|ijt l»

■jji

^IfflRfla

U
ill
 A N

Inaugural Phyfiological Differtation

ON THE

CATAMENIA:
TO WHICH ARE SUBJOINED,

Obfervations on Amenorrhoea.

Submitted to the Examination of the

Rev. JOHN EWING, S. T. P. Provost,

THE TRUSTEES AND MEDICAL PROFESSORS OP THl

UNIVERSITY OF PENNSYLVANIA,

For the Degree of Doctor of Medicine*

By JAMES WESTWOOD WALLACE, of Virginia,.

Member of the Royal Medical Society of Edinburgh.

PHILADELPHIA:
PRINTED BY T. DOBSON, AT THE STONE-HOUSE,;
NO. 41, SOUTH SECOND-STREiiV

MDCCXCHI.
V. : \\ 7
 To BENJAMIN RUSH, M. D.

Profejjor of the Inflitutes and Clinical Medicine,

in the Univerfity of Pennfylvania,

WHOSE charader is not lefs efteemed for

literary accomplifhments, than morality and

benevolence, and to whom this Univerfity is
much indebted for his vafl: fund of fads and

many ingenious and new fpeculations,

This Diflertation,

Is gratefully infcribed,

By his Friend,

THE AUTHOR.
GUSTAVUS RICHARD BROWN, M. D.

Sir,

SINCE the pradice of Dedication is meant

to
dcfignate efteem and
friendihip, permit me
to infcribe the following Differtation to you ;

if it merits your approbation, alone, I fhall

feel myfelf amply compenfated. Confider it
as the fruit of a ftudy commenced under your

aufpices, r

And believe me to be,

Your Friend,

THE AUTHOR.
 To JOHN THOMSON MASON.

S I R,

IMPRESSED with the raoft lively fenfe

of Gratitude your deceafed father, whofe
to

memory I revere, I cannot in filence overlook

the fon of my patron and friend ; permit me,

then, as an acknowledgement for the particular

care and attention fhewn me at an
early period,
to dedicate this Differtation to
you,

And believe me,

Your Friend,

THE AUTHOR.
 INAUGURAL DISSERTATION.

I.

HT^HE uterus is fituated in the hypogastric

-*-
region, is a hollow vifcus, and is
defign-*
ed to receive the firft rudiments of the fcetus,
which it retains until its parts are completely

evolved, and is fitted to make its firft appear

ance on the theatre of the world. The nerves

of the uterus are

principally derived from the
intercoftal ; its arteries from the hypogaftric
and fpermatic. Thefe arteries are fo ramified
through the fubftance of the womb, which is
of a lax, fpongy confiftence, that they form a

very confiderable part of its fubftance. When

the fubftance of the uterus is divided after a

lucky injedion of the uterine arteries, it ap

pears be
nearly
to all vafcular. When we me

ditate on ftrudure, furprife at the great

this

quantity evacuated at fome times may ceafe,

that the
and we
may difcover aftonifhment
A difchargc
 ( 2 )
difcharge is not more often immoderate, when
we refled that it proceeds from the open
mouths of perhaps a half million of veflels.
This organization fo curious and interefting is

evidently neceflary to enable the fyftem

to

effeduate that phenomenon called the menfes.

II.

From the mouths of the uterine arteries

that difcharge of blood called the catamenia is
poured fourth. This flux appears defigned
for the fupport of that condition of the uterus
which enables it to retain and fupport the im

pregnated ovum.
III.

The menfes is a
difcharge of pure arterial
blood from the uterine arteries. They appear
at puberty, and return at periods, and
ftated
ceafe in advanced life. Though the various
morbid affedions to which the fex is liable, in

terrupt the courfe and vary the quantity, they

are
generally abfent during pregnancy and lac
tation : They are confidered as peculiar to
*
the human female.
IV. Con-

Some have afterted that a

* certain ipecies of monkey men-

ftruate, bat this is doubtful.

 ( 3 )

IV.

Constitution, climate, and modes of

living,alter very considerably the period at

which this healthy evacuation firft makes its

appearance. As this period is eftablifhed at

puberty, the eruption will be earlier or more

late, as the human ftrudure is fooner evolved
under the warm breezes of a mild, or retarded

by the cold of a
northerly climate. The
menfes appear later in thofe of a rigid fibre, are
more painful and tedious, than in others of a

more lax habit, and whofe conftitutions are lefs

bordering on torpor of the nervous, and rigi

dity of the mufcular fyftems.

