CHAPTER V.
Mismenstruation.
AMENORRHŒA.
The first variety of cases of amenorrhœa are those where no menstrual fluid has ever been secreted. All girls, as we have seen, do not menstruate at fifteen years, as all children do not cut their first teeth at seven months, and in either case there may be no disease. But when a female has reached adult life, when her frame has assumed the character of womanhood, when she is not chlorotic, and when all her organs (save the sexual) perform their functions naturally, then a cause of the absence of the flux should be looked for. Menstruation may be absent from congenital malformation. The ovaries may be wanting, or if present may be atrophied or diseased; perhaps they present scarcely a trace of a Graafian vesicle; or these glands can exist and the uterus be absent or imperfect; or there may not be found a trace of a vagina. In the second variety of amenorrhœa there has been a secretion of the menses but no evacuation of them. This may be because there is an occlusion of the vagina, or the os uteri may be imperforate. When the os is closed by a membrane, the structure may be incised with the bistoury, or perhaps be ruptured by the uterine sound.
The third variety is the most common form of amenorrhœa, viz: that in which the flux having been properly established and appearing regularly for a time, has been prematurely arrested. But it may be said of amenorrhœa in its various forms, that it is not so much a disease as a symptom of disease; a consequence of either individual organization, disorder of the uterus or ovaries, or of some other organ or organs sufficiently important to affect the constitution.
Hence all the means that restore the system to health, medicinal and hygienic, may be recommended as tending to cure the complaint, and hence we have to inquire whether there is serious disease in any of the organs when the question of pregnancy arises, on account of the disappearance of the menses.
It is always necessary in treating amenorrhœa to consider the cause of it, and we should know that it may come from torpitude of the secernent vessels of the uterus, produced by anxiety of mind, cold, or suddenly suppressed perspiration; falls, especially when accompanied with terror; or a general inertness and flaccidity of the system, and more particularly of the ovaries. (F. 172, 173).
DYSMENORRHŒA.
There are few women who pass through the whole period of sexual vigor without having more or less frequently to endure an attack of dysmenorrhœa. Some few females experience great pain with each flow, from puberty to the change of life, while in others pain is only an exceptional accompaniment. With some women marriage effects a cure, while in others it either aggravates or originates dysmenorrhœa. Three distinct varieties of dysmenorrhœa have to be considered: the neuralgic, the congestive, and the mechanical.
The variety which is called NEURALGIC DYSMENORRHŒA is more frequent in unmarried females; and if married, in those that have not borne children; and most frequently affects those of a nervous temperament, and of a thin, delicate habit. The paroxysms present all the characteristics of neuralgia. For a time before the catamenia appear there is a sense of general uneasiness, a deep-seated feeling of cold and headache, sometimes alternating with pain in the back and lower part of the abdomen, perhaps extending down the thighs.
The flux comes on sometimes slowly and scantily, or in some cases in slight gushes. The discharge may be paler than natural, and may be mixed with slight clots. In some cases there is a membrane of plastic lymph discharged either in shreds, or in the form of the uterine cavity that it has lined. Conception is rare under such circumstances.