LESION OF GENITO-URINARY ORGANS. —Any lesion of the genital apparatus may cause amenorrhoea, especially me tritis, endometritis, and parametritis (both acute and chronic), and flexion or malposition of the uterus. Adhesion due to a previous pelvic peritonitis is an occasional cause of hyperinvolution of the uterus following pregnancy. At rophy of the ovaries, senile atrophy fol lowing pregnancy, and cystic ovarian de generation are among the less common etiological factors. A most complete examination of the pelvic organs should be made, if necessary, under ether in such cases.
If menstruation does not appear at the age of puberty, a careful scrutiny on the part of the physician is obligatory and imperative. Case of a young woman, 24 years of age, in whom the amenorrhoea was of organic origin. A dermoid and a suppurating multilocular cyst were found and removed. Report of the pa thologist harmonizes with the theory of the ease both from physiological and pathological stand-points: 1. That the dermoid had usurped the place and de stroyed the function of the right ovary.
2. In one of the cyst-walls of the mul tilocular ovarian cyst was found a shrunken ovary the size of a large lima bean, and within this ovarian stroma, was found a corpus luteum spurium. To the presence of this ovarian stroma was due the womanly development, with ovulation and the futile effort of men struation and its consequent suffering..
3. The ease demonstrates the possibility of ovulation without menstruation. 4. It leaves doubt whether the absence of the oviducts was primary or secondary to the grave disease of the ovaries, with the possibility that they were congeni tally absent. 5. It presents the rare and exceptional condition of a perfectly de veloped woman who had an ovary and a uterus, who ovulated, was sterile, and never menstruated, and yet was ruined in health by Nature's effort to establish an impossible normal function. W. B. Chase (Amer. Jour. of Obstet. and Dis. Women and Children, Oct., 'OS).
Exposure to cold during menstruation, by inducing congestion of the pelvic or gans, is one of the most active exciting causes, especially when supplemented by a local chronic disorder.
The most important condition with which this disorder might be confounded is pregnancy. The reader is referred to the article under that head.
Case of a healthy girl, aged 15, who had been subject for a year to gradmA swelling of the abdomen. The period had ceased for two months only. The breasts became hard and tense. The hymen was intact. Peritonitis of tuber culous origin suspected. On opening the abdomen an enormous cyst, which con tained t.\\ enty pints of lluid, discovered. Its pedicie was twisted and had risen in the parovarium. On the day after the operation the catamenia reappeared and the abdon.en soon resumed its normal form. Cortiquera (Anales de Obst., Gine.,
y Pcd., Jan., '96).
Pathology. — A pathological identity can hardly be attributed to amenorrhcea, owing to its complex causes, the diverse physiological conditions peculiar to the cases, and the diathetic conditions that may be present. The fact that the true nature of menstruation itself is not known adds another objection; and it may safely he said that the pathology of amenorrhcea is that of the diseases causing it, until the local disorders brought about by each will have been determined. The following extracts are given to indicate the present trend of thought regarding the cause of menstru ation.
Blood-pressure varies greatest at the commencement of menstruation, least im mediately after; remains about the same height seventeen days, when it again begins to rise. Derangement of this cycle leads to various pathological phenomena. A. W. Johnstone (Amer. Jour. of Obstet., Slay, '95).
Evidence recently furnished by Heape justifying opinion that ovulation is not the cause of menstruation. We should not speak of menstruation as occurring once a month, but as occupying a whole month. Lawson Tait (Provincial Sled. Jour., Jan. 1, '95).
All evidence favors the theory that ovulation and menstruation are inde pendent; ovulation in a modified form continues during pregnancy. Byron Robinson (Amer. Gyn. and Obst. Jour., Aug., '95).
Study of over three thousand cases showing that earlier menstruation in tropical countries is not due to climate, but to too early sexual excitement. Jou bert (Indian Sled. Gazette, Apr., '95).
Diagnosis. — Primary amenorrhoea that is, total absence of menstruation— is usually due, as already stated, to the absence of one or more of the organs of generation. It must be distinguished from retention of the menses, clue to atresia of the cervical canal, of the va ° or of the vulva. In the latter case no menstruation has existed, but the general premonitory symptoms of men struation have occurred, though followed by no menstrual flow. Cases in which one or more of the organs are absent are not very infrequent, while cases of imperforate hymen are comparatively common.
Prognosis. — Amenorrhoea due to ab sence of any of the organs is, of course, incurable. The same may be said of eases in which the approach of meno pause or other conditions pointing to senility of the uterus. Although amen orrhcea, when due to a serious chronic disease, is usually cured with difficulty, hope may always be entertained when the causative disorder is not in itself a fatal one. Return of the menstruation in any chronic disorder, when the blood presents its normal appearance, is an encouraging sign.
[The prognosis of secondary atrophy with amenorrhoea depends greatly on the condition of the ovaries, and is practi cally hopeless if they are atrophied.