DYSMENORRHEA: 
BY 
JNO. M. JOHNSON, M.D., 
PRESIDENT ATLANTA ACADEMY OF MEDICINE, LATE PROFESSSOR OF PHYSIOLOGY 
AND PATHOLOGY IN ATLANTA MEDICAL COLLEGE. 
READ BEFORE ATLANTA ACADEMY OF MEDICINE JAN. 12,1875 
ATLANTA, GEORGIA I 
DUNLOP, WYNNE & CO., PRINTERS, 11 NORTH BROAD STREET. 
1875. DYSMENQRRHCEA: 
V6* 
JNO. M. JOHNSON, M.D., 
President Atlanta Academy of Medicine, Late Professor of Physiology and 
Pathology in Atlanta Medical College. 
READ BEFORE ATLANTA ACADEMY OF MEDICINE JANUARY 12, 1875. 
Neither our philosophy, the logic of speculation, nor the in- 
quiries of physiologists and gynecologists, have led us to harmo- 
nious conclusions regarding the essential nature of menstruation. 
We have not been able to penetrate the arcanum in which its se- 
crets are hid. The field is an inviting one. Messenger after mes- 
senger has gone forth to explore it, and all have returned empty- 
handed, declaring that its secret springs are not ready to be re- 
vealed, and its laws too mystical for the present state of human 
knowledge. What wonder, then, that we hear the cry from one, 
Lo, here ! and from another, Lo, there 1—that one should say it 
is due to ovarian influence, and another that it is an inherent and 
independent function; and still another, that it is a co-relative 
function, requiring the co-operation of other organs to complete 
it? We should be charitable in all matters of opinion towards 
each other. We should neither reflect at random, nor condemn 
at a venture, but, like Paul, believe all things, hope all things, 
taking care to hold fast to that which is good. 
Before proceeding with the subject, I wish to lay down some 
general principles which will render my views more intelligible. 
Every organ of the body is independent of every other organ in 
the essential function assigned to it. The brain and cord, liver and 2 
D YSMENORRRCSA. 
spleen, ovaries and womb, all perform different functions in tlie 
living economy. In making a pin, for instance, one man pre- 
pares the metal, another makes the wire, another cuts it the pro- 
per length, another polishes and sharpens it, another makes the 
head, and another puts it on. As in mechanics, so with the com- 
plete organism; rudimentary nutrition begins in the mouth; 
the food, masticated and insalivated there, is made homogene- 
ous in the stomach, where certain products are absorbed; it then 
passes to the duodenum, where a process awaits it; the resi- 
dium with the fats, after receiving the pancreatic juice and bile, 
is emulsified; and while in the small bowel, the products ap- 
propriate to their functions are absorbed by the lacteals, con- 
verted into lymph, and carried into the circulation near the heart 
by its own duct. 
I shall speak of reflex action as a psycho-physiological func- 
tion, such as occurs in the sexual coitus, in the nutritive pro- 
cesses, and all the animal functions, leaving out, of course, the 
morbid phenomena. For instance, the hen lays an egg perfect 
in all its parts, but, if she has not seen the male, the nucleus is 
wanting, and the physiological action fails. But, having seen 
the male, she selects her nest in a quiet, hidden place; this is a 
physical function. She lays an egg in it every day until the 
nest is full; this is a pyscho-pliysiological function. She sits on 
them until they hatch; this is a mixed function, and the hatching 
is the consummation of the primary embryo-physiological action. 
In the hen, ovulation is independent of sexual interference; 
the egg matures, and is thrown out perfect in every particular, 
but will not reproduce. In the woman, the same state of facts 
exists. The egg is formed simultaneously with all the other or- 
gans, and is a part of the complete organism, but remains pas- 
sive until the psycho-physiological forces begin to develop. 
These consist—first, in a love of offspring; second, the innate de- 
sire of every female to be a mother. Gradually the pubes and 
mammary glands give evidence of approaching puberty. Here 
begins a new train of psycho-physiological actions. The womb, 
that has been passive up to this time, now asserts its great func- 
tion; “ pleasure waves her enchanting wand;” erethism begins, 
the reflex function follows, and the train of physiological actions 
we call menstruation begins. 
The vascularity of the womb is in proportion to the wonder- 
ful function it is intended to perform. It is penetrated by innu- D lrSMEX OPiRTICEA. 
3 
merable arteries. It is made of lateral and transverse fibres, 
very small, but very powerful, and held together by equally pow- 
erful connective tissue. It is ramified by millions of arterioles 
and capillaries, only separated from the cavity by a thin epithel- 
■ mi. A stassis is set up: this results in rupturing the epithel- 
ium, and relieving the congestion by a flow of blood, which we 
call menstruation. Another great function marks this period. 
