There is no
agreement as to the cause of _Mittelschmerz_. Addinsell
attributed it to disease of the Fallopian tubes. This, however,
is denied by such competent authorities as Cullingworth and Bland
Sutton. Others, like Priestley, and subsequently Marsh (_American
Journal of Obstetrics_, July, 1897), have sought to find the
explanation in the occurrence of ovulation. This theory is,
however, unsupported by facts, and eventually rests on the
exploded belief that ovulation is the cause of menstruation.
Rosner, following Richelet, vaguely attributes it to the diffused
hyperaemia which is generally present. Van de Velde also
attributes it to an abnormal fall of vascular tone, causing
passive congestion of the pelvic viscera. Others again, like
Armand Routh and MacLean, in the course of an interesting
discussion on _Mittelschmerz_ at the Obstetric Society of London,
on the second day of March, 1898, believe that we may trace here
a double menstruation, and would explain the phenomenon by
assuming that in certain cases there is an intermenstrual as well
as a menstrual cycle. The question is not yet ripe for
settlement, though it is fully evident that, looking broadly at
the phenomena of rut and menstruation, the main basis of their
increasing frequency as we rise toward civilized man is increase
of nutrition, heat and sunlight being factors of nutrition.
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