EMMENAGOGUES. 
BY 
GIDEON C. SEGE R M. D., 
HARTFORD. 
[From the Proceedings of the Connecticut Medical Society, 1888.] 
HARTFORD, CONN.: 
Press of The Case, Lockwood & Brainard Company. 
1888. EMMENAGOGUES. 
Gideon 0. Segue, M.D., Hartford. 
The presentation of a few practical points respecting some 
medicinal agents influencing the menstrual function, rather than 
an elaboration of all the different means that have been employed 
to correct menstrual irregularities, is my purpose in this paper, 
and that without entering upon the discussion of surgical inter- 
ference. 
It will be convenient to consider remedies from the indications 
requiring their use, as shown in the well recognized symptoms of 
amenorrhcea, dysmenorrhcea, and menorrhagia. 
Amenorrhcea.- In amenorrhcea from anaemia and chlorosis, the 
chalybeates are indicated, combined with the best hygienic 
measures. 
In such young girls when the "-expected " time has arrived the 
mother often advances the opinion that the amenorrhcea is the 
cause of the girl's ill health. By assuring her that the contraiy 
is true, and enlisting her aid, a powerful ally is obtained and the 
patient is placed in an entirely different mental atmosphere, one 
most conducive to the improvement of her health. In the use of 
iron, in such cases, I have had a gratifying experience with the 
Blaud pill, which consists of equal parts of ferrous sulphate and 
potassium carbonate. The treatment is directed to the correction 
of the constitutional condition as the cause of the amenorrhcea. 
Good nutritious food ; out of-door exercise of an amusing and 
agreeable nature, combined with a cheerful home atmosphere ; 
removal of, as far as possible, all sources of irritation to the ner- 
vous system ; relief from attention to school duties ; and a change 
of residence, by the new scenes and surroundings arousing the 4 
EMMENAGOGUES. 
patient to renewed interest in life from the sluggish, apathetic 
condition in which such girls are so often found. These hygi- 
enic conditions constitute the principal treatment, to be supple- 
mented by the Bland pill, beginning with two and increasing to 
five grains, three times a day, after meals. A careful persistence 
is often all that is necessary to restore the systemic condition, 
and, good health instituted, the menstrual function is normally 
induced. 
I began the use of the salts of manganese, in cases of irregular, 
deficient, and arrested menses, as recommended by Ringer, soon 
after the publication of his experience with the permanganate of 
potash ; using the tablets and pills of that drug, in both of which 
forms, although the emmenagogue action was pronounced, there 
was so much gastric disturbance attendant upon its administration 
that I was ready to discard it when the binoxide of manganese 
was introduced to take its place, and has proved a most excellent 
substitute, having the full emmenagogue effect without any gas- 
tric irritation consequent upon its exhibition, in my experience. 
In delayed or difficult menstruation I have used the two-grain 
pills of the binoxide of manganese, but more recently the tablet 
triturates, one grain each of Fraser & Co.'s manufacture. One of 
these is given, three times a day. after meals, during the interval, 
and the dose doubled (gr. ij.) during the time of the menstrual 
molimen. After one or more months the binoxide may be discon- 
tinued during the intermenstrual period, and begun again a few 
days before the expected return of the menses, and continued 
through the period. A course of a few months often results in 
establishing the function in a normal manner. 
In his "Hand-book of Therapeutics" (eleventh edition, p. 231) 
Ringer says of the permanganate : "It will restore menstruation 
after the lapse of two years or longer " ; and again, " I find it 
successful in cases of ansemia and in plethoric patients." 
In case of sudden suppression of the menses from shock, as in 
"catching cold ''during the flow, the hot footbath or sitzbath 
has long been a most valuable domestic remedy. The hot sitz- 
bath, of fifteen or twenty minutes' duration, may be repeated 
every three or four hours, small doses of aconite (ms. ss. to ms. 
j. of the tincture) being given every fifteen minutes until diapho- 
resis is established, and then the intervals extended to every hour 
or two, when two-grain doses of binoxide of manganese may be EMMENAGOGUES. 