V.

In countries near the torrid zone the cata-

menia appear as early as the eighth or ninth

years. In the Icy regions they are retained to

the 20th and 25th years. In this temperate
climate they generally manifeft themfelves
about the 13th or 14th years.

VL As
 ( 4 )

VI.

As the menfes indicate thematurity of the

fyften7, and as the maturity cf this is neceflary
to generation, and as
premature venery is high
ly injurious to the conftitution, the laws of
molt nations have determined what age fe
at

males are
marriageable. This is much influ
enced by climate, &c. In Perfia, India, and
other countries contiguous to the torrid zone,

marriages are celebrated at the eighth or ninth

year. Marriages in this country are never
celebrated until the female attains to fourteen,
and the male to fixteen, years of age.

VII.

The firft travellers over the northern coun

tries, whofe obfervations have been publifhed,

affirm that the females of thofe northern coun

tries do not menftruate. But the moil rerpeda-

bleauthority has fince
fhewn, that the females
of Lapland and Kamfchatka, and all the di
minutive race of the Efquimaux, diffufed over
fuch immenfe trad* of land near the
frigid
zone, obey this univerfal law of the human fe
male
 ( -s )
male ceconomy. Though the menfes in thefe
countries appear late, continue a fhort fpace
of time, and return after long intervals, and

although they flow from certain women only

during the fummer, while there is an abun
dance of aliment ; yet among thefe nations
they are no lefs necefTary to conception and
the health of the fyftem, than among the in
habitants of more
temperate climates, and any
deviation from the laws of the climate pro
duces fimilar affedions to thofe which occur
to females nearer the torrid zone. A variety
frequently occurs in the different Situations of
the fame country. Haller mentions a percep
tible difference in the women inhabiting a high
er or lower fituation of the fame kingdom.
He obferved the appearance of the catamenia
in certain low and warm diftrids as early as the

eighthyear of age ; but in more mountainous

and northern diftrids as late as the twentieth
and twenty-fifth years. In thefe United States
a
variety is obfervable agreeable to the variety
of country and modes of living. Though
they appear generally about the 13th or 14th
year in this country, I have feen one inftance
of their occuring as early as the ninth year.
Van Swieten has obferved that the females of
Holland menftruate more
copioufly than other
women
 ( 6 )
women inhabiting the fame latitude. This he
afcribes to the ufe of the foot-ftove fo common

among them ; indeed I conceive this pradice

can have much influence on the difcharge.
Modes of living no doubt influence the time
of appearance, the quantity, and the duration
of the catamenia. The ufe of warm cham
bers and foft beds often increafe the evacua

tion :
Contrary circumftances produce contra
ry effeds.

VIII.

The earlier the evacuation begins the fbon-

er does it difcontinue, and vice verfa. Females

inhabiting very fouthern latitudes attain to ma

turity at the ninth year, are mothers at four
teen, or fooner, paft child-bearing at twenty-
five, and exhibit ftrong marks of old age at
thirty. It has been obferved that in very
northern climates, women bear children at the
*
advanced age of fixty. In the United States
of America the menfes generally ceafe on or

about the45th year, at which time the wo

men
generally ceafe to breed.
IX. The

* Dr. Monro's Lectures on

Phyfiology.
 ( 7 )

IX.

The appearance of the menfes is

ufually
announced by the following fymptoms. The
ftrongeft marks of puberty now manifeft
themfelves, the manners alter, the voice be
comes
changed, the mammas fwelled and tur
gid, and the pubes now fhew the firft marks
of covering. To thefe fucceed heat and red-
nefs of the genital fyftem, fometimes to a de

gree bordering on nymphomania. The fyftem

now becomes affeded with
languor and lafli-
tude, vertigo and head-ach, and various pains
are alfo felt in the
hypogaftric and lumbar re
gions: The eyes now become languid and dull,
a blue colour appears below the orbits : A
ferous difcharge now breaks forth from the
uterus which relieves the afflided fair,

X.

