Menstruum

“ It is to be observed that in menorrhagia there is much less pain than in the opposite state, namely, deficient menstruation.
DYSMENORRHEA. I next speak of dysmenorrhea, or painful, difficult, or laborious menstruation. This is not only a very common affection, but one of the most painful to which females are subject. Many a woman has spent almost her whole menstrual life with as much pain occurring at each menstrual period, as though labor itself had been passed through. What untold sufferings, alas! are women brought to endure in this disease. ”

“ I have had patients who for months would have a perfectly normal menstrual flow of three to five days to whom a serious mental disturbance always brings a profuse menstruation. The arrest of a woman by mistake just before or at the beginning of her menstrual period will often cause a greatly increased flow and great weakness will follow. Women approaching the menopause already have a tendency to an increased flow though not beyond the bounds of what might be considered normal, and at this time almost any shock will produce profuse menstruation and lead to prostration. ”

“ Tardy and Suppressed Menstruation—Chlorosis—Sudden Check of the Menses. One of the most important of all subjects connected with the health of females, is that of disordered menstruation.
You will find, as you read medical works on Females, the word amenorrhœa, which signifies a partial or total obstruction of the menses in women, from other causes than pregnancy and old age. You will find, also, the words menorrhagia, signifying an immoderate flow of this discharge, and dysmenorrhea, meaning difficult or painful menstruation. ”

“ A female must not forget, however, that she may mistake her condition, and that such mistakes are not at all unlikely to arise from the circumstance that the symptoms which naturally accompany the cessation of menstruation, much resemble those of pregnancy. She passes over the menstrual period;—she is struck with this. Other symptoms are soon manifested; the size increases—the breasts even become swollen and painful—the stomach disordered, and the appetite capricious;—flatulence collects in the intestines ”

“ Menstruation, or the regular periodical discharge of blood from the uterus, is a phenomenon that occurs only in the human race and in some monkeys. The anatomical changes that accompany menstruation have not yet been definitely determined. In some species of monkey—Semnopithecus entellus and Macacus rhesus2—the following changes appear to take place at the menstrual periods: The endometrium first becomes swollen and congested as a result of the growth of the stroma, and increase in the number and size of the blood-vessels. ”

“ Dysmenorrhea, from its Greek derivation, signifies a difficult monthly flow, and is applied to menstruation when that function becomes painful and difficult. Menstruation, like other healthy operations of the body, should be painless, but too frequently it is the case, that discomfort and distress commence twenty-four hours before the flow appears, and continue with increasing pain, sickness at the stomach, and vomiting, until the patient has to take to the bed. When the discharge does occur, speedy relief is sometimes obtained, and the patient suffers no more during that menstrual period. ”

“ Absence of Menstruation—Amenorrhea.—The absence of menstruation after it has been established, does not, as a rule, indicate any disease of the womb or female sexual organs. It is to be regarded merely as a symptom and can be, as previously stated, safely ignored if the general health is good. If the general condition is poor, and the quantity and quality of the blood deficient, it is a provision of nature to suppress menstruation in the interest of the general health. ”

“ Amenorrhœa at the time of the menarche may depend on complete aplasia of the ovaries, associated with a rudimentary and imperfect development of the uterus. In such girls, the development of whose reproductive system is thus imperfect, the continually expected menstrual flow fails to appear, in spite of the fact that a recurrent menstrual discomfort, evoked by the congestion of the genital organs, recurs at intervals of four weeks; as, for instance, colicky pains in the abdomen, irritable, nervous states, and mental disturbances. ”

“ Menstruation, then, commences at puberty and ceases with fecundity, and generally during the period of giving suck. As a general fact, women who experience no menstruation can never bear children.
COMMENCEMENT OF THE MENSTRUAL DISCHARGE. This is usually preceded by more or less disturbance 41of the general system. There may be a general excitement or a depression, or the two in alternation. There is often experienced a sense of weight in the loins, accompanied sometimes by a feeling of tension in the epigastrium, or pit of the stomach, with pain in different parts of the body. ”

“ Morbid and Irregular Menstruation, under the different heads of scantiness, chlorosis, or morbus virginius, retention, partial obstruction, and total suppression. The menstrual eruption is generally and naturally preceded by heat of the loins, and weight about the uterine region, frequently with pain and cholick, lassitude, headach, dulness of vision, disturbed sleep, inappetency, and nausea, pain and load about the breast: all which, with many other troublesome symptoms, usually disappear on the establishment of this salutary and critical evacuation. ”

“ Neglect during menstruation, especially in the young girl, is a frequent cause of subsequent suffering. The effect of menstruation upon the whole system is remarkable. The nervous, vascular, and digestive systems all share in the menstrual function. The usual work of the girl at school or other employment should be altered to suit the altered conditions of her body at the menstrual period. Long school hours and close mental application or active exercise are too often continued at this time. ”

“ Normally, menstruation should proceed naturally and without pain or suffering. When pain or suffering is experienced in connection with menstruation, it is simply because of some lack of health in the general system; and when such general health is restored, the trouble ceases. Painful menstruation is called "dysmenorrhea," and arises from several causes, principal among which are the following: Errors in diet, errors in dress, undue exposure, constipation, lack of proper exercise, or to a contracted or congested condition of the Uterus or the Fallopian Tubes. ”

“ I shall, however, take this opportunity of stating that, as careful investigations have shown, the periodic processes in question are not limited to the uterus and the ovaries, but affect also the external genital organs, which become congested simultaneously with menstruation; and further that the entire feminine organism is affected by an undulatory rhythm of nutrition, the rise and fall of which correspond to menstruation and to the intermenstrual interval, respectively. ”

