For membranous dysmenorrhoea, scari fication of the OR externum at intervals of three or four days between the periods is recomnrended. Just before the flow is expected the CerVi X is dilated, the in terior of the uterus thoroughly curetted, and a spiral-wire stem introduced; this is worn continuously during at least three subsequent periods, the patient be ing directed to take hot vaginal douches even when menstruating. Duke (Med. Press and Circ., July 10, '95).
Dysmenorrhcea is successfully treated by applications to the mucous membrane of the uterine cavity. The treatment consists in the injection of 10 minims of 3-per-cent. mixture of Churchill's tinct ure of iodine and water into the:uterine cavity every four or five days during the intermenstrual period, beginning about five (lays after the flow has ceased, and giving the last treatment about five days before the next period begins. As an injector a fine glass tube, curved an inch from one cnd and ex panded into a funnel shape at the other, is used. A piece of sheet rubber covers this end, and by the pressure of the finger the contents are passed into the uterine cavity. A speculum is not neces sary, the majority of eases being un married. The pain and exposure made necessary by the use of a speculum is objected to. Langstaff (Brooklyn Med. Jour., May, '97).
The spasmodic variety is by far the most common, as there is frequently lit tle to be detected beyond the symptom of severe spasmodic pain. Some relief may be obtained by sedatives externally or internally, but there is always the danger of setting up an opium or chlo ral habit; it is better to dilate the uterus, either by tents or solid instru ments. The use of tents is not free from danger, both from sepsis and from fracture or tearing away of a piece of the tent upon extraction. To effect rapid dilatation the solid dilator well regu lated is to be chosen. The uterus can be easily secured by the vulsellum for ceps if a sound is previously introduced into the cavity, and a series of dilators can then be passed rapidly, with the re sult that the patient is relieved, at least for many months. Murdoch Cameron (Brit. .MN1. Jour., Oct. 24, '97).
In sterile married women prescription of abstinence. from marital relations for longer or shorter time, followed by free dilatation immediately before their re sumption. often proves successful in cur
ing dysmenorrhoea. Bicycling is of ad vantage, and if growing girls, especially when an;ernic, were systematically en couragcd to practice that exercise in moderation, we should by and by have less spasmodic dysinenorrhwa. Comte' (Brit. Med. Jour., Oct. 24, '97).
In every ease, without exception, gen eral treatment must be most thoroughly tried first. At the time of puberty many girls get far too little exercise, and too little care is taken to keep them warm, especially at night. It is essential that the feet be kept warm during the night whenever there is uterine dysmenorrhoea, or, indeed, whenever there is any pelvic trouble. As soon as there is the slightest appearanee of the -period' the girl must be kept rigidly in bed, and not allowed to get up until the pain is entirely gone. A large poultice should be kept over the abdomen. A brisk saline draught al the commencement, or, if possible, twelve hours before, and then a mild diapho retic, with a small dose of bromide of sodium or potassium, if the patient be strong, or if weak some aromatic spirit of ammonia are best.
In regard to the local treatment there is more or less difference of opinion. The stem-pessary- is unscientific; it can only relieve, seldom cures, and may do harm. Dilatation consists of two kinds: slight and great. The first is suitable in the ease of married women, when flex ion is not great, and it is used in the hope that by distending the canal impreg nation may take place, and the dysmen orrliwa thus be cured. An amesthetie is not required. Overdilatation may be done with tents or the rapid forcible method. Whatever instrument is used in the rapid method, the stretching ought to be carried out while the uterus is fixed by tenaculum in its natural posi tion; not when it is drawn to or out side the vulva. Keith (Med. Press and Circ., Oct. 27, '97).
Obstruction from the presence of tumors within the uterus which may cause excessive pain can be relieved only by their removal, and the requisite oper ations must also be performed if the menorrhoea is caused by displacements of the uterus or its incarceration by matory exudate. Any less radical form of treatment for such conditions has, in the experience of the writer, proved to be only time-consuming and futile.