Treatment.—It might be quite appar ent from the foregoing that, while the treatment may be either medical or sur gical, the latter, however, will usually give the more satisfactory- and radical results. Modern gyruccology is cast in surgical lines, and while it would be folly to deny that many mistakes have been made in its name (for mistakes are al: ways made in the development of a new department of knowledge), it has ap proached nearer to fundamental condi tions by directly attacking tissues which are involved in disease than have other methods of treatment which are more circuitous in their course.
Considering the subject of treatment, therefore, as divisible into palliative and radical, the former will include the methods by means of drugs (which occa sionally may produce a permanent re sult), and the latter (which do not in fallibly produce a cure) those methods which involve surgical procedures. Of course, a judicious combination of both medical and surgical means will often prove efficacious.
Of the drugs which may be given to relieve the pain of menstruation, mor phine combined. with atropine should be reserved for very rare cases whether given by the mouth or hypodermically. It should be given in the smallest possible doses, 1/8 grain sufficing to relieve pain in most cases as well as a larger quantity. One must not forget the seductive influ ence of this drug, especially upon real nervous, hysterical women. Many women find relief from the pain in ques tion by drinking hot herb-teas: chamo mile, scutellarium, boncset, flaxseed, etc. These can do no harm and are innocent as to the formation of drug-habits.
3Iore or less meritorious preparations are much in vogue, but in some cases they seem to be entirely inert, either from instability or want of uniformity in the preparation or some peculiarity in the patient.
Oxalate of cerium, in 6-grain doses every hour, considered specific for the dysmenorrlicea of well-nourished, robust women, in cases where the pain comes at or before the beginning of the flow. Chambers (Med. Record, July 7, '83).
Apiolin is especially indicated in spas modic and congestive dysmenorrlicea, in doses of 3 minims in capsules, three times a day. Hill (.Med. Standard, June, '91).
ln non-inflammatory cases viburnum prnnifolium gives brilliant results, not to be obtained from any other remedy except morphine. A teaspoonful of the fluid extract three times daily to be given. Schwartze (Then Gaz., Aug. 15,
'94).
.Manganese is a most valuable remedy in unmarried women, and a trial ex tending over three months is recom mended before relinquishing its use. Its action appears to be upon the nerve.s or nerve-centres concerned in the men strual function rather than upon the blood. Administration of manganese does not interfere in any way with iron and vegetable tonics, but rather en hances their effects. The black oxide is the most convenient form of prescrip tion. If nausea is produced the drug should be given in a small dose: 1 grain at a time gradually increased. A 3-grain dose is found to be as efficacious as a larger one. Charles O'Donovan (Med. News, Nov. 27, '97).
The following formula has given good results:— B. Tincture of hydrastis Canadensis, Tincture of viburnmn prunifolium, of each, equal parts.
AI. Ten drops to be taken every two hours. Lutand (Jour. de MM. de Paris, Jan. 2, '93).
Cases in which the flow is ushered in by severe cramp-like pains for three or four days preceding the menstruation 3/,-drachm doses of the fluid extract of viburnum prunifolium in hot water three times a, day may be given, and on the morning of the expected period a full dose of magnesium sulphate. Ii the pain comes on in spite of this, 5-grain doses of antipyrine, repeated every two hours for three doses, if necessary, will often relieve it. Arthur A. Browne (Montreal Med. Jour., Apr., '98).
In dysmenorrlicea thyroidin is "a uterine and ovarian anodyne and seda tive, as it arrests the different impres sions at their formation." One grain of thyroidin is given in capsnles thrice daily, for two days before menstruation is due; the gliantity is increased to 2 grains thrice daily during the flow. Re lief is afforded in over SO per cent. of cases. The treatment is efficient when the uterus and ovaries are in normal position. Any pathological lesion must be remedied by proper surgical meas ures. Stinson (Amer. Jour. of Obstet rics, July, 1902).
The various currents of electricity have all been vaunted as useful means of treatment, and in many cases they are prompt in producing relief. Especially is this true of the faradic current, but if the cause of the trouble lies in a defect of structure it would be unreasonable to ex pect a permanent result from electrical treatment so long as the cause remains.