I mean ovulation. The ovaries are glands. They are analogues 
vf all the other glands. Each has power to organize and ma- 
ture the products peculiar to it, independently of all interference 
from other organs. All of these products are utilized by the 
economic forces. The ovaries, like other glands, contribute their 
product in the form of a small cell, which is the result of its in- 
herent power. This cell burrows its way through the substance 
of the gland by an ulcerative process, and falls into the oviduct 
which transmits it to the womb. Here, when impregnated, it 
begins the work of organization. Instinct with life, it attaches 
itself to the mucus surface of the womb at the fundus; and as 
the spider weaves his web at the top of the ceiling without visi- 
ble support, so by inherent power it organizes a double placenta, 
with a double function-one on the maternal side, and the other 
on the fcetal side. The double function consists of distinct tu- 
bules, innumerable in number, which ramify from both sides, 
without entering or being entered by either. It throws around 
a double decidua as a support and protection. It organizes its 
own blood—not a drop of the mother’s blood enters it. This 
blood is expelled by the fcetal heart, and ramifies the foetal side, 
the impurities of the blood passing by exosmosis, while those 
from the maternal side, by endosmosis, impart oxygen and nutri- 
tion, which is carried back to the fcetal heart, and distributed 
for the support and growth of itself. 
Thus it will be seen that the ovaries have a single function, 
that of ovulation, while the womb has the incidental function 
>f menstruation, and the real one of nursing the foetus to ma- 
turity. 
I have said that menstruation was an incidental, and not the 
i eal, function of the womb. At first, it asserts the right of an 
established womanhood, with all of the responsibilities and du- 
' ties belonging to it. Its return after the birth of a child was 
doubtless to keep the parties separated for a period of four or 
♦fix days, to allow the sperm to mature, the better to insure a 4 
D YSMEXONRllCEA. 
healthy offspring. Its further significance is found in its inhe 
rent vascularity, so that, under all circumstances, whether en- 
larged by pregnancy and the proliferation of substance which 
attends it, or reduced after delivery by involution and the de - 
generation and absorption of adventitious substance for making 
new matter for the womb in pregnancy, or the absorption of it 
after delivery, there should be blood enough to accomplish both 
objects. The enlargement in pregnancy and complete involu- 
tion after delivery proves conclusively thgt the womb was not in- 
tended to be a stationary organ. The monthly erethism and. 
flow keeps its fibres soft and elastic by the thorough irrigation of 
the parenchyma, and the inner walls as well, so that its inherent 
functions may be performed without injury or even pain, and 
hence the monthly menstrual recurrence is a law to itself, in view 
of its real function. 
Between the ovaries and womb there is; but a single anatomi- 
cal connection, and that is a small fibrous non-vascular ligament, 
which begins at the edge of each ovary and ends in an attach- 
ment to the corners of the womb at the fundus. They have no 
nerves, arteries or veins in common, and, from the force of cir- 
cumstances, can have no function in common. 
It is asserted by authors, and generally believed by medical 
men, that, ovulation occurs monthly. This belief is founded on. 
the doctrine of co-operative ovarian function in setting up men- 
struation. This cannot be true. Pregnancies occur constantly 
where there has been neither mollimen nor flow. I have had 
many such cases. I delivered one woman eight times who had 
never felt the mollimen or had the flow after the first pregnancy. 
To attempt to establish co-operation of function by a coincidence 
of function is certainly the wrong method of reasoning. My be- 
lief is that ovulation is not regulated by periods, but by the gen- 
erative power of the organ, and that ovulation may occur once 
a month or once a year, and always independent of .any other 
causation than its own inherent force. Much has been written 
and spoken about monthly ovulation and the washing away of 
the ovum by the menstrual flow. Nature never commits whole- 
sale mistakes in this way. Every seed has its time to ripen, and 
then, under the proper conditions, to germinate and grow. The 
acorn finds its bed in the virgin soil beneath the bough, where, 
under the influence of heat and moisture, it may quicken and 
grow to the dimensions of the parent stock. So, in like manner, I) YSMEXORRIHEA. 
5 
the ovum fulls into the oviduct and finds its stroma in the womb, 
and, when impregnated, arrests at once, by inherent power, the 
mollimen and flow, and, in quiet and security, completes its great 
task. In view of these facts, I must think the attempt to co-relate 
these functions a fallacy. 
I will now ask your attention very briefly to the anatomy of 
the womb, together with a brief summary of its actions in con- 
nection with its real and incidental functions. The womb is a 
cul-de-sac, with an external serous and an internal mucous sur- 
face. The virgin uterus weighs about one and three-fourths 
ounce. It is from one and a half to two inches in width at the 
fundus, tapering nearly uniformly to the neck, which is half an 
inch in diameter, and is from two and a half to three inches in 
length. The anterior and posterior body of the womb is flat. 
Its parenchyma consists of fibres very small and ductile, and 
capable of great extension, which traverse the womb longi- 
tudinally and laterally, and are held together by condensed cel- 
lular tissue, also very flexible and capable of great expansion. 
Its greatest thickness is about an inch; the internal surfaces al- 
most repose upon each other. The cavity somewhat resembles 
the capital letter Y; the top of the Y, extending from side to 
side, receives the fallopian tubes at the edge of the fundus. The 
womb is situated at the base of the cul-de-sac of Douglass, at- 
tached posteriorly and laterally to the peritoneum, and anteri- 
orly to the vagina. It reposes upon the rectum posteriorly, and 
upon the bladder anteriorly, and laterally upon the broad liga- 
ments to which it is attached. It may change its position from 
side to side, or backward and forward, as the rectum and blad- 
der happen to be full or empty, alternately. The impending 
omemtum and bowels may sometimes cause temporary changes 
in its position, and may even cause uneasiness and pain, which 
is quickly relieved by lying down or emptying the bowels. I 
have said that the womb was an inch thick, and I may add al- 
most as solid as the same thickness and structure of gum elas- 
tic, but a little more flexible. Acute angles and flexions of the 
womb cannot take place except from destructive ulceration, super- 
involution, epithelioma, cell proliferation, or something heavy 
enough to hold the womb out of its axis until atrophy of the 
fibres takes place. The function of menstruation lasts from three 
to six days. The amount discharged is from five to eight ounces. 
