Dysmenorrhea in Girls.

Marie Tobler has investigated 700 cases of dysmenorrhea in Frankfort. In Tobler's series the symptom was primary in 234 patients. By primary dysmenorrhea painful menstruation beginning when the catamenia are first established is understood. Secondary dysmenorrhea, beginning later, was present in 466 of Tobler's cases, 322 being girls and 144 married women.

He concludes:

(1) the distinction between the primary and secondary form in multipart is important; the latter is distinctly the more frequent.

(2) Both forms are markedly frequent in nulliparous girls with constitutional disorders, such as chlorosis; in others where the establishment of the catamenia is retarded; in others where the patient's vocation is exhausting or unhealthy; and in others with constipation, indicating impaired function of the alimentary canal.

(3) Menorrhagia is the rule in girls with secondary dysmenorrhea.

(4) The dysmenorrhea of young girls is markedly premenstrual, with its climax during the first hours of the show of blood. The pain is not of the labor type, but continual, and often associated with general malaise.

(5) The genital tract does not show any lesion sufficient to explain the source of pain.

(6) The fact that dysmenorrhea in young girls is so often secondary does not support the theory of purely mechanical agencies (stenoses, flexions) as its cause.

(7) Neither the circumstances of the patient's life nor her clinical history can in the great majority of cases justify the theory that the origin of dysmenorrhea lies in the nervous system.

(8) The majority of cases of dysmenorrhea in young girls appears undoubtedly due to disturbances in the pelvic circulation. Passive hyperemia is a common result of faulty nutrition, hygiene, and clothing; it is increased during the periods, so that very active hyperemia results. As the elastic elements of the uterus are not rarely ill developed in youth, these disorders of the pelvic circulation entail stretching and compression of nerves.

(9) Tobler believes that the principal seat of the pain lies in the subperitoneal connective tissue, where the vessels and nerves are most exposed to pressure.

(10) Clinical observation and the results of treatment favor this theory.

(11) In contradistinction to the morbid conditions associated with dysmenorrhea in young girls, painful menstruation in married and parous women is often observed in patients where distinct morbid changes in the genital tract exist.

Still, Tobler is uncertain how far such changes can be looked upon as the cause of the dysmenorrhea, and disturbances in the pelvic circulation may be, after all, the true agents in the establishment of the pain.—British Mod. Jour.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.