APIOLINE IN Amenorrhoea and Dysmenorrhoea* By RICHARD S. IIIIJL, M. I)., WASHINGTON, D. C. [Reprinted from Virginia Medical Monthly, April, 1891.] While the title of my paper is "Apioline in Amenorrhoea and Dysmenorrhoea," I shall refer principally to the latter. The subjects of amenorrhoea and dysmenorrhoea are of much interest, both to the general physician and the gynse- cologist. I am very well aware that much has been written upon them, especially upon dysmenorrhoea, but am fully con- vinced that these troubles have not been given that amount of practical medical attention by the several text books which they deserve. Hence, I wish to call your attention to those drugs used and highly recommended by others, and espe- cially to the use of one drug which has given, in my hands, great satisfaction, and to cite several cases treated success- fully with it. If I am able, through my remarks to-night, to lead my fellow membejgto make such inquiry and give such thought to these diseases or troubles, and thereby relieve the suffer- ings of one poor woman, I shall be well repaid. * Read before the Medical and Surgical Society of the District of Columbia, February 16th, 1891. 2 We all know what great anxiety is caused in many fami- lies ; what great worry is caused many a mother by her daughter not being "sick" regularly, or for months ata time; besides this anxiety and worry, the suppression of the menses is most assuredly, to a greater or less extent, un- healthy. The monthly suffering in many cases of dysmen- orrhoea, is almost equal to the pains during the worst cases of labor, and far more prejudicial to good health, keeping the poor sufferer in a constant state of dread and fear. Dr. E. W. Mitchell, in the discussion of his paper on "The Medical Treatment of Dysmenorrhoea," October 10th> 1889 (ffm. Journal Obst., Vol. XXIII, page 329), says: "From his observation, two classes of girls were especially liable to dysmenorrhoea, forming the extremes of society. First, the daughters of wealth, who are sent to school early, have little healthy exercise, but keep up the dissipations of so- ciety, late hours, etc. Secondly, the girls of poor families, who are ill-fed, work very hard, and in addition, have often inherited a weak constitution." During my past connection in the service of " Diseases of Women " in the Central Dispensary in this city, and also in my private practice, my experience is the same as that of Dr. Mitchell. I will go further and say, that the first class above mentioned, do not respond to treatment as readily as those of the second. ♦ In the first class of cases, we are compelled to treat on a supposition to a great extent, and for a long time, since any examination is most positively refused both by the patient and by her mother. As Dr. Geo. F. Shrady says in an edi- torial in the Medical Record, Vol. 35, page 129: "The general practitioner is often asked to relieve cases of this nature in girls who would never submit to an exam- ination or operation, preferring rather to suffer pain indefi- nitely, than the shame of a physical investigation into the nature of their trouble. In such cases, the physician is forced to try the effect of medicinal agents, groping, it may be, in the dark, before insisting upon an examination. Such being the case, it is well to learn what remedies have been found to be of occasional service in relieving symptoms of 3 this nature which are not dependent upon actual organic disease." I have said in the beginning of this paper, that the text- books have not given these subjects, especially amenorrhoea, full medical attention. The treatment is passed over in a very general way, stress being givnn to the general health, out-door exercise, sending patient to the country, ocean trip, Turkish baths, hot hip baths, attention to bowels; then a passing mention that the emmenagogue remedies are some- times useful. With these preliminaries, great attention is then given to the surgical treatment by bougies, dilatation, tampons, pessaries, etc., but it is here that we must remem- ber what Dr. Duncan says on this subject: "No rules that I can give you will make up for want of good sense and good feeling on your own part, but I shall give you some hints. The first is that you should, as a rule, not resort to the treatment by bougies in an unmarried woman without the consent of three parties-firstly, your own ap- proval ; secondly, that of the mother or guardian of the pa- tient ; thirdly, that of the patient herself. All of those should be quite aware of the circumstances, and of what is proposed to do." (Hart and Barbour, " Manual of Gyne- cology," page 556.) Upon menstrual disorders, we are greatly indebted to the following gentlemen for the deep study and practical expe- rience which they give in the following articles: Dr. Wy- lie, on "Menstruation and its Disorders," (Am. System of Gynec., Vol. I); Dr. Palmer in a paper read before the Eighth Annual Meeting of the American Gynaecological Society (Trans. Am. Gyncec. Society, 1883, page 101); Dr. Segur, in a paper before the Connecticut Medical Society at its annual meeting in 1888, on the " Medical Treatment of Menstrual Disorders"; Dr. E. W. Mitchell, in a paper on " The Medical Treatment of Dysinenorrhoea," read before the Cincinnati Obstetrical Society, October 10, 1889 (Am. Journal of Obs., page 259.) The last two papers, as their titles show, give especial attention