MENSES, CATAMENIA, in medicine, the monthly evacuations from the uterus of women not with child or not giving suck. They are so called from mensis "month," the period wherein they return. They are also called flowers, courses, &c. By the Jewish law a woman was unclean while the menstrual blood flowed; and the man who touched her, or the moveables she had touched, was declared unclean.—Levit. xv.
The menses make one of the most curious and difficult phenomena in the whole human body; for the explanation whereof, many hypotheses have been framed, though the matter is yet scarcely ascertained.
It is generally agreed by all, that the necessity women are under for some extraordinary supply to compensate the expence, and support them during the time of gestation, was the final reason why this redundancy at other times was given them, which continues whilst this necessity subsists, and ceases when, according to the constitution of the female frame, it is no longer required; but this is all they agree in. Some, not content with this occasion alone, will have the menstruous blood offend in quality more than quantity; which they argue from the pain it gives many women in the evacuation; with many other idle notions.
Others ascribe this effect to an imaginary dominion of the moon over the bodies of women. This was formerly the prevailing opinion; though the smallest reflection would have shown the weakness of it: for, had this purgation been owing to the influence of the moon, all women of the same age and temperament would have found it at the same periods and revolutions of the moon, i. e. at the same time; which all experience shows to be false.
There are two other opinions which carry with them great probability, and are argued with a great deal of strength and reason; in both which, the quality of the blood is allowed to be innocent, but they still differ about the reason of its issue. The former is that of Dr Bohn and Dr Freind, who maintain this flux to be the result of a plethora or plentitude; and to be evacuated only for relief against the quantity.
Dr Freind, who has maintained the cause of a plethora with the greatest strength and clearness, supposes, that this plethora arises from a coacervation in the blood-vessels of a superfluity of aliment, which, he thinks, remains over and above what is expended by the ordinary ways; and that women have this plethora, and not men, because their bodies are more humid, and their vessels, especially the extremities of them, more tender, and their manner of living generally more inactive than that of men; and that these things concurring, are the occasion that women do not perspire sufficiently to carry off the superfluous alimentary parts, till they be accumulated in such quantities as to distend the vessels, and force their way thro' the capillary arteries of the uterus. It is supposed to happen to women more than the females of other species, which have the same parts, because of the erect posture of the former, and the
Menfes. the vagina and other canals being perpendicular to the horizon; so that the pressure of the blood is directed towards their orifices: whereas in brutes, they are parallel to the horizon, and the pressure wholly is on the sides of those vessels. The discharge, he thinks, happens in this part rather than in any other, as being more favoured by the structure of the vessels; the arteries being very numerous, and the veins sinous and winding, and therefore more apt to retard the impetus of the blood; and consequently, in a plethoric case, to occasion the rupture of the extremities of the vessels, which may last, till, by a sufficient discharge, the vessels are eased of their overload.
This is the substance of Dr Freind's theory; from whence he very mechanically and very philosophically accounts for the symptoms.
To his argument, why women have menfes rather than men, we may add from Boerhaave, that, in the former, the os sacrum is wider, and stands farther out, and the os coccygis farther in; the ossa innominata wider, and farther apart, and the lowest of them, as well as the lower eminences of the os pubis, farther outwards than in the latter. Hence, in women, the latitude or expansion about these bones, and the capacity of the pelvis, is vastly great in proportion to those of men; and yet, in a woman not pregnant, there is not much to fill this expanse. Again, the foreside of the thorax is smoother in women than in men, and the blood-vessels, lymphatics, adipose, and nervous vessels, membranes, and fibres, are much laxer in women than in men: whence all their cavities, cells, vessels, &c. are more easily replenished, and the humours aggregated in them; besides, that they are found to perspire less than men, and to arrive much sooner at their maturity, or flux of increase. To which he adds the consideration of the soft pulpy texture of the uterus, and the vast number of veins and arteries with which it is filled. Hence a healthy maid, being arrived at her growth, begins to prepare more nutriment than is required for the support of the body; which, as there is not to be any farther accretion, must of necessity fill the vessels, and especially those of the uterus and breasts, they being the least compressed. These will be dilated more than the others; whence the lateral vasculæ evacuating their humour into the cavity of the uterus, it will be filled and extended. Hence a pain, heat, and heaviness, will be felt about the loins, pubes, &c. the vessels of the uterus, at the same time, will be so dilated as to emit blood into the cavity of the uterus, and its mouth will be lubricated and loosened, and blood issue out. As the quantity of blood is diminished, the vessels will be less pressed, and will contract themselves again closer, so as again to retain the blood, and let pass the grosser part of the serum; till at length only the usual serum-passes. Again, there are more humours prepared, which are more easily lodged in vessels once dilated; and hence the menfes go and return at various periods in various persons.