These fymptoms only appear when the

menfes are about to become eftablifhed. Ma
ny month** and even years are confirmed be
fore this is effeded. Thefe fymptoms, com

monly precurfors to the event, occur month-

. 4 ly,
 ( * )
with fome alleviation in
ly, though generally
proportion as the ferum becomes more tinged
with blood. difcharge becomes, at length,
The

pure arterial blood. The eyes

now
acquire their
wonted brilliancy, the lips become tinged with
an
agreeable red, the cheeks bloomy, gaiety and
chearfulnefs fucceed to languor and defponden-

cy ; and now the fair one, refplendent with

joy, through all nature diffufes her charms.

XL

The evacuation may be divided into three

ftages, the beginning, height and decline. It

commences firft ferous ; this gradually becomes
more coloured, until pure arterial blood comes

forth. In the dedine the blood becomes mix

ed with ferum, which gradually increafes un

*
til pure ferum is again evacuated. This fe
rous
difcharge, diminifhes gradually, until a
final ftop is put to the evacuation. The fyf
tem, at thistime, often becomes affeded with
various diforders, as vertigo, difpepfia, apo

plexy and fyncope.

XII. The

*
This is not the cafe with all wor/.en —
fome evacuate

pure arterial blood to the Iaft.

 ( 9 )

XII.

The menftrual period when once eftablifh

ed, becomes uniform, unlefs interrupted by
pregnancy, ladation, or difeafe ; though it is
various, as has been before mentioned, from
climate and modes of life. difcharge ufu-
The
ally returns onee in twertty-feven or thirty
days, and rarely continues longer than five or
or fix, and feldom fhorter than two
days. A
deviation; lefs frequently takes place in the
time of recurrence, than in the
quantity, or
time of continuance.

XIII.

It is difficult toafcertain, precifely, the

quantity evacuated at one menftrual period, as
it is impoflible to come at an adual meafure-
ment. Experiments to afcertain the quantity
have been propofed, and indeed really made
with a fponge ; but as part of the blood may
be abforbed, as the orifice is flopped up by the

fponge, it mufi be but an inaccurate experi

ment. The ufual quantity for a healthy fe-^
male of a moderately lax fibre is from three to
B fix
 ( io )
fix ounces. Luxurious living, warm cham

bers, and a fedentary life, very much alter the

quantity.

XIV.

It may not be improper in this place to enu

merate the opinions that have been entertain
ed of the nature of the catamenia. They
have been of fo deleterious
fuppofed nature,
a

as extinguifh the life of a

to male, and de-
ftroy the germination of plants. This certain
ly is giving the evacuation more poifonous
power than any thing in nature poffenes.
Haller mentions that gardeners would not al
low their wives or daughters to approach a

plant, if recently fet, if their catamenia were

flowing. The Italians harboured a notion
that the breath of a woman during that period
would kill filk worms. La Motte retains the
idea of thefe being deleterious, but
women

with fome limitation ; he only fufpeds thofe

with red hair He relates a ftory of a fervant
—

maid whofe hair was red, fpoiling a calk of

wine and half a hog, by having accefs to the
former during her menftruation, and fairing
the latter at the fame peri@d, which foon pu-
trified. Indeed, I think La Mottes red head
ed
 ( «
)
ed fervant man, would have been equally de-
ftrudive to his wine and pork. The impro

bability of thefe tales deftroys entirely their

credit.

XV.

The idea of menftrual blood being poifon-

ous
appears to have arifen from laws and in-
ftitutions of the Oriental nations. The par
ticular fource of this error firft arofe among
the Jews : they were fond of cleanlinefs, and
converted their cuftoms into religious ceremo
nies —
Their Legiflator enjoined purifications
as a
part of religion. After the mod ordina
ry and necefiary duties of life, they were com
pelled to have recourfe to purifications. Thefe
purifications were thought particularly necef-
fary to menftruating females. If a male
touched the bed on which the female lay, he
was
thought impure for fome time. The poor
female was after this period unclean for feven
days. It is not to be wondered at, that fuch
opinions prevailed among the vulgar after a
ftrid adherence to the above cuftoms.

The
 ( I*
j

XVI.