It recurs every twenty-eight days. The blood discharged does 6 
D YSMESORRIHEA. 
not coagulate, in consequence of ammoniacal gases and other al- 
kaline secretions, except where the flow is too great. 
Regretting the necessity for this lengthy introduction, I come 
now to dvsmenorrhcea—its pathology and treatment. The term 
dysmenonhoea is derived from three Greek words, meaning a 
difficult monthly flow. It is very generally understood to mean 
painful menstruation. As normal menstruation is a painless 
function, when the opposite condition exists it becomes the duty 
of the pathologist to detect and explain as far as possible the 
exact nature of the departure, with all the anatomical relations 
to the diseased action. This is called the pathology of dysmeu- 
orrhoea. Thomas says (see “Diseases of Women:” New York; 
1869; page 472): “Any condition, whether general or local, af- 
fecting the structure of the uterine walls, the ovaries, or the sur- 
rounding areolar or serous tissues, so as to render the nerves sup 
plying these parts morbidly sensitive, may produce pain in con- 
nection with the first part of the process;’’ or, “anything im- 
peding the escape of blood from the uterus or vagina may pro 
duce it by interfering with the second part.” He gives, as an 
example, any “general condition resulting in neuralgia of the- 
uterine or pelvic nerves, or a local inflammatiom altering their 
state, might readily creato pain in the first stage, while either a 
natural or acquired stricture of the cervix would probably com- 
plicate the second in the same way.” 
He then proceeds with the subject under the following noso - 
logical arrangement, to-wit: neuralgic, congestive, inflammatory, 
obstructive, and membranous. He also says that it is difficult 
to locate the seat of pain—that “ in the first varieties the pain is 
seated in the uterus, in the ovaries, or in the cellular tissue or 
peritoneum surrounding the pelvic viscera.” Again he says : 
“ Some of the most intractable cases with which I have met have 
been due to pelvic peritonitis or cellulitis, which, even after in- 
flammation has subsided, has left the nerves supplying these- 
paris in so sensitive a state that pain is excited in them by the 
process of menstrual congestion.”—(Page 173.) 
Niemeyer says it is due to flexion, nervous disorder and conges- 
tion, where there is severe pain before the commencement of the 
bleeding; also from mental uneasiness, which sometimes trans• 
fers the disease to remote organs, causing neuralgia and cramps, 
lasting sometimes to the close and even after menstruation has 
ceased. He says further, that these symptoms occur without per- D YSMEX ORRHCEA. 
7 
ceptible organic changes, as often as otherwise, and are not con- 
fined to the plethoric, but extends to the weakly and anremic as 
well; that, in some instances, the pain is caused by spasmodic 
contractions of the os—and again, of the uterus, like labor pains; 
but the symptoms do not give way until a copious hemorrhage 
intervenes for its relief. He thinks it difficult to determine 
whether the pain is kept up by hvpertemia of the pelvic organs 
for a long period, or by the difficulty of the escape of a graaffian 
follicle, deeply imbedded in the ovary and covered by thickened 
peritoneum. (See Niemeyer, Text-book Practical Medicine, voL 
2, pp. 143-44.) 
Dr. James Y. Simpson treats the subject under two heads— 
ovarian and uterine dysmenorrhcea. He thinks that while gen- 
erally not the seat of pain, we are justified in believing that 
where there is pain in the back and inguinal regions, at the pe- 
riod of menstruation, the ovary is probably the seat of inflamma- 
tory action, causing the pain. This opinion is founded on the 
existence of the kind of pain described in two females ho had 
attended, neither of whom had even a rudimentary womb to in- 
duce the suffering of dysmenorrhcea. Allow me to say that if 
there was no womb the blood vessels and nerves common to it 
were not wanting, and there was the mollimen and stassis com- 
mon to this function, but no organ to allow the escape of blood. 
Except as above stated he regards the uterus as the seat of the 
disease. He divides the disease as follows: Neuralgic, Conges- 
tive, Inflammatory, Gouty or Rheumatic, Membranous. (See 
Diseases of Women, page 227. 
Scanzoni says, “We have already designated a good many dis- 
eases that may give rise to the phenomena of 
such as “anomalies of conformation, flexion, contractions and 
obliterations of the womb,” etc. His special pathology is given, 
under the head of Organic, Nervous, Congestive, Hysteralgia. 
Upon the authority of Gooch, he calls hysteralgia “permanent 
dysmenorrhcea,” notwithstanding the menstrual epoch has noth- 
ing to do with the pain, which continues from day to day, month 
to month, and year to year. Upon the authority of Gooch again 
he traces the pathology of this disease to an inflamed and very 
painful condition of the mammary glands; thus making rnasto- 
dynia a cause of the most terrible form of dysmenorrhcea, which 
he has not been able to cure, or even modify by remedies. 
