A recognition of these rather intangible facts is of consequence to the nurse, as it deepens her appreciation of the necessity for nursing her patient as a complete entity, mentally, physically, spiritually and emotionally. We are insistently reminded at every turn that no one part of the patient, no one aspect of her condition can be separately considered and the remainder overlooked.
The patient can be nursed quite satisfactorily only when she is nursed completely.
Relation Between Ovulation and Menstruation.—Menstruation and ovulation are apparently associated and interdependent, but the exact relation between the two is still obscure and puzzling. It is generally accepted that complete removal of the ovaries stops ovulation and is followed by a cessation of menstruation, and yet cases have been recorded which suggest that these two functions are not invariably correlative.
Evidence of this possible independence is that, although pregnancy must be preceded by ovulation, it has occurred before puberty or after the menopause. And not infrequently pregnancy occurs during lactation, a period when the menstrual function is usually suspended.
It has been claimed by some observers that menstruation has occurred after the complete removal of both ovaries, which would, of course, preclude the possibility of further ovulation. It is possible, however, that in such cases either the ovaries were not entirely removed, though believed to be, or that an accessory ovary existed, since a very small fragment of ovarian tissue will permit the occurrence of ovulation.
As to their chronological relation, information available at present suggests that ovulation occurs about ten or twelve days after the close of the preceding period, and that the corpus luteum formed at the site of the rupture reaches its highest development some ten or twelve days later, and that the degenerative changes in the corpus luteum, in case of non-fertilization of the ovum, give rise to menstruation.
Modifications of Menstruation. Dysmenorrhea is painful menstruation.
Menorrhagia is an abnormally copious menstrual flow.
Amenorrhea is irregularity or, to be exact, suppression of the menses. The suppression may be due to an obliteration of the neck of the uterus, or to an occlusion of the vaginal opening.
Vicarious menstruation is an escape of blood from other parts of the body coincident with menstruation. Blood may ooze through the skin covering the breasts; also from hemorrhoids or from the surface of ulcers. Or there may be nose-bleeding, vomiting of blood or pulmonary hemorrhage, particularly among tuberculous patients. Vicarious menstruation usually occurs among nervous, high-strung women and may be regarded as an evidence of ill health. The amount of blood lost in this way is much less than the amount of the menstrual flow.