TREATMENT OF CONFIRMED BILIOUSNESS. 265 Thus I have seen jaundice occur in young women from the sudden suppression of the menstrual flow, and have sometimes noticed a persistent loss of appetite for months, notwithstanding the administration of alteratives and tonics. It must also be noted that when uterine diseases occur at the change of life, they are more frequently attended by biliary derangement, and by the secretion of an enormous quantity of bile. TREATMENT. The frequency and tenacity of biliary and dyspeptic affections at this period, explain why purgatives have been considered the principal medicines required; but an occasional purgative will have little effect; a systematic plan of treatment must be resorted to, and calomel or blue pill associated with the comp. ext. of coloc., or with the soap and aloes pill, is well borne and often required. Since my last edition, there has been an attempt to prove that mercury does not promote the flow of bile, but I submit that experiments made on healthy dogs, do not apply to diseased men and women. It is a matter of daily experiment to find, that while various purgatives repeatedly taken, bring away no bile, one dose of calomel will cause yellow, burning bile to pass in the motions, so I consider calomel and blue pill to be indispensable for the treatment of diseases of the liver at the change of life. The only tonics that should be given while the liver is thus engorged, are the diluted mineral acids, taken alone, or in some slightly bitter infusion, three times a day, before meals, and immediately after them fifteen drops of liq. potassæ, in a wineglass of water, and one or two effervescing draughts, with citric acid and carb. of soda and potash, should be also taken during the day. They may be flavored with syrup of ginger, or syrup of orange-peel, or ten to fifteen drops of chloric ether. Instead of porter and beer Seltzer water with light wine should be advised. Prolonged tepid baths are useful, and an occasional small bleeding may favor the action of the remedies. The late Dr. Wright attributed great efficacy to hydrochlorate of ammonia, which he gave in a mixture with hydrochloric acid. I have seen cases which resisted all treatment cured by a course of mineral waters at Vichy, or at Homburg, or Kissingen; the action of the waters being admirably assisted by early hours, plain diet, and the complete change of all the associations of life. VOMITING. This is not uncommon during the change of life, sometimes accompanying the menstrual flow, and replacing it at others. This symptom generally yields to morphia, a twelfth or a sixth of a grain of the acetate being given in an effervescing draught, and repeated until sleep be induced. A patient, who for years had suffered from vomiting at the menstrual periods, is always relieved by less than half a grain of the acetate, while two grains taken in the twenty-four hours, will not always quell the vomiting of another patient. One patient had no other symptom than water-brash, which appeared at cessation, and recurred every month for eight months. Hufeland and Menville speak of the liability of women to hæmatemesis, which occurred in four of my cases. DIARRHEA. This has been noted as occurring in an habitual manner, at this period, by Gendrin, B. de Boismont, and ChamIt may constitute the only symptom of cessation, and should always be considered a critical discharge, and Portal saw its suppression by active remedies bring on anasarca. The advantages and disadvantages of diarrhoea at the change of life are well shown in the following cases: CASE 49.-Chronic diarrhoea.-A tall, stout, and florid lady, aged fifty-seven, showed an hemorrhagic tendency by the abundance of the menstrual flow, the liability to dysentery, and by her numerous confinements being always accompanied by a flooding. When fifty, the lady met with severe family misfortunes, flooding ensued, the menstrual flow ceased to be regular, occurring, even now, as a mere show, after nervous excitement. Soon after fifty, she suffered from erysipelas in the head; and as a result of this, of cessation, and of mental shock, the lady remained long in a very nervous state. Ever since the ménopause, for the last four years, this patient has had three or four motions every day without pain or any debilitating effects, the appetite and digestion continued excellent, and the increased mucous flow from the intestines sufficiently relieved the constitution, as the health remained good, notwithstanding the absence of perspiration until lately. CASE 50.-Diarrhea aggravated by cessation.-Sarah C. is a thin, nervous, chlorotic-looking single woman, of forty-seven. The menstrual flow appeared at fourteen, and continued regular until six months back, when it became very irregular. Flushes, perspirations, nervousness, and irritability were then troublesome, and twice during this period she has had to leave her place on account of diarrhoea. She states that, ever since the menstrual flow first appeared, she has always had from three to six motions a day, but was always most troubled at the menstrual periods. Until lately, however, this state of the bowels never interfered with her health or appetite, but now, six motions occurring daily, completely incapacitated her for work, although they were unattended by pain. I moderated the diarrhoea by blue pill and chalk mixture, and then prescribed my usual remedies with success. Dr. Cockerton, of Montgomery, consulted me respecting a lady, aged fifty-three, who, during the dodging time, suffered from dysentery, then flooding, on its subsidence, from great relaxation of the bowels, with racking pains in the lower part of the abdomen, which occurred regularly every morning, and were evidently connected with uterine disease. Chambon also has seen the constitution thoroughly shattered by diarrhoea at the change of life. I have met with women who, in advanced age, had several semi-fluid motions in the course of the day, without suffering in the least, and Dr. Day has met with similar cases. TREATMENT.