bility of the system, and consequently of the ves sels of the uterus. But, in such cases, the suppression always appears as symptomatic of other affections, and is therefore not to be considered here.

1010. The idiopathic cases of suppression (1008) seldom continue long without being attended with various symptoms or disorders in different parts of the body; very commonly arising from the blood, which should have passed by the uterus, being determined more copiously into other parts, and very often with such force as to produce hæmorrhagies in these. Hence, hæmorrhagies from the nose, lungs, stomach, and other parts, have appeared in consequence of suppressed menses. Besides these, there are commonly hysteric and dyspeptic symptoms produced by the same cause, and frequently colic pains, with a bound belly.

1011. In the idiopathic cases of suppression (1008) the indication of cure is to remove the constriction affecting the extreme vessels of the uterus; and, for this purpose, the chief remedy is warm bathing applied to the region of the uteThis, however, is not always effectual; and I do not know of any other remedy adapted to the indication. Besides this, we have perhaps no other means of removing the const..ction in

rus.

fault, but that of increasing the action and force of the vessels of the uterus, so as thereby to overcome the resistance or constriction of their extremities. This, therefore, is to be attempted by the same remedies, in the case of suppression, as those prescribed in the cases of retention (1004, 1006). The tonics, however, and cold bathing, (1004) seem to be less properly adapted to the cases of suppression, and have appeared to me of ambiguous effect.

1012. It commonly happens in the cases of suppression, that though the menses do not flow at their usual periods, there are often at those periods some marks of an effort having a tendency to produce the discharge. It is, therefore, at those times especially when the efforts of the system are concurring, that we ought to employ the remedies for curing a suppression; and it is commonly fruitless to employ them at other times, unless they be such as require some continuance in their use to produce their effects.

1013. Nearly similar to the cases of suppression are those cases in which the menses flow after long intervals, and in less quantity than usual; and, when these cases are attended with the disorders in the system, 1010, they are to be cured by the same remedies as the cases of entire suppression.

1014. It may be proper, in this place, to take notice of the dysmenorrhoea, or cases of menstruation in which the menses seem to flow with difficulty, and are accompanied with much pain in the back, loins, and lower belly. We impute this disorder partly to some weaker action of the vessels of the uterus, and partly, perhaps more especially, to a spasm of its extreme vessels. We have commonly found the disease relieved by employing some of the remedies of suppression immediately before the approach of the period, and at the same time employing opiates.

CHAP. IX.

OF SYMPTOMATIC HEMORRHAGIES.

1015. I HAVE thought it very improper, in this work, to treat of those morbid affections that are almost always symptomatic of other more primary diseases; and this for several reasons, particularly because it introduces a great deal of confusion in directing practice, and leads physicians to employ palliative measures only. I shall here, however, deviate a little from my general plan, to make some reflections upon symptomatic hæmorrhagies.

1016. The hæmorrhagies of this kind that especially deserve our notice, are the Hæmatemesis, or Vomiting of Blood; and the Hæmaturia, or the Voiding of Blood from the urinary passage. Upon these I am here to make some remarks; because, though they are very generally symptomatic, it is possible they may be sometimes primary and idiopathic affections; and because they have been treated of as primary diseases in almost every system of the practice of physic.

SECT. II.

OF THE HEMATEMESIS, OR VOMITING OF BLOOD.

1017. I have said above (in 945) in what manner blood thrown out from the mouth may be known to proceed from the stomach, and not from the lungs but it may be proper here to say more particularly, that this may be certainly known when the blood is brought up manifestly by vomiting without any coughing; when this vomiting has been preceded by some sense of weight, anxiety, and pain, in the region of the stomach; when the blood brought up is of a black and grumous appearance, and when it is manifestly mixed with other contents of the stomach, we can seldom have any doubt of the source from whence the blood proceeds, and therefore of the existence of the disease we treat of,

1018. We must allow it to be possible that a plethoric state of the body, from general causes, may be accompanied with causes of a peculiar determination and afflux of blood to the stomach, so as to occasion an hæmorrhagy there, and thence a vomiting of blood; and in such a case this appearance might be considered as a primary disease. But the history of diseases in the records of physic afford little foundation for such a supposition; and on the contrary, the whole of the instances of a vomiting of blood which have been recorded are pretty manifestly symptomatic of a more primary affection.

Of such symptomatic vomitings of blood, the chief instances are the following.

1019. One of the most frequent is that which appears in consequence of a suppression of an evacuation of blood which had been for some time before established in another part of the body, particularly that of the menstrual flux in women.

1020. There are instances of a vomiting of blood happening from the retention of the menses; but such instances are very uncommon; as a retention of the menses rarely happens in consequence of, or even with, a plethoric state of the body; and as rarely does it produce that, or the hæmorrhagy in question.

There are instances of a vomiting of blood hap