MENSTRUATION AND ITS DISEASES. 25 



during its development and enlargement puts the tunica albuginea 

 and peritoneal coat upon the stretch, and thus becomes a source of 

 irritation ; in consequence of which there is an afflux of blood to the 

 parts (that is, to the ovaries, tubes, and uterus), which is discharged 

 into the latter organ ; the vesicle finally ruptures, the irritation is 

 removed, and the flow ceases. This view is supported by Drs. Lee, 

 Gendin, Negrier, Pouchet, Raciborski, and others ; but is denied by 

 Dr. Ritchie and others, who contend that ova may be discharged 

 without menstruation, and the reverse, that the maturation of ova is 

 an effect, and not a cause ; but the whole is yet in a transition state. 

 That the ovaries are concerned seems proved by the fact, that in 

 their absence there is no menstrual flow. The blood that is dis- 

 charged in menstruation is considered by Mad. Boivin to be identical 

 with venous blood, and the opinion is adopted by Prof. Meigs and 

 M. Duges. Although there are many, and the larger number, who 

 look upon it as altered blood, and deficient in fibrin, the first opinion 

 would seem to be supported by the microscopic investigations of M. 

 Donne and others. 



The uterus is congested during menstruation, so are the Fallopian 

 tubes and ovaries ; the vagina is relaxed and distensible, and the os 

 uteri is soft, pulpy, and swollen. All of which conditions disappear 

 when the flow ceases, and the parts return to the normal condition. 



Amenorrhoea. — By this term is understood an absence of the 

 menstrual flow. There are two varieties : eynansio menshmi, when 

 they have never appeared ; and suppressio inensium, when, having 

 once appeared, they have been arrested from any cause. The first 

 may depend upon several causes, viz. : congenital malformation, as 

 absence of the ovaries, uterus, or vagina, closure of the cervix, im- 

 perforate hymen, &c. ; or, it may be dependent upon the health or 

 habits of the patient. The diagnosis is not always easy; if malfor- 

 mation be suspected, recourse must be had to a per vaginam exami- 

 nation, and the defect, if possible, relieved by an operation. If the 

 retention be dependent on constitutional causes, remove them. If 

 the patient is of a full habit, venesection, mild diet, hip-balhs, &c. 

 When the reverse obtains, an opposite plan of treatment must be 

 followed ; tonics, as iron and its preparations, a generous diet, ex- 

 ercise, warm clothing, hip and foot baths, always bearing in mind 

 that the woman is not sick because she does not menstruate, but that 

 she does not menstruate because she is sick, or in other words that 

 amenorrhoea may be merely a symptom of deranged health. 



Siiypressio 7nensiuvi, occurs also in two forms : Acute, when 

 the discharge is arrested during the flow ; as, by cold, em^otions, 

 &c. ; and chronic, where it occurs in consequence of the acute, or 

 from gradual failing of the health, disease of ovaries, and critical 

 period, &c. The most important point in the early treatment is not 

 to confound the disease with pregnancy. In the acute form, if there 



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