BY JAMES T. ALLEY, M. D., NEW YORK.

The few clinical remarks under this head will be upon Amenorrhoea Suppressa or suppressed menses, rather than that variety known as retention.

This perhaps is the form of the disease we most often meet, for the reason that its causes are more abundant and effective than those of retention. No function of the animal economy is so liable to temporary obstruction as this, from the fact that in most others, their action is a regular habit and not easily perverted, whilst this is critically periodical, so that the influence of the smallest causes whether physical or mental during the first hours of the commencing congestion are often sufficient to defer for another month the capricious impress of the vital forces. Doubtless the causes of this disease are far more often slight mental, than purely physical ones.

If severe and persistent paroxysms of ague, which have resisted the most powerful remedies, are suspended by a monopoly of the mind, if violent nerve-pains and other serious diseases are checked by common mental impressions, how much more easily may the occasional and gentle action of nature in establishing this function be frustrated in its course by the operation of any of the various passions of the mind. Accordingly in the treatment of this disease, regard should always be paid to mental quietude at the time of the expected recurrence. I report the following cases, not because of anything especially new, but as adding to the stock of clinical facts, the importance of which, in developing the pathogenetic action of drugs, is greatly disregarded. Our science is greatly in need of carefully reported cases, not that they may serve as precedents to follow, but that we may compare, and infer the specific action of the drug employed.

Case 1st. A girl 19 years of age, fleshy and strong in muscular development, of active habit and excellent health, had always been regular until 9 months ago, when, from a slight exposure to cold near the menstrual period, and from unusual anxiety of mind, the menses did not appear. After 3 months she began to show the usual constitutional disturbance, when she was placed under the care of two eminent allopathists, who treated her for three months and then decided that she would not recover without removing to another climate. This change she was unable at the time to obtain, and discouraged and low-spirited, she came to me for treatment. Her abdomen was greatly distended, so that her friends were fearful of reports against her character. Appetite impaired, occasional nausea, bloated red appearance of the face, red spots upon the cheeks, flushes of scarlet redness over the body, heavy, dull and languid in motion, confused, obtuse and forgetful in mind, rush of blood to the head, beating headache, especially when stooping, heavy pressed feeling of the head, humming in the head. These were the principal symptoms which she now presented. In looking at a case which had been of so long standing and appeared so obstinate, I was reminded of the cases I had seen treated at my old Alma Mater by Aloes, Myrrh, Quinine, Iron, hipbaths, leeches, mustard, &c, and felt thankful that these old ceremonies of the law were passing away, and that a psychical gospel is now the salvation scheme for the body. I prescribed Pulsatilla⁶, dose every four hours. In less than 24 hours the menses made their appearance in a natural regular flow, the patient convalesced rapidly; the succeeding periods have been normally observed and health is now re-established without a change of climate, and almost without moving from the house. Three years ago in another journal, I condemned Pulsatilla, because of its failure in certain cases in which it appeared to be indicated, but have since found the failures were rather to be attributed to my own neglect than to the remedy itself. Pulsatilla must be given in dilutions above the 3d if we desire to have the full benefit of its remedial powers. If thus given, and if the indications are such as to justify its administration, it will almost never fail.

Case 2d. is that of partial suppression in a married lady without children, active, lymphatic temperament, in whom the menses ceased sooner than usual, and who applied for treatment a few hours after the cessation. The few symptoms present were those indicating Opium. I gave her the 1st. dilution, and after two doses she returned, desiring me never to give her that medicine again, as she came near ' flowing away.' Opium was, many years ago, recommended in large doses for suppression, but generally combined with 'cathartics' or 'emenagogues,' and even thus empirically given in barbarous doses seemed to show somewhat of its specific operation. That it has a specific action upon the uterus cannot be denied. I have not sufficiently perfect reports to give the full indications for its use, but its merits in several cases of late, will certainly commend it to careful examination.

Case 3d. A woman, married, aged 23, large and masculine in appearance, lymphatic temperament, idle in habit, had been under treatment 9 months for suppression caused, as her former physician (a specialist,) told her, by disease of the neck of the uterus.

When she came under my care, the disease of the cervix if there had been such, was not so much as to prevent the menstrual discharge. All the appearances were healthy excepting thickening of the walls of the neck, the cause of which, from peculiar circumstances, I was not able to ascertain; neither am I aware what the treatment of the specialist may have been for the months during which she was under his care. I gave her Mercurius protiod. for the abnormal thickening and Thuja occidentalis for the suppression. Three days after giving the Thuja her courses returned profusely, and continued for nearly a week to the great relief of the patient. I omitted to mention that during the months of her former treatment she became anaemic, dropsical, and greatly debilitated, suffering greatly from palpitation and disturbance of the nervous system. Her periods were regular for three months, when again they ceased but were quickly restored by Pulsatilla⁶. The special physical symptoms in this case it was impossible to observe and accurately meet, as they were hidden and overpowered by the dropsical condition of the patient. Thuja was given therefore more from the local indication and the circumstances in the history, than from the partially deceptive symptoms then present.