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Related article: differs from the congestive, the spasmodic, and the membranous varieties, which are all of them likely to be either accompanied or followed by menorrhagia. The amount of the dis- charge is not proportioned to the severity of the pain. The flow is scanty and intermittent, and, as in the case which I have related, the inter-menstrual period is generally lengthened and irregular. If the obstruction is congenital, or has come on Amitriptyline Hydrochloride from any cause before marriage, these patients are sterile ; Amitriptyline 50 Mg for the same mechan- ical obstacle which interfered with the men- ^^S^hST 01 ™ 1 ™' 3 '" 8trua I exit, will prevent the ingress of the semen into the uterine cavity, and proper fecun- dation will be impossible. If the closure of the cervico-uterine "outlet takes place in consequence of cauterization, or of post- partum inflammation in one who has borne a child or children, she also 25 Mg Amitriptyline may afterwards become barren from the same cause. Dpt^ cy GoogIe 190 THE DISEASES OF Purchase Amitriptyline WOMEN. If the dysmenorrheas depends upon congenital mal-formation of the cervix uteri this condition can be readily recognized by the proper employment of a Sims* speculum and the uterine sound, 10 Mg Amitriptyline conjoined with the " touch." If it had its origin in puerperal inflammation ; if it has followed the extension of simple or specific vaginitis into the canal of the cervix; if it depends upon some uterine ob- Phyuoil tiploralioB. ,. . , J . • • liquity, or Amitriptyline Online the Online Amitriptyline presence of a foreign Amitriptyline 25mg growth ; or if it is the sequel Amitriptyline 10mg of cauterization, tie previous history and treat- ment of the case will facilitate the diagnosis. The simple fact . that at the first attempt you fail to pass the sound into the uterine cavity should not lead you to decide the Amitriptyline Buy case to be one of Buy Amitriptyline obstructive dysmenorrhea ; for 50 Mg Amitriptyline in a healthy state of the uterine mucous membrane, and in the interval of menstruation, the internal os is in many cases so tightly closed that it requires considerable skill and Amitriptyline Mg experience to pass this Buy Amitriptyline Online instrument at all. But if the canal of the cervix is not absolutely impervious, a little patience and tact will enable you to succeed. You may sometimes insinuate a small Sims' probe, when a large Bound, more especially a stiff one, could not be intro- duced without undue force and unnecessary suffering. I need hardly Amitriptyline 25 remind you that you will gain an entrance into the uterine cavity in this manner much more easily "at the month" than at any other time. Tou should remember that in this form of dysmenorrhaaa there is not necessarily a complete and entire Cheap Amitriptyline retention of the menses, The distinguishing characteristic of the disease TtH^iow, ud wtui it ja t^t there is a mechanical impediment to the monthly flow, which may or may not amount to a positive obstruction and arrest thereof. The failure of the prac- titioner to get a correct idea of this fact explains the proneness to blunders in the diagnosis and treatment of tins affection ; for ob- structive dysmenorrhosa bears as little resemblance to endo-cervi- citis and to uterine ulceration as it does to Amitriptyline 10 perimetritis or to hema- tocele, and to confound them is both 10mg Amitriptyline inexcusable and mischievous. The prognosis will vary with the cause of the disease, and also with the consequences of the menstrual irregu- larity. If the original organic defect, whenever it exists, can be remedied or compensated by surgical meana, Dpt^ cy GoogIe DYSMENOEKHfRA. 191 recovery will follow. If the acquired or accidental obstruction,, whatever it 25mg Amitriptyline is, can be removed, the result may be favorable. Something, however, will depend upon the state of health, which is secondary, and which has been, induced, directly or indirectly, by the persistent derangement ef the menstrual 1 function. If the dysmenorrhea has existed for years, thepatient may be so ill with symptomatic endometritis, gastritis, gastro-enteritia, ovaritis, cys- titis, chronic hepatic and digestive derangements, tuberculosis, diseases of the nervous system, or a depraved condition of the blood, as to prevent her complete recovery. And this, although' the ease and regularity of the flow have both finally been estab- lished. Therefore, yon should be careful how you promise to perform a radical cure of this painful affection. Treatment. — One of the most successful and satisfactory achievements of modern gynaecology consists in having supplied, us with the means of cure for most cases of this. ■^ t1t,tmM "- disease. From, the nature of itB causes, yon will infer that the treatment of obstructive dysmenorrhea must be chiefly of a Order Amitriptyline surgical kind. Internal remedies are suited to the' relief, and possibly the cure, of other varieties of painful menstru- ation, but they are of little or no permanent avail in this. The cause of the suffering is physical and mechanical, just as in a case of stone in the bladder, or of biliary calculus, and although, by ■ the use of constitutional means, we may mitigate the pain and! other incidental symptoms,, yet the cure will depend upon the removal of the cause. If the seat of the stricture is at the os externum, a slight inci- sion may suffice to open the cervical canal. If, as most frequently- bappens, it is at the os internum, it will be most prudent to try the virtues of dilatation, and reserve the cutting as a dernier renort. Dilatation is equally applicable to most cases of atresia.. of the cavity of the neck of the organ. When the passage is very narrow yon will begin with a small copper sound, or probe, which may be passed every third or fourth,