Dr. Robert Barnes (Clinical History of Diseases of Women: 8 
TJ YSMENOIUUKEA. 
London,) gives as Lis pathology of dysmenorrhcea the following 
varieties: Neuralgic or sympathetic; congestive or sympathetic; 
mechanical abnormalities of the uterus; fallopian obstruction; 
ovarian disorder constituting a distinct form. 
Again, he sub-divides as follows: 1st. In which there is man- 
ifest enlargement of the uterus. 2d. Subinvolution, with chronic 
inflammation of the uterus following labor or abortion. 3d. Re- 
duction of the uterus, (or flexion) most generally retroflexion. 
4. A projecting conical vaginal portion, with very small os exter- 
num uteri. 5th. Lateral reclination, mostly associated with im- 
perfect development of the uterus. 6. Disorder of distant organs, 
especially the digestive organs, attended or not by one or more 
of the preceding structural faults, and almost always by impaired 
sanguification and nutrition. 7th. A morbid condition of the 
ovaries. 8th. From various undigested and ill understood phe- 
nomena, where there is no physical fault, and from limited means 
of observation, he ascribes to nervous disorder. 
As I -wish to make the views of leading gynecologists clear, I 
will refer again to Thomas, to his summing up of what seems to 
be the accepted doctrines of the profession on the subject of dys- 
menorrhoea. You will please remember that he makes five vari- 
eties, viz: neuralgic, congestive, inflammatory, obstructive and 
membranous. He says, in all the seat of pain is uncertain. He 
thinks in the first thi'ee the pain is seated in the uterus or ova- 
ries, in the cellular tissue, or peritoneum surrounding the pelvic 
viscera. The worst cases he had seen were due to pelvic perito- 
nitis or cellulitis. He does not regard dysmenorrhoea as a dis- 
ease per sc, but as a symptom of an abnormal condition, such as 
the neuralgic diathesis, chlorosis or plethora, certain toxemia, as 
malaria, gout, rheumatism, luxurious and enervating habits, to- 
gether with onanism, causing the neuralgic variety. (Page 173.) 
To plethora, exposure to cold, mental disturbances, sluggish 
portal circulation, displacement of the uterus, fibrous tumor, as 
the cause of congestive dysmenorrhoea. (Page 173.) 
To endometritis, peri-uterine cellulitis, pelvic peritonitis, and 
ovaritis he ascribes inflammatory dysmenorrhoea. (Page 177.) 
To contractions of the cervical canal, flexion or version of the 
uterus, vaginal stricture, polypus in utero, obturator hymen, or 
fibroid in the parenchyma of the neck he ascribes obstructive 
dysmenorrhoea. 
He expresses no opinion of the membranous variety; some D YHMEX0RU1UKA. 
9 
ascribing it to ovarian disease; others, as Hanfield Jones and 
Simpson, look upon it as an exfoliation of the uterine mucous 
membrane, for which no cause can be assigned. Kolb and oth- 
ers think it an exudation from endometritis. 
I have now given the opinions in brief of live representative 
gynaecologists of the origin and history of this disease. I agree 
with them in much they fifty, but disagree with them in many 
things. I have taken great pleasure in reading and studying 
their views. There is an earnestness of inquiry that I admire; 
and a proof of the honesty with which they hold their opinions is 
that they are willing the world may read them and better them 
if they can: 
I will now proceed to give my views of the etiology, pathology 
and treatment of dysmenorrhcea, remarking, at the same time, 
that I have been observing and treating this disease for near 
forty years, but have never written a line on the subject until 
now. I beg you to bear with my style, or rather the want of it. 
Etiology. This disease is clearly traceable to early childhood. 
Jf the same pains were taken with children that an expert stock- 
raiser bestows upon his horses, etc., the result would be equally 
satisfactory. Comparative physiology also, if we had time to 
pursue the analogy, would be equally replete with valuable sug- 
gestions. 
Go to Kentucky, and examine the stock farm of the late Rob- 
ert A. Alexander, and ask his numerous overseers if they ever 
have consumption, big-head, polevil, swinny and spavin among 
the stock, and he will say, No. Ask him why, and he will tell 
you that his first cam is to develop the constitution of the colt 
and promote its growth. Next he looks to the useful qualities. 
He is taught to come when called; to walk, trot'or run at the 
word; his coat is kept clean, he sleeps warm, is fed and watered 
regularly, trained and educated, and it is his business to see that 
he is properly fed. Ask the horticulturist or gardener, and they 
will tell you that plants have constitutions and laws of life; while 
more simple than animals in their organizations yet they can no 
more be violated with impunity than can the laws that govern 
animal life. 
And are children less valuable than horses, cattle and sheep, 
or fruit trees, vines and forests? Here is the beginning of dys- 
menorrhcea, and many of the most formidable diseases we are 
called upon to encounter besides. I wish I had time to pursue 10 
D YSMEX0BR1KE A. 
this subject, but I have not; I can only put up a finger-board 
here and there. Forty-nine times out of fifty dysmenorrhcea re- 
sults fi’om the want of that care that a good stock-raiser or gard- 
ener bestows upon his pets. For the rest, accidents occurring 
in afterlife, anatomical deformities and eccentricities; also, inher- 
ent or acquired vices in the constitution, etc. 
