With those who are sufferers the underlying causes are various, and demonstrate the important role which the reproductive organs play, not alone in the propagation. of species, but in the experiences of daily life.
One hundred and twelve cases of dys menorrhoea examined. One of the most striking points is the very large num ber of sterile women; 44, or a fraction less than 40 per cent., belong to this class. Of those who had been pregnant, 12 had never had a child at full tern); 15 more had had a miscarriage since the last full-term child was born, leaving less than 37 per cent. of the total num ber whose last pregnancy had come to full term. These figures would seem to indicate that, in a large proportion of patients suffering from dysmenorrhoea, there were present lesions which also interfered with conception. One hun dred out of the 112 suffering from pain ful menstruation were found to have some marked organic lesion of the pelvic organs. William S. Gardner (Atlanta Med. and Surg. Jour., Dec., '95).
The causes may be classified as follows, viz.: heredity, disease, occupation, and trauma.
1. Heredity. With many women the defects in the structure of the reproduct ive organs are congenital and necessitate dysmenorrhoea.
Uterine dysmenorrhoea is caused by a malformation of the uterus, due to want of proper development. To this are added the thickening of the mucous membrane and congestion at the time of the menstrual flow. The bend, plus the thickening of the mucons membrane and congestion, is the cause of the pain. On examination, anteflexion of the uterus is almost certain to be found. Keith (Brit. Gyn. Jour., Nov., '97).
Inflammatory diseases of the ovaries and the Fallopian tubes and adhesive de formities of the uterus are at times the causes of dysmenorrhcea. In 100 of Kelly's operations on tubes and ovaries the appendix was found adherent in 21 cases, and in 7 it required removal. Out of 58 personal cases in which inflamma tory appendages had to be removed, the appendix showed enough evidence of dis ease to justify rentoval in 20 cases. In 9 of these the adhesions between the ap pendix and the right appendage were very intimate. A. MacLaren (Amer. Gyneec. and Obstet. Jour., July, 1900).
It does not avail that the remainder of the physical organization is normally developed; indeed, one frequently sees women of the finest physique and superb presence whose incomplete pelvic appa ratus condemns them to semi-invalidism during a considerable portion of each month.
On the other hand, puny, delicate women with normally-developed pelvic organs suffer with dysmenorrhcea on ac count of their perverted general nutri tion, their flabby muscular system, and their low-ebb vitality, to which the re curring monthly congestion brings a strain which they are ill fitted to bear.
The defective organization may in clude any portion of the genital appara tus; in the vulva it may take the form of an impermeable hymen, producing an absolute barrier to the discharge of im prisoned blood; in the vagina it may consist of bands and septa with almost equal obstruction to the outflow of the menstrual fluid; in the uterus it may be an almost-impervious cervical canal, an occluded os internum or externum, less frequently a rudimentary corpus uteri or one with its two halves uncoaleseed or its canal obliterated; in the tubes or ovaries the structure may be rudiment ary or the seat of some form of con genital d sense.
Steno.is may he due to swelling of the mucous membrane occurring only at the time of menstruation, and consequently impossible to diagnose at other times. Treub (Centralb. f. Gyniik., July 17, '97).
Dysitienorrinea should be divided into dysmenorrhceal endometritis and uterine spasm. The first includes all forms in which there is any local mechanical ob stacle; all other eases are uterine spasm, which affects the sphincter of the uterus, —that is, the cervix. Of 107 patients observed, 37 complained of painful men struation. In 32 a local cause was dis covered, but in the 5 others, virgins, the affection was spasmodic. Besides there were 21 who had manifest stenosis without painful menstruation. Among these subjected to curetting there were 17 with dysmenorrlicea, but only 1 had marked stenosis. Of these last, 8 were completely cured by curetting; of the 9 others, 7 returned with a relapse of their old trouble, and 2 received absolutely no relief. De Leon (Centralb. f. Gynitk., July 17, '97).