The mental symptoms alone of these patients often furnish us with data enough upon which to base our pseudo-psoric remedy. These patients are sad, gloomy, full of fanciful notions, foreboding, are fearful, extremely sensitive, nervous and irritable. Sometimes they may pass through the menstrual period with but little suffering, but it is followed with prosopalgia of a prolonged and distressing nature. I have said little of the neuralgias, the many reflex symptoms, and untold sufferings of these patients. Usually in a marked case where the tubercular element is present, we have retroflexions and all sorts of malpositions of the uterus. Their sufferings date from an early period following puberty, within a year or two at least. In Sycosis, the neuralgias are displaced by the rheumatic element. In fact about all the pains of Sycosis are rheumatic. We have muscular rheumatism prevailing in many cases. Of course we have many pains that are similar to pseudo-psora, but on close analysis the rheumatic element can be traced back to the cause. Often they have muscular rheumatism at intermenstrual periods, lumbago or stiffness of the muscles of the neck and aching in the limbs. We have aching of the limbs in the tubercular, but it is accompanied with great weariness, with pelvic congestion so severe that they are unable to stand on their feet any length of time. In Sycosis the uterine pains are spasmodic, colicky, often extending over the whole abdomen, and generally felt in the membranes of the ovaries and tubes.
The remedies called for in sycotic dysmenorrhoea are Colocynthis, Chamomilla, Colchicum, Cyclamen, Rhus tox, Bovista, Actea racemosa, Phytolacca, Sepia, Lachesis, Medorrhinum, Nat. sulph, Caulophyllum, Gelsemium, Dulcamara and occasionally Pulsatilla, Arsenicum alb, Lycopodium, Nux vomica, Croton tiglium, Asarum, Viburnum opulus. These are a few of the sycotic remedies, but there are many others that we will call your attention to in giving the indication for the remedies. The miasmatic element will be mentioned under each remedy. The flow frequently comes in gushes with much pain, and is, as a rule, dark and clotted, as we have already mentioned. The menses of a tubercular patient seldom clot, they are more apt to be thin and watery or bright red and copious. The odor of the tubercular menses is like blood, while the sycotic is musty, or it has a fish-brine or stale fish odor. It is often irritating, corrosive, excoriating, producing pruritis at some period of the flow, generally at the close. The pruritis is a biting, smarting, itching sensation, and the discharge quite often excoriates, and produces an erythema of the parts with which it comes in contact. Often we find some form of salpingitis even to complete destruction of the ovarian tubes, or we may find any of the lesions mentioned in the beginning of their work.
When we have the tubercular element combined wit the sycotic we have the worst form of dysmenorrhoea to deal with. There is no worse combination outside of a malignancy than where dysmenorrhoea is based upon a tubercular basis with a sycotic addition to magnify all its phases. Usually in a typical sycotic patient, whether acquired or hereditary, there is some form of irritation of the bladder about the time of the appearance of or during the menses. The urine either passes frequently or in small quantities, or it is copious and frequent with more or less pain or irritation of the neck of the bladder. The menses are almost always dark, clotted, and difficult to wash out. Menstrual colic is frequent with ovarian pains and there is tenderness of the breasts during the flow.
Enough has been said to give the reader some idea of a case of sycotic dysmenorrhoea, and a fuller expression of it will be brought out as the indications for the remedies are given. The treatment should be continued until the patient menstruates normally or nearly so, which may take from three months to a year, and in some cases even two years. Prescriptions made during the inter-menstrual period are the most efficacious, as the acute expression has quieted down and the latent expression is shown more clearly, and upon this symptomatology it is better to base your prescription.
J.H. Allen was a student of H.C. Allen. He was the president of the IHA in 1900. Dr. Allen taught at the Hering Medical College in Chicago. Dr. Allen died August 1, 1925
Books by John Henry Allen:
Diseases and Therapeutics of the Skin 1902
The Chronic Miasms: Psora and Pseudo Psora 1908
The Chronic Miasms: Sycosis 1908