By the effusion of blood from the rent ovary into the peritoneum 442 ON UTERINE AND OVARIAN INFLAMMATION, AND ON DISEASES OF MENSTRUATION. INTRODUCTION. THE dark ages of uterine pathology extend to 1816, when, by showing the possibility of an ocular examination of the womb, and urging the frequent necessity of doing so, Recamier enabled his disciples to apply to diseases of that organ the recognised sound principles of general pathology. All the works that were written on inflammation of the reproductive organs previous to that period are now almost useless, possessing merely an historical interest, like the uncouth Byzantine pictures which figure in our galleries. There can be no worthier representative of the old school of pathology than Sir C. M. Clarke, and he, although writing in 1821, and treating of uterine discharges at great length, has only twelve very unsatisfactory pages on inflammation of the uterine mucous membrane. Those who followed in the path opened by Recamier in 1816 have necessarily derived precision by adding ocular demonstration to the previously known methods of investigating the diseases of women. the dark ages of gynecology, diseases of menstruation divide the whole of female pathology, whereas ocular investigation has taught us how many different organic lesions determine diseases of menstruation, and reduced to extremely limited size the chapters on Amenorrhoea, Dysmenorrhoea, &c. &c. In It will be sufficient to pass in review the received meaning of these traditional terms to see that inflammation, and the results of inflammation of the womb and of the B ovaries, figure largely in what is understood by AMENORRHOEA, DYSMENORRHEA, MENORRHAGIA, LEUCORRHEA, and HYSTERIA. Thus I find that AMENORRHOEA either impliesAbsence of organs of ovulation, their destruction, their chlorotic arrest of development; Sub-acute or acute ovaritis; Or it may represent the inflammation, or the obliteration, of the Fallopian tubes; Undersized womb; Inflammation of the womb; Its induration-J. P. Frank; Retroversion of the womb-Dr. Rigby; Morbid stricture, or obliteration of the neck of the womb; Ulceration of the neck of the womb-Dr. H. Bennet ; Or the organs of reproduction may be perfect, but, under the influence of various acute and chronic diseases, the menstrual flow may be impeded or suppressed. DYSMENORRHOEA either indicates An undersized womb; Deviations of the womb; Inflammation of its body, or of the inner surface, with or without false membranes ; Stricture of the neck of the womb; Its induration; Ulceration of the neck of the womb in nearly all extreme cases-Dr. H. Bennet ; Cancerous affections of the neck of the womb; Coarctation of the vagina; And constitutional diseases, such as a rheumatic or gouty habit-Dr. Rigby; Sub-acute ovaritis; Pelvi-peritonitis; Tubal inflammation and partial obstruction, with flow of blood into the peritonæum ; A neuralgic ovarian affection. MENORRHAGIA represents either Uterine catarrh and internal metritis ; Cancerous affection of the womb; Ulceration of the neck of the womb in nearly all cases Dr. H. Bennet; Displacements of the womb; Irritable uterus; Sub-acute ovaritis; A neuralgic affection of the ovaries. Chronic catarrh of the Fallopian tubes-Rokitansky; Hyper-secretion of the mucous follicles of the neck of the womb in most cases; Ulceration of the neck of the womb in most cases-Dr. H. Bennet; Various inflammations of the vagina or external organs in most cases-Lisfranc; Thus the same terms have been made to express very different morbid conditions. In With imperfect notions of the physiology of menstruation and of the diseases of the reproductive organs, our forefathers did right in grouping facts round the most salient morbid phenomena of menstruation, for it is the keystone of the pathology of women, and I maintain that the only way to well understand their diseases is to institute a comprehensive analysis of the varied phenomena of this function. my last edition, I studied separately each of these phenomena, showing the transformation of each healthy symptom into a diseased one, and again tracing this same morbid symptom amongst those of healthy or diseased pregnancy and lactation, or amongst those of inflammatory and other affections of the reproductive organs, thus finding the prototype of most diseases of women in the performance of a healthy function, just as Lelut, in his work on the Demon of Socrates, has shown that there is a healthy type and origin for the chief forms of mental alienation. The words AMENORRHEA, DYSMENORRHEA, MENORRHAGIA, and LEUCORRHEA, then, cannot be received as meaning substantive diseases, because vague and injudicious treatment would spring from vague and general terms. Such words can only be applied in an adjectival sense to point out the different morbid conditions of the organs of generation which produce in so many different ways the diseases of menstruation. This is no idle question of words, for any practitioner |