THE 
BOSTON MEDICAL AND SURGICAL JOURNAL. 
New Series.] 
Thursday, August 29, 1872. 
[Vol. X.—No. 9. 
(Drigmal Communications. 
AMENORRIICEA; 
ITS CAUSES AND TREATMENT; ESPECIAEEY BY 
ELECTRICITY. 
By William rfi Baker, M.D. Harv. 
We have read with interest the suggestions 
made and the cases reported in this Journal 
relative to our subject; and these have so 
impressed us with its importance as to lead 
to a new investigation of it, both by ex- 
periment and by a review of the most re- 
cent and the best authorities. The results 
of this study are given in this article. We 
will briefly consider the causes of this af- 
fecticwnd the various methods of treat- 
ing it, particularly that by electricity ; and 
we will endeavor to show in what class of 
cases this agent should be employed, what 
variety of it should be used, and what is 
the best method of its application. 
The term amenorrhoea etymologically 
denotes “not to flow monthly”; or, in 
other words, the morbid suspension or non- 
appearance of the menses. 
To understand this abnormal state, we 
must consider the normal condition which 
it interrupts. In obedience to a natural 
law, which we cannot fully comprehend, 
one or more ovules mature and burst from 
either or both ovaries, passing into the 
uterus through the Fallopian tubes, once 
in about twenty-eight days during the pe- 
riod of fecundity. At this time, under the 
influence of the ganglionic system of nerves 
connecting the ovaries and uterus, conges- 
tion is produced in the latter as it already 
exists in the former; the uterus becomes 
thereby somewhat engorged, and conse- 
quently descends toward the floor of the 
pelvis. Its mucous membrane being swol- 
len and the vessels thereof enlarged, the 
walls of the capillaries burst under the ex- 
cessive congestion, and haemorrhage ensues. 
The menstrual flux was not formerly con- 
sidered a true haemorrhage, but an effort of 
nature to expel injurious substances, from 
the accumulation and retention of which 
very deleterious consequences were feared. 
But it is generally received by physiologists 
of our time, and proved by microscopic ex- 
amination and chemical analysis, to be a 
veritable haemorrhage ; and therefore the 
former apprehensions of danger from the 
postponement of the menses beyond the 
age of puberty, or the time of their periodic 
return after it, are shown to be groundless. 
Amenorrhoea, as previously indicated, is 
an anomaly of this function, an abnormal 
state of the organs concerned in menstrua- 
tion. In the works of most writers, prior 
to a period comparatively recent, it was 
treated as a disease, and considerable space 
devoted to it as such, and to other diseases 
which were thought to follow and to be 
produced by it, the effect being substituted 
for the cause. But the riper experience and 
the more advanced scientific knowledge of 
to day attach to it only a symptomatic im- 
portance, and treat it as to the disease that 
produces it rather than the effect produced 
by it, since it is itself a result of an abnor- 
mal condition of these organs, of the blood, 
or of the nervous system—all of which 
should be in a state of perfect integrity. 
It is more common in the higher than in 
the lower classes of society, on account of 
the frequent retirement of the former from 
those activities and habits of life which 
contribute to the health and vigor of the 
body. 
Causes.—One of the best classifications 
of these, for precision and completeness, is 
that given in the admirable work of Prof. 
T. G-. Thomas. To this we have made one 
or two additions. 
“ Abnormal states of the organs of gene- 
ration : as the absence of the uterus or 
ovaries, rudimentary condition of either or 
both of these, occlusion of the uterus or 
vagina, metritis or endometritis, supei’invo- 
lution, pelvic peritonitis, atrophy of both 
ovaries,” fibrous tumors of the uterus and 
cystic degeneration of both ovaries. 
“Abnormal states of the blood: as in 
chlorosis, plethora, phthisis, cirrhosis and 
Bright’s disease.” 
Vol. X.—No. 9 
Whole No. 2326 142 
MEDICAL AND SURGICAL JOURNAL. 
“ Abnormal state of the ganglionic ner- 
vous system.” — This occurs in “atony 
from nervous depression, from indolence, 
luxury, deficiency of fresh air, want of ex- 
ercise and constitutional disease, as phthi- 
sis,” and the like. 
The most common causes of amenor- 
rhoea are chlorosis or anaemia, and phthisis, 
which does not prevent the establishment 
of the menses, because the tuberculous 
diathesis is not usually developed at so early 
an age. To these may be added atony of 
the nervous system from the above-named 
causes, rudimentary condition of the ute- 
rus or ovaries, occlusion of the uterus or 
vagina, superinvolution, prolonged anxiety 
of mind, severe haemorrhages from other 
parts of the body, or long-continued dis- 
charges from the various mucous surfaces, 
or in fact anything which interferes with 
the proper nutrition of the body. 
