The cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / Edited by John Forbes, Alexander Tweedie, John Conolly.

Date:: 1848

Credit: The cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / Edited by John Forbes, Alexander Tweedie, John Conolly. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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$the g'^neral excitement be subdued, the employ- ment of einmenagogues would be injurious. It is also questionable, whether, even after this has been accomplished, any of the substances supposed to act directly on the uterus should be employed ; but if tiiey may be administered, they will be most likely to prove beneficial when given imme- diately after the reduction of the febrile excitement. The employment of emmenagogues is not con- fined to cases of simple obstruction or suppression. In some females the pain with which menstruation is accomplished embitters much of life 8omc of the substances employed as emmenagoirues are supposed directly to lessen uterine irritation ; and thence they are closely allied with sedatives and antispasmodics. I. Direct Emmenagogues*—These may be divided into immediate and mediate. 1. The only immediate emmenagogue is elec- tricity. It is well known that when this power- ful agent is passed through any part of the body, a painful sensation is felt at the point of commu- nication. Thus, if the knob of a discharging rod, connected with a chain communicating witli the outside of a charged Lcyden jar, be applied to one side of the pelvis, and the knob of the jar itself be applied to the side, a feeling will be instantly pro- duced, as if a small sword was thrust through the part, and a stimulant impulse is given to the ute- rus, by the direct passage of the electrical fluid through it. The stimulant influence of a shock thus communicated, is obvious by the sensation which it excites ; but it equally takes place, though in less degree, ^'hen no sensation is produced, as when a continued current of the fluid is passed through the organ, by making it a part of a cir- cuit communicating with the prime conductor of an electrical machine. The direct application of electricity is admissible only when a torpor of the Uterus exists, indicated by a suppression of the catamenia with a pale complexion and a languid state of the circulation. But even in this state of the habit and the organ, it must be remembered that, whilst applied in moderation, this agent rouses the activity of torpid parts, in large quan- tity it injures materially, if it do not destroy alto- gether the excitability of this organ. In employ- ing electricity, therefore, as an emmenagogue, it should be first used under the form of accumulated electricity, or the bath as it is termed, then the aura, and, lastly, shocks should be given. At first, the shock should be moderate ; as, in nervous ha- bits, syncope has followed the unguarded commu- nication of powerful shocks ; but with ordinary caution in its application, electricity has been found a powerful agent in amenorrhoia, depending either on general debility of the system or atony of the uterus itself. (See Elf.cthicitt.) The influence of ergot of rye, secale cornutum, on the impregnated uterus, at the period of parturition, has led to the belief that it may be employed as a direct emmenagogue. Admitting that ergot acts directly upon the uterus, it cannot be denied that its influence in parturition is ojiposcd to that which is requisite for exciting the uterine discharge. If menstruation be a secretory action, a certain supply of blood is requisite for its performance ; but ergot acting on the motor nerves, and causing muscular contraction, would necessarily lessen this supply, and produce a state of parts more calculated to impede than to forward the menstrual discharge. Experience has also demonstrated that ergot has indeed very slender pretensions to the character of an emmenagogue. 2. The mediate direct emmenagogues compre- hend both organic and inorganic substances. Among the former, madder, the root of the rubia tinctoriim, has been long employed and relied upon, without any accurate idea of the manner in which it operates ; although, from its tinging the urine and the bones of a red colour, it has been supposed that, as it passes into the circulation, it finds its way to the uterus, and directly influences that organ. The late Dr. Barton, an Amciican physician of eminence, placed great reliance on ita deobstruent powers; and it was also much esteemed by the late Dr. Home, of Edinburgh, who, in his clinical experiments and histories, has recorded his decided opinion of its efficacy as an emmenagogue. He gave it in doses of from ^ss to _^i, twice or three times a day. But notwith- standing these authorities, madder is an equivocal emmenagogue, and is now rarely or never employed. Savine, the leaves and herbaceous part of the juniperus sahina, which owes its stimulant pro- perties to a volatile oil having some affinity to that of turpentine, is an energetic emmenagogue ; and from its pronencss to produce uterine hemorrhage, and cause abortion, there is some reason for the opinion that the volatile oil is taken into the cir- culation and acts directly upon the uterus, on which it exerts a stimulant influence. ]\Iore than a century ago, its tendency to produce abortion led to its employment as an emmenagogue; but from an opinion expressed by Dr. Cullen, it fell into disi'cpute. In whatever manner it acts, savine, or its oil, is well adapted for cases of amenorrhcea connected with a feeble stale of the constitution, and a languid circulation. The dose of the pow- der is from gr. v. to gr. x.; that of the oil, which can be readily formed into an oleo-saccharum, from m.n. to w.vi. The extract, ordered by the Dublin Pharmacopoeia, is a useless preparation ; the volatile oil being dissipated by the heat neces- sary to be used in forming the extract. Seneka root, the root of the polygala senega, is esteemed a useful and active emmenagogue by the American physicians. The active principle, which is supposed to be a peculiar salt, first noticed by Peschier, and named by him polygaline or poly- galina,* resides in the bark of the root. Dr. Hartshorne, of Philadelphia, who first employed it as an emmenagogue, found that it was most use- ful in recent cases of amenorrhoea. He began its use two weeks previous to the expected appearance of the catamenia, giving it in the form of a satu- rated decoction, to the extent of a pint in twenty- four hours, pushing the dose as far as the stomach would permit, until the discharge appeared. Dr. Chapman, of Pennsylvania, adds his testimony to that of Dr. Hartshorne in favour of seiiega root, and believes mat it exerts a specific action on the uterus ; but it ought to be mentioned that the patient is directed to be prepared by an alterative course of calomel, carried to gentle ptyalism ; on * Pescliier procured gr. 100 of tins salt from 6 ounces of tliL' root. He assorts that it is united with a p^iruliai acid, whiclj he has called polygalinic.$