Th e menfes are apt to become acrid by long

retention in the folds of the vagina ; and if

copulation is performed in this fituation, the

male often cbntrads a difeafe fimilar to Go

norrhoea, but this generally ceafes fpontaneouf-

ly in a few days. Perhaps this difcharge from
the male urethra might have given- rife to the
^

rigor of the Jewifh cuftoms refpeding the

fair fex, But now, when fcience and civiliza*
tion have banifjied fuperffttion and bigotry, the
greateft ornaments of the human race, are no

longer considered .as mere convenient utenfils,

the former ridiculous cuftoms done away,
are

and women perform their domeftk and focial

pleafures without any fufpicion of harbouring
a natural poifon^

XVII.

The eaufe of the menftrual fltix has given

rife many fpeeulations among Medical Phi-
to

lofophera. Some of them have been engaged

refpeding minute inquiries into the proximate
caufe of menftruation ; but the refults of their

inveftiga-
 ( ,»3 )
inveftigations afford
nothing fatisfa&ory on

the fubjed, and all I can do will be to enu

merate fome of thofe which appear moft

plaufible.

xyiu.

It has been faid that the fides are daufed,

the growth of vegetables accelerated, and the
human fyftem much influenced
by the moon,
as in
mania, epilepfy, &c. The moon alfo has
been fuppofed to be the caiife of the
menfes, as
they appear at the interval of a lunar month. But
this laft hypothefis is built on a
tottering bafis.
As the influence of the moon is extended to all
the animal creation, why is it exerted on the
human female alone, and not extended to the
inferior order of animals ? If the catamenia are
the efFed of lunar influence, why do they oc

cur at puberty, and ceafe in advanced life?

Would not the moon exeit its influence on all
the females inhabiting the fame lattitude, the
fame country, the fame city, the fame hof-

pital, and all the fifterhood, inhabiting the

fame convent, at one time, and would not the
catamenia return at exadly ftated periods ? Fi^
2 nally,
 ( 14 )
would not all women become pregnant
natty ,

of the month ?
nearly on the fame day

XIX.

Fermentation has been fuppofed the

caufe of the menfes ; but the idea of fermen

tationgoing on in the living animal blood has
been entirely done away by the learned and

ingenious Dr^ Guftavus Richard Brown of

Maryland, in a differtation publifhed at Edin
burgh, de oitu animalium caloris.

XX.

The experiments of Spallanzani fully evince

that fermentation does not go on even in the
Stomach ; and when this is admitted, it cannot
be fuppofed that any can take place in the ute
rine arteries. The idea of fermentation in the

living body is inconfiftent with the laws of the

animal economy, and indeed with reafon.
What power can ad by inducing fermentation
once a month ? If fermentation is the caufe
of the evacuation, I will afk, what flops the
procefs when once commenced ? This error

firft arofe among the Chymifts.

XXI. On
 ( 15 )

XXL

On the other hand, the mechanic fed have

fuppofed it occafioned by the depending fitua-

tion of the uterus. To this opinion let it fuf-
fice to fay, that fome women confined to bed
for many years menftruate freely and copiouf-

ly. I know one inftance of a woman, in the

Royal Infirmary of Edinburgh, who menftru-
ated freely though fhe had been confined to
bed nine years. She was much fubjed to me-

norrhagia.

XXII.

Universal plethora has been fuppofed the

caufe of the phenomenon. But when we
confider the lax cellular texture of the lungs
more
eafily admitting of a determination than
any other part of the body, we might more
reafonably exped hemoptyfis than catamenia.
Nay, when the fyftem has been reduced much
below its natural plethoric ftate by hemorr

hage even the morning of an expeded erup

tion, ftill the menfes flow.

XXJII. Another
 ( I a )

XXIII.

Another modern opinion is, that of a

partial plethora of the uterine vefTels. For

this opinion there are many advocates. If
uterine plethora produces catamenia, why do

they appear at puberty, and ceafe in advaflced

life ? Wounds of the inferior
extremities, from
which considerable hemorrhages proceed, fel-
dom prevent the flux, though they are inflided

immediately before the evacuation is to come

forward.

XXIV.