Pathology. It is not necessary that I should go through the 
catalogue of the varieties of this disease, all of which, except my 
own, have been given in the copious extracts I have made from 
the text-books of two continents. And yet I must admit that the 
diseased physiology remains as much in the dark as it was forty 
years ago, when Bennett, the pupil of Lisfranc, gave the views 
of that great pathologist, as well as his own, in such glowing 
eloquence to the profession. 
At that day, a woman nowr and then would seek advice gener- 
ally through another person—her husband, if she had one—for 
dysmenorrhcea, or any other womb trouble. Dewees and Chapman 
were the great lights of the profession at that day. Dewees 
thought that the true pathology of dysmenorrhcea was due to 
rheumatism and gout, while his great cotemporary thought that 
the pathological characteristics indicated that the disease was 
croupal. Dr. Dewees recommended, fi'om his standpoint, the 
compound tincture of guaiacum, while Dr. Chapman, from his 
recommended seneka snake root. When a lady patient, suffering 
from dysmenorrhcea, went to consult the doctor, the only thing tc 
find out was whether it was the rheumatic or croupal form of dys- 
menorrhcea. That question being settled, and if rheumatic, tincture 
of guaiacum was given, and if no signs of rheumatism, then seneka 
snake root, wras ordered. If a cure did not follow, a mistake in 
diagnosis was alleged, and the other treatment at once instituted. 
This, and regulating the bowels, foot and hip bathing, rest, with, 
occasional horseback exercise, visiting the kin, and, if unmar- 
ried, matrimony, generally in a fewT months so far re-established 
the health as to be satisfactory, and there was an end of it, with- 
out mentioning the womb once. But things have changed; since 
Teal discoursed on tic douloureux, and Bennett on the womb, and 
gynaecology has become a specialty, and speculums, sponge and 
sea tangle tents, caustics, cutting instruments, together with sev- 
eral hundred varieties of pessaries and lightning rods, womb dis- 
eases have multiplied until the larger half of our women are 
hysterical and unhappy about some impending womb trouble I) YSMEXORIUHE A. 
11 
that they know will kill them unless it can be cured, and they 
talk about “ my womb ” as though it were “ my nose.” 
It is high time for thoughtful people to look this subject in 
the face, and redeem society from an incubus that threatens its 
best interests. Educate the mothers of the country up to their 
duty, and they will perform it with willing hands. 
Many of the vices of the constitution, as well as functional 
ills, begin in early childhood by disturbing innervation just at 
the time when it most needs the sustentation of a generous hy- 
giene, affectionate dealing with in the way of advice, and the ex- 
ercise of forbearing confidence, tempered with authority. Child- 
ren should not be kept too warm when awake or asleep. They 
should not be kept in the house when it is safe to be out of 
doors; nor should they be allowed to wear shoes during the 
thermal months until they are old enough to know when they 
may safely take them oft*. They should be taught and required 
to eat everything that is set before them of good quality, avoid- 
ing dainties and sweetmeats, which spoil the appetite, weaken 
digestion, disturb assimilation, and arrest innervation. Children 
should be raised pretty much as you would train a prize fighter* 
they eat mutton and beef as much as they will, not sodden in 
fats, but free from them, with a little bread, some vegetables, cof- 
fee or tea once a day, with a small amount of sugar and milk. 
Thus they increase the general innervation, develop muscle with- 
out fat, and elevate the constitutional forces to the highest point 
of activity and endurance. They should be taught to eat every- 
thing just as it should be eaten, and, more than that, compelled 
to do it. Every physician has lost patients because he could not 
nourish them, and he could not nourish them because they had 
been fed upon a limited diet, such as could not be resorted to 
when sick, and which had not made a necessary supply of lymph 
and blood to reinforce the system with in the emergency of a 
protracted illness, as typhoid fever or dysmenorrhcea, where the 
digestive organs are deeply involved. A lady said to me: “I 
don’t allow my children to eat meats and coarse bread.” "Why, 
madam ? “ Because it makes them gross in their habits and in- 
stincts, and restless at night.” It is a mistake, madam. Give 
your children properly cooked lean beef or mutton, fowls, etc., 
and teach them to eat in proper quantities whatever you put on 
your table; also soup, coffee, tea and milk; and when they get 
ill, as the}* will not be likely to do if thus fed, you can nourish 12 
I) 1'SMEX OREIKK A. 
them from some of the many articles of food they have been ac- 
customed to eat when in health. But if they are raised on can- 
dies, nuts, tea cakes, sugar-plums and the like, with sugar on 
their butter and biscuit every time they call for it, and none of 
the coarse meat and bread, etc., that you inveigh against, they 
will be miserable, unhappy beings, without health or constitu- 
tions, and when they grow to be men and women, will both be 
frauds upon their wives and husbands, if they ever get to be 
such. Feed your children thus, give them the free, open air, 
turn them barefooted in the warm ■weather, and your children 
will have beauty, strength and activity, and brains besides. 