5 
given with, or substituted for, the aconite. The sitz-bath is to be 
preferred, but, when it is not available, the next best thing is the 
hot foot-bath, with hot vaginal douches. I have seen so much ill 
effects resulting from vaginal douches improperly given, that it 
will, perhaps, not be out of place to say a few words respecting 
that simple procedure, which, nevertheless, is so seldom properly 
accomplished. 
The first requisite is a proper syringe, and the fountain syringe 
with hard rubber fittings, having a capacity of not less than two 
quarts, as in Goodyear's fountain syringe No. 3, is the best 
for the purpose. A chair placed near the side of the bed will 
serve for the feet to rest upon, while the patient lies upon her 
back across the bed, the hips upon the edge and slightly elevated. 
One end of a yard and a half of rubber sheeting, about a yard 
wide, or of some other water-proof material, should be placed 
under the patient's hips and the two lower corners pinned 
together, thus forming a funnel to conduct the water to a vessel 
placed below. After filling the fountain with water, at a temper- 
ature of 110° F., to which may be added a teaspoonful of sodium 
chloride, or biborate, it should be hung about two feet higher than 
the bed, and before introducing the irrigator pipe, all air should 
be expelled from the tube by allowing the water to flow through 
it. As the local application of heat is the object desired, the flow 
should be slow and without force, the temperature as high as can 
be readily borne, with the tube kept well up in the posterior cul- 
de-sac. An aloetic purge can often be used with advantage in 
combination with this treatment. 
This method will seldom fail in aborting the attack and induc- 
ing a return of the flow. 
Dysmenorrliaza. - Manganese, used just before and during the 
menstrual period, has, in many cases, given most happy results in 
dysmenorrhoea. In one case, a married woman, age 40, regular, 
obliged, during her menstrual period of about three days, to spend 
most of her time in bed, because of pain and lassitude, under the 
influence of six grains of the binoxide of manganese, daily, be- 
gun just before and continued during the molimen, is able to attend 
to her usual duties with only slight discomfort. Another case - 
single, age 27 - always had much pain with some irregularity - 
was treated in the same manner (six grains daily at the time of 6 
EMMENAGOGUES. 
her periods), and now is more regular, and free from the distress- 
ing pains. 
Pulsatilla, in drop doses of the tincture every fifteen minutes 
until relief from the pain, and then continued in same doses as 
required, in cases where there was a decided neurotic element, has 
given me some good results, but since using manganese, in com 
junction with the bromides (gr. x to gr. xx), with, in some cases, nux 
vomica (gtts. ij to gits. v. of the tincture), I find that I seldom use 
pulsatilla. These neurotic cases are apt to suffer from considera- 
ble general disturbance - headache, nausea, etc., and, with such, a 
dose of twenty grains of antipyrin will often act like a charm; 
the severe manifestations passing away quite speedily, and the pa- 
tient being able to complete her period without much discomfort. 
I find that the effects of antipyrin are produced more speedily 
and surely by the patient retiring to a quiet room and lying with 
the eyes closed for at least an hour after taking it. 
The application of heat, as in the sitz-bath or douche, is an 
effective adjuvant to internal medication when used at the beginning 
of the molimen. 
Menorrhagia. - In menorrhagia, due to chronic congestion and 
hypertrophy of the uterus, with lack of tonicity, ergot has given 
me the best satisfaction. I have found it of advantage to give it in 
small (gr. v.) doses, continued for a considerable time, and to com- 
bine it with cimicifuga (gr. x.) in a bitter tonic. 
II Fl. Ext. Ergotse, 3ij. 
Fl. Ext. Cimicifugse, § ss. 
Tr. Gentian. Comp., ..... §i. 
Elix. Calisayse q. s. ad., . . . . §iij. 
