[Reprinted from the American Gynaecological and Obstetrical Journal 
for April, 1895.] 
MENORRHAGIA AND METRORRHAGIA AS CAUSED BY 
CONDITIONS OTHER THAN FIBROIDS* 
By E. L'H. McGinnis, M. D. 
In treating the above subjects, I am led to believe that there are 
many of you who probably anticipate a brochure on the merits of 
electricity, my name having become more or less identified with its 
use in gynaecology Let me therefore hasten thus early in the few 
moments of your time given to me to assure you that I shall touch but 
lightly upon its use here, preferring rather to hear your discussion 
first, and in concluding it I may be led to speak of my results with the 
current. 
The terms menorrhagia and metrorrhagia may be and often are 
misleading, as any free flux of blood is generally placed under one or 
the other heading, depending upon the time of its occurrence. But 
what would be haemorrhage in one case would be but normal men- 
struation in another of different temperament, so no positive rule can 
be laid down as a dividing line between them, beyond a comparison 
of the amount of flow lost by the same patient during previous cata- 
menial periods. The length of time occupied is another element to 
be borne in mind when deciding upon its abnormity, and even when 
the amount lost during one customary period may not be large, yet 
when the time of the flow is prolonged the aggregate flux may be 
a drain upon the general health of the patient, and in such cases 
should be classed under one head or the other. 
When a usually healthy and well-nourished woman, with no pre- 
vious history of excessive flow is met with and found to be suffering 
from a loss of blood which is quite beyond her customary amount, 
the one cardinal point in the diagnosis of the cause is to determine in 
exactly what way the circulation is interfered with, and no amount of 
curetting or astringent applications to the canal will ever be of lasting 
benefit until the proper circulation is re-established. Whether the in- 
* Read before the Alumni Association of the Woman's Hospital, February 13, 
i895- 
Copyright, 1895, by J. D. Emmet and A. H. Buckmaster. E. L'H. McGinnis, M. D. 
2 
terference is due to the presence of a fibroid, a flexion, a metritis, or 
even an impaction of faeces, it matters little as regards this one symp- 
tom, and it is my firm belief that we have here the true explanation 
of violent haemorrhage in a comparatively small submucous or a mural 
fibroid, while a much larger peritoneal one will cause little or none. 
Of course the condition of the blood itself may have something to do 
with it, but its importance seems to me to be secondary to the other 
cause. The use of certain drugs, too, such as quinine, iron, aloes, etc., 
may temporarily affect the flow, but their discontinuance is nearly 
always followed by freedom from excessive menstruation when normal 
local conditions exist. 
By far the most common cause of menorrhagia and metrorrhagia 
is said to be the presence of fungosities on the endometrium, and yet 
we can not be sure that the same condition which causes the endome- 
tritis fungosa does not cause the haemorrhage rather than the fungi. 
The removal of them by curette or other means certainly brings 
about a diminution of bleeding in most cases, but unless the proper 
conditions of circulation are restored at the same time, the trouble is 
most likely to recur. 
Pelvic cellulitis itself may be sufficient cause for the conditions 
under consideration ; and no less an authority than Dr. Emmet re- 
cently informed me that he had known of cases due entirely to pres- 
sure of impacted fcecal matter in the rectum, which were speedily re- 
lieved by free catharsis. 
When we take into consideration the amount of obstruction which 
must necessarily take place in malpositions of the uterus, and espe- 
cially in flexions, we can not but wonder that the symptom is not 
more prevalent; for around the angle of the flexion, the blood must 
necessarily be more or less dammed back, and with the constant force 
of the heart beat behind it some outlet for the accumulation must be 
found and this is usually the uterine canal and vagina. 
We are all familiar with the angry, engorged appearance of a lac- 
erated cervix when hard scar-tissue is pressing upon the blood-vessels, 
and its disappearance when its pressure is removed by operation. 
Of course malignant degeneration of the blood-vessels may cause 
haemorrhage in any mucous-covered tissue, so that it requires but 
passing mention here. 
It was my intention in treating of this heading to merely bring it 
before you for discussion-as it will be your remarks that are of value 
-and I therefore lay the subjects before you rather than these few 
notes.