Chapter 11 - Female Diseases
Introduction to Female Diseases
Inflammation of the Neck of the Womb
Inflammation of the Ovaries
Absence of the Menses
Profuse Menstruation
Painful Menstruation
Green Sickness
Cessation of the Menses
Polypus of the Womb
Uterine Hydatids
Inflammation of the Womb
Falling of the Womb
Falling Over of the Womb
Tumors of the Womb
Cancer of the Womb
Ovarian Tumors
Inflammation of the Fallopian Tubes
Inflammation of the Vagina
Itching of the External Parts
Tubal Pregnancy
Prevention of Pregnancy
Antiseptic Dressings
Milk Leg
Child Bed Fever
Puerperal Convulsions
Nursing Sore Mouth
Broken Breast
Sore Nipples
Sex of Child, How to Regulate Before Birth

11.7 Painful Menstruation

Painful Menstruation. Dysmenorrhea

DYSMENORRHEA is from three Greek words which mean, literally, a difficult monthly flow. These words do not precisely describe the complaint; for it consists not so much in a difficult, as in a painful flow.

Symptoms. This affection is always marked by more or less pain while the courses are on, especially during the first day or two. The pain sometimes begins two or three days in advance of the evacuation. It extends over the whole lower part of the belly, running down, at times, to the thighs, and causing great distress in the back. It is frequently so violent as to resemble the pains of labor, compelling the sufferer to take the bed, and drawing from her tears and groans, and occasionally throwing her into spasms most painful to witness. So terrible are the monthly sufferings which some women experience from this cause, that the anticipation of it destroys much of their peace, even during the intervals of respite.

The Causes of this complaint are very numerous. There is, doubtless, such a thing as pain in the womb from rheumatism, and especially from neuralgia, though these are much rarer forms of the complaint than many suppose.
Pains at the monthly periods are often induced by a displacement of the womb. If the organ fall over backward or forward, its nerves are pressed upon in an unnatural way, and when the parts are crowded with blood, it is very natural for painful sensations to be excited. In these cases, the neck of the organ is bent at right angles, and the canal which passes through it is, of course, strictured, so that the evacuations are necessarily made with difficulty.
And this leads me to remark, that the passage through the uterine neck becomes, occasionally, from inflammation or other cause, almost closed. The result is, much difficulty and great pain in passing the monthly secretion.
There are no causes which excite painful menstruation more often than inflammation in the uterine neck and the ovaries. An increased flow of blood to an inflamed part always causes pain. An inflamed foot or leg has to be laid up in a chair, because it aches when put down. The reason is, that when hanging down it is more full of blood, and the sensitive nerves are painfully compressed. When the finger is hot with inflammation, we assuage the pain by holding it up for the blood to run down. For the same reason, the inflamed ovaries and uterine neck ache when the blood flows to them in large quantities, at the menstrual period.
Congestion of the lining membrane of the womb itself is a frequent cause of painful menses. It is a condition of the membrane of the womb similar to that of the larynx in membranous croup. There is the same pouring out of what physicians call coagulable lymph, which forms itself into a membrane. This membrane the womb strives by strenuous contractions to throw off, and finally succeeds in expelling it, not whole and entire, but in shreds and patches. These shreds, which women sometimes call skinny substances, are characteristic of the disease. The efforts to expel them cause pains very much like those of natural labor, and sometimes almost as severe.

Treatment. Painful menstruation, excited by the falling over of the womb, backward or forward, is cured, of course, by putting the organ back into its proper position.
Pains caused by stricture of the canal through the uterine neck, are cured only by enlarging the passage. This is effected by introducing at first a very small bougie, and then a larger and a larger, until the passage is of the usual size. It is a delicate operation, quite successful in careful and skillful hands, but liable to produce mischief when improperly conducted.
In all the forms of this disease, the treatment should aim, not merely at palliation, but at a cure. and generally, I am happy to say, a cure is attainable. Yet how many women suffer for years until health has fled, and life has become a burden, receiving from their medical attendant the assurance that palliation only is possible !
It is necessary at each monthly turn to do something, in these cases, to quiet the pain. For this purpose, twenty drops of spirits ether in a wineglass of tepid water, thrown into the bowel, will be highly serviceable. For a like purpose, one pill (120) may be taken twice a day, beginning one day before the menstrual flow. A belladonna ointment (170) maybe rubbed upon the neck of the womb with great advantage, and a teaspoonful of viburnum compound taken each hour.
In the congestive form of this disease, that in which the membrane is formed on the internal surface of the womb, and thrown off in fragments, the liquid acetate of ammonia, or spirits of Mindererus, is a very valuable remedy taken in two teaspoonful doses, in a table spoonful of cold water, three or four times a day, while the pain lasts.
Medicines almost innumerable have been put on the market for this complaint, of which Hayden's viburnum, liquor sedans, dioviburnum, and a host of others, are examples. These are usually harmless, and may be used. Gin, in goodly doses, is often serviceable by stimulating the circulation. Turpentine cloths, the hot water bottle, rest in bed, etc., also help amazingly. But whatever remedy may be used at the time, even though the pain be severe enough to require an anodyne, the cause must be sought and treated.

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