MUNDE, Assoc. Ed., Annual, '90.] Treatment. — Women who object to becoming pregnant represent a large pro portion of the cases of amenorrhoea met with. Special care, therefore, should be taken not to administer emmenagogues, under such circumstances, or to intro duce instruments into the uterus. In bona fide cases, however, amenorrhoea be ing more of a symptom than a disease per se, the original cause should be dili gently sought after and removed, if pos sible.
When diagnosis between functional amenorrhcea and pregnancy is difficult, senecio may be safely prescribed before deciding, as it will probably cure the one, and certainly will do no harm to the other. Senecio will not cause abortion nor in any way influence the course of pregnancy. W. E. Fothergill (Edinburgh Med. Jour., May, '9S).
Emmenagogues may be classified into two classes: medicinal and physiological.
Severe physical shock or fright some times causes the menstruation to return suddenly.
When the arrest of menstruation is due to exposure to cold, warm baths and vaginal injections, sinapisms to the thighs and calves of the legs, saline laxatives and manganese-binoxide pills (2 grains each), one or two after each meal, are frequently successful. This drug acts by increasing the vascularity of the pelvic organs. The permanganate of potassium, or the lactate, in 1-grain doses three or four times daily, after meals, act in the same manner.
The following treatment is highly rec ommended in suppression of the menses: R Liquor fend et quinia citratis, ounce.
Liquor potassii arsenitis, 3 drachms. Strychnine, Atropine, of each, 'I, grain.
Elixir of orange-peel, enough to make S ounces.
M. Sig.: Teaspoonful in water, before meals, three times daily. The ingredi ents, or dose, to be increased according to the tolerance of the patient.
This is continued until there is mani fested the peculiar menstrual discomfort, when it is discontinued and the followiag given:— R Potassii permanganatis, 10 grains. Divide into pills No. x, compressed or in capsule.
Sig.: One pill followed by one-half glassful of water, before meals, three times daily.
Also: Manganesium binoxide, 10 grains.
Divide into 10 compressed pills or into as many caps'iles.
Sig.: One pill after each meal, three times daily.
By the second or, at most, the third day after taking these the flow usually becomes fully established. If the man
ganese does not fully effect this at the first attempt, the first Irescription is re lied on during the interval, and the pills commenced about three days before the expected time.
In ordinary menstrual suppression the last two used as above, are es pecially effective. De Wces (Med. and Surg. Reporter, June 30, 'SS).
In amenorrhoea, associated with mental diseases, the potassium permanganate is to be given in 1-grain pills three times daily, and after three months in 2-grain doses. The pills should be given for fully three months after the courses appear, and must be taken without intermission. Macdonald (London Practitioner, June, 'SS).
Of the manganese compounds the bin oxide seems to give the best general re sults, though it cannot always be relied upon. The lactate is also an efficient and irritating agent. Segur (Med. Record. Feb. 2, '89).
When manganese-binoxide pills are given they should be followed by a little water fifteen minutes later, in order to avoid the burning pain in the stomach, which they are liable to cause. E. J. Hauck (Va. Med. Monthly. Aug. 30. '91).
When there is any faulty constitu tional condition, this should be treated. Amemia especially requires iron with ar senic and strychnine or mix vomiea. and, as the anmemia improves, menstruation is more likely to he established. As to the action of reputed emmenagogues, such as manganese dioxide. potassium perman ganate, etc.. the results in per sonal experience have not been encour aging. After a reasonable trial of drugs, if no result is obtained. it is usually ad visable to examine the pelvic organs, preferably under an anaesthetic, for, if a condition of nnder-development be present, prolonged drug treatment is futile, and is disappointing to the pa tient. Under these circumstances it is best to explain the condition and leave matters alone. Stimulation by electric ity is usually undesirable and unneces sary in the ease of single patients, though it may be tried in exceptional cases if the fact of amenorrham is a source of worry to the patient. The most effective stimulus is that supplied by marriage. A. E. Giles (Clinical Jour., Jan. 30, 1901).