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rus may be consuleredis of an intermediate nature. The opinion hicli ea lopi onciliis subjec must ver much influencetur practice and liencerit is materia to distinguim to hicli it is to be
This is to e done o one of two grounds; ither rom the causes indu- cing the complaint, or rom the concomitant circumstances. In the present in stance, froni the firs of these e can derive no light forcit id not manifestlyaris froni an particula cause W aremeret tolli that i succeeded the ivingsuck to a child during whicli period themenses for the mos pari, are,antinia a then, probably rom an anastomosis ofvesseis, there is a real abstractionis hiood Do the uterus iself his neve couldbe supposed to have any tendenc in inducinian increassed discliarge. Is there- fore, lam allowexto conjecture, I wouldhe incline to go fartheriach, and would see for the cause of it during the state of pregnanc orietivery It is wellino ia,
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that at these period the condition of the uterus and iis esset are much assected. This, however, e must conside a meret conjecture, and mus endeavourcio determine the question hich e have sta- ted on the last round vir from Concommitant appearances. On his round, then, I propos to tali a vie of each in
An uncommon determination to the uterus, heir' genera cause of menorrhagia somelimes arises froni particular locat affections. Such, for Xample, ascauses retardinith flow of blood into theneighbourin vesseis henc the compression of these esset is an useful reme-d for restoring obstructed menses. More frequently hoWever, it is the effect fgenera fulta esstri herice the menstrua dis charge is accelerate land increased by highan plentiful iving. O neither the oneno the other, o ever of these circumstances is here any evidenc in the present case. The circulation through the inferior extremitte is the sameris usual, And
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and ver mar o genera plethor is absent. There is no tendenc to a dro yO lethargi state no genera sense of meight oriatnes, no turgescency, o floridcomplectioim no great hemorrhagica tendencyci On the contraro , rom palenesse, delicacy, and debili ty there is rathe room for suspectin inanition. Heiace, Ponthe whole, o the supposition o an un-
common determination to the uterus, there is ver litile foundation. The secon genera cause of menorrha-gia whicli, mentioned, as an increa- sed actio of the uterus A peculiar actio of this viscus I rechon necessar toaccount for the menstruat disicharge. Suchan action unquestionabi takes place at certain period os regnancy and isthen the cause of delivery, and of coui se, in ome degree, of the lochia disicharge. Is however, therei suci a natura action, that it ma be subjected to a morbidcondition is no to e questioned ano that his may be attended illi a preter natura state of the disicharge both a to
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time an quali ty, an hard ly b doubted. Such inordinate actio ma he consideredas an affection of the nervous kind. ima theres ore e in luce by at the varietyis causes iv in ris to these and when present, ill chieflyte indicated bypain and irregularit a to the period of disicharge. It is eli nown that tem porar spasm and contractions heginning
in the uterus, re osten propagate to theneighbourin paris. Such is alway the natur os labour-pains, unies a far asthey are the effect o distention Such frequently precede delivery, illi eopleos delicate habiis for a considerable time. Such are osten describe fas attendants up on the menstrua disicharges an such, fro in the description iven, ould seemto e the patris marhed in the presentcasse. I cannot heli thinhing, heres ore, that here is a stron presumption a tolli existence of this cause and whe wefarther adi the hori interval betweenthe menstruat disicharge, his presumptionis much corroborated, speciali a thepains
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patias are particulari severe hen it iapostpone to more than the ordinar intervals I must conclude, heres ore, that here an inordinate action of the uterustahes place, and probabinio a degre sufficient to account for at the symptonas. But the existence of this cause cloes notpreclude others. t rem alias, heres ore, to
conside ho far the last cause a be concerned that is, the want of due resistance to the impetus of blood a the uterus. Os ali the cause of menorrhagia, this is perhaps the mos common. It is induce by various accidenis, itherii ving ris to relaxatio of the system in generat, or of the uterus in particular. Itis the produc lihewis of various morbidassections of the uterus, a cancer, ulce
ration, and the like. When there is, therefore suci a multiplici ty of causes, it is no surprising that it inould frequently occur Andes dolo doub that,to sonae degree, it a tali place in thepresent case of this there is even Ome presumption, froin the continuance of the disse