M. Sig. One teaspoonful in water after meals. 
My experience with electricity in functional menstrual disorders 
has been limited, but is of such a nature as to encourage me in the 
further trial of the faradic and interrupted galvanic currents 
through the pelvis, or with one pole inter-vaginal or inter-uterine, 
the other being applied to the spine or abdomen, in cases due to 
an atonic condition of the uterus, and a continuous galvanic current 
in the neuralgic pain of dysmenorrhoea. The investigations and 
experience of Apostoli in this branch of uterine therapeutics, to- 
gether with that of others who are incited to its study by the 
reports of his successes, will undoubtedly demonstrate its value. 
The ease of administration of the binoxide of manganese, being EMMENAGOGUES. 
7 
practically tasteless, its eminently sedative effects and its innox- 
ious character, especially the notable absence of any oxytocic influ- 
ence, in the dosage recommended, has induced me to place con- 
siderable reliance upon it in the treatment of functional disturb- 
ance of menstruation. 
It may be well to' say one word of warning respecting the use of 
manganese. Instances are not wanting where this drug has been 
used with success as an abortive, but in all such cases the dosage 
has been greatly in excess of six grains a day, which is the maxi- 
mum that I would use in any case from which the condition of preg- 
nancy could not be eliminated. 
But the causes of menstrual disorders are so largely due to me- 
chanical disturbance or organic disease that only disappointment 
can result, in the vast majority of cases where emmenagogues are 
depended upon, to the exclusion of surgical means to correct them. 
The following communications, from prominent physicians in 
different parts of the country, who have paid special attention to 
this class of diseases, will, 1 trust, be of interest. They are in 
reply to a request for " your favorite remedy and its mode of ad- 
ministration in, 1st, Amenorrhcea; 2d, Dysmenorrhcea; and, 3d, 
Menorrhagia": 
A. F. A. King, M. D., Washington, D. C. 
These diseases are but symptoms of some pathological condition on 
which they depend. I have but little reliance upon any one medicinal 
remedy. I think the "Pil-Aloes et Myrrh" a good emmenagogue - 
perhaps one of the best, when the use of it is desirable. As to menor- 
rhagia, where medicine is desired to check the flow temporarily, the 
Tr. Fl. Chloridi has served me well. But I find so many cases of this 
disease depending upon constipation and foecal accumulation that if I 
should be asked for any one medicine requisite to stop it, I should be 
inclined to answer somewhat in the same way as Cicero (I think it was 
he) did to the individual who inquired of him the three great requisites 
of an orator. You remember that he replied; the first thing is action, 
the second action, and the third action. So for menorrhagia (in the ma- 
jority of cases), the first thing is purge, the second purge, and the third 
purge. Dysmenorrhcea can hardly be cured by medicine, except per- 
haps in the congestive variety, where I have found large -- very large - 
doses of the spirits mindererus §j, every two hours during the period, 
often give strange relief. But blood-letting, local and general, and 
various other hygienic measures, will be requisite. But each of these 
diseases, (or rather symptoms, for they are nothing more) can be cured 8 
EMMENAGOGUES. 
only by finding out and relieving the pathological conditions - local or 
general, or both - on which they depend. I place very little reliance 
upon any single medicine, just as the disease (or rather symptom) of 
cough can only be cured by removing the bronchial, pulmonary, laryn- 
geal, cardiac, gastric, uvular, etc., condition on which it depends. 
M. Putnam-Jacobi, M. D., New York. 
1. I know of no one drug that can be relied upon in amenorrhcea. 
I have tried the permanganate of potassa, in one case where the periods 
had been missed twice after a sea voyage, and came on shortly after the 
use of the drug. In several other cases it has been too irritating to the 
stomach. Apiol is not powerful enough. Apart from general treatment 
usually indicated (albuminous food, hydrotherapeutics, iron), the three 
specific remedies I have found useful are : a leach to the cervix uteri, or 
galvanism within the uterine cavity, or the rubber health lift. I have 
three or four very nice successes with the latter agent. 