Many girls reach the age of puberty healthy enough; but 
they are going to school, and cannot be kept away because they 
will fall behind in their classes. They go through mud and 
slush, and sit with cold feet all day, with an aching back and 
head, while the process of menstruation is beginning, because 
they are too modest to speak of their peculiar illness, and too 
ambitious to quit school long enough to develop the .function, and 
thus, unnoticed by mother or matron, the function becomes dis- 
eased. Every day girls are sent from home to boarding schools, 
where they have to ascend three or four flights of steps to their 
recitation rooms or dormitories, warmed by red-hot stoTes, or 
not warmed at all, with this function just beginning or but im- 
perfectly developed, and they are given a little hot tea at night, 
if anything, and told to keep up with their studies. We must 
exalt the functions of menstruation and ovulation to the dignity 
of other organs and functions, even of the brain itself, before we 
-can cure existing evils or elevate the race to its pristine manhood 
and longevity, and save it from premature suffering and death. 
Modern civilization is crowding its innovations upon us in ago- 
nizing heaps, and they must be resisted. High-heeled shoes and 
boots, tight corsets with steel waists, light party dresses in mid- 
winter that are scarcely too warm for summer, are the make-up 
•of the modern belle. As a result, wealth and time are spent in 
seeking health; suffering and death follow. Out of this our pro- 
fession may make money, but honor never! Our great business is 
to prevent disease; the lesser is to cure it. 
The girl should have an ample play-ground and all the priv- 
ileges of outdoor exercise consistent with the weather. She 
should be taught practical botany, knitting and sewing, with 
the minor domestic duties and pursuits, at ten years of age. At DYSMEXORMKEA. 
13 
twelve she should start to school, but study no higher branches 
than geography and arithmetic. When the mollimen begins, or 
the breasts and pubes show signs of puberty, then she should be 
taken in hand by her mother, her bowels kept open, her feet and 
body kent reasonably warm, and be given free access to the open 
air without violent exercise; and when the mollimen begins, as 
it generally does, by fullness in the head, pain in the small of the 
back, uneasiness and bearing down in the pelvic organs, then she 
should have an enema of warm water, at a temperature of 103Q, 
filling the circuit of the colon to the ilio-csecal valve; wrap the 
hips in a blanket wrung out of water as hot as it can be borne, 
and keep this up until the menses flow as freely as necessary. If 
there is pain which this does not relieve, douche the womb with 
very warm water, thrown slowly against the portio-vaginalis, with 
the long tube of a Davidson syringe, for twenty or thirty minutes. 
If this fails, empty the warm water from the bowels, and give an 
enema of twenty or thirty drops of black drop, in one teaspoon- 
ful of warm water, and put this into the bowel with an ounce 
syringe with a long tube, say an inch at least, so as to pass it 
over the sphincters with certainty; but if not retained, repeat 
until it is, and after waiting an hour for the absorption of the 
black drop, then repeat the hot wrater enema, and continue to 
repeat the treatment every two hours, until a full flow is estab- 
lished. 
The young lady, for such she now1 is, should still be kept from 
school and from hard study until two or three months .shall have 
passed away, and the same treatment observed as directed above, 
until the mollimen and flow come and go without pain. If the 
constitution and menses are well developed together, in after life, 
my word for it, there will be no painful menstruation, except as 
the result of accidents or criminal neglect. 
I come now to diseased menstruation. Beyond the fact that 
dysmenorrhcea is a diseased function, we are almost as much in 
the dark as ever. We know what will not cure, and that is per- 
haps something gained. The greatest gyntecological authorities 
of the day have not been able to locate the seat of the pain with 
certainty. Some ascribe it to the womb; some to the ovaries; 
some to the reflex forces, to inflammation of a peculiar kind, that 
leaves no traces behind; others again to hypersesthesia, blood 
stassis, etc. Amid this poverty of facts we have appealed to fic- 
tion also. A disturbed axis comes in for its share of responsibil- 14 
b YSMEX0RR1HEA. 
ity; notwithstanding it is demonstrable that the womb has no 
exact position. When the rectum is empty and the bladder is 
full it may be found in the trough of the sacrum; when the rec- 
tum is full and the bladder is empty it may be found encroaching 
anteriorly; when there is pressure from the viscera above, it 
dodges to one side or the other, but cannot go very far, for the 
reason that it is attached on either side to the broad ligaments; 
nor for good reasons can it be pushed downwards to any hurtful 
extent into the vagina, without great violence and a long train of 
preceding symptoms; and yet sometimes the womb does take on 
organic trouble requiring surgical interference. Where there is 
proliferation on one side and not on the other, flexion may result, 
and atrophy of the fibres, at the point of the greatest stress, on 
the weak side, take place. Or where there is ulceration of suffi- 
cient extent about the neck, a flexion will result from cicatriza- 
tion; also occlusion of the inner os, more or less permanent. And 
again, attresia of the neck, and sometimes destruction of the en- 
tire portio-vaginalis by ulceration, or the imprudent and long 
continued use of caustics, causing cicatrization at the end of the 
vaginal cul-de-sac. But in an experience of forty years and 
-more, I have never seen these diseases except amongst courte- 
sans of the lowest order, or those that had been such. 