-I seek to restrain the diarrhoea by diet and abstinence, but if that be insufficient, chalk mixture should be given, and after that small doses of Dover's powder with blue pill made up into pills. Extra clothing and exercise, a warm bath, and, if the patient be plethoric, a small bleeding may be useful. The following cases will show the plan to be adopted in cases of Entorrhagia: CASE 51.-Periodical entorrhagia.-Miss M., thin, nervous, and chlorotic, consulted me in 1853, being then forty-eight, The menstrual flow appeared at fifteen, and continued regular until about three years ago. For a year the flow was sometimes more, at others less, and it suddenly ceased two years ago, after a succession of frights, which thoroughly shook her nervous system. Her health, good until cessation, has been bad ever since. She is often troubled with cough, leucorrhoea, and loss of power in the lower limbs. She has become unusually nervous, feels, at times, as if she were going into fits, talks of strange sensations in the head, as "if she had taken something to make her silly." This nervous state is peculiarly marked every three months, when she menstruates by the bowels for about six days. Several times a day she feels great pain at the lower part of the abdomen, there is then anal tenesmus, and she passes a small quantity of blood and mucus. This has occurred for the last two years, and during all this time there have been no flushes nor perspirations. In this case, nature actually did for two years what I have sometimes recommended, to take a small quantity of blood from the system. I gave her the comp. camph. mixture before, the carbonate of soda after meals, 3 grs. of blue pill, with 2 of ext. of hyosc., on alternate nights, and a warm bath for an hour, every other day. This was continued for about a month with great amendment of the nervous symptoms, and a week before the time for the passing of blood by the bowels, I had 4 oz. of blood taken from the arm, which prevented the hemorrhage. I then advised the mixture and carb. of soda to be taken as before, and so much of sulphur and borax as would insure a comfortable action of the bowels. In a few weeks gentle perspirations had become habitual, and afforded great relief. This patient took the syrup of citrate of quinia and iron, in 60-drop doses, twice a day for two months, and became comparatively strong. I had again 4 oz. of blood taken away before the hemorrhage was due, and lately, when I saw the patient, she was in good health. CASE 52.-Repeated entorrhagia and hæmoptysis.-Miss G., a tall, delicate-looking lady, consulted me in 1852. The menstrual flow appeared at sixteen, and it had been no source of trouble until two years ago, when it became irregular, sometimes missing for two or three months, sometimes being scanty, at others so abundant as to amount to a flooding. After shivering and griping pains, this patient has sometimes passed considerable quantities of blood and mucus, and once she brought up a large quantity of blood from the lungs. Since cessation took place, the passing of blood from the bowels has not been more frequent, and notwithstanding continuous flushes and perspirations, she is very nervous, is troubled by sensations at the pit of the stomach, as if some one were sitting there, has choking sensations never before experienced, is very low-spirited, has crying fits, and though sleeping pretty well at night, could do so all day. What, however, the patient most complains of is, frequent recurrence of pain at the lower part of the abdomen, and for the last few nights the legs, the pudenda, and the seat, are much swollen. This led me to anticipate a recurrence of the entorrhagia, so I ordered a hot linseed poultice to the lower part of the abdomen at night, and an ounce of castor oil to be taken in the morning, during which day she passed "blood and corruption," and continued to do so with a great deal of griping for five days, after which all her abdominal suffering vanished. All her life, this patient had never less than three motions a day; the menstrual periods always ending with five or six motions a day; this being the habit of the body, it is easy to understand that for the last year, ever since cessation, the system should seek relief by the intestinal surface. With a view of remedying this state, I ordered the co. camph. mixture before, and the carb. of soda after meals, 3 grs. of blue pill, 1 of ext. of gentian, and 1 of ext. of hyoscyamus, every other night; 10 grs. of Dover's powder every other night; a belladonna plaster to be applied every week to the pit of the stomach, and warm baths to be taken for an hour on the alternate nights. This treatment was continued with considerable advantage for a month, when the baths and plasters were omitted, and the pills were only taken occasionally. Two months after I first saw the patient, I had 4 oz. of blood taken from the arm, and this was repeated three months later. I last saw her about a year ago, and she was well; neither the hemorrhage nor the menstrual flow had returned. CONSTIPATION. This was observed in twenty-three cases, and yielded to the continued use of mild but varied purgatives. In some cases the patients suffered severely from colics, as was the case with Mrs. T., aged forty-seven; the menstrual flow coming at fifteen, had left gradually at forty-five. Ever since cessation she had been constipated, instead of relaxed, as before; and during the last year she has been troubled every two |