Painful menstruation often co-exists witb acute anteflexion of the uterus. The cla.ss of patients who suffer from this type of disease are usually, if mar ried, sterile, and the supervention of pregnancy often effects a cure. Williams (lirit. Med. Jour., Oct. 24, '97).
Membranous dysmenorrlicea has no connection with pregnancy or abortion, is not productive of sterility, and can become cured spontaneously. The fibri nous membranes are to be regarded as true dysmenorrhceic membranes, and are not dependent upon an inflamtnation of the uterine mucosa. Fibrinous mem branes are the product of necrosis orig inating in litemorrhage and transudation. Kollmann (Wiener klin. Rund.. Apr. 29, 1900).
In all cases thus connected with he redity, defective organization, etc., recur ring monthly congestion produces ten sion in poorly-conditioned structures, and, if the tension in the vessels is suffi cient to result in transudation of their contents, the outlet being imperfect or wanting, pain will be the inevitable result.
2. Disease. Disease of one kind or an other may cause dysmenorrhcea, whether the disease occurs before or after puberty. Before puberty there are many forms of disease which arrest the development of the pelvic organs and result in dysmenor rhoea. The exanthemata seem to be es pecially productive of this effect. Why this should follow has not been satisfac torily explained. Measles, scarlet fever, small-pox, all have their victims in whom such a result has been observed.
Of the diseases subsequent to puberty which produce dysmenorrhoea there are those which are local and others which are general. Of the former may be men tioned fibroid tumors either within the uterine canal, in its muscular substance, or within its peritoneum, and inflamma tory disease of the tubes of the ovaries or of the pelvic peritoneum. All these diseases may, by their obstructive effect, prevent free discharge of blood during the menstrual epoch, and produce pain. Of the general diseases may be men tioned typhoid fever, certain diseases of the liver and gall-bladder, anzemia, etc.
The same result is often seen in cases in which there is excessive development of fat. Women who become very obese are very frequently sufferers from dys menorrhoea.
3. Occupation. Some occupations are especially prone to result in rhoea. Those who work in a very hot mosphere, like cooks and laundresses; those who are constantly exposed to cold and dampness, like fishwives or workers in rnines (unwomanly occupations); those who work in poisonous substances, —copper, arsenic, lead, phosphorus, and sulphur; those who are confined for long hours in factories, stores, and ment-house "sweat-shops" are, in many instances, sufferers with dysmenorrhoea. [it is a pity that civilization, which lifts done so much to ameliorate many physical evils, has also brought in its wake many others. The field for 'Milan thropy and preventive medicine, in this direction, is a very wide one, and legis lation has yet much to do in emanci pating women from such distressing, ex perience. A. F. CURRIER.] 4. Trauma. Dysmenorrhoea from this cause is, in most cases, the result of diffi cult parturition, the genital organs sus taining severe injuries and cicatrization and contraction ensuing. The hardened tissues are amumic and the necessary elimination of blood is accomplished with difficulty and pain. Occasionally there are direct injuries to the genital organs, apart from parturition, which also produce deterioration of the tissues of those organs, and are likewise followed by painful menstruation.
Prognosis.—The prognosis in dys menorrhoea varies with the conditions and varies also with the treatment. If it depends upon structural defects, and those defects are remediable, a cure will result. It sometimes persists during the whole menstrual life, but with many women it gradually becomes tolerable, as all ills which are long endured become tolerable.
With regard to prognosis much will depend upon the general condition of the subject, great improvement in that direction often leading to menstruation, which is less painful or not painful at all. The prognosis in cases in which drug treatment alone is used is very uncertain; while such treatment is proper enough simply as a means of relieving or be numbing pain, it has nothing more than a temporary and palliative effect when the pain is due to an anatomical fault or defect.