These causes are more or less permanent 
and internal; others are occasional and ex- 
ternal in their primary source; but their 
results in turn become the causes of this 
affection—e. g. exposure to cold or wet, 
sudden fear, excitement and severe sick- 
ness. But these are only of secondary im- 
portance ; for instance, the influence of 
cold or wet at the period of menstruation 
may cause a sudden suppression of the 
flux and produce an acute metritis, which 
may become chronic, resulting in a perma- 
nent amenorrhoea. 
Where the causes of this phenomenon 
are so various and recondite, great skill 
and thoroughness of examination are indis- 
pensable, in order to accurately determine 
the particular condition which produces 
the abnormal state, and therefore to distin- 
guish the mode of treatment. 
Differential Diagnosis.—Before deciding 
upon the treatment, as the author above 
referred to suggests, the practitioner must 
distinguish this affection from pregnancy, 
from the climacteric period, and from de- 
layed menstruation. 
If great caution is not exercised in dis- 
tinguishing this affection from pregnancy, 
a mode of treatment may be adopted, as 
we have before intimated, which may be 
both injurious to the subject and destruc- 
tive to the foetus. 
Treatment.—This, as previously stated, 
must vary with the causes producing the 
affection. There can, of course, be no treat- 
ment in cases of the absence of both ovaries, 
a condition extremely rare. 
The absence of the uterus is more easily 
diagnosticated, but is equally beyond reme- 
dy, although the symptoms which are usu- 
ally alleviated by the haemorrhage from this 
organ, if urgent, may be periodically re- 
lieved by veiresection. Like the former, 
this condition is extremely rare. 
In cases where a rudimentary or-atro- 
phied condition of the uterus or ovaries, or 
where super involution of the uterus, are the 
cause of this state, electricity, of which 
we shall shortly speak, affords the most 
efficient method of treatment. 
When occlusion of the cervix or of the 
vayina exists, a surgical operation is neces- 
sary. A case of the first-named class was 
treated by the author in December, 1871. 
A brief of the case then made is as follows : 
K. C. was a native of Ireland, aged 30 
years, having been married six months, 
and until within five months of marriage 
always strong and well, when, without any 
known cause, the menses ceased. At each 
succeeding monthly period the patient had 
all the usual symptoms of menstruation, 
except the haemorrhage. Two days before 
her marriage, being the menstrual period, 
she had very severe pain, with the dis- 
charge of only two or three drops of blood. 
But from that period to the time when first 
seen, there was no return of the catamenia. 
A digital examination of the vagina proved 
it to be normal; examined bimanually, the 
uterus was found not enlarged, perfectly free 
and movable, slightly retronexcd ; cervix 
normal as to position, size and consistency; 
but no os could be felt By speculum, no 
os was to be discovered ; but after several 
minutes’ delay a single drop of secretion 
appeared at the centre of the cervix, show- 
ing that there was not a total occlusion of 
the os. After considerable manipulation, 
a probe of the smallest size was passed, 
when the cervical canal was found to be 
unobstructed, and the cavity of the uterus 
not enlarged. This was followed by the 
use of probes of larger size, until an orifice 
was obtained sufficient for the admission 
of an exceedingly small sea-tangle tent. 
The next day, this being removed, the ori- 
fice was found so much enlarged as to admit 
a tent of tolerably large size, which was left 
in position for twenty-four hours; and, when 
removed, the first phalanx of the linger could 
be readily introduced through the os. The 
patient was not seen again for five months, 
when she reported herself entirely relieved, 
the menses having appeared ten days after 
the last operation, and been regular from 
that date. 
In this case what became of the men- 
strual flux, which the symptoms warrant 
us to believe occurred each month ? That 
no such discharge appeared externally is evi- A M E N 0 RRII(E A. 
143 
dent ; and yet the non-enlargement of the 
uterus and the subsequent operation proved 
that there was no blood pent up within the 
cavity of this organ. Can any one reasona- 
bly doubt that this blood, which may have 
been less than usual in amount, was remov- 
ed by the absorbents, so active in all parts 
of the body ? 
In cases more grave than the above, 
when the cervical canal is absolutely closed, 
resort must be had to the knife. 
