Some observations on dysmenorrhea at Goucher college

Over against 100 who had never had dysmenorrhea on entrance but who developed occasional dysmenorrhea in college, we find the following figures: Of 228 with a history of “dysmenorrhea always” or “occasional” on entrance, 122 show no absence in college for dysmenorrhea. Of the remainder, 64 have but one absence and only 42, two or more. In none of the resident students from 1920 to 1924 has dysmenorrhea been of such a severe type that it was not relieved by rest in bed, heat and simple analgesics. Insufficient study of endocrine therapy at Goucher has yet been made for any conclusions of value on this form of treatment. All students at Goucher must meet the requirement of three hours weekly in physical training or an assigned substitute. Sports such as golf, hockey, basket ball, baseball, tennis, swimming, dancing and horse-back riding are engaged in by those who are physically fit. Most of the students with dysmenorrhea filled out questionnaires on their menstrual history and habits of personal hygiene. About half were assigned special exercises to develop the abdominal type of breathing.1 Students with severe, persistent dysmenorrhea were referred to gynecologists for examination. In looking for etiology in the occasional dysmenorrheas there is a tendency to draw post hoc ergo propter hoc conclusions. We can easily find types with poor posture, weak abdominal muscles, vasomotor disturbances, unhealthy tonsils, poor personal hygiene, poor nutrition or constipation. Improvement in one or more of these conditions may be followed by relief of dysmenorrhea, but an equal number of control cases in the college group may be found in which exactly similar conditions exist without dysmenorrhea. Excluding a very small number of cases traceable to local pelvic disorders, the etiology of dysmenorrhea in this college group remains obscure. Let us take a few typical histories from the senior class: 1. R. B., city student, history of “dysmenorrhea always” on entrance. Constipation, underweight, poor abdominal muscles, unhealthy tonsils. Gained eleven pounds in college, posture improved. Only one absence for dysmenorrhea during four years in college. 2. S. M., resident student, history of “dysmenorrhea always,” on entrance. Constipation, underweight, poor posture. Gained eight pounds. Two absences for dysmenorrhea in four years at college. 3. L. W., resident student, history of “dysmenorrhea always,” on entrance. Under-weight twenty-six pounds, poor posture, vasomotor disturbances. Little improvement in abdominal muscles in spite of special exercises. Gained ten pounds. Two absences for dysmenorrhea in four years at college. 4. D. W., city student, history of “dysmenorrhea always,” on entrance. Poor posture and vasomotor disturbances. Improvement in posture. Three absences for dysmenorrhea during four years in collge. 5. E. A., resident student, history of “dysmenorrhea always,” on entrance. Vasomotor disturbances, weak abdominal muscles. Improvement in posture. No absences for dysmenorrhea during four years in college. 6. E. H., resident student, history of “dysmenorrhea always,” on entrance. Weak abdominal muscles. Marked improvement in muscles. No absence for dysmenorrhea during four years in college. 7. P. L., resident student, history of occasional dysmenorrhea, on entrance. Poor posture, large unhealthy tonsils, vasomotor disturbances. Tonsils removed in 1923. No absence for dysmenorrhea in four years at college. 8. C. C., resident student, history of occasional dysmenorrhea on entrance. Poor posture, unhealthy tonsils, poor nutrition. Tonsils removed July 1922. Gained eleven pounds. Posture improved. No absence for dysmenorrhea after summer 1922. One in first year. 9. M. H., city student, history of occasional dysmenorrhea, on entrance. Circulatory disturbances, weak abdominal muscles, poor personal hygiene. Above conditions improved. Three absences for dysmenorrhea during four years in college. 10. H. N., city student, history of occasional dysmenorrhea, on entrance. Weak abdominal muscles, vasomotor disturbances, poor personal hygiene. Improvement in above. No absence for dysmenorrhea in four years in college. 11. A. V., resident student, history of occasional dysmenorrhea, on entrance. Weak abdominal muscles on entrance, poor personal hygiene. “Afraid of being fat”. Underweight. Lost eleven pounds. Posture improved decidedly. Three absences for dysmenorrhea in fourth year at college. 12. L. L., resident student, history of occasional dysmenorrhea on entrance. Under-weight, weak abdominal muscles, unhealthy tonsils. Gained seven pounds after tonsils were removed. Posture improved. No absences for dysmenorrhea in four years in college. 13. M. G., resident student, history of occasional dysmenorrhea, on entrance. Posture good, tonsils unhealthy, vasomotor and circulatory disturbances, poor personal hygiene, poor nutrition. Gained four pounds. No absence for dysmenorrhea in four years in college. 14. M. C., resident student, history of occasional dysmenorrhea on entrance. Tall thin type, poor posture, vasomotor disturbances, “always tired”. Abdominal muscles improved. Three absences for dysmenorrhea during four years in college. 15. M. C. C., city student, history of occasional dysmenorrhea, on entrance. Had freshman year at another college where she went in for athletics. Spent two hours daily on train coming to Goucher. Little time for athletics. Slump in posture. Four absences for dysmenorrhea during three years at Goucher. 16. A. E., city student, history of “dysmenorrhea always”, on entrance. Good posture, bad personal hygiene. Irregular eating and sleeping. “Afraid of getting fat”. Thought she must go out every night for entertainment. No dysmenorrhea at camp in summer. Dysmenorrhea always at other times. Three absences in four years at college. 17. V. K., city student, history of occasional dysmenorrhea. Constipation, chronic appendix trouble. Vasomotor symptoms, good posture. Constipation improved. Six absences during first three years for dysmenorrhea and two in last year. 18. H. L., city student, history of occasional dysmenorrhea on entrance. Some toxic symptoms, posture good. Lost four pounds in weight, slumped in posture and personal hygiene. Four absences for dysmenorrhea in four years in college. 19. M. R., city student, history of occasional dysmenorrhea, on entrance. Toxic symptoms, chronic appendix trouble, poor personal hygiene, good posture. Five absences for dysmenorrhea in four years in college. 20. M. L., resident student, history of occasional dysmenorrhea, on entrance. Weak abdominal muscles, vasomotor disturbances, poor personal hygiene. Posture not much improved. Four absences for dysmenorrhea in four years in college. 21. B. L., city student, history of occasional dysmenorrhea, on entrance. Very poor posture, poor nutrition, vasomotor disturbances, poor personal hygiene. Posture improved. Gained five pounds. One absence for dysmenorrhea in four years. 22. M. R., resident student, history of occasional dysmenorrhea on entrance. Weak abdominal muscles, poor posture. Thought special exercises helped her. Two absences for dysmenorrhea in four years. While weak abdominal muscles appear to be the most common finding in these cases, some students with perfectly good muscles report occasional dysmenorrhea. In all the student interviews an attempt was made to change the student's attitude toward herself. One in her freshman year admitted that she was glad of an excuse to stay in bed with dysmenorrhea and get out of the rush of college life once a month. Others admitted that they were always expected to go to bed at home; their mothers did before them. Some became ashamed of this record. Is not the improvement in dysmenorrhea to be traced rather to a stiffening in “back bone” than abdominal muscles; to the development of a point of view that looks with scorn upon a life of physical handicap? Undoubtedly the satisfying and interesting life which most college girls enjoy makes them eager to have good health. If, in working for improvement in general health and hygiene their dysmenorrhea improves, how shall we determine whether it is special exercises or mental attitude that effects the cure?