2. Dysmenorrhcea is the result of much too complex conditions to be 
considered with regard to any one remedy. It very frequently depends 
upon fundal endometritis, and is cured by ihtra-uterine applications of 
carbolic acid or iodized phenol. Symptomatically, chlorodyne is most 
valuable for severe pain. Moderate pain from irregular circulation 
through the uterus is often dissipated by apiol. I think chlorodyne 
particularly suited for cases with limited spots of peritonitis around the 
ovaries or fimbria1.'or in Douglas's cul-de-sac, caused by escape of secre- 
tions, or even of menstrual blood from tubes. 
3. Menorrhagia, again, is often symptomatic, as of fungous endome- 
tritis, displacements, lacerations, etc., each requiring its own treatment. 
But a combination of fluid ext. ergot (gtt.. xx) Tr. digitalis (gtt. v.) in 
tr. cinnamon every three hours, often overcomes even the symptomatic 
menorrhagias, and those of small fibroids. For the same purpose hy- 
drastis is certainly a most valuable remedy, 20-30 drops every three 
hours. 
James R. Chadwick, M. D., Boston. 
I have jotted down a few of the remedies that come to my mind. I 
am sorry that I have not time to elaborate. 
1. Amenorrhcea. 
Electricity, oleate of manganese, iron, and general tonic treatment. 
2. Dysmenorrhcea. 
R Ext. Belladonnse,gr. j. 
Aq. Camphor,§j. 
M. Sig. 3 j every hour until relieved. 
1) Wine of coca. EMMENAGOGUES. 
9 
R Ext. Fl. (alcoholic) Viburni Prunifolii, - § jss. 
Tr. Cannabis Indic., ----- §ss. 
Morph. Acet., - - - - - - gr. j. 
M. Sig. 3j doses. 
Electrolysis by Apostoli's method, electric baths, bromides, general tonic 
treatment. 
3. Menorrhagia. 
Acid, sulphuric arom., gtt. xx. Three times a day. 
Ergot between the menstrual periods. 
Chian turpentine. 
Hydrastis Canadensis. 
Paul F. MundeS, M.D., New York. 
For amenorrhcea I have chiefly employed manganese. My attention 
was called to the remedy soon after its introduction into practice by 
Ringer, and I was induced to give it an early trial, since my experience 
with all other medicinal emmenagogues had been exceedingly unsatis- 
factory. Indeed, I had arrived at the point of discarding the familiar 
remedies, saline, rue, tansy, gossypium, etc., and of relying almost 
exclusively on local heat, counter-irritation, scarification and leeches to 
the cervix, and intrauterine and ovarian galvanization and faradization. 
I began with the permanganate of potash, using it in pills and cap- 
sules, gr. i. to ii., after each meal, during the whole intermenstrual 
period. But I soon discontinued the solid form, because I was 
informed by druggists that the remedy was liable to decompose in that 
shape. I therefore tried it in solution for a time, prescribing 3i. to 
§ i. of distilled water, of which ten drops were to be put into a tumbler 
of water and drunk immediately after eating, followed at once by 
thorough rinsing of the mouth. No discoloration of the teeth was pro- 
duced by the solution used in this strength, and the taste was not par- 
ticularly unpleasant. About two grains were thus given at each dose. 
Patients did not object greatly to this medicine at first, but soon com- 
plained of the amount of fluid they had to swallow three times a day, 
and of increasing dyspeptic symptoms. And hence, after several 
months' trial, I was beginning to fear that the chemical difficulties of 
administering the remedy, might interfere with its popularization, 
when the introduction of the gelatine-covered pills of binoxide of man- 
ganese by McKesson & Robbins seemed to offer an elegant, tasteless, 
indestructible, and efficient substitute. I have used the two-grain pills 
made by this firm in numerous cases, giving one or two pills after each 
meal; one, if the remedy was continued through the whole month; one 
or two, if it was given only during the week preceding expected 
menstruation, and have found it certainly quite as efficient, and I think 
less injurious to the stomach than the permanganate of potash. My 10 
EMMEN AGOG UES. 
