Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    88/332 (page 68)
    (a) Congestive or Pre-menstrual; (b) Membranous; (c) Spasmodic. The so-called gouty and rheumatic forms of dysmenorrhea are really inflammatory in nature and may be included in the first variety. With our present knowledge of the ripening and rupture of the Graafian follicles it seems inadvisable to add an ovarian dysmenorrhea to the list. There is every reason to suppose that the ovary may be attacked by neuralgia as are other organs; this is, however, quite independent of menstruation. (ci) Congestive or Pre-menstrual Dysmenorrhea. The latter of these two is perhaps a novel term, but it seems suitable in that it expresses the time at which pain usually occurs in this class of case—viz., chiefly before the onset of the flow : it includes the congestive and inflammatory varieties of most authors. The pathological causes which may lead to this variety of dys- menorrhcea are: (1) Pelvic inflammations (para- and perimetritis) ; (2) Metritis; (3) Presence of a fibroid in the uterine wall or projecting into its cavity ■ (4) Retroflexion and retroversion, under certain condi- tions ; (5) Certain cardiac and hepatic affections. The influence of pelvic inflammation will be most clearly shown by the history of a case. A patient, menstruating up to the present time normally and painlessly, owing to a chill is attacked by slight local pelvic peritonitis (perimetritis). The acute symp- toms subside under treatment, but adhesions have formed which tend in various degrees to displace the hitherto normally situated uterus, ovaries and tubes. The uterus may be bound down in a state of retroversion or retroflexion, the circulation in the broad ligaments interfered with, the tube twisted in various ways, and the fimbriated end become adherent to the surface of the ovary. This latter organ also may lose its mobility and become more or less firmly fixed in the pelvis. Should a repetition of the pelvic peritonitis occur, which is not unlikely, the above pathological condition is aggravated. . Given that during menstruation enlargement from increased vascularity of the pelvic organs occurs, it can easily be understood how the presence of these adhesions will alter the circulation ot