In other instances painful menstruation is accompanied by no diminution, but perhaps by excess of the catamenia, and may be connected with hiemor rhoids, loaded bowels, &c., or with other diseases of the uterus, irritability, tenderness. fibrous tumors, tie. Sometimes coagula are discharged in place of the ordinary fluid, or it is mixed with membranous shreds. We have no knowledge of the pathological causes of these states, and must be content with the explanation which disordered function conveys.
I think we must be cautious in admitting the possibility of a contracted state of the orifice as a cause of dysmenorrhcea. Dilatation at all eventa constantly fails in relieving it.
§ 2. ifenorrhagia.—This term does not include occasional hemorrhage, but must be restricted to the undue persistence and the too frequent recurrence of regular menstruation. It is most commonly dependent on some general state of system ; rarely produced by plethora, it is much more frequently due to im poverished blood : hence it is seen in disease of the kidney or in general debility, increasing the anEemia which accompanies these conditions.
Sometimes it is the consequence of undue excitement of the sexual organs : and it is not an uncommon consequence of the imperfect return of the uterus to its normal state after tedious labor or miscarriage.
Occasionally hemorrhage very closely resembles menorrhagia when it comes on at regular intervals, and these are determined by the congestion or whatever else it is that gives rise to the monthly return of the menses ; but hemorrhage means something more than mere excess of the natural flux. It is associated either with destruction of surface, or with polypous or fibrous growth, or with irregular position of the placenta in pregnancy ; some times it appears during the early periods of pregnancy, simulating irregular rather than excessive menstruation: in all cases, sooner or later, hemorrhage ceases to wear the aspect of regularity, and its irregular appearance is the best indication that it is not menorrhagia.
§ 3. Leucorrhcea.—This disorder is nothing more than an ex cessive secretion of the natural mucus which lubricates the passage. Attempts have been made by discriminating the especial charac ters of the secretion, to determine whether it comes from the uterus or the vagina. These facts may be interesting as curious pathological researches, but they are of no value in practice : whatever restores the tone of the gstem at large, and along with that gives a healthy character to e mucous lining of the gene rative organs, relieves leucorrhcea ; local remedies may aid in its removal, but alone, though they check it for a time, they leave the cause of the disorder untouched. It is not a true catarrh, and
this it is which best distinguishes it from gonorrhoea : the latter begins with irritation of the vagina, and possibly of the urethra, causing painful micturition ; this is soon followed by a copious secretion of thick puriform matter, which gradually assumes the character of a thin discharge, and cannot be distinguished from leucorrhcea : it is the history alone that enables us to distinguish in cases of long standing between the one disorder and the other.
In children true catarrh of the vagina, vaginitis as it is called, is not uncommon. It attacks the very same individuals who are from cachexia liable to ulcerations of the mouth, to excessive im petiginous eruptions with copious purulent discharges; and like them is manifestly constitutional. It has often given rise to un founded suspicions and charges of crime, but there ought not to be any doubt in a medico-legal point of view, because of the absence of bruises or local injury ; there are no signs of inflam mation present except a degree of soreness or irritation of the surrounding skin from the purulent secretion lodging upon it. It may be dependent on the presence of asearides.
Whenever vaginal discharge is spoken of, we ought to ascertain whether it be at all offensive, because it may be induced by cancerous disease: if blood tinged at other than the monthly periods, it is not improbable that it is de pendent on commencing scirrhus.
Lencorrhaa is so uniformly connected with causes independent of the uterus itself, that its associations demand general investigation much more than its amount or its other peculiarities. it is found with an anemic state, with a Hobby and relaxed habit, or with a condition of the rectum which excites irritation of the uterus or vagina. Upon a correct knowledge of these rela tions depends the successful treatment of the disease, and, on the other hand, its existence serves to point out the actual condition of a patient who may be seeking relief for other disorders, or explains some derangement of health which might otherwise be misunderstood.