In occlusion of the vagina, occasioned 
general]}7 by an imperforate hymen or con- 
genital malformation, there is great danger 
of the death of the patient from peritonitis 
or pyaemia, in consequence of the opera- 
tion ; the blood which is retained within 
the cavities of the Fallopian tubes, the 
uterus and vagina, and which, being 
suddenly evacuated from the two latter, 
is forced by the contraction of the ute- 
rus from the tubes into the peritoneal 
cavity, thereby producing inflammation. 
There is also danger lest immediately after 
the evacuation of the blood from the uterus, 
air should enter that organ and cause a de- 
composition of the blood remaining there, 
which, being absorbed, produces pyaemia. 
As a precautionary measure, the blood 
should be withdrawn in small quantities 
and at considerable intervals, care being 
taken to avoid the entrance of air. 
When endometritis, peritonitis, fibrous 
tumors of the uterus, or cystic degeneration 
of both ovaries are the causes of amenor- 
rhoea, they, and not it, should be treated. 
When this affection is dependent upon 
chlorosis or ancemia, these should be first 
treated by generous diet, exercise in the 
open air, and the various preparations of 
iron ; and when by these means the system 
is brought up to its normal standard, if 
menstruation does not take place sponta- 
neously, it may be promoted by the appli- 
cation to the uterus of a local stimulus, as 
of electricity. 
On the contrary, where amenorrhoea re- 
sults from plethora, arestricted diet, activity, 
free air, and even venesection may be found 
beneficial. Nature itself suggests the pro- 
priety of this latter course, since when the 
menses are interrupted or very much dimi- 
nished for any considerable period, litemor- 
rhage often takes place from some other 
part of the body—as from the lungs, sto- 
mach, intestinal canal, mucous membrane 
of the nose or mouth, from the skin, or 
whatever part may have been most reduced. 
The greater impulse of the heart and the 
quickened circulation which always exist 
at such times in sympathy with the conges- 
tion of the organs of generation, increase 
the pressure against the walls of the ves- 
sels and rupture them at the point of their 
greatest weakness. In these cases of vica- 
rious menstruation the haemorrhage is com- 
monly more copious than the catamenial 
flow, and it is apt to induce an anaemic con- 
dition requiring the administration of the 
tonics before mentioned. 
If phthisis, cirrhosis or Bright's disease 
be the cause of amcnorrhoea, these affec- 
tions should receive our treatment, for 
under such circumstances the normal hae- 
morrhage from the uterus would only be a 
source of additional weakness. 
When this condition results from an 
atomic state of the nerves, the use of nervous 
tonics, as nux vomica, strychnia and simi- 
lar drugs, is indicated, together with exer- 
cise in the open air, liberal diet and the 
general application of electricity, to be 
spoken of hereafter. When these have 
sufficiently elevated the tone of the system, 
emmenagogues may be useful, foremost 
among which is the local application of 
electricity. Other local stimuli which may 
be advantageously used ai’e the passage of 
the sound, the introduction of the tent, 
cupping of the cervix, stimulating enemata 
and hot baths. These means not only act 
upon the uterus, but often promote ovu- 
lation. 
Treatment by Electricity.—In this branch 
of our subject it will aid us to classify the 
methods for the application of this agent, 
and its results, according to the mode of its 
generation and use, into statical, galvanic 
and Faradic. 
Statical or frictional electricity has been 
employed in medical science for more than 
a hundred years. But early in the present 
century it began to be supplanted by gal- 
vanism, and still later by electro-magnet- 
ism, on account of the inconvenient size of 
the electrical machine, the influence of the 
weather upon its action, the difficulty of 
regulating the quantity required and of ap- 
plying it only at the precise point where it 
was needed. For these reasons its use is 
now generally discontinued. 
Galvanism dates from near the close 
of the last centuiy, and in the very begin- 
ning of the present the discovery of the 
Voltaic pile introduced it to medical sci- 
ence. But this apparatus was soon super- 
seded by the galvanic battery, which is 
now in general use. 
The continuous current is specially ap- 
plicable to cases in which there is a want 
of proper development of the uterus or 
ovaries, or in which there lias been an ex- 144 
MEDICAL AND SURGICAL JOURNAL. 
cessive structural change of the same, as 
in atrophy of both or superinvolution of the 
former, and perhaps in some other cases, 
which the practitioner will readily recog- 
nize. 
A case is here introduced which came 
under the personal observation of the wri- 
ter, and which shows how this current may 
succeed where other modes of its applica- 
tion fail. 
