MEMBRANOUS DYSMENORRHEA FROM 
REPELLED ERE DELONS. 
By R. Luulam, \I. 1)., Chicago, III. 
Not the least curious and wonderful of all the physiological 
processes known to us is the periodical development of the 
lining membrane of the uterus. This process of “ nidation,” 
or nest-making, is as essential a factor in menstruation as it is 
in generation. If it occurred only once in a year, as in the 
(estimation of animals, it would still be remarkable for its 
delicacy, and for the peculiar contingencies with which it is 
beset. But, in women, its monthly repetition multiplies the 
risks of its becoming disordered, and there are comparatively 
few who pass through the whole period of menstrual life 
without suffering some of these consequences. 
Membranous dysmeno rlicea is not so well understood, nor so 
skilfully and successfully treated as other kinds of painful 
menstruation. This fact is partly due to its relative infre- 
quency. For, compared with the spasmodic and obstructive 
varieties it bears about the same proportion that cases of breech 
presentation do to those of the cephalic extremity. 
Now that the shreds, or casts, thrown off in this disease are 
known to be caused by the exfoliation of hypertrophied mu- 
cous membrane of the uterus, and not by the exudation of 
lymph, and the formation of a new or croupal membrane, its 
morbid anatomy is very much simplified. And the fact that 
this product is decidual and not diphtheritic, homologous and 
not heterologous, is destined greatly to modify its special the- 
rapeutics. world’s homoeopathic convention. 
2 
But, however great the advance that has already been made, 
the etiology of membranous dysrnenorrhoea is incomplete. 
For, although the felt-like shreds, or strips, which are moulted 
in this disease are recognized as portions of a menstrual, or 
nidal decidua, it still seems practically impossible for physi- 
cians to separate in their minds the formation of this product 
from the existence of the inflammatory process. The most 
recent author even proposes to style it an epithelial endome- 
tritis (endometritis exfoliativa).* On the one hand he de- 
clares that the sieve-like casts and pieces, consist of the hyper- 
trophied mucous membrane which, from the rapid production 
of free cells, is detached and thrown off at stated periods; on the 
other that the process is inflammatory and exudative, and not 
a mere exfoliation. Experience proves, however, that while a 
woman with membranous dysrnenorrhoea may also have ende- 
metritis, she is quite as likely to have ovaritis, or even endocar- 
ditis as a coincident affection. 
Accepting the view of Oldham and others that the cause 
of this disease may frequently be found in ovarian irritation 
and inflammation ; the idea of Dewees that the rheumatic dia- 
thesis is responsible for its existence.in a certain proportion of 
cases; and the more modern claim that it may be caused by 
uterine deviations, my experience leads me to conclude that 
there are some examples of this affection which are inexpli- 
cable and incurable by, or through, either or all of these dif- 
ferent theories. In other words, these theories do not apply to 
all cases indiscriminately. 
The most intractable cases of this singular affection that 
have come to my knowledge have been associated in their 
clinical history with the existence and sudden disappearance 
of a cutaneous eruption. This eruption may, indeed, have been 
very slight and possibly have been forgotten by the patient 
herself. It may also vary in its character in different persons, 
being either papular, herpetic or vesicular, squamous, syphil- 
tic, or erysipelatous. In one of my cases it was a “rash, like 
prickly heat; ” in another, the patient was positive that she 
had once had the “ hives,” and that her menstrual difficulty 
followed directly upon their being “driven in.” 
*Dr. Beigel, in the Archio.fur Gyna/col., Band ix. Heft I. 3 
MI'MBRANOUS DYSMl XORRHCEA. 
Sometimes the appearance of this eruption upon the face, 
hands, or body, alternates with the menstrual disorder ; but 
more frequently, unless medicines have been taken to “ drive 
it out,” no trace of it can be found at any time. In one case 
of erysipelas of the legs and thighs the lesion extended to the 
genitals, and to the womb, and a membranous dysmenorrhoea 
of six years standing was the direct result. 
In one of my patients, who was very ill with this form of 
dysmenorrhoea, the repercussed eruption had not been seen for 
eighteen years until it blossomed out as the result of my treat- 
ment ; and I have recently cured another in whose case the 
“salt rheum” had disappeared twelve years before, with the 
immediate advent of shreds and bits of membrane in the mon- 
thly discharge. 
The comparative frequency of cases of this kind, which have 
been more or less intimately associated with skin affections, pre- 
cludes the possibility of their accidental relation. For, out of 
twelve cases of real membranous dysmenorrhoea which I have 
treated within the last five yem, eight of them have been of this 
sort. In this list I do not include those milder cases which are 
very much more numerous, and in which there is merely an in- 
creased desquamation of the uterine epithelium in the form of 
diaphanous shreds, or patches. This contingent of menstrua- 
tion is sometimes met with in uterine deviations, catarrhal 
endometritis and menorrhagia, and is much more easily cured. 