The twenty-seven cases of dysmenorrhcea treated by McIn- 
tosh, twenty-five of whom were cured, and eleven bore children, 
is a wonderful piece of hyperbole. They are represented to have 
been cured by dilating the cervical canal to the size, if I recollect 
right, of a No. 13 bougie. Why exceed the provision of nature in 
this respect? There is scarcely a physician of experience that 
has not attempted dilatation of the cervical canal, and with what 
results? In my own experience, positively none. In less than 
half the time the experiment lasted, the canal had contracted to 
•its original size. I have tried the smooth metallic bougie of 
•McIntosh, sponge tents and seatangle. I have opened the por- 
tio-vaginalis from side to side, but I have never relieved sterility 
•or cured dysmenorrhcea in a single instance, or even modified its 
severity for a longer period than one month, after which the same 
grievous sufferings returned to vex and harrow as before. 
For Dr. J. Marion Sims I have the highest respect. He has 
shed renown upon his profession and his country. His success- 
ful treatment of vesico-vaginal and recto-vaginal diseases, his 
•removal of cysts, tumors, etc., is a monument to his genius that D YSilEXORIUKEA. 
15 
will stand forever. But I have no doubt the time will come when 
be would be glad that half the contributions he has made to 
medicine and surgery, both at home and abroad, could perish 
forever. No man can be accurate who thinks and executes so 
rapidly. His treatment for sterility, by slashing the neck from 
side to side, by caustics, tents and the like, must fall before the 
light of experience. But decades must pass away before the 
mistakes of a great man can be corrected. An enlightened mind 
and benevolent heart make the great law of medicine and sur- 
gery, and when intelligent and honest convictions are followed, 
truth will unveil itself to the honest worshipper by and by. 
It would require a volume to do justice to this subject. To 
point out the absurdities in pathology and treatment would 
be a huge task. To change the literature and the curriculum 
of the schools would be impossible; and existing evils will have 
to continue, and perhaps to multiply, until time and experience, 
the great revealers of truth, shall have wrought a change in our 
methods of inquiry and application of facts. 
My treatment for dysmenorrhcea is very simple. It consists, 
first, in preventing the disease by the function prop- 
erly at the beginning—taking care, however, to resort promptly 
to the same means, if the disease threatens to come on again. 
If the patient under treatment for dysmenorrhcea is ancemic 
from any cause, correct the evil by an appeal to the three great 
functions in the nutritive processes, to-wit: digestion, absorp- 
tion, and assimilation; economize all of the forces; exhaust 
nothing; support everything. The best general tonic for the 
stomach is equal parts of the tincture of quassia and the tinc- 
ture of stillingia, given in drachm doses three times a clay, in 
water. Where duodenal digestion is at fault, the means I have 
employed is, the tenth of a grain of the tartrate of antimony in 
one drachm of water, and five drops of laudanum, taken three 
times daily until the symptoms of duodenal dyspepsia, or the in- 
ertia of the organ, is relieved. If the lacteal system is at fault, 
then avoid the coarser fats and use none other than small por- 
mons of cod-liver oil, gradually increased as the patient can bear 
-it; this, with a reasonable amount of new, sweet, faultless butter, 
will meet the exigencies in the lymphatic system. For making 
blood, the triple phosphates, where they agree with the stomach, 
is the best preparation I have used; also stimulants, of any kind 
best suited to the palate, should 1*3 used freely. Exercise in a 16 
D YSMEN0RR1KEA. 
carriage, or horseback riding, will assist materially in bringing- 
relief to the patient. But, above all things, look to the nutri- 
tive system. If medicines, however well adapted to the disease, 
are found to so disagree as to lessen the capacity to take food, or 
interfere in any way, stop its use at once, and rally the appetite 
by stimulants, jellies, chicken and beef essence, exercise in the 
open air, etc. But when the mollimen comes on, use the hot en- 
emas, hot blanket and douche, and also the black drop, as di- 
rected, and continue this treatment to the end of the period, and 
continue it at any time between the periods when there is pain, 
and don’t allow it to exist at all. 
Sometimes there are kidney troubles, not unfrequently troubles- 
of the liver and spleen, and very often of the cord. If* however, 
you can reach the nutritive functions, and the patient can once 
begin to take food with a relish, the Rubicon is crossed. If the 
bowels are constipated, they should be kept regulated by giving 
half-grain portions of calomel, with two grains of hard loaf-su- 
gar, carefully triturated in a mortar for ten minutes at least, and 
given on the tongue and mixed with the saliva, and swallowed 
at bed-time when the stomach is empty; and if it fails to act by 
morning, it should be repeated one hour before eating, and then 
await results. It acts mildly by restoring the secretions only, 
and not as a purgative. It will not impair the appetite or re- 
duce the red matter of the blood. 
Regarding dysmenorrkcea as purely a diseased function, if 
the nutritive organs are in good condition the only thing neces- 
sary to be done in addition is to regulate the bowels without 
purging them, and thereby interfering with nutritive and other 
supporting measures. Again, in all cases of dysmenorrhoea of 
the kind we are considering, the muriate of ammonia should be 
given three times daily. For this purpose one ounce of muriate 
of ammonia should be dissolved in two pints of water, and a table- 
spoonful given three times daily, and the use of it continued for 
two or three months, for the purpose of expanding the urine and 
defebrinating the blood, and preventing first, infarction of the 
arterioles and venules; and secondly, the formation of fibrous 
tumor, which, more frequently than many suppose to be the case, 
is the termination of dysmenorrhoea, and brought on by it. 