to the medical treatment. We will now pass on to the ordinary emmenagogues, re- membering, of course, that the general health and condi- 4 tion must be looked after; tonics, out-door exercise, good nourishing food, are all very necessary. The following drugs are among those that have been generally used and recommended for amenorrhoea: Iron, arsenic, cod-liver oil, permanganate of potash, salts of manganese, santonin and apiol. In dysmenorrhoea, actea racemosa, pulsatilla, gelse- mium, cannabis indica, cimicifuga, bromides, chloral, cam- phor, viburnum, antipyrin, hyoscyamus, belladonna, oxa- late of cerium, permanganate of potash, salts of manganese, electricity, faradic and galvanic currents, bi-chloride of mercury. Capsules of apiol and apioline in both amenor- rhoea and dysmenorrhoea. Apiolinum or apioline is the true active principle of apium petroselinum, or common parsley ; and according to an acticle in the Satellite of the Annual of the Universal Medi- cal Sciences, April, 1890, page 163, is prepared by M. Cha- poteaut, of Paris, as follows : "After complete exhaustion with light petroleum ether, the resulting liquid leaves on distillation, a semi-congealed residue of neutral substances, fatty acids, etc., which, when treated with alcohol, is partially soluble. The alcoholic so- lution on evaporation leaves a product which, in addition of caustic soda, yields a thick, reddish, liquid, boiling at 275° C., specific gravity, 1.113, which may be looked on as a pseudo-apiic alcohol." Physiological experiments made in the laboratories of the Faculty of Medicine of Paris, show that apioline has a special action on the circulatory system of the smooth, mus- cular fibres of the uterus, producing vascular congestion and excitement with contraction. I have been able to find but very little in the text-books upon this subject. They all mention apiol as having been used with more or less success. Some writers go so far as to claim it superior to any other emmenagogue. Now if apiol is recognized as good, and if apioline is, as claimed, a supe- rior preparation, and the actfwe principle of apium petroseli- num, it should then be superior to apiol, and rank among the best, if not the very best emmenagogue. My experience 5 has been far more satisfactory with apioline than any other drug. Munde and Wells, in their very valuable articles and re- searches in Dr. Sajous' Annuals for 1889 and 1890, on "Dis- eases of the Uterus, etc., and Disorders of Menstruation," Vol. XI, do not mention, and report no articles mentioning apioline. In Wood's Materia Medica and Therapeutics, sixth edition, 1886, page 587, under head of apiol, no mention is made of apioline. In Bartholow's Materia Medica and Therapeutics, seventh edition, 1889, page 736, under head of apiol, no mention is made of apioline. In Potter's Therapeutics, second edition, 1890, page 106, no mention of apioline under head of apiol is made. In Hare's Therapeutics, 1890, page 64, there is no mention of apioline. In Shoemaker's Materia Medica and Therapeutics, 1889, Vol. XI, page 447, we read: "It is said to be not abortifa- cient. In cases of scanty or deficient menstruation, with pains, etc., one capsule can be given after meals, thrice daily, for a week before the expected period, as recommended by Dr. Fordyce Barker. I^.-Apiolini, grm. iv., ft. capsules. No. xx (Chapoteaut). Sig.-Take three each day during week preceding menstru- ation. It is especially appropriate when amenorrhcea de- pends upon anaemia." Report of Cases. Case No. I.-Missouri W., a mulatto, washerwoman, age 32 years. Robust constitution, always healthy, except severe dysmenorrhcea, which she has had since birth of her only child six years ago; which after three days labor was delivered dead with forceps. Since then, always obliged to remain in bed first two days of menstruation, which usually lasted four days. Since she came under my care, about two years ago, she has been treated with hot douches, permanganate of potash, and bi- noxide of manganese, for about three months without relief. I gave her in December, 1889, twelve capsules of apioline, of three minims each, and ordered her to take one three times a day before meals, beginning three days before, and 6 continuing to second day of period. The capsules acted marvelously. Period came on and lasted four days ; quan- tity free, no degree of pain, remained at work entire time. I ordered same prescription for next period, but no flow and no pain. The woman soon proved to be pregnant, and on October 21, 1890, after three hours' labor, I delivered her with forceps, of a 10| pound male child. The father and mother are still thanking me, and insist that it was my medicine that gave them " a live boy baby." Case No. II.-Miss E., white, age 23, small, anaemic, and of nervous temperament. Came to me from the country in May, 1890, for severe dysmenorrhoea. Had taken quantity of different kinds of medicine with no relief, now had to go to bed, take brandy in large quantities, apply mustard plasters, and remain in bed for two days. Period usually lasted one week, and was irregular. I gave her twelve cap- sules of apioline, three minims each ; ordered her to take one three times a day before meals, beginning three days before, and continuing until second day of period. Re- ported great relief after first trial. I told her to go home and take the capsules as I ordered again at next period, and to report to me. She is now entirely well. She took the apio- line for three months in succession, and not since. Case No. III.