ABSENCE OF MENSTRUATION--AMENORRHEA.--The absence of menstruation after it has been established, does not, as a rule, indicate any disease of the womb or female s.e.xual organs. It is to be regarded merely as a symptom and can be, as previously stated, safely ignored if the general health is good. If the general condition is poor, and the quant.i.ty and quality of the blood deficient, it is a provision of nature to suppress menstruation in the interest of the general health. For this reason it is safe to disregard the amenorrhea and build up the bodily strength.

This explains why some girls pa.s.s the usual age of p.u.b.erty and show no signs of menstruating. They are poorly developed s.e.xually, through deficiency of blood. If, on the other hand, a girl should have all the symptoms of menstruation every month, but no flow, she should be examined by a physician to determine if there is any obstruction to the escape of blood. Total absence of any symptoms of menstruation extending into adult life, may indicate an absence of the s.e.xual organs. During the first year after p.u.b.erty it is quite natural for menstruation to be irregular; after the function is thoroughly established there are many causes that may be responsible for its temporary absence.

CAUSES OF AMENORRHEA.--Any condition or circ.u.mstance which reduces the general health or impoverishes the quality or quant.i.ty of the blood and weakens the nervous system, will result in a stoppage of the monthly periods. Among these are insufficient food and exercise, overwork, overstudy, exposure to cold, sitting on cold steps or gold ground, wearing damp clothes, bathing in cold water at the beginning of menstruation, powerful emotions, as great fright, anger, anxiety; acute diseases, such as typhoid fever, cholera, the infectious skin diseases; chronic diseases such as Bright's disease, heart disease, consumption; anemia and chlorosis are very common causes. Obesity or an overfat condition will cause an early suppression of the menses which may result in a fruitless marriage. Displacement of the womb and other local disorders frequently result in scanty or delayed menstruation. Anxiety lest pregnancy may occur in the newly married may cause a delay in the periods. A radical change of climate or sometimes a visit to the country, or changed circ.u.mstances may stop the flow for the time being.

TREATMENT.--The treatment of amenorrhea, or absence of menstruation, will depend on the underlying cause. A careful investigation should be made into the mode of life and the hygienic surroundings of the patient.

Her general health and her mental condition should be inquired into. If the patient is not in good health, or is not obtaining exercise in the open air, or if she is a victim of mental worry or of domestic unhappiness, or if any sufficient cause exists for the amenorrhea it must be removed before any treatment may be expected to relieve the condition. If the patient is a married woman the possibility of pregnancy should always be borne in mind, and no radical treatment inst.i.tuted until this has been excluded. If the absence of menstruation is dependent upon defective development of the s.e.xual organs we cannot expect much from any treatment. The amenorrhea from exhaustive diseases will usually correct itself with, or soon after, the establishment of convalescence. In diseases which tend to death, as in consumption, heart disease, etc., the function is never reestablished. A very common habit of most people is to regard the absence of the monthly periods as the cause of their ill health. It is not, it is the result of the ill health. Get rid of the bad health and the menses will take care of themselves. That form of amenorrhea which is the result of change of climate or surroundings will regulate itself as soon as the victim becomes acclimated or reconciled to the change, or returns home if the visit is of brief duration.

As a general routine treatment, good wholesome food, regular hours, fresh air, sunlight, and judicious exercise, with such other measures as may be suggested by the condition of the blood and nervous system, are the indications in the way of treatment. Anemia and chlorosis (poor blood) should be treated by the administration of iron in some form.

Obesity should be reduced by diet, exercise, and such other treatment as may be found efficient and not detrimental to health. Overwork, mental and physical, should be stopped, and sedentary habits changed to a more active out-door life. The acute suppression from exposure to cold, wearing of damp clothes, sitting on cold stones or cold or damp ground, sea bathing in very cold water, is very often a.s.sociated with an acute inflammation of the womb itself and calls for rest in bed, laxatives to open the bowel, hot application to the lower part of the abdomen and a teaspoonful of Hayden's Viburnum in a gla.s.s of hot water every four hours until relieved. The use of the sitz bath is frequently successful if taken at night followed by a laxative and a hot drink.

PAINFUL MENSTRUATION--DYSMENORRHEA.--Most, if not all, victims of painful menstruation are of a nervous temperament. Dysmenorrhea is simply one symptom of the general nervous condition. The nervousness may be acquired or it may be the result of heredity. In girls it has been found to be an accompaniment of the overwork and worry of school and student life. Girls who suffer greatly from it while in school are entirely free during vacation from school.

There is a type of painful menstruation known as neuralgic dysmenorrhea.

This is simply a local expression of a general neuralgic tendency. It comes under conditions which favor neuralgias in other parts of the body. Girls and women affected with this type of dysmenorrhea are often anemic, hysterical, and not infrequently the victims of malaria, rheumatism, or other diseases which tend to impoverish the blood and reduce nerve vitality. The pain resembles neuralgia elsewhere. It comes and goes, it may last a brief time or a long time, it may be very mild or very severe. The pain bears no fixed relation to the flow, it may proceed, accompany or follow it.