Neuralgic dysmenorrhoea is often, and perhaps generally, the 
result of toxannic causes, as asserted by two of the authors from 
whom I have quoted. But it may arise from other causes also; I) YSMEN OlilUICE A. 
17 
as congestion, commencement of malignant disease, hyperaesthe- 
sia of a part, or all, of the sensory uterine nerves. But no matter 
what may be the cause, the treatment I have laid down will give 
perfect relief, until other remedies can be brought to bear, such 
as arsenic, quinine, iron, cicuta, etc. 
In membranous dysmenorrhoea I advise the hot water and 
black drop treatment, and also mild ptyalism, muriate of ammonia 
daily for three months, and keeping the bowels scrupulously reg- 
ulated, but not purged; for this purpose the compound cathar- 
tic pill is the best. If there be whites, as there generally is, I 
make a wash of two ounces muriated tincture of iron and four of 
water; and every night I elevate the hips on a pillow, and throw 
half an ounce as far as I can carry a glass female syringe into 
the vagina and discharge it. This I repeat every night, and, in 
severe cases, three times daily for two or three days, and after- 
wards every one or two days repeat at night, until there is a dis- 
charge of loose, diseased epithelium, organized by the wash into 
a skinny substance resembling yellowish paper, which passes in 
strips as large sometimes as the hand, and sometimes the com- 
plete cast of the vagina will come at once. When these slips be- 
gin to come, encourage them to do so by the douche, but continue 
the iron until this ceases, or the part becomes tuo much inflamed 
to go further. Whenever the whites show a disposition to re- 
turn, do the same thing over again, and continue until the symp- 
tom yields. 
Scanzoni says, on the authority of Gooch, that the form of 
dysmenorrhoea known as livsteralgia is due to mastodynia; and 
while I do not believe its pathology traceable to that cause, the 
fact remains that the breasts are very much swollen and sore a 
large portion of the time. I am treating a case now that I be- 
lieve will recover, unless something malignant developes. The 
mollimen is violent and the mammary glands exceedingly sore 
for ten days before the flow begins. When it comes on, it is very 
free, but does not bring relief. It lasts about six days—some- 
times longer. When it passes away, the pain in the womb re- 
mains, and returns once or twice daily. The pain and swelling 
of the breasts, however, cease gradually after the How is over. 
I have been using the hot water and black drop, always with 
present relief, but the symptoms recur daily. She cannot take 
the muriate of ammonia, and Ihave determined to try the carbon- 
ate, and have thus prescribed, but do not know with what success 
up to this moment. I base my hopes of success on resisting 
the pain, overcoming congestion, elimination of fibrine by am- 
monia, and restoration by nutrition and hygiene. 18 
l> YSMEN ORE IRE A. 
Lastly, obstructive dysmenorrhcea calls for a few remarks. 
Thomas ascribes this variety to contractions of the cervical ca- 
nal, flexion or version of the uterus, vaginal stricture, polyp us- 
in-utero, obturator hymen, or fibroid in the parenchyma of the 
neck. I treat this just as I have recommended for the other 
varieties of this disease. They are, in fact, one disease, with 
diverging anomalies. We have to deal with a diseased func- 
tion. My object is to call attention to this fact, and also to 
a treatment in harmony with it. By carefully soothing the 
diseased organ in the manner suggested, you will rob dys- 
menorrhoea of its horrors. By strict attention to the nutritive 
system, by proper exercise in the open air, restraint from ex- 
cesses, going early to bed and sleeping well, the process of resto- 
ration will be inaugurated, and great results follow. By this 
treatment I have cured two cases of hysteralgia, pronounced 
incurable by leading gynaecologists; also, three of membranous 
dysmenorrhcea (all I ever treated); also, metritis and perimetri- 
tis; and, if taken in time, cellulitis will disappear from the cata- 
logue of pelvic diseases. Leucorrhoea is nearly an invariable at- 
tendant upon dysmenorrhoea. This can be certainly cured by 
using, as a vaginal enema, the muriated tincture of iron, one-third 
or one-half strength, every night and morning, introduced with 
a blunt female syringe—half an ounce of the mixture to be thrown 
down to the base of the vaginal cul-de-sac, and the portio-vagi- 
nalis compelled to remain in the bath all night, by placing a pil- 
low under the hips; the fluid will then penetrate the cervical ca- 
nal to the os; and, by keeping this up for three nights, until the 
discharge ceases, you will have cured the disease. If it returns, 
treat it the same way. 
With the treatment for dysmenorrhcea heretofore recommend- 
ed and the muriated tincture of iron, used as above, I have cured 
the most inveterate cases of uterine catarrh. Uterine surgery 
should only be resorted to after everything else has been tried; 
and if the treatment here proposed be followed out, and deiibri- 
nating remedies properly and persistently used, in my opinion 
there will not be much of it required. 
And finally, keep it before you that dysmenorrhoea developes 
a majority of the diseases that women suffer from. Their name 
is legion. But, bring on the menses properly, keep the function 
healthy, treat the diseased function as indicated, pay special at- 
tention to the nutritive organs, regulate the bowels well to one 
action a day, and you will cure a vast majority, and make life a 
joy and not a burden to all the unfortunate victims to dysmen- 
orrhcea.