Other palliative measures are warm hip-baths in which the patient may sit ten to fifteen minutes, the temperature of the water being sufficient to produce relaxation of tissue, and hot mustard water foot-baths, which must be used only long enough to produce a glow of the skin.
Hot salt-baths calm the pains of dys menorrhoea and notably diminish men strual flow. Mironoff (Ejenedelnoya, No. 35, '95).
In ovarian dysmenorrhcea all remedies which are likely to relieve pelvic conges tion should be employed, such as hot injections and sitz-baths, hot-water bags to the lower part of the abdomen, and saline laxatives. Internal medication is of very little a.vail. In eases, however, in which menstruation is not profuse the mother-tincture of pulsatilla in 5-drop (loses every three hours is very useful. Minnie (Med. Brief, May, '96).
With mud-baths and the medicated waters of Kreuznach, .Aix, Toplitz, Schwalbach, and other well-known pean resorts useful results have been obtained, but they are not available for the majority of our American patients.
A change of residence, especially from the sea-shore or near the sea-level to an elevation of one or two thousand feet,will often give permanent relief. The writer has repeatedly seen women who menstru ate with great discomfort at the sea shore, while on sea-voyages, or in a damp atmosphere under some other conditions. Of course, if there is no anatomical lesion one usually becomes habituated to at mospheric conditions after a few months or years.
If the pain is due to a neurosis the treatment should be addressed to the nervous system,—the bromides, hyoscya mus, aconite, and the coal-tar prepara tions being employed.
If the general nutrition is at fault it is hardly necessary to say that it should be improved by a carefully-selected diet, suitable exercise, cheerful companion ship, and always and above all by the use of approved laxatives to keep the bowels freely open. Again and again has the writer found a constipated habit at the bottom of a history of painful menstru ation.
The majority of cases of dysmenorrhcca in school-girls is functional in origin. Environment should be such as would be most conducive to their general health. They should be kept out of school dur ing their first menstrual year, and those of a nervous temperament for a longer period 6f time. They should have calis
thenic training for the special develop ment of the muscles of the back and ab domen, and should be warmly clothed. If there is any tendency to pain during menstruation, the young patient should be put to bed and kept there the entire period. Pine (Northwestern Lancet, Dec. 15, '89).
The field of surgical treatment for dysmenorrhcea is a large one and fre quently will result in the happiest conse quences. The chief objects of surgical treatment are to relieve obstruction, to produce stimulation, and to improve local nutrition.
The causes of obstruction have been mentioned, and should be removed as completely as possible; an imperforate hymen should be divided or dissected away; obstructing bands in the vagina should be cut and a series of vaginal dila tors worn until the normal caliber of the vacrina has been restored. Bands and constrictions at the os externum or in ternum should be divided, a narrow cer vical canal should be dilated and cu retted, especially when the glands are the seat of exuberant or unhealthy secretion.
[The most efficient treatment for ordi nary forms of dysmenorrhoea is careful dilatation, with the steel dilator, to the extent of an inch or an inch and a quar ter, using careful antiseptic precautions. After the dilatation it is well to insert an intra-uterine pencil containing 10 grains of iodoform. 11TUNDE and WELLS, Assoc. Eds., Annual, '89.] Slow dilatation urged as being equally efrective and less dangerous than rapid dilatation. Talbot (Amer. Jour. of Obstet., Jan., '89).
Rapid dilatation for the relief of dys menorrh(ea depending upon flexion or ob struction is advocated, in the absence of contra-indications. Goodell (Amer. Lan cet, July, '89); Dickman (Kansas Med. Catalogue, June, '89); Townsend (Amer. Jour. of Obstet., Dec., 'SD); Madden (Satellite of the Annual, Sept:, '89).
Repeated curettings at short intervals advocated for membranous dysmenor rh(ea. After each curetting the canal should be carefully treated to an applica tion of pure carbolic acid. Reamy (N. Y. Med. Jour., June 10, -93).