It has been conjedured,and with confidence

aiTerted, that the uterine veins are of a firmer
texture than the
arteries, and this texture, by
retaining the venous blood, produced plethora
in the arteries. In my humble opinion, it muft
be difficult indeed to afcertain the
compara
tive difference between vefTels in a lifelefs and
collapfed ftate ; though by the afliftance of
microfcopes fome difference might be fufped-
ed, the conclufion drawn cannot
bejuft; for
great is the difference between animate and in
animate
 ( 17 )
animate matter. A fubftance, endowed with
life, exhibits various phenomena peculiar to

itfelf, and vice verfa.

XXV.

Another modern theory is, that the blood

difcharged, is not fimple blood, but a fecreted
fluid. Shew one fecretion that returns at

ftated times, and I will admit the menfes to

be of the fame nature. The urine is difcharged
at certain times, yet the fecretion of it incef-

fantly goes on. Bile becomes, at particular

times, more abundant than ufual, ftill the fe
cretion is carried on, during a healthy ftate,
with uniformity. Paflions of the mind, and

irritating fubftances, produce a preternatural

flow of tears, yet the fecretory fundion is uni

formly continued to preferve the humidity of

the eye.

XXVI.

How can
any glandular fundion be per
formed only at ftated times, while the ftruc-
ture of the gland remains entire, and the fup-

ply of blood is uniformly the fame ? An at

tempt to prove the menfes a fecretion, only
C removes
 ( is )
removes the truth the farther off, and in
volves the fubjed in additional obfcurity.

XXVII.

After delivering the various opinions on

the fubjed of catamenia, I cannot conceal my

aftonifhment, that the caufe of menftruation

fhould yet remain an objed worthy of invef-

tigation. Let us, for a moment, fuppofe it

that it depended on
proven to demonftration,
lunar influence, on a ferment, on a pofition
of the uterus, on
general or on
partial pletho
ra, and, laftly, on a true fecretion. Permit
me to afk, what pradical advantage could fol

low ? As the labours of the learned have been

fruitlefs, fuccefs on this point cannot be ex

peded : And, if we judge of the future by
the paft, the caufe of menftruation will ever

remain hidden in the recefles of obfcurity.

XXVIII.
t

In all probability all we fhall ever know on

the fubjed, is, that it is pure arterial blood,

which proceeds from the mouths of thofe
uterine arteries wThich open into the cavity of
the
 ( *9 )
the uterus. This fad is the
fupported by
combined teftimony of the moft celebrated
anatomifts Europe and America afford. This
ftrudure being difcovered by no theoretic au
thor, anxious to make it the bafis on which
he might rear an elegant fuperftrudure, but
delivered in the form of fimple truth, has
a

obtained the credit of all

phyfiologifts. In
deed it has been proven by injedion * -inver- —

tions of the uterus alfo demonftrates this fad,

as the blood then be feen from
can to proceed
the open mouths of the uterine vefTels.

XXIX.

Every medical muft

acknowledge
man

that the menfes

indifpenfably neceiTary to
are

the health of the female, and the propagation

of the human fpecies. Though the difcharge
is in fo many refpeds inconvenient, as being

fubjed to excefs and deficiency, either of

which will deftroy both the health of the
fyf
tem and the power of procreation. When we

contemplate on thefe inconveniencies to which

the human female is alone fubjed, in a philo-

fophic
*
7T,- Fyfe's private Dcinonftratie-ns on
Auitomy, Edin-
U:roh.
 conclude that
fophic view, we might be led to
animals.
they are but imperfedly finifhed
In a fuperftitious light, we might fuppofe the
meant as a curfe on the fex for the
difcharge
tali of man.

XXX.

We come now to a
part of the fubjed
which Phyficians have more generally agreed
on —

ufes of menjlruation.
the

XXXI.

The menfes are defigned, principally, to

preferve andup a ftate of tonic unifon

keep
between the uterus and ovaria, to give to the
uterus that condition which capacitates it to

retain the impregnated ovum ; to carry a fuf-

ficient quantity of blood for the fupport and
evolution of the fcetus in utero ; and to fup
port the health and welfare of the female ceco-
nomy»* The difcharge may ferve other pur-
pofes, but they are merely fecondary.

XXXII.

Conception never
appears before the
menfes, and never after they have ceafed —

this
 ( 21
)
this a
ftrong mark of the wifdom in all natu

ral inftitutions ; for, during both periods, the

fyftem is incapable of affording, a fufficient
degree of nourifhment for both mother and
foetus.