This hypothesis, however plausible, is opposed by Dr Drake, who maintains, that there is no such repletion, or at least that it is not necessary to menstruation; arguing, that, if the menfes were owing to a plethora so accumulated, the symptoms would arise
Menfes. gradually, and the heaviness, stiffness, and inactivity, necessary symptoms of a plethora, would be felt long before the periods were completed, and women would begin to be heavy and indisposed soon after evacuation, and the symptoms would increase daily; which is contrary to all experience, many women, who have them regularly and easily, having no warning, nor any other rule to prevent an indecent surprise, than the measure of the time; in which, some that have slipped, have been put to confusion and shifts no ways consistent with the notice a plethoric body would give. He adds, that even in those who are difficultly purged this way, the symptoms, though very vexatious and tedious, do not make such regular approaches as a gradual accumulation necessarily requires. If we consider what violent symptoms come on in an hour, we shall be extremely puzzled to find the mighty accession of matter, which should, in an hour or a day's time, make such great alterations. According to the hypothesis, the last hour contributed no more than the first; and of consequence, the alteration should not be greater in the one than in the other, setting aside the bare eruption.
This is the substance of what is argued against Dr Freind's theory; which, it must be owned, notwithstanding these objections, is still the most rational and consistent that has yet been advanced.
Those who oppose it, give into the doctrine of fermentation, and maintain the evacuation of blood in those parts to be an effect of an effervescence or ebullition of the blood. This opinion has been maintained by many, particularly by Dr Charleton, Bale, De Graaf, and Drake; the two first of whom suppose a ferment peculiar to the women, which produces this flux, and affects that part only, or at least principally. De Graaf, less particular in his notion, only supposes an effervescence of the blood, raised by some ferment, without assigning how it acts, or what it is. The sudden turgescence of the blood occasioned them all to think, that it arose from something till then extraneous to the blood, and led them to the parts principally affected to seek for an imaginary ferment, which no anatomical inquiry could ever show, or find any receptacle for, nor any reasoning necessarily infer. Again, that heat which frequently accompanies this turgescence, led them to think the case more than a plethora, and that there was some extraordinary intestine motion at that time.
Dr Drake improves on the doctrine of a ferment; and contends, not only that it is necessary there should be a ferment, but a receptacle also for this ferment; concluding, from the suddenness and violence of the symptoms, that a great quantity must be conveyed into the blood in a short time, and consequently, that it must have been ready gathered in some receptacle, where, while it was lodged, its action was restrained. But he goes farther still, and pretends to ascertain the place, &c. both of the one and the other, making the gall-bladder to be the receptacle, and the bile the ferment. This liquor he thinks well adapted to raise a fermentation in the blood, when discharged into it in a quantity; and, as it is contained in a receptacle that does not admit of a continual issue, it may be there reserved, till in a certain period of time
Menfes. the bladder becoming turgid and full, through the compression of the incumbent viscera, it emits the gall; which, by the way of the lacteals, infinuating itself into the blood, may raise that effervescence which occasions the aperture of the uterine arteries. To confirm this, he alledges, that persons of a bilious constitution have the menfes either more plentifully, or more frequently, than others; and that distempers manifestly bilious, are attended with symptoms resembling those of women labouring under difficult menstruation. — If it be objected, that on this principle men should have menfes as well as women, he answers, that men do not abound in bile so much as women, the pores of the former being more open, and carrying off more of the serous part of the blood, which is the vehicle of all the other humours, and consequently a greater part of each is discharged through them than in women, wherein the superfluity must either continue to circulate with the blood, or be gathered into proper receptacles, which is the case in the bile. The same reason he gives why menstruation should not be in brutes: the pores of these being manifestly more open than those of women, as appears from the quantity of hair which they bear, for the vegetation whereof a large cavity, and a wider aperture of the glands, is necessary, than where no such thing is produced: yet there is some difference between the males and females even among these, some of the latter having their menfes, though not so often, nor in the same form and quantity, as women.
He adds, that the several phenomena of the menfes, whether in a natural, a regular, or diseased case, flow naturally and readily from this hypothesis; and that whatever may be accounted for from a plethora, or from any particular ferment, may without any straining be applied to this.
