Diagnosis. Ordinarily the character of the pain and the regularity of its occurrence at each menstrual period will establish the nature of the case, but a positive diagnosis rests alone on a physical examination. The presence of an obstruction must be demonstrated beyond a doubt. This is accomplished chiefly by the touch and the sound, though a bi-manual or rectal examination, or even the speculum, may be necessary.
Prognosis. This depends chiefly upon our ability to overcome the mechanical obstruction. In some cases, however, the general state of the health resulting from persistent menstrual derangement is such that the prospects for an ultimate radical cure as less hopeful.
Treatment. The administration of remedies which accomplish so much in other varieties of dysmenorrhoea, is of little use here. The obstruction which gives rise to the trouble being purely mechanical in its nature, the treatment is necessarily surgical in character, though the pain may sometimes be temporarily relieved, or the constitutional or concomitant symptoms ameliorated by the use of the indicated remedy, or, by proper hygienic measures. In some instances the patient finds by experience that she obtains some relief by assuming and maintaining a certain position. This usually occurs when the trouble arises arises either from flexion or uterine distortion from a fibroid tumour.
Therapeutics of Dysmenorrhoea.
Aconite. Congestive dysmenorrhoea; high fever; abdomen swollen, hot and sensitive to the tough; vomiting; great restlessness and anxiety; pelvic inflammations.
Ammonium Carb. Cholera-like symptoms at the commencement of the menses; blood black and clotted; acrid, making the thighs sore; especially in nervous delicate women.
Ammonium Mur. Discharge of a quantity of blood from the bowels at every catamenial period; during the flow the discharge at night is more profuse.
Apis. Congestive or neuralgic dysmenorrhoea from ovarian influences; enlargement of the right ovary, which is sensitive and painful; also with pain in the left pectoral region, with cough; sharp plunging or stabbing pains in the uterus, or in the head, sometimes followed by convulsions, at every menstrual period, the patient feeling tolerably well during the interval scanty, dark urine; waxy skin.
Asclepias Cor. Dysmenorrhoea associated with dropsy; or catarrhal conditions, intermittent, bearing-down, labor-like pains.
Belladonna. Congestive dysmenorrhoea in plethoric women, especially girls, of when associated with local pelvic inflammations; rush of blood to the head; throbbing headache; full bounding pulse; abdomen hot, painfully distended and sensitive to the touch or jarring; great pressing downward in the genitals, as if they would protrude through the vulva.
Borax. Membranous Dysmenorrhoea. Menses too early, too profuse, and attended with colic and nausea.
Bromium. Membranous dysmenorrhoea; violent contractive spasms during the menses, lasting for hours, leaving the abdomen sore; loud emissions of flatus from the vagina.
Bryonia. Membranous dysmenorrhoea, or, when associated with rheumatic symptoms; distention of the abdomen, and colic; profuse flow; stitching pains, worse from the slightest motion.
Cactus. Excruciating, agonizing pain in the lumbar region during the menses, sensation of painful constriction in the groins, extending around the pelvis; flow scanty, ceasing when lying down; acute pains and sensations of constriction about the heart.
Cantharis. Membranous dysmenorrhoea; burning in the vulva and ovarian region; itching in the vagina; vesical tenesmus and painful urination.
Caulophyllum. Congestive or neuralgic varieties; also obstructive from retroflexion or retroversion; spasmodic pains in the uterus and various portions of the hypogastric region, congestion and irritability of the uterus; fullness, heaviness and tension in the hypogastric region; scanty flow.
Chamomilla. Drawing from the sacral region forward; griping, pinching, or labor-like pain in the uterus, followed by discharge of large clots of blood; tearing pain in the legs; very sensitive to pain; nervous and irritable.
Cimicifuga: All things considered, this is our most valuable remedy in all varieties of dysmenorrhoea. It is especially useful in congestive or neuralgic forms, when occurring in nervous, hysterical or rheumatic women; lancinating shooting pains in the uterine and ovarian regions; bearing-down in the uterine region and small of the back; excruciating pain in the abdomen, small of the hysterical spasms; scanty flow; between the periods debility, nervous erethism, neuralgic pains.
Cocculus. Neuralgic dysmenorrhoea in nervous, hysterical women; cramps in the abdomen; colic pains; faintness and debility; nausea; convulsions.
Collinsonia. Obstructive or other forms of dysmenorrhoea resulting from haemorrhoids or constipation; pruritus; displacements.
Gelsemium. Neuralgic, congestive, and what has been termed by some authors, spasmodic dysmenorrhoea; severe, sharp, labor- like pains in the uterine region, extending to the back and hips, dull aching in the lumbar and sacral regions; neuralgia of distant parts; cramps in the abdomen and legs; convulsions.