Sterility is as common and constant a symptom of mem- 
branous dysmenorrhoea as is the shedding of the membrane 
itself. And there can he no better guarantee of the cure of a 
case of this form of dysmenorrhoea than is furnished by a 
fruitful conception and labor at term. The clinical history of 
barrenness often includes the history of old skin affections 
which, in some unaccountable way, have interfered with the 
function of reproduction. The remarkable effects of certain 
mineral waters as a cure for sterility, and for complicated 
disorders of the catamenial function, can best be explained by 
their value in some chronic cutaneous diseases which have first 
been repelled and then resisted other modes of treatment. 
Anatomically the epithelium is the epidermis of the mucous world’s homceopathtc convention. 
4 
membrane. Clinical experience has long since demonstrated 
the mutual sympathy and morbid relations of these two sur- 
faces. The occurence of a metastasis of disease from one to 
the other is in no wise rare or remarkable. Indeed it is very 
common, more especially in case of those membranes which, 
like the lining of the nose, of the throat, and of the utero- 
vaginal tract, are in direct continuity with the external integu- 
ment. 
The modern classification and description of skin affections 
is quite in accord writh the idea that, under certain circum- 
stances, almost any of them might be translated to the uterine 
mucous membrane. The moment we define eczema as “a ca- 
tarrhal inflammation of the skin,” * we have declared upon its 
proneness to migrate from the outer to the inner surfaces of 
the body, and to work mischief in them. 
Manifestly, the internal lesion, which is due to this cause, 
will be intractable, if not grave in character, in ratio with the 
delicacy of the function involved. For the monthly forma- 
tion, enlargement, separation and reproduction of the uterine 
mucous membrane, its progressive changes, its retrogressive or 
fatty degeneration, and the escape and cessation of the flow 
are so many physiological steps that such an invasion would 
almost certainly interrupt or modify. And it might very 
easily change the natural and proper exfoliation of the uterine 
epithelium at the month into a morbid separation of the sub- 
jacent mucous layers, and the shedding of a thick and tough 
cast of the uterine cavity. 
That these identical consequences do sometimes follow the 
repercussion of an eruption, I am fully persuaded, not only 
because I have been able to trace the beginning of a mem- 
branous dysmenorrhoea directly to such an accident, but also 
because I have found it possible to cure this secondary form of 
the disease through a knowledge of this fact, and by using it 
as a key to the special therapeutics of the case. 
Since the preparation of this paper was begun, two of my 
colleagues have consulted me concerning the best treatment 
o o 
* A Handbook on the Theory and Practice of Medicine, by F. T. Robert, 
M. D., etc., p. 1018. 5 
MEMBRANOUS OYSMENORKHCEA. 
for membranous dysmenorrhoea, each of them having a case 
of the kind under his professional care. The above theory of 
its exceptional origin was explained, and they were asked to 
inquire particularly with reference to the clinical history of a 
previous or coincident skin affection. The following evidence 
afterward supplied by these gentlemen, has the merit of being 
fresh without having been fabricated expressly to support the 
theory under consideration. 
Case 1.—This case is reported by Prof. G. A. Hall, M. I)., 
whose notes read as follows: “ Mrs. M., aged 35 years, resides 
in Chicago. The menses first appeared at 13 years of age, and 
were natural until her marriage, at twenty-two. She has two 
children, the first of which was born ten months after mar- 
riage, and the other three years later, with one abortion since 
that time. * 
“ During her youth and up to the period of her first labor, 
she was troubled with the ‘ hives,’ or nettle-rash, but after the 
birth of the child it ceased, and she had nursing sore-mouth 
for weeks. This was followed by a chronic diarrhoea, which 
lasted for several months. The tongue has remained soft, 
patulous, spongy, and is sometimes slightly ulcerated. 
“ After the diarrhoea was controlled, a small, round spot, as 
big as a half-dollar, would appear on the inside of the left 
thigh. It came first before, and remained during the men- 
strual flow. It looked very red, and was attended with an in- 
tolerable itching, but it disappeared nearly three years ago, at 
the time of the miscarriage. The latter was not painful, but 
after a moderate flowing for twenty-four l*>urs, the embryo 
and placenta were thrown off intact. Ten days later she had 
secondary htemorrhage which lasted for ten weeks. She was 
greatly reduced in strength, and has never fully recovered her 
health. 
“ Four weeks after the cessation of that flow the menses 
were resumed, and for the first time the membranous shreds 
and casts, of which I send you a specimen, appeared. Iler ap- 
petite became morbid, and she craves starch and salt. Since 
the miscarriage she has never had the itching spot on the inside 
of the thigh, or anywhere else externally. The catamenia are world’s homoeopathic convention. - 
6 
now attended with moderate pain and flowing for three days, 
when the membrane is extruded, after which the pain ceases, 
and the flow continues for three days longer, but moderately.” 
Case 2.—For the details of this case I am indebted to J. E. 
Morrison, M. D., of Hyde Park, Illinois. “ Miss G. M., twen- 
ty-three years of age, began to menstruate in her twelfth year. 
From her second year until puberty she had suffered from 
running sores, and occasionally from an eruption like bee- 
stings, with a flue rash over the body, but especially about the 
waist. For the first three years, or until she was fifteen, her 
skin was never well, nor was the menstruation either painful 
or too profuse. 