Females generally begin to menstruate about the age of fourteen or fifteen, and cease about fifty; though instances have occurred of their commencing sooner and continuing longer. There are, therefore, two critical periods in the lives of females which require their particular attention. In order to escape the chlorosis, and other similar diseases, incident to that period of life when the menfes commence, they should avoid indolence and inactivity, and accustom themselves to exercise in the open air as much as possible. Unwholesome food, dulness of disposition, and strait cloaths, are very injurious to females at this season. The discharge in the beginning is seldom so instantaneous as to surprise them unawares. The eruption is generally preceded by symptoms that indicate its approach; such as a sense of heat, weight, and dull pain in the loins; distension and hardness of the breasts, head-ach, loss of appetite, lassitude, paleness of the countenance, and sometimes a slight degree of fever. When these symptoms occur, every thing should be carefully avoided which may obstruct the menstrual flux, and all means used to promote it; as sitting frequently over pans of warm water, drinking warm diluting liquors, &c. When the menfes have begun to flow, great care should be taken to avoid every thing that tends to obstruct them; such as fish, and all kinds of food that are hard of digestion, and cold acid liquors. Cold is likewise hurtful at this period; as also anger, fear, grief, and other affections of the mind. From
whatever cause this flux is obstructed, except in the state of pregnancy, proper means should be used to restore it; and if exercise in a dry, open, and rather cool air, wholesome diet, generous liquors in a weak and languid state of the body, cheerful company, and amusement fall, recourse must be had to medicine. — When obstructions proceed from a weak relaxed state of the solids, such medicines as tend to promote digestion, to brace the solids, and assist the body in preparing good blood, ought to be used. See MEDICINA-INDEX.
When the menstrual flux is too great, the patient becomes weak, the colour pale, the appetite and digestion are bad, and oedematous swellings of the feet, dropsies, and consumptions, often ensue. This frequently happens to women about the age of forty-five or fifty, and is very difficult of cure. It may proceed from a sedentary life; a full diet, consisting chiefly of salted, high seasoned, or acrid food; the use of spirituous liquors; excessive fatigue; relaxation; a dissolved state of the blood; violent passions of the mind, &c. In order to restrain the flux, the patient should be kept easy both in body and mind. If it be very violent, she ought to lie in bed with her head low; to live upon a cool and slender diet, as veal or chicken-broths with bread, and to drink decoctions of nettles or the greater comfrey. If these fail, recourse must be had to stronger astringents, &c. See MEDICINA no 246.
The discharge of the menfes is interrupted naturally during pregnancy: but this is not always the case, because some have them three months, some six months, and some during the whole time of gestation, though in less quantity than at other times. The menfes are mostly interrupted during the time of giving suck, though many women have a return about the third or fourth month after delivery, and almost all have them again in the ninth or tenth month. In cases of obstruction, the menstrual blood hath discharged itself by other outlets.
It usually happens that this periodical discharge ceases between the age of forty and fifty; and the season in which this takes place is critical to the sex. — However, those who survive this period without contracting any chronicl disease, become more healthy and vigorous than they were before. About this time, some are afflicted with the well known symptoms of plethora, heat, flushings, restless nights, troublesome dreams, and unequal spirits; others are attacked with inflammations of the bowels, or other internal parts; spasmodic affections of various parts, stiffness in the limbs, swelled ancles, with pain and inflammation, the piles, and other effects of plenitude. Those of full plethoric habits, accustomed to copious evacuations, will find great relief by bleeding frequently in moderate quantities, keeping the bowels lax, moderating their diet, and using sufficient exercise that is not too heating. If an immoderate flux of the menfes happens at this period, it should be restrained by gentle laxatives, cooling medicines, rest, anodynes, a most sparing not too liquid diet, rather than by very copious bleedings and astringents of any kind. Dr Fothergill observes, that various purgations of aloes, the tinctura facra, pil. Russi, elixir proprietatis, and other compositions of this kind, are recommended as proper purgatives.
purgatives to be used on the cessation of the menses. But many inconveniences have arisen from these heating medicines, as the piles, strangury, immoderate discharges of the menses, racking pains in the loins, and other similar complaints. Rhubarb, fena, magnesia, sulphur medicines, small doses of jalap, and various combinations of these, may be substituted in the room of the others, and will supply sufficient variety to the prescriber and patient. When the menses are about to go off, they appear for the most part irregularly both in time and quantity; once in a fortnight, three, five, or six weeks; sometimes very sparingly, at other times in immoderate quantities. Great losses of this kind are often prevented by taking away four or five ounces of blood a few days after the first menstrual suppression. If a patient has in early life been subject to cutaneous eruptions, sore eyes, glandular swellings, or other obvious marks of morbid humours subfusing in the constitution, and all which may have disappeared about the time the menses became regular, an issue is an advisable drain, and may prevent many inconveniences. If at this time ulcerous sores break out about the ancles, or in other parts of the body, they ought to be continued open, or artificial drains substituted in their stead; for those who will have them dried up are soon after carried off by acute diseases, or fall into those of a chronic nature.