During the intervals general treatment should be instituted according to the indications. All functions at fault are to be regulated. Anæmia is to be corrected, the debilitating effects of malaria counteracted, good digestion promoted, and a weakened nervous system strengthened. These indications are met by tonics in various forms, notably iron and zinc; by antiperiodics, as quinia and arsenic; by stomachics; and by the judicious use of wine. There are other remedies quite as useful as drugs—cold sponging and shower-baths, followed by vigorous rubbing, general electrization, and, when the patient cannot or will not take outdoor exercise, massage. Change of scene and air is sometimes beneficial or even necessary. In many cases of pronounced neuralgic form, or in which the nervous system has been shattered by the severity or long duration of the attacks, there can be but little hope of amelioration without a thorough change of habits and mode of life in every respect.
The local treatment will be according to the conditions present. In the obstructive form, polypi are to be removed if present, and in stenosis the patency of the canal restored. Dilatation may be accomplished by tents. Should these fail, resort may be had to surgical measures, as the frequent passage of bougies gradually increasing in size, forcible dilatation with steel dilators under an anæsthetic, or by incision. Each of these measures has its advocates, and with all cures have been effected. Flexions should be corrected as far as possible by a vaginal pessary. Intra-uterine pessaries more certainly correct the deformity, but great care should be exercised in their use. If inflammation be present, uterine or pelvic, they will not be tolerated or will do positive injury; nor should a patient with any instrument of this kind ever be allowed to pass out of reach of the physician unless she can herself remove it.
The treatment of many cases of congestive dysmenorrhoea is very similar to that of suppressed menstruation from cold—warm drinks, hot foot- and sitz-baths, fomentations, and douches.
Particular attention should be paid to the bowels, not alone to correct constipation, but to give full relief to a clogged portal system by saline purgatives. If there be prolapsus, a pessary should be adapted so as to keep the uterus up in its place; by this means passive congestion is much relieved. Bromide of potassium is a reliable remedy as a corrector of pelvic congestion. In the congestive cases of anæmic subjects iron will act beneficially; in inflammatory congestion it does injury. Dysmenorrhoea dependent upon hyperplasia or endometritis should receive the treatment appropriate to those affections.
In neuralgic dysmenorrhoea the general treatment is far more important than the local. All those hygienic and therapeutic measures already detailed should be faithfully persevered with. For the relief of pain and control of the nervous symptoms enemata of asafoetida are useful. Chloral may also be administered in the same way or by the stomach, with camphor, valerian, and the æthers as required. In this form apiol has been successfully used; the evidence as to its value is clearer than the explanations of its mode of action. It may be given in capsules, each containing five grains, one, two, or three daily.
Some local measures often render good service: among them is the passage of bougies, which sometimes modify the sensitiveness of the cervical canal, as they do that of the male urethra. The galvanic current, both continuous and Faradic, has effected cures, but the cases to which it is best adapted or in which it is most likely to be good cannot be clearly indicated. A galvanic stem-pessary may be used, observing due caution. This instrument has been modified and much improved by Thomas: being made like a string of metallic beads, it is extremely flexible, and many of its former objectionable features are removed.
A successful treatment of membranous dysmenorrhoea has not yet been promulgated. The great difficulty of its cure is admitted by the highest authorities. Some cases associated with stenosis of the cervix have been cured by dilatation—a fact which but strengthens the general principle of correcting all anatomical changes whenever possible. Strong caustics have been applied to the interior of the uterus with a view of exerting an alterative influence upon the seat of the disease. The course seems correct in theory, but in practice it has not proved fruitful of good results, and treatment in the majority of cases is limited to palliation.
In regard to marriage in females afflicted with dysmenorrhoea, it may be stated to be advisable in many cases of the neuralgic form and in anæmic subjects where the flow is so scanty as to border on amenorrhoea. In cases of the congestive form, if dependent on inflammation or on organic lesions, as fibroids, there is very great probability that the symptoms will be aggravated by this radical change of mode of life.
Menorrhagia.