A. D. was aged 20 years, single, domes 
tic, and a native of Ireland. She had been 
in a chlorotic condition ; but this state had 
been so far corrected in August, 1871, that 
it was thought advisable to apply electri- 
city as a local stimulant. The menstrual 
flow had never appeared but once, and then 
about a year previously ; but it continued 
oidy one day. Upon bimanual examina- 
tion, nothing abnormal was found. The 
Faradic current was applied externally— one 
electrode to the sacrum, the other to the 
pubes for five minutes on two successive 
days, with no marked effect. Five days after- 
wards, the galvanic current, with six cells 
of Stohier’s zinc and carbon battery, was 
applied externally to the same points for 
five minutes. This produced, on the same 
day, pains through the pelvis, with slight 
haemorrhage from the genitals. The appli- 
cation was repeated the next day, and the 
flow became natural. Unfortunately, after 
this the patient was lost sight of, and there- 
fore the permanent result could not be as- 
certained. 
In this case, why did the continuous cur- 
rent succeed where the interrupted failed ? 
Was it not due to catalysis—that is, to the 
action of this agent upon the bloodvessels, 
dilating them, quickening the circulation, 
and thereby bringing about the How ? 
Faradization has but a slight effect upon 
the sympathetic nerves, which supply the 
ovaries. Galvanism, however, has a pow- 
erful effect upon them ; and this, as we have 
just intimated, is probably the reason why 
we failed with the former and succeeded 
with the latter. 
But in all cases where galvanism is em- 
ployed, caution must be exercised : first, 
not to continue the application too long, 
and thereby produce exhaustion and col- 
lapse ; the proper length of time is from 
three to five minutes ; Second, lest too 
great a persistence in a uniform direction of 
the fluid should destroy the tissues at the 
point of application by its caustic action, 
a result which can be realized only by a 
very strong current, and which may be 
avoided by a reversion of it once in from 
thirty to sixty seconds ; Third, for reasons 
just given, too strong a current should not 
be used, The proper quantity may be as- 
certained by the galvanometer. 
Proper Mode of Application.—In the use 
of the galvanic battery, one electrode should 
be applied to the lower portion of the spine, 
whence proceeds the nervous supply of the 
parts requiring treatment; the other, either 
externally to the abdomen in the region of 
the uterus or ovaries ; or internally, direct- 
ly to the cervix or to the interior of the 
uterus. 
A very convenient instrument for apply- 
ing the continuous current is the galvanic 
pessary of Sir J. Y. Simpson, modified by 
Dr. Noeggerath, and still further by Prof. T. 
G. Thomas. If the use of this pessary 
causes excessive irritation, the instrument 
must be temporarily withdrawn and the 
current from the battery substituted. 
It is not yet decided whether the bene- 
ficial results of this pessary are to be attri- 
buted to the mechanical effect of the metals 
or to the chemical action of the current—a 
question which, it is to be hoped, progres- 
sive science may ultimately decide. 
Electro-magnetism was first used in 1832 
by Faraday, whose name it now generally 
bears. It was soon after applied to medi- 
cal science, and re-animated the whole de- 
partment of electro-therapeutics on account 
of its special adaptation as a remedy for 
certain phases of disease, because from the 
greater tension and diminished volume of 
its current, it has been found specially ap- 
plicable to cases where its effects are de- 
sired upon the muscles and vaso-motor 
nerves. 
The cases, relative to our subject, in 
which Faradization is of the greatest bene- 
fit, are those of acute suppression of the 
menses, resulting from undue exposure to 
cold or wet, from strong mental emotion, 
and in other cases requiring a local stimu- 
lant. It is also ust'ful where an atonic 
state of the nervous system exists. In 
many of these cases it should be administer- 
ed in connection with some other therapeu- 
tic agent, as the various tonics, for ex- 
ample. 
Proper Mode of Application.—Many wri- 
ters give the following rule: —One elec- 
trode should be applied to the lumbar re- 
gion of the spine, the other to the hypo- 
gastrium. This may be true as a general 
law, but it requires more minute specifica- 
tion. This rule is correct where the elec- 
tricity is from the secondary inductive coil, 
because in this case the course of the cur- 
rent is changed at each interruption; and 
it makes no difference in respect to the ute- AMENORRIHEA. 
145 
rus which electrode is applied to either 
point. But this rule does not apply where 
the electricity is from the primary induc- 
tive coil, because here the course of the 
current is not changed ; and experiment 
proves that the positive pole should be ap- 
plied to the lumbar and the negative to the 
hypogastric regions, in order that the fluid 
may pass in the same direction as the nerve 
fibres. 