* About this time, however, the eruption would sometimes 
disappear from the external surface, and this change was al- 
ways observed to increase the monthly pain. For the last four 
years, excepting only at very long intervals and temporarily, 
no sign of the skin affection has shown itself; but the dys- 
tnenorrhoea has become more and more pronounced. Within 
that time it has assumed the membranous form, and firmly or- 
ganized shreds are thrown off at every return of the ‘ period.’ 
Her suffering in that interval has been very severe, and thus 
far has resisted all medical aid.” 
Concerning the curative indications which are deducible 
from this bit of clinical experience, we have to acknowledge 
that as yet they are neither very explicit nor complete. To 
have treated only eight cases of this particular kind of mem- 
branous dysmenorrhcea, and to have been consulted in perhaps 
a dozen others bv letter and otherwise, does not warrant us in 
dogmatizing upon its special therapeutics. The temptation to 
speculate upon this subject, however, is very strong, but we 
forbear. For what a remedy “ought” to do, and what it 
really will do, are not always the same thing. 
Where the precise character of the eruption which has pre- 
ceded the menstrual lesion is unknown, we can not, perhaps, 
do better than to begin the treatment with the use of Sulphur. 
In the case already referred to,* where the eruption had not 
* Vide the author’s Clinical and Didactic Lectures on the Diseases of Women, 
1872, p. 195. 7 
MEMBRANOUS DYSMl XORRHCF.A. 
been seen for eighteen years, this remedy, in the thirtieth dilu- 
tion, had the desired effect, and produced a marked and lasting 
amelioration in the uterine symptoms. 
But, if the nature of the eruption can be determined, either 
by direct inspection, when it crops out occasionally ; through 
the description of an intelligent parent or patient, who remem- 
bers just what it was; or, by the ferreting action of Sulphur, 
we shall know better how to proceed. In this case we vent- 
ure to recommend the following practical hints for trial and 
confirmation, or rejection, as they shall prove worthy or other- 
wise : 
If the eruption is, or has been, like Urticaria, give Arseni- 
cum alb., Rhus tox., or Urtica urens. 
If what is vulgarly called the “ hives,” Apis mel. (in the 
third decimal trituration), Belladonna, Chamomilla. 
If it is, or was, herpetic or vesicular, Cantharis, Rhus tox. 
If squamous, or “ scurfy,” Borax,* Arsenicum, Nux mosch., 
Dulcamara, Silicea, Sepia. 
If scrofulous, and otherwise unclassifiable, Sulphur, Calc, 
carb., Hepar sulph., Mercurius. 
If syphilitic, Thuja, Nitric acid, Mercur. iod., Kali iod., Mc- 
zereum. 
If from suppressed rubeola, or if it alternates with ophthal- 
mia, Pulsatilla; or, in the former case especially, Cuprum 
acet. 
If it is erysipelatous, Belladonna, Cantharis, Rhus tox., 
Apis mel. 
Should further experience verify the importance of knowing 
that repelled eruptions do sometimes cause a membranous dys- 
menorrhcea, this limited and imperfect list of remedies will 
doubtless be very much changed and enlarged. It is not im- 
probable that there are some medicines which, although they 
are not now supposed to possess any ctirative relation to the 
disease in question, may yet prove, through this general indi- 
cation, to be very useful in its treatment. 
* Transactions of the Homoeopathic Medical Society of the State of New York, 
Vol. X., p. 280. WORLD S HOMOEOPATHIC CONVENTION. 
8 
There are undoubtedly good grounds for confidence in the 
virtues of the Calcarea carb. as a remedy in this particular 
variety of dysmenorrhcea. It does not appear to be suited to 
all cases, and certainly does not deserve to be extolled as a 
specific; but, when it is appropriate, its curative action is quite 
as marked as it often is in too frequent menstruation and in 
menorrhagia. I have no question that, as a uterine polychrest, 
it is possessed of an intimate and specific relation to the fatty 
changes which occur eaehjmonth in the uterine epithelium, the 
physiological separation of which permits and provides for the 
exit of the menstrual blood from the surcharged capillaries. 
We have a forcible illustration of this quality of the Calcarea, 
in its ability to discuss certain moibid growths, which it re- 
solves awray through a similar metamorphosis; but more 
crudely, in the power of lime to detach the pseudo-membrane 
in croup and diphtheria. Our workers in the Materia Medica, 
and in gyna3Cology, should define this relation, and develop 
this suggestion. 
The frequent indication for Calcarea carb. in scrofulous and 
other skin affections is suggestive of its value in the mem- 
branous dysmenorrhcea, which is secondary upon these erup- 
tions. With the few exceptions in which I have prescribed 
the sixth or the twelfth attenuation, I have alwrays given the 
third decimal trituration in these cases. 
If we find, in a given example, that dysmenorrhcea due to 
this cause is complicated with ovaritis, or rheumatism, the pre- 
scription may need to be modified. But it should not be for- 
gotten that ovaritis itself is as likely to result from certain sup- 
pressed eruptions as it is from the sudden metastasis of a gon- