Southern Medical and Surgical Journal - Georgia Regents University

412 Healthy and Morbid Menstruation, [J^^y*limate physiological connexion between the ovaries and thefunction ot" menstruation, 1 have not often been able to trace,clinically speaking, menonhagia to such disease, unacconi))aniedby uterine lesions. At the same time, it is quite possiblethat the irritable state of the ovaries, which inflammatorydisease of theuierus so very frequently induces, may re-actonthe menstrual function, and contiibute to exaggerate and pervertit. In these cases, however, the uterine lesion is generallyaccording to my experience, the primary and principal causeof the nienorrhagia ; on its removal the ovarian irritation disappearingalong with the menorrhagia.Menorrhagia at the Dawn and Close of Mensti^uation.—Menorrhagiais occasionally met with at the dawn and close ofmenstruation, from mere uterine congestion, apart from anylocal inflammatory disease.Thus, the first manifestation of the menses may be characterizedby a severe attack of hcemorrhage, the subsequentperiods being physiological ; or the menses may continueto appear haemorrhagically at irregular intervals for severalmonths. This latter type of menorrhagia, however, is muchless frequently met with than the first. When, also, the mensesare about to cease definitively, and become physiologicallyirregular, profuse menstruation, amounting: to flooding, is notunusual, as a result of mere congestion. Thus the menses willdisapr>ear for two or more months, and then return with excessiveabundance. It is very seldom, however, even at thisperiod of life, that ha3m.orrhagic menstrual fluxes occur frequently,and assume a continued character, in the absence oftumours or malignant disease, unless there be inflammatory ulcerationof the cervix. In nearly all the instances of very obstinatehaemorrhage at the change of life which I meet with, Ifind, on examination, that the congestion and hcemorrhage arekept up by inflammatory and ulcerative disease. Indeed someof the very worst instances of protracted and severe hiemorrhagethat I have ever seen, have been cases of this description ;and what satisfactorily proves that the inflammatory affectionis the cause of the continued haemorrhage is, that when it iscured the haemorrhage generally ceases. This is not, however,invariably the case. I have occasionally met with females atthe critical period of life, in whom haemorrhage obstinatelypersisted after the removal of the inflammatory and ulcerativedisease of the cervix, which had probably in the first instancegiven rise to it. In several of these cases, however, time ordilatation of the cervix has subsequently proved that the haemorrhagedid not pi-oceed from a sound uterus, but was connectedwith the presence of a polypus, or of a fibrous tumour, so smalland obscurely situated as not to have been recognized at first.