experience extends to, I am sure, in round numbers, at least one 
hundred and fifty cases; I have kept no record, but should think the 
number would approach nearer two hundred than far below it: for the 
cases in which I have employed the remedy during the past five years 
in private practice, and particularly at the Polyclinic, have been quite 
common. My experience may be formulated as follows: 
In amenorrhcea due to chlorosis or anaemia, or to change of climate 
(as in servant girls immigrating to this country) the manganese has 
acted as a general tonic, similar to iron, with an apparent special influ- 
ence on the sexual organs, so that often after one month, and usually 
after two months' use, menstruation has reappeared. A continuance 
of the remedy has resulted in re-establishment of the regular flow, and 
gradually the administration was limited to one week before the 
expected period. How much improved nutrition and acclimatization 
may have aided in this result I cannot say. 
Amenorrhoea, apparently due to deficient ovarian innervation, as so 
frequently occurs in stout, flabby, often sterile women, was but little 
benefited by the manganese. 
But plethoric women, with sluggish portal circulation, and cold 
hands and feet, who were in the habit of skipping one or more periods 
without apparent cause, and who were constantly in fear of having 
conceived, were generally much relieved at seeing their flow appear 
after from several days to a week's use of six or twelve grains of 
mangan. binox. daily. 
On several occasions, merely to temporize until I could make a posi- 
tive diagnosis, and to quiet the patients, I gave manganese without the 
slightest effect, until a subsequent examination revealed pregnancy. It 
is not, therefore, an abortifacient, although I would advise caution in 
its use in doubtful cases. 
In unexpected, temporary suppression from cold, nervous shock, or 
from unexplained causes, manganese will usually be depended upon to 
restore the natural flow within three or four days; twelve grains being 
given daily. I do not recollect being told that the flow was in any case 
excessive, or painful, when it was not so before. But a scanty flow 
was almost always increased by the remedy. 
In conclusion I must, however, emphasize most particularly one disa- 
greeable feature of the remedy, namely, its frequent unreliability. 
While in many cases it would do all that was desired, in others, appar- 
ently identical, it would disappoint me by proving an utter failure. 
Thus, 1 recollect two cases this winter, both of suppression for several 
months, in plethoric, sluggish women, where a three to four days' use 
brought on a natural flow, greatly to the delight of the ladies - who 
were correspondingly disappointed when at the next period a week's 
administration was entirely ineffectual. EMMENAGOGUES. 
11 
My conclusion is that manganese is particularly useful in cases of 
anaemia, where a general tonic is indicated; and in cases of temporary 
suppression; and that it seems to exert in many instances a specific 
action on the female sexual organs. But that it is an uncertain remedy, 
which may fail in apparently the same conditions where it formerly 
succeeded. Finally, it is not injurious unless used in too large doses, 
and does not usually produce abortion. Its great objections are unreli- 
ability, and a tendency to cause gastric disturbance. 
Quite recently I have used repeatedly the lactate of manganese in one- 
grain triturate tablets, prepared by Hazard & Co., as a general tonic, 
and thus as an emmenagogue, with considerable benefit. The advan- 
tage of this preparation would seem to be its easy digestibility. 
2. For dysmenorrhcea I have found the tr. of pulsatilla in three to 
five drop doses ter die quite effectual, when given several days before 
and during the period, chiefly in the neuralgic variety, as in young 
girls and unmarried women. In congestive dysmenorrhcea, saline laxa- 
atives just before the period, hot sitz-baths, and a small blister over 
each ovary just before the period. In married women, scarifying or 
leeching at the same time in the month. For obstructive dysmen- 
orrhcea nothing but dilatation, usually rapid, proved of benefit. In 
fact, internal medication has failed me too often in dysmenorrhcea to 
enable me to be very enthusiastic in favor of any single remedy. 
3. Menorrhagia. Fl. ext. gossypium and ft. ext. ergot, equal parts, 
in teaspoonful doses every two or three hours, has usually checked the 
flow. Also fl. ext. hydrastis canad. gtt. xx, doses every two or 
three hours, has, at times, been useful; also oil of erigeron, gtt. v, 
doses three or four times daily. In obstinate cases, nothing but vaginal, 
and even uterine, tamponade succeeded in arresting hemorrhage. If 
the uterine tampon was used it was soaked in tr. ferri persulph. and 
glycerine aa., or tr. iod. comp, and left in the uterus for forty-eight 
hours, the vaginal tampons for the same length of time. 