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discharge, and rom the quantit to hiclii occurs for,hile the resistanc is considerable inordinate action,il neve give any great disicharge. ut o the other hand there is no reason to presume that laxit 1 the sole causes otherwis many of the present symptoms ould e,anting, and the patient ould no froni herice beas sected illi alias si distremn to her. Tibere is likewi se ome presumptio that
the laxit is o no very considerable degre for the patient, a farris e cantearn, is no assected with the fluor albus. Hence, although the blood evacuation beos considerable continuance, it would appea that, after the mos powerfui causesare removed the resistance to the passage of the fluid is sufficient to prevent nyother dis harges Andes conside the continuarice of a disicharge unde the form ofleucorrhoea tote a stronge marios laxitythan even a large evacuationis biood Upon the whole then, m idea of this complain is that it ma in ome degre de pendopon diminis hed resistance to the
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blood a the uterus; ut that tris principali the effect of inordinate action Thus would conside it tot in a reat mea fure an affection ultimatet dependinion
On his supposition I mustiwn I ammuch atis ossi illi regari to the prog-nosis Aster ali attempis to illustrate nervous affections pracstitioner are illi much difficulted illi regard to them and par ticulari respecting thei termination ear totali in the dark. The have nofixedis determine i oui se Perhaps, in generat, the continue in proportion tothei severity; et heia the are seem-
stinate, resistin ali attempis to Ure; and where the are mos alarming theywil osten uddent dis appear. I ould not, herefore, e surprised is the reco- ver of the present patient Was ver sud den anda,illio besastonis hed is her dis- eas continues obstinate, in spite os ali thalcante done to remove it This las event reckon, of the wo the mos probabie.
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Thi dis eas has atready remalnei se a considerable time even for the pace of severat ears. During that period there has been no tendencycio mitigation Onthe contrary, ather an increasse of symp- toms an debility, nausea, an umilarcomplaints are no induce a sequelae of the origina affection. It is farther obe observed that he has atready used man remedies and w may reas nably presume non of the east powerfui. Whenit has resisted these there is es tot expected rom thers nor, o the therhand is there any great prospectis a natural cure This might indeed, e expected a thos times hen the system un- dergoes an great revolutio, suci a theperiod when the menses usuali leave women But with our patient this is probabi ver far distant, a me istut litile pastrie twentieth year. There is nother cir cumstance rom hicli a natura curemight be expected As, have suppost linis morbi affection tole in a great meas ure induced by one regnancy, it might be
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be removed by another. mere the patient, in the presentituation to ali illichild, it ould probabi give soni tem-POrar cure ut besides that herous is no dead it appears that here is very litile hance of this even froni a secondmarriage. Her complaint indeed is in
nancy ut in others, Ver much againstit. And while the inordinate actis of the uterus gives patia resemblinithos oflabour, he would e constanti exposladio the ange of abortion. Even regnanc for a natura time, although givingsome chance of cure might yet have very opposite essedis tanti in place of removing, might greatly aggravate the disiense. Upon the whol then, the probability, think, is that the present assection illhe tedious a least, is the patient does notin a sinor time fati a victim to it.
It will heres ore naturali Occur, as
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sions. It si no means rare o find thudis eas terminatin fatally, frona the immediate cons uences of the quantit os disicharg. and in proportion to iis continuance, there is alway greater ris of this, a the resistanc a the uterus is fcoui se diminis hed. The evacuation hi-therio has no been to fuch an extent asto threaten any imminent anger: ut more is to e apprehended froni the n- suence of long continued evacuation ulli system. In his way he has atready been greatly debilitated an by a continuance of the discli arge may a lati sinhiander it: et without soni sensibi alteration of the fympionis, ,ould ainlope that his may not appeta uddenly, and
that w may at eas have an opportunityos tryinidisserent remedies. must, however, observe, that amVery much atra osse both with respect tolli generat planis cure and the particular remedie to e used Froni the vie gi-Ven of the complaint, I am inclinei toconside it chieflycis of the nervous ind.