Mechanical dysmenorrhea is that form in which a mechanical impediment exists to the escape of the menstrual fluid. The internal ca.n.a.l may be too small, displacement, growths, either inside or out of the womb, faulty development, or frequently simple congestion will act as an obstruction and cause pain from tension. The pain accompanying mechanical dysmenorrhea is very different from the neuralgic type. It comes on gradually, increases slowly until it is very severe and stops suddenly. A gush of blood from the womb announces the fact that the obstruction has been overcome and the womb has emptied itself; as soon as this occurs the pain ceases.

In the mechanical variety there are frequently clots in the menstrual flow. Inasmuch as this type may be caused by imperfect development of the womb, it is common to find that pain has characterized the monthly periods from the time of the first menstruation. It may, however, as stated above, be caused by growths which had their beginning at a later period.

TREATMENT.--For the neuralgic variety the treatment should be general.

The whole object is to build up the general health. Fresh air, sunlight, out-door exercise, plain, substantial food, regular hours, pleasant surroundings, and such medication as may be indicated, should be the course to follow. The bowels should be kept regular and digestion aided in every way possible, if necessary by rest from school, or work, or by a change of air and scene. If the patient is inclined to malaria she must take quinine and live in a locality free from that tendency. If rheumatic she should take the remedies advised in that disease and avoid colds, wet clothes, or sitting in cold, badly ventilated rooms, churches or theatres. If there are no distinct evidences of special tendencies, general tonics may be given to advantage. These should consist chiefly of iron, a.r.s.enic, phosphous, nux vomica, cod liver oil, etc.

The treatment of mechanical dysmenorrhea of course implies removal of the cause. As this necessitates operative procedure, or at least an examination by a physician, it is best left in his hands.

STERILITY

Sterility means the inability to become a parent. A woman who is sterile cannot become a mother. She is for some reason unable to have a baby.

A childless union is frequently the cause of much unhappiness. There is something lacking in the expression "a childless home." It seems a paradox, as home is inherently a.s.sociated with children and happiness.

It has been stated that one out of every eight marriages is barren. The average time which elapses after marriage and the birth of the first child is seventeen months. Physicians agree that if a woman goes over three years after marriage without having a baby her chances of having one are small. If children are desired, and they usually are by childless parents, every effort should be made within the first three years to ascertain the cause of the sterility, and if it can be rectified. The barrenness may be dependent upon some physical defect which will quickly respond to the proper medical treatment. It is well to remember, however, that the defect is not always the woman's. In every six childless marriages about one is due to sterility in the husband. The age of the greatest fertility in women is between twenty and twenty-four years. It is rare to find a barren woman between these years. Nature evidently intended that the duties of maternity should be a.s.sumed between the twenty and twenty-fourth year. If married before the age of twenty the statistics prove that barrenness exists in one woman in every twelve. If married after the twenty-fourth year the chances of having children decreases with the age of the woman.

If a mother goes for three consecutive years without becoming pregnant the chances are that she will have no more children. Consequently if other children are desired it is unsafe to rest upon the a.s.sumption that a woman will again be a mother simply because she has been one in the past. Many conditions could, and may, have occurred since the last pregnancy (and may be as a result of that pregnancy) to change her natural fertility into a condition of temporary sterility. An examination should therefore be made before too long an interval elapses and the facts learned. It will usually be found in such cases that a displacement or laceration, or at most, some cause easily remedied is immediately responsible for the apparent barrenness.

CONDITIONS WHICH AFFECT THE FERTILITY OF WOMEN

CLIMATE.--It is a well-known fact that more children are born in southern regions than in northern countries. It may be a.s.serted, therefore, that climate affects the fertility of the race.

STATION IN LIFE.--Children are more numerous among the poor than among those who are wealthy and enjoy the luxury of riches. This condition cannot, however, be construed as a true expression of fertile efficiency. It is more a comparison of ethics, and when we express it thus we are giving it its most charitable name.

SEASON OF THE YEAR.--The spring of the year, being more favorable to fecundity, exerts an influence over the increase of population. Nursing mothers are as a rule sterile until after weaning time. This is not always so however, and the possibility of pregnancy taking place while nursing a baby, and before menstruation is reestablished must be reckoned with as it occurs quite frequently.

AGE.--Age may be said to affect the fertility of women inasmuch as sterility is the natural and proper condition before menstruation is established and after menstruation ceases.

THE TENDENCY TO MISCARRY.--Because a woman has never given birth to a living child is no proof that she is sterile. Many women have the ability to conceive but for some reason they have acquired the misfortune, or the "knack," of miscarrying. This is a condition of the gravest significance and will be considered at length in its proper place.