XXXIII.

Rarely, or never, is coition prolific im

mediately before menftruation ; and the true

and final caufe of the evacuation is, doubtlefs,

to effeduate pregnancy. Few would become

pregnant were the intervals fhorter. Sapient

nature has fo organized the human female

ceconomy, that women, unlefs affeded by dif-

eafe, may become pregnant almoft at
any
time.

XXXIV.

Coition, immediately fucceeding the dif

charge, is often fruitful ; but the time, of all
others the moft critical, is a day or two after
the flood has ceafed —
a
fpace of feveral weeks
is neceffary to form the adhefion of the ovum to

the uterus —

were the menfes to occur at fhorter

intervals, the ovum would frequently be loft.
XXXV.
 ( « )

XXXV.

Those females afflided with menorrhagia,

fluor albus, or amenorrhcea, generally un
are

fruitful and this ftate of the fyftem, fo incon-

—

fiftent with the female ceconomy, is the only

caufe of fterility which the art of medicine
can
remedy. Obftrudions of the fallopean
tubes; imperfedions of the ovaria, and va
rious other morbid affedions of the internal

parts, are not to be difcovered by human faga-

city, and, if difcovered, admit of no cure.

Ninety-nine of an hundred cafes of fterility

proceed from irregularities of the menfes ;
and, in ninety-nine cafes of an hundred, we
may promife a cure of barrennefs, when it
proceeds from thefe caufes *.

XXXVI.

Those women wrho are

fubjed to an he

morrhage vicarious to the menfes, are fterile,

though the evacuation be monthly ; for, fince
the blood does not pafs through the uterine

vefTels,
*
Dr
Gregory's Lectures on the Pra&ice of Medicine,
Edinburgh.
 ( 23 )
vefTels, they lofe their adivity and tone.

Do not the ovaria fympathife with the uterus

and partake of its morbid affedions ? Can

conception ever take place when the ovaria

and uterus are not in perfed unifon with
each other?

XXXVII.

Some females of robuft conftitutions, and

ri<rid fibre, are called viraeos. Thefe from

conftitution menftruate fparingly, or none at

all. They are alfo, with few exceptions,

found to be barren —
In what manner is this
to be explained ?- Can rigidity of mufcular fi
bre communicate a fimilar ftate to the arteri

al ? Are the arteries endowed with*

fyftem
mufcular fibres and mufcular properties ?

XXXVIII.

Those females are the moft prolific from

whom the menfes flow regularly, and appear
neither too foon nor too late. In temperate

climates, where the menfes flow moft regular

ly, the number of inhabitants is generally in
proportion to the fruitfulnefs of the foil. Wo
men
 ( 24 )
men of the eaft are prolific —
thofe of the
north the contrary. Perfia and India abound
in inhabitants Tartary and Lapland have
—

few. The women of Perfia and India men-

ftruate regularly and eafily —

Thofe of Lap
land and Greenland, late and fcanty, and, con-
fequently, are not very prolific.

XXXIX.

How wifely has nature ordered all things.

India and Perfia are fertile and abound in in
habitants. Ruffia, Lapland, and Kamfchat-
ka are
inhofpitable and barren, and have,
comparatively fpeaking, but few inhabitants.
The north called the hive of nations, be-
was

caufe their numbers had gradually increafed

until the produdions of the foil were infuffi-
cient for their fupport. Hence they migrat
ed to fruitful countries, and excelled
more

the inhabitants, enervated by luxury and eafe,

both in valour and numbers.

XL.

A nurse cannot give fuck to more than

one child, with convenience, at the fame
time ;
 ( 2J )
time ;and, during the period of ladation fhe
ought conceive;
not to for which purpofe na

ture has fo wonderfully eftablifhed the female

ceconomy, that when the catamenia ceafe, the
breafts fwell ; and, during the flow of the
milk, the menfes are abfent. During pregnan
cy the vefTels of the uterus are adive and dif-
tended thofe of the mammae are flaccid and
—

quiefcent. When pregnancy and the lochial

flow have terminated, the breafts become dis
tended, and the milk foon mahifefts itfelf. If
the mother does not give fuck to the in
fant, the menfes foon refume their wonted /

courfe. But, when the mother performs that

natural fundion, the menfes do not flow;
and, during this period, the woman does not
become pregnant, though, indeed, exceptions
to this have been mentioned on the records of
medicine.

XL1.

The mother cannot afford fufficient nou-

rifhment for the child at the breaft, and the

fcetus in utero at the fame time. During preg
nancy the milk alters in its nature, and be
comes an improper nburifhment for the child.

E
Pregnane^
 ( 26 )
Pregnancy and ladation are fundions entire
ly oppofite. A nurfe, defirous to become

pregnant, fhould difcontinue the ofBce of giv

ing fuck.

XLIf.

The length of time for giving fuck is pre-

fcribed by nature ; for, fo foon ars the infant,
by the affiftance of teeth is enabled to chew

food, it ought then to be weaned ; for, at

this time, the infantine fyftem requires a more
fubftantial nourifhment, and the milk begins
to
acquire new qualities.

XLI1I.

It Cannot have efcaped obfervation, that

the human female is apt to become impregna
ted foon after menftruation. Other females
are
incapable of conception only during the
venereal rage, when the uterine fyftem is
excited.

XLIV.

In infancy, the ovaria are fmall in fize ; and

in females of advanced years they are dimi-
nifhed
 ( 27 )
nifhed and contraded. They remarkably
are

full in brute animals, they are in fea-

when
fon. Do not the ovaria, in a particular condi
tion of adivity, by their ftimulus, difpofe to

venery, and is it not this particular ftate of the

ovaria that gives the female venereal appetites?
Does not the female fyftem fall into a leuco-

phlegmatic and lax ftate, which gives predi£-

pofition to dropfy and many other difeafes
when the ftimulus of this ftate of adivity of
the ovaria and uterus is abfent ? The illuftri-
ous Cullen has offered conjedure
a when

treating of amenorrhcea, and fuppofes that a

certain ftate of the ovaria in females prepares

and difpofes them to the exercife of venery
about the period when the menfes firft ap

pear. This muft, evidently, be the ftate of

adivity abovementioned.

XLV.

Since menftruation is of this nature, it is

proper that the fame fundion fhould be want

ing in animals of an inferior clafs. if they
were endowed with the faculty of meriit ma

ting, they would

enjoy uninterrupted
an fe
now the of man alone.
cundity, privilege
XLVL Amen-
 I 28 )

XLVI.

Amenorrhea or obftruded catamenia, fb

frequently met with, and fo often deftroying
the health and happinefs of the female, by
inducing difeafes grievous in their nature ;

and, what is ftill of more ferious confequence

to mankind, barrennefs —
I will fhortly men
tion, but would happily embrace an opportu
nity of a more ample detail, would the nature
of this differtation allow it.

XLVII.

Any interruption of the menftrual dif

charge conftitutes the difeafe now under con-

fideration, except that interruption, or tempo
rary ceffation, the confequence of pregnancy
or ladation. During the abfence of the cata
menia, from either of thefe caufes, the female

fyftem is freed from thofe fymptoms which fo

conftantly attend an unnatural obftrudion.

XLVIII. As
 ( *9 )

XL VIII.

As the flow of the catamenia depends on

a ftate of tone in the uterine arteries capaci

tating them to propel forward their contents,

any power that takes away or diminifhes that

ftate, will produce the difeafe. The powers
that effeduate this are numerous —
as Cold,
fear, great exertions of the fyftem, penurious
diet, warm chambers, foft beds, late hours,
excefs in venery, the ufe of ardent fpirits,
of tobacco, tedious and lingering labours, fre

quent abortions, &c.

XLIX.

The fymptoms commonly attendant on

this difeafe, are fluggifhnefs in motion, and
—

fome inability to perform it, acid erudations,

gaftrodynia, naufea, lofs of appetite, diftenfi-

on of the ftomach from flatus, fometimes a
defire for chalk, leucophlegmatic appearance
over the whole
body, dematous fwellings of
the lower extremities, vertigo, headach, pains
felt in the hypogaftric and lumbar regions,
particularly at the menftrual period, alvus

conftrida,
 ( 3° )
conftrida, the pulfe becomes much accelerat
ed upon hidden emotion, to which the fex are

liable, palpitation fyncope, when either

and
of thefe occur, hyfteric fymptoms generally

fupervene, and fometimes to fuch a degree

as to form
hyfteria in its exquifite charader.