Alex. J. C. Skene, M. D., Bkooklyn. 
In regard to amenorrhcea I have no special remedy that I use. I en- 
deavor to find out the constitutional and local conditions which cause 
the amenorrhcea, and relieve them if possible. When this is accom- 
plished menstruation is usually established without any further treatment 
or medication. In regard to dysmenorrhcea the same statement would 
apply to a certain extent. If the pain is due to a general hyperthesia 
of the nervous system, I give bromide, or cannabis indica, or compound 
spirits of ether and camphor, or antipyrine. If it is due to some 
organic disease of the uterus, such as flexion or inflammation, I try 
to relieve this condition; this accomplished, the dysmenorrhcea will dis- 
appear. Menorrhagia, when due to the congestion of the uterus, is 12 
EMMENAGOGUES. 
sometimes controlled by hydrastis canadensis, 15 drops of the fluid ex- 
tract every four or five hours. When caused by enlargement of the 
uterus, from submucous fibroid, ergot will sometimes help, but electrol- 
ysis, after the method of Apostoli, is more effectual. If it is due to 
fungus growths of the mucous membrane, the curette is the only reliable 
means. 
Robert Battey, M.D., Rome, Ga. 
1. Amenorrhea.- My experience with emmenagogues has been a 
disappointing one. I secure the best results, usually, by the use of the 
galvanic stem. 
2. In dysmenorrhea I prefer Falk's antacrid tincture to any other 
medicament. 
Hydrg. Chi. Corros., gr. x. 
01. Sassafras, 3i. 
Bals. Canadensis, §ss. 
Spts. Aeth. Nitrosi, - - ' - - - § iss. 
Tr. Guaiaci, § iiss. 
M. ft. Sol. Sig. 15 drops on sugar three times a day, after meals, for 
ten days prior to each period. 
3. In menorrhagia, gallic acid and ergot have done me most service. 
William Goodell, M.D., Philadelphia : 
1. Amenorrhcea. - The rest treatment, with massage, electricity, and 
iron and arsenic in large doses. 
2. Dysmenorrhea. - Forcible dilatation of the cervical canal under 
ether. 
3. Menorrhagia. - (a) Curetting; (6) digitalis and sulphuric acid. 
In anaimic cases, the best haemostatic is a combination of ergot and 
large doses of iron, during the intervals of the fluxes. 
Wm. M. Polk, M.D. (by Chas. C. Barrows, M.D.), New York: 
Treatment of amenorrhea is by iron, cod liver oil, and faradization. 
Dysmenorrhea- If from stenosis, divulsion of cervix. From peri- 
uterine inflammation, local counter irritation and packing vagina. If 
this is not successful, laparotomy and relief of uterus, and appendages 
from hampering adhesions by breaking them up. 
Menorrhagia, according to cause. Generally due to retained secun- 
dines or chronic hypertrophic endometritis, polypus, fibroids, carcinoma 
or sarcoma. Treat the cause as is required in each case. 
These testimonies, as well as the recommendations of our au- 
thorities, in books of reference, show no marked unanimity in the EMMENAGOGUES. 
13 
choice of emmenagogue remedies; nor should we expect to find it 
otherwise, when we consider the many and varied causes that call 
for the use of this class of drugs. 
Those who have used manganese agree in respect to its efficiency 
'in many cases of functional uterine disturbance; and, in the bin- 
oxide, we seem to get the full emmenagogue effect without the 
irritation following the exhibition of some other form, as, for in- 
stance, that of the permanganate of potash. 
The ends of this paper will have been attained if I succeed in 
calling to your attention a remedy which your experience shall 
prove to be of value in relieving some of those distressing symp- 
toms for which emmenagogues are used. x