The influence of a temporary separation has had excellent results in a great many historical cases. Where the married couple seem to be lacking in some one or other of the emotional or temperamental qualifications, it is advisable to suggest a temporary separation. When this period has expired and they resume marital relationship the element of novelty, acting as a stimulus, quite frequently reestablishes a fertility that was seemingly suspended, or awakens it if conception has never previously taken place.

There are a great many cases on record where, conditions having remained the same, women have become fertile after years of seeming barrenness.

It is impossible to explain, or to satisfactorily understand these cases. It is quite common to note cases in which women have never become pregnant until a number of years after marriage, even when the desire to have children existed. There is one case on record of a woman married at eighteen, but although both herself and her husband enjoyed habitual good health, conception did not take place until she was forty-eight years of age when she bore a healthy child. Women should not, therefore, become easily discouraged in the hope of having a baby, especially when they have a clean history, and a healthy body. The conditions may change and may become favorable when hope is about to die.

CAUSES OF STERILITY IN WOMEN

Inasmuch as it is necessary to consult a competent physician in all cases of sterility, it is not necessary to go into detail regarding each possible cause, other than to explain how each may produce barrenness.

It will be observed that a competent physician is specified and advised in these cases. This is very important because many advertising, or "quack" doctors, particularly solicit these kind of cases. They are not competent to be trusted with such cases and will likely effect more harm than good. A woman should not hesitate to consult the best available medical authority if she is a victim of sterility. There is nothing to be ashamed of. It is a perfectly proper medical situation and should receive the best medical advice and investigation. The following are the more frequent causes of absolute sterility.

(A) Displacement of womb.

(B) Diseases of womb, ovaries or fallopian tubes.

(C) Malformations.

(D) Lacerations or tears of mouth of womb.

(E) Tumor.

(F) Leucorrhea.

(G) Physical debility.

(H) Special blood poisons.

(I) Great obesity.

(J) Anemia.

(K) Self-abuse.

(L) Habitual alcoholism.

(M) Lack of moderation in the marital relations.

(N) Certain diseases may be a.s.sociated with barrenness: cancer, diabetes, consumption, Bright's disease, etc.

(O) Certain temperamental conditions may be a.s.sociated with barrenness: lack of affinity, frigidity.

THE KNACK OF MISCARRYING

DISPLACEMENT OF WOMB.--In many instances the primary cause of the displaced womb was some energetic, muscular effort, made while the victim was yet a girl,--probably before menstruation began. Whatever act first caused a slight tilting of the womb, must necessarily have been an unusual physical effort, and as girls are getting more and more strenuous we may look for more trouble in this direction in the future.

Inasmuch as a slight tilting of the womb gradually gets worse it is a reasonable expectation to believe that sterility is a natural sequence to displacement. The girl may have been the victim of painful menstruation which was neglected, because not quite painful enough to compel medical relief, which is sought for only as a last resource unfortunately under the circ.u.mstances. Intercourse may also have been more or less painful,--a condition which again is mistakenly and imprudently borne in silence and left to take care of itself. But when persistent sterility faces her, the woman seeks medical a.s.sistance and her trouble is discovered. As the displacement is found to be the cause of her sterility, its correction, which is a comparatively easy medical problem, not only cures the barrenness but happily relieves her of the menstrual distress and all other pain.

The treatment for displacement consist of placing medicated pieces of wool or cotton, called tampons, in the v.a.g.i.n.a in such a position as to hold the womb, _as_ nearly in its proper place as is possible. After a time nature will so strengthen the ligaments that they will hold the womb and a cure is, therefore, affected. The length of time necessary to cure depends upon the length of time the displacement has existed. It may take, from two to four months. When the displacement is of long standing and is accompanied with more or less inflammation, adhesions sometimes grow between the womb and the adjacent organs. It is necessary to resort to surgery in such cases, but the result is always good and the danger practically nothing.

DISEASE OF THE WOMB, OVARIES OR FALLOPIAN TUBES.--Disease of the womb, ovaries, and fallopian tubes, which renders the victim sterile, is as a rule the direct result of infection. Such infection is conveyed by the husband to the wife. This is quite a common condition. The simple fact that such conditions exist leads us to hope that the time is not far distant when it will be compulsory for all partic.i.p.ants in the marriage ceremony to submit to a thorough physical examination. By this means, and by this means only, will the innocent be protected. No one can conceive, unless he has been identified, as a physician, with one of the large metropolitan hospital clinics, of the extent of this cla.s.s of disease, and of the frightful suffering caused, and innocent lives ruined, by infection conveyed in this way. It is a tragic corollary to the marriage vow "for better or for worse."

If a woman is fortunate enough to fall into the hands of an honorable physician, who will tactfully explain to her the serious significance of her condition and obtain her consent to treat her until she is cured, which in all probability will include a surgical operation, and will do so with diligence, without regard to the size of the bill, she will indeed be a lucky woman. It is from women who are suffering with such diseases,--most of them without the slightest idea of what ails them,--that the venders of advertised nostrums reap their fortunes, and it is from the same victims that most of the advertised medical "quacks"