L.

As the caufe of this difeafe is atony in

thofe arteries which, in a healthy ftate, pour
forth the menfes, the indication of cure is to
remove this ftate of debility. But another
caufe of obftruded menfes has, and I think
with propriety, been afligned, that is a con-
ftridion of the mouths of the arteries. This
is efpecially the effed of cold, and the
more

expofure of the fyftem to a humid atmof-

phere, and the feet to a damp ground. Here
the indication of is very different. When
cure

the obftrudion from the laft caufe is accompa.-

nied by fymptoms of pyrexias, as it frequent
ly is, blood letting, and an antiphlogiftic regi
men
generally remove the Complaint in a
■fhort fpace of time. When dyfpnaea attends
tlie fever, which it does very frequently, ve-
nefedion
 ( )
3'
nefedion is more
particularly indicated, and

may be repeated occafionally.

LI.

To. anfwer the firft indication of cure, the

phyficianfhould have in view the ftate

always.
of atony of the uterine veffels. This ftate is

prefumed to be always prefent, and commu

nicates, by fympathy, a general laxity of fibre
and leucophlegmatia.

LI!.

The healthy tone may be reftored by

thofe remedies called tonics by writers on the

materia medica fuch as cold bathing, the ufe

—

of chalybeate waters, and the various preparati

ons of iron ufually kept in the fhops. Peruvian

bark and iron combined, forms an excellent

medicine. Alfo, iron combined with the va

rious bitters and aromatics. Iron

vegetable
in its different forms merits particular atten
tion, for feldom does the patient recover
without the liberal ufe of this valuable emme-

nagogue.

LIU. The
 ( 3* )

LIII.

The tone of the uterine arteries may alfo

be excited by remedies that ad more imme

diately on the uterus, venery, when admif-

as

fible —
Cantharides feem alfo to ad on this vif-
cus
by confent ; alfo aloes, warm fomentati
ons applied to the hypogaftric region, though

this fhould only be applied at the menftrual

period. Pediluvia, bodily exercife and the

exercife of geftation, compreflion of the ex
ternal illiacs. Van Swieten mentions cures

being effeded by this Though I

pradice.
have feen it feveral times pradifed in the Roy
al Infirmary of Edinburgh— L have never
feen good effeds refult from it. The general

adion of the fyftem may be excited by elec

tricity.

LIV.

Cantharides have been much ufed as an

emmenagogue, and fo far as my obfervation

has extended, it has been of confiderable effi

cacy. When exhibited in the form of tinc

ture, in fmall dofes, repeated two or three

4 times
 () 33
times a-day, efpecially when the above
and
tonics are employed, I have feen it produce
the moft defirable effeds.

LV.

When the pradice of medicine was guid

ed by the vague and hypothetical fancies of

Phyficians, and during the period the humo

ral pathology was fo much cherifhed in the
Schools of Medicine, when the phenomena of
difeafes were
explained on the principles of

acrimony, morbific matter, and Lentor, this

difeafe ferved its turn to convince the learned
and ingenious Phyficians of old that Lentor,
the Boerhaavean hobby-horfe, really did exift,
2x1a was the caufe of difeafes.*

LVI.

The miftaken caufe of this difeafe led the

advocates for the Humeral Pathology to a
pradice not lefs fallacious than their theory,
viz. the ufe of mercury for the cure cf amen

orrhea. This medicine was adm'niftered

with

*
Vide IJOwTh.uvc —
Van Swicten's Comtuentarits*
 ( 34 )
with view to open the arteries obftruded by
a

an
impermeable matter, Lentor; that the ufe of
mercury is always unfafe or inefficacious in this
difeafe I will not affert ; but, that the indifcri-
minate ufe, for a
length of time, is pradice
a

to be depended on, I can

pofitively deny.

LVII.

Since theexpulfion of the humoral Patho

logy, Phyficians have fought for a different
fource to explain the phenomena of difeafes,
viz. changes in the folidum vivum, this has
and
given rife to a more rational pradice one

more
generally attended with fuccefs.

THE EN D.