Hyoscyamus. Extreme nervousness, even to mania, or hysterical spasms; during the menses convulsive trembling of the hands and feet; headache, nausea and profuse sweat; labor-like pains in the uterus, with pulling in the loins and small of the back; involuntary loud laughter and silly actions; lascivious, uncovers and exposes herself.
Ignatia. In nervous, hysterical women who sigh and brood over imaginary troubles; violent labor-like pains, followed by discharge of black clotted blood of a putrid odor.
Kali brom. Very nervous, restless and sleepless; neuralgic form from ovarian or uterine irritation; obstructive form from sub-involution or fibroids.
Kali Carb. Cutting, stitching pain in the abdomen; aching in the small of the back; uterine spasm; menses acrid, of a bad odor, excoriating the thighs; especially useful after loss of fluids or vitality, especially in anaemic persons.
Kali Iodium When occurring in mercurial, syphilitic or scrofulous subjects, or when associated with or arising from chronic rheumatism; frequent urging to urinate when the menses appear; tearing, darting pains in the limbs; painful bloating of the abdomen; subsultus tendinum; always worse at night.
Lachesis. Labor-like pains and sharp pains in the left ovarian region and in the uterus, relieved when the flow begins; the uterus will not bear the contact even of the clothes, which cause uneasiness, but not pain.
Lilium Tig. Neuralgic dysmenorrhoea, or dysmenorrhoea from displacement; bearing-down, with sensation of heavy weight and pressure in the uterine region, as if the whole contents of the pelvis would press out thorough the vagina; severe neuralgic pain in the uterus and ovaries; sub-acute uterine inflammations; sympathetic cardiac symptoms.
Nux Vomica. Contractive uterine spasms; colic pains followed by the discharge of coagula; pressure toward the genitals; pain in the back; nausea; faintness; constipation; irritable, oversensitive, choleric patients.
Platina. Painful sensitiveness and constant pressure in the region of the mons veneris and genital organs, with internal chills and external coldness, except of the face; bearing-down and drawing pains in the abdomen; spasm and screaming; flow dark and clotted; ovarian inflammation; pruritus; nymphomania; hysteria.
Pulsatilla. Heavy pressive pain in the abdomen and small of the back, as from a stone; the limbs tend to go to sleep; menstrual colic; flow thick and black; chilliness; symptoms ever changing; shifting pains; nausea, especially mornings; the patient peevish, fretful and inclined to weep.
Secale. The discharge black, fluid, every fetid, expulsive pains; colic; spasms, cold extremities; cold sweat; weak pulse and great prostration.
Senecio. Dysmenorrhoea with urinary sufferings, tenesmus, heat and urging; pain in the back and loins; pale, weak, nervous sleepless, hysterical; catarrhal subjects.
Sepia. Dysmenorrhoea from endometritis; weakness and tired pain in the small of the back; bearing-down and pressure in the uterine region; leucorrhoea before the menses, yellow, like milk; excoriating; like pus; of bad smelling fluids; displacements.
Sulphur. Long standing and obstinate cases in scrofulous subjects; headache before the menses; headache and nosebleed during the menses; blood thick, dark, acrid, corroding, sour- smelling; yellowish, corrosive leucorrhoea; burning in the vagina.
Thuja. The congestive from from ovarian inflammation; distressing burning pain when moving; she must lie down; much noisy flatus in the abdomen; vaginismus.
Ustilago Maidis: Membranous dysmenorrhoea; the blood dark and clotted; constant aching distress in the uterus; burning in the ovaries.
Veratrum Alb. Dysmenorrhoea, with vomiting and purging, or exhausting diarrhoea and cold sweat; nymphomania before the menses.
Veratrum Viride. The congestive variety; menstrual colic; intense cerebral congestion; strangury before the menses; convulsions.
ALLEN CORSON COWPERTHWAITE was born at Cape May, New Jersey, May 3, 1848, son of Joseph C. and Deborah (Godfrey) Cowperthwaite. He attended medical lectures at the University of Iowa in 1867-1868, and was graduated from the Hahnemann Medical College of Philadelphia in 1869. He practiced his profession first in Illinois, and then in Nebraska. In 1877 he became Dean and Professor of Materia Medica in the recently organized Homeopathic Department of the State University of Iowa, holding the position till 1892. In 1884 he accepted the chair of Materia Medica, Pharmacology, and Clinical Medicine in the Homeopathic Medical College of the University of Michigan. He removed to Chicago in 1892, and became Professor of Materia Medica and Therapeutics in the Chicago Homeopathic Medical College. From 1901 he also served as president of that College. He is the author of various works, notably "Insanity in its Medico-Legal Relations" (1876), "A Textbook of Materia Medica and Therapeutics" (1880), of "Gynecology" (1888), and of "The Practice of Medicine " (1901).