cessation of the menses for several months ; headache ;
weakness of sight; nervous trembling of the hands; earthy color of
the face; prolapsus uteri; diarrhoea with tenesmus; oedematous swell-
ing all over; tearing in the limbs, worse at night in bed, with con-
stant sweating.

iVliliefolium, hemoptysis.

IVIatp. mur., age of puberty; melancholy and sadness, or hastiness
and impatience; awakes with headache; has frequent fluttering of
the heart; the tongue is covered with small blisters, or shows the
appearance of a so-called map-tongue ; the bowels are costive and
move with great dif&culty, and there is cutting pain in the urethra
after urination.

Phos., menses too late, or not appearing; tight feeling in the chest,
with dry, tight cough, and spitting of blood, worse before midnight ;
bloatedness below the eyes ; a great deal of vertigo.

Puis., age of puberty, or suppression, especially from getting the



440 FEMALE OEGANS.

feet wet ; nervous, timid, tearful disposition ; always anxious about
domestic affairs ; pale, yellowisli color of the face ; dyspeptic feelings
from eating pork or any thing fat ; inclined to looseness of tlie bowels ;
tbirstlessness and chilliness; always feel worse in a warm room;
hsemoptysis, hsematemesis.

Rhus t., suppression from getting wet.

Senecio gracilis, suppression ; inability to sleep, nervous irritability ;
loss of appetite ; coated tongue ; bowels constipated ; constant feeling
of lassitude ; disinclined to move about ; wandering pains in back
and shoulders. Is called "the female regulator."

Sepia, age of puberty or later ; headache, with nausea ; jerking with
the head ; paralytic sinking down of the eyelids ; yellowness around
the mouth, across the cheeks and nose ; loathing of all food, even the
smell of cooking nauseates her ; nausea when riding in a carriage ;
diarrhoea after drinking milk ; cold hands and cold feet, with frequent
flushes of heat to the head and face ; pot-belliedness.

Sulphur, great congestion to the pelvic organs and to the head;
cold feet, and heat on the top of the head ; the patient is very irrita-
ble, and inclined to religious reveries ; chronic inflammation of the
eyelids; or other psoric eruptions ; dreads to wash with cold water ;
feels exhausted from talking; all worse when standing; sleepy in the
day-time ; sleepless at night ; great agitation of the blood in the whole
body.

3. DysmenorphoBa, Menstruatlo Difficilis.

We understand by this, painful menstruation, without regard to
the quantity of blood discharged, though in most cases the menstrual
flow is scanty.

The different complaints accompanying it set in either before or at
the time when the menstrual discharge begins, and generally last a
day or two, and sometimes through the whole menstrual period.

We distinguish, according to its causes, three forms of dysmenor-
rhoea :

1. Dysmenorrhoea in consequence of struchiral changes or flexions
of the uterus, which has been termed by some writers mechanical dys-
menorrhoea ; compare the related chapters.

2. Dysmenorrhoea in consequence of congestion in the uterus, or
congestive dysmenorrhoea ; it usually commences with all the signs of
congestion to the pelvic organs — strong action of the heart, conges-
tion of the head, and febrile motions in general. These symptoms
continue one, two, or three days, until a more profuse discharge of



DYSMENOEEHCEA. 441

blood has taken place. Not only plethoric individuals are prone to
it, but also weakly and anaemic individuals. It is possible that, in
some instances, this congestive state is induced by a thickened state
of the peritoneal lining of the ovaries, and the consequent difficult
perforation of a Graafian follicle. Very violent congestion may canse
an exudate between the mucous lining and the parenchyma of the
uterus, in consequence of which portions of the loosened membrane
are thrown off and discharged — membranous dysm.enorrlioea.

3. Dysmenorrhoea, in consequence of a morbid sensibility of the ner-
vous system in general and the uterine nerves especially, or neuralgic
dysmenorrhce,a. This manifests itself as a disturbance in the healthy
equilibrium of the mind's action and a dejection of spirits, which
commences even before the menses ; the menses are attended at their
beginning with distressing pains in the uterine region, in the back,
•and lower extremities, or with neuralgic pains in more distant organs,
or with cramps, spasms, &c. It is quite possible that in some cases
the violent, spasmodic, labor-like pains in the womb are caused by a
spasmodic closure of the os uteri.



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 44 of 65)