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Disorders of the Monthly Illness Menstruation

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Absence of' the Monthly Illness (A m e n or r hcea). —Strictly speaking, the term amen orrhcea, meaning want of the monthly discharge, is only applied to those cases where the monthly illness has never appeared at any time. It is, however, also applied to cases in which the monthly illness has been present, but has after a time disappeared. This latter condition is more correctly termed suppression of men struation.

It is necessary to notice this distinction, for, if a girl has reached the age when the illness might be expected, and it has not appeared, it is sometimes necessary to assure one's self that the non-appearance is not due to some obstacle to the escape of the discharge externally, the ill ness actually occurring, but the discharge being retained.

Absence of the Illness through Retention. —In the virgin condition there is a membrane, called the hymen, which stretches across the lower end of the genital passage. The mem brane is, as a rule, not complete, a small opening existing in the centre, through which discharges from the womb escape. But in some cases, not frequent, the membrane is com plete, and thus no discharge can escape. The obstruction may exist at the mouth of the womb itself. In such cases the symptoms of the monthly illness appear without discharge. At regular intervals pains in the back and sides occur, and with each return they increase in severity. The patient has a feeling of weight, and grows pale and sallow. The retained dis charge, accumulating from month to month, causes the belly to enlarge and a tumour to appear, which undergoes regular monthly in crease. The girl': friends, putting the absence of discharge and the enlargement of the abdo men together, suspect pregnancy, and many an innocent girl has thus come under unmerited rebuke.

It is even possible for such an obstruction to occur in some part of the womb or passage after the illness had become established, and this must always be borne in mind.

This condition is remedied by surgical inter ference, opening a way for the retained dis charge to escape. Such cases are, however, always attended with risk.

Complete absence of monthly illness may also be due to some arrest of development of the genital organs. There are thus cases in which the ovaries or womb have been absent, or present in an undeveloped condition. In ab sence of the ovaries the girl does not exhibit the changes in form from girlhood to woman hood. The breasts remain small and the hips

narrow, the voice is manly and harsh, and the appearance becomes masculine.

Absence of the Illness through Suppres sion, that is after the illness had become more or less regular, may arise from a variety of causes. It may depend upon a condition of general health or a poor quality of blood (see ANAMIA, p. 313). The feeble condition of general health is often the result of over-work, over-pressure at school, improper quantity or quality of food, want of fresh air, confinement in the bad atmosphere of a crowded work-room, or of some acute disease, &c. The opposite condition of too full-bloodedness may also produce suppres sion of the illness. Disease is another cause, and especially consumptive disease of the lungs, dis ease of the kidneys, and digestive and nervous disorders. Emotion, fright, or grief sometimes occasions the disturbance. The illness may be suddenly arrested by cold.

The absence from failure of general health is sufficiently evidenced by the paleness of the patient. She is wanting in energy, listless and languid. These cases are readily enough sepa rated from those due to cold or full-bloodedness.

The treatment is regulated by the cause. It is sufficient to state the kind of treatment need ful in the variety dependent on the general health, and that due to sudden suppression owing to cold, &c. •It includes good nourishing food of a plain kind, containing a fair proportion of animal food, sweet milk, eggs, fish, fowl, beef, soups, &c. The bowels must be kept regular, a saline medicine, such as seidlitz, Hunyadi Janos mineral water, or the effervescing citrated magnesia being given, if required. Especially. is it necessary to insist upon abundance of life in the open air, and moderate exercise. While over work is extremely hurtful, the absence of some bodily or mental occupation is also injurious. Change of air and sea-bathing are strongly advised, and, to those who can afford it, a visit to some of the Continental spas is recommended, especially Kissingen in Bavaria, Kreuznach in Rhenish Prussia, Schwalbach in Nassau, Spa iu Belgium, Bourboule in France. In England Woodhall Spa, in Lincolnshire, is re commended. Much standing, stooping, or pro longed sitting is to be avoided. As to medicines it is impossible to state what suits every case, but tonics belong to the kind required. Iron and arsenic are particularly valuable.

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