-Miss B., white, aged 23 years, strong and healthy, very fond of society and attending dancing par- ties. Consulted me June, 1890, for treatment; had suffered almost tortures at her periods for the past four or five years, but would never consult a physician. Period lasted six days; always remained in bed during the first two days; took stimulants and used hot water to abdomen. I ordered twelve capsules of apioline, three minims each. Directed her to take one three times a day before meals, beginning three days before and continuing to second day of period. Relief began at first period, as she experienced but a mode- rate degree of pain; I renewed the prescription for next period; since then she has been perfectly well; does not suffer an hour from menstruation. Case No. IV.-Miss N., white, aged 25 years; actress; tall and very anaemic; hysterical and nervous temperament. In 1885, she had a severe case of inflammatory rheumatism; came under my care first in spring of 1888; was then very anaemic and hysterical; always had severe hysterical con- vulsions at every menstrual period, lasting off and on for four days. I have had her on iron, arsenic, cod-liver oil, bitter tonics, malt and pepsin, bromides, asafoetida, per- 7 manganate of potash, binoxide of manganese, antipyrin, etc. After a trip to the seashore in the summer of 1889, she improved considerably, and again joined a theatrical com- pany that fall, and remained "on the road " until February, 1890, when she was brought home in a state of complete nervous prostration. I was anxious to give up the case, but the family insisted upon retaining me. I was now at a loss to know what to do. My patient was worse than ever, and had acquired the morphia and whiskey habits. Her stom- ach rebelled against food, and she was almost crazy. I positively forbade morphia, and had her continually watch- ed; allowed a moderate quantity of whiskey in milk punch, and with raw egg as food. Prescribed maltine with iron, quinine and strychnine, and gave night and morning pills of aloes and asafoetida. She improved slowly. During the latter part of the spring of 1890, I insisted upon an examination to try and find the cause of the dys- menorrhoea from which she still suffered, but it was most positively refused at the time. Later, however, I did exam- ine her, and found a very small uterus, high up. While under examination, she went off in a hysterical attack, and I had to stop. Two more attempts were made at other times with the same result, as I did not care to use an anaesthetic; continuing my general tonic treatment, using large doses of maltine and iron, I determined last October to try apioline. She took apioline just before and during the period for three months with some relief. I began giving her capsules of apioline three times each day during January. Her men- strual period in January (second week) was the least painful yet. She feels much better, is in good spirits, and says she will soon be well and return to the stage. She has just reported that she menstruated during the second week of the present month (February, 1891), had slight pains, did not go to bed nor have a nervous attack. I shall continue apioline and stop all other medicine for the present. Case No. V.-Reported by the kindness of Dr. James D. Morgan.-An actress having suffered for years at her cata- menia; flow generally scanty and often membranous in character. Several days before her menstrual epoch suffer- ed violent congestive headache, palpitation of the heart and great despondency. The flow generally made its appearance with most excruciating agony, often throwing the patient into convulsions, opisthotonos being sometimes pronounced. Patient had been treated by many distinguished physicians 8 in many different cities, and, correspondingly, had tried many remedies. I had but recently read of the virtues of apioliae, and through the aid of a neighboring pharmacist, I secured the drug. The good results were manifest a few hours after the capsules were given, and the patient contin- ued to use them with marked relief at her menstrual peri- ods. Some two months ago, I was called to see this same young actress, and found her almost convulsed in dysmen- orrhoea. She told me that in the hurry of travelling she had lost her medicine, and that she had found nothing to relieve her so much as the medicine I had ordered. I gave her a prescription for the capsules of apioline, and presume that the drug is having the same salutary effect. In conclusion, I would say, that apioline is decidedly the most reliable drug that I have yet used in dysmenorrhoea. In all of the few cases I have so treated, relief has invaria- bly resulted, but by no means do I claim it to be a spe- cific. I regret not being able to report some cases of amenor- rhoea treated successfully; I have, however, had no failures, for in the three cases where the apioline has been used in amenorrhoea, pregnancy has followed. I, however, firmly believe it is beneficial in amenorrhoea; for in all my cases of dysmenorrhoea treated with apioline, I noticed an in- creased flow of the menses, and its physiological action is most active upon the uterus and ovaries, "A stimulant to the uterine system," as Bartholow says of apiof (Materia Medica, page 604). 1449 Rhode Island Avenue.