FIRST LINES OF THE PRACTICE OF PHYSIC. PART I. BOOK IV. CHAP. VI. OF THE MENORRHAGIA, OR THE IMMODERATE FLOW OF THE MENSES. 966. BLOOD discharged from the vagina may proceed from different sources in the internal parts but I here mean to treat of those discharges only, in which the blood may be presumed to flow from the same sources that the menses in their natural state proceed from; and which discharges alone, are those properly comprehended under the present title. The title of Metrorrhagia, or hemorrhagia uteri, might comprehend a great deal more. 967. The menorrhagia may be considered as of two kinds; either as it happens to pregnant and lying-in women, or as it happens to women neither pregnant nor having recently born children. The first kind, as connected with the circumstances of pregnancy and child-bearing, (which are not to be treated of in the present course), I am not to consider here, but shall confine myself to the second kind of menorrhagia only. 968. The flow of the menses is considered as immoderate, when it recurs more frequently, when it continues longer, or when, during the ordinary continuance, it is more abundant than is usual with the same person at other times. 969. As the most part of women are liable to some inequality with respect to the period, the duration, and the quantity of their menses; so . it is not every inequality in these respects that is to be considered as a disease; but only those deviations which are excessive in degree, which are permanent, and which induce a manifest state of debility. 970. The circumstances 968, 969, are those which chiefly constitute the menorrhagia : but it is proper to observe, that although I allow the frequency, duration, and quantity of the menses to be judged of by what is usual with the same in dividual at other times; yet there is, in these particulars, so much uniformity observable in the whole of the sex, that in any individual in whom there occurs a considerable deviation from the common measure, such a deviation, if constantly recurring, may be considered as at least approaching to a morbid state, and as requiring most of the precautions which I shall hereafter mention as necessary to be attended to by those who are actually in such a state. 971. However we may determine with respect to the circumstances 968, 969, it must still be allowed, that the immoderate flow of the menses is especially to be determined by those symptoms affecting other functions of the body, which accompany and follow the discharge. When a larger flow than usual of the menses has been preceded by headach, giddiness, or dyspnoa, and has been ushered in by a cold stage, and is attended with much pain of the back and loins, with a frequent pulse, heat, and thirst, it may then be considered as preternaturally large. 972. When, in consequence of the circumstances 968, 971, and the repetition of these, the face becomes pale; the pulse grows weak; an unusual debility is felt in exercise; the breathing is hurried by moderate exercise; when, also, the back becomes pained from any continuance in an erect posture; when the extremities become frequently cold; and when in the evening the feet appear affected with oedematous swelling; we may from these symptoms certainly conclude, that the flow of the menses has been immoderate, and has already induced a dangerous state of debility. 973. The debility, thus induced, does often discover itself also by affections of the stomach, as anorexia and other symptoms of dyspepsia; by a palpitation of the heart, and frequent faintings; by a weakness of mind liable to strong emotions from slight causes, especially when suddenly presented.. 974. That flow of the menses, which is attended with barrenness in married women, may be generally considered as immoderate and morbid. 975. Generally, also, that flow of the menses may be considered as immoderate, which is preceded and followed by a leucorrhœa. 976. I treat of menorrhagia here as an active hæmorrhagy, because I consider menstruation, in its natural state, to be always of that kind; and although there should be cases of menorrhagia which might be considered as purely passiye, it |