“ No young girl should feel alarmed if, owing to the negligence of her parents or guardians to prepare her, she is surprised by this first flow from the genital organs. Puberty is the proper time for the appearance of menstruation. This is the periodical development and discharge of an ovule (one or more) by the female, accompanied by the discharge of a fluid, known as menses or catamenia. Menstruation, in general good health, should occur about every twenty-eight days, or once in four weeks. ”

“ Effects of Pregnancy.—Pregnancy appears sometimes to break in upon the disease, and cure it; but it is far oftener true, that females who suffer from dysmenorrhea, are incapable of conceiving. Oftener, in this disease, there is a too scanty flow of the menstrual discharge. Sometimes, however, it commences with little or no discharge, but ends in a very copious gushing forth of the menses, which brings entire relief from the pain. ”

“ Preventive treatment really begins very early. In the chapter on menstruation we referred to the importance of a young woman’s ascertaining the cause of painful menses, in the interest of good obstetrics, since inflammation of the uterine lining or a uterine misplacement might be responsible not only for the dysmenorrhea, but if neglected might, later, be factors in causing interrupted pregnancies. ”

“ These physical disturbances accompanying menstruation vary so widely in different women, and in the same women at different times and under different conditions, that it is not possible to draw a classical picture of the condition. But all of the symptoms above described will persist with more or less severity throughout the entire menstrual life of one woman, while perhaps only one or two of them will occasionally disturb another. Whatever discomfort there may be usually begins from one day to a week before the discharge appears ”

“ THE SEXUAL ORGANS.
The continued use of opium or morphine has a decided effect upon the sexual apparatus. One of the first changes to be noticed in women is scantiness, then irregularity, and finally, total cessation of menstruation. In some cases an occasional period is observed, but as a rule, the stopping is decided and permanent until the habit is abandoned. Occasionally menstruation occurs when a change is made from one preparation to another, or from one mode of administering to another. ”

“ Cessation of Menstruation.—The non-appearance of the catamenia, though a most valuable sign, is by no means a conclusive one, as menstruation may be arrested by diseases of various kinds; while, on the other hand, there are many well-recorded cases of women who have menstruated regularly during the whole period of their pregnancy. There have been also cases in which the menses only occurred during pregnancy; and in a few still more curious cases, women who have never menstruated have been known to have borne several children. ”

“ The organs in proximity to the uterus, partaking as they do of the menstrual congestion, are also markedly affected. There is rectal tenesmus, and on the part of the bladder frequent micturition and dysuria. Remote organs are influenced either directly or by sympathy. The breasts become tumefied and tender. There is flatulence, nausea, or even vomiting. The nervous system, during normal menstruation in a state of erethism, responds readily to the painful impressions, and presents symptoms of the most varied character and degree, amounting even to general convulsions. ”

“ DECLINE OF THE MENSES. The nearer a woman approaches her forty-fifth year (cæteris paribus) , will be the risk of some irregularity in the menses; and as this period is more frequently the one at which any latent disease of the uterus shows itself, it is always looked forward to with much anxiety by women. Indeed, so replete is this time with horrors to many, that we may very justly suspect apprehension to be the cause of some of the distressing symptoms, which sometimes accompany this interesting process of the human uterus. ”

“ In many instances, an apparently normal woman may during menstruation exhibit a mental state so abnormal that we are led to speak of it as a menstrual psychosis. Apart from this, however, it appears that during menstruation the mental life of woman never remains entirely unaffected. Finally, we must mention certain changes in the sense-organs which not infrequently accompany menstruation, such as herpes conjunctivæ, exophthalmos, limitation of the visual field, and swelling of the nasal turbinate bodies. ”

“ In the congestive variety of dysmenorrhea, the menstrual period may be ushered in without pain; after a few hours, the pulse becomes stronger and more rapid, the skin grows hot and dry, the menses stop, there is uneasiness, restlessness, and severe pelvic pains. Evidently, the mucous membranes of the Fallopian tubes and uterus have become congested, and the pain results from the arrest of the functional process, the exudation of blood.
The causes are plethora, exposure to cold, excitement of the emotions or passions, and a morbid condition of the blood. ”

“ Thus it may result from physical exertion among the working classes; and from dancing, skating, riding, or mountaineering, among girls belonging to the well-to-do classes, during menstruation. Again, we meet with it in girls who work very hard at the sewing-machine; and, finally, in those who have long practiced masturbation. Through uncleanliness at the time of menstruation, the blood with which chemise and drawers are stained and the pubic hair soiled, undergoes decomposition, and this may lead to catarrhal inflammation of the vulva and vagina and of the endometrium. ”

“ There ripens in one of these bodies each month a human baby-seed,9 which finds its way to the uterus through the little fallopian tube and is apparently lost in the debris of cells and mucus which, with the accompanying hemorrhage go to make up the menstrual flow. This continues from puberty to menopause, each gland alternatingly ripening its ovum, only to lose it in the periodical phenomenon of menstruation, which is seldom interrupted save by that still more wonderful phenomenon of conception. ”

“ When we call to mind also the close sympathy between the uterine organs and every other part of the system, it shows us how important a proper menstruation is to the general health, because without it those organs must be diseased, and consequently every other part of the system liable to suffer with them. ”

“ When on careful examination no abnormality can be discovered in the reproductive organs, when the bleeding in question recurs at the intervals and in association with the general symptoms to which the woman thus affected has been accustomed during her previous menstruations, and when the amount of blood discharged is not abnormal, it is permissible to conclude that we have to do with a persistence of true menstruation, even though the woman has some time since completed the fifth decennium of her life. ”