It is advisable first to try this external 
application, on account of the facility of its 
use, and for the sake of sparing the deli- 
cate feelings of the patient; and it will 
commonly be found sufficient. But if this 
is not effectual, resort must be had to its 
application to the cervix or even to the 
fundus of the uterus. The advantage of 
the internal application to the cervix over 
the external, results from the absence, in 
that part, of nerves of sensation, and from 
the consequent opportunity of using a 
stronger current and applying it to the de- 
sired point. 
We have an appropi’iate illustration in the 
case of M. B., a seamstress, married, 
who entered the Boston City Hospital, and 
became the patient of Dr. J. G. Blake, 
March 25th, 1871. The patient had suffer- 
ed from the symptoms of anaemia since the 
birth of her child, two years previously. 
Upon examination, the uterus was found 
retroverted, but not specially enlarged, and 
perfectly free and movable. She was im- 
mediately put on tonic treatment. Two 
weeks after entrance, catamenia appeared, 
though very slight ; none subsequently for 
three months, although for some days pre- 
vious to her expectation of it, the usual 
emmenagogues, and external stimulants to 
the parts were used. During this third 
month she had so far recovered from the 
anaemic state that between the periodsjwhen 
the menstrual flow should have appeared 
she was comparatively well. On the 5th of 
July, when the catamenia was expected, 
until the 8th, Faradization of the fundus of 
the uterus was practised by the author at 
the request of the attending pli3Tsician. A 
current from the secondary inductive coil, 
sufficiently strong to produce a pricking 
sensation in the hand of the operator, was 
used. The positive electrode was applied 
to the lumbar region and the negative to 
the fundus of the uterus. 
If any inquire why we did not, in this 
case, first apply electro-magnetism exter- 
nally, our answer is found in the advanced 
state of the catamenial period and in the 
severity of the symptoms of the patient. 
After the second application for five mi- 
nutes on two successive days, the men- 
strual flow appeared, and in a few days the 
patient was discharged from the hospital, 
“well.” She was seen again after nine 
months, and reported perfect regularity of 
the menses from the last application. 
Brief of other Cases.-—The value of these 
would, in many instances, be greatly em 
hanced if the causes could have been more 
fully stated. 
We are indebted to Dr. Francis Minot, 
of this city, for the three following cases 
in his own practice. 
March, 1871. Mademoiselle M. had been 
regular until eleven months ago, when 
catamenia ceased without known cause. 
On the 13th, 14th and 15th of the month, 
electricity was applied through both hands 
and from one hand to the opposite foot 
for five minutes. On the 16th inst., patient 
reported that the catamenia appeared on 
the previous evening, in the most natural 
manner, and still continued. 
June, 1867. A. B. had perfectly normal 
menstruation ; none subsequently for six- 
teen weeks; cause of cessation unknown. 
On Oct. 2d electricity was applied through 
both hands, and on the two following days 
it was applied in a similar manner, and also 
from each hand to the opposite foot, the 
current being reversed. On the evening of 
the latter day the catamenia appeared. 
Another case also occurred without 
known cause. The last menstruation was 
perfectly normal in time and amount. But 
here electricity was applied in a similar 
manner as in the previous cases, yet with- 
out any effect. 
Dr. Golding Bird reports twenty-four 
cases treated by statical electricity, the 
current being passed through the pelvis 
from the sacrum to the pubes, at intervals 
of from two to three days. The result 
was cure in twenty cases, the remaining 
four being chlorotic. 
Drs. Beard and Rockwell report fourteen 
cases with these results:—eight cured; 
one approximately recovered ; and five not 
benefited. 
Dr. Althaus in his remarks on amenor- 
rhoea reports one case in his own practice, 
treated by Faradization, which resulted fa- 
vorably. He also quotes from the New 
York Journal of Medicine of 1844 a re- 
markable case in the practice of Dr. Le 
Conte, of Georgia, in which a negress, 70 
years of age, in whom the menses had been 
absent more than twenty years, was treat- 
ed by thunder and lightning from the Al- 146 
MEDICAL AND SURGICAL JOURNAL. 
mighty’s battery, one charge from which 
brought on the menstrual flow, which con- 
tinued regularly for the two succeeding 
years. 
Thus, each form of electricity has its 
specific action and produces its specific re- 
sults ; and, therefore, the cause of the 
affection should be sought and well under- 
stood in order to apply the agent appro- 
priately. 
The author would gratefully acknowledge 
his obligations to Dr. D. F. Lincoln and 
others for their valuable suggestions in the 
preparation of this article. 
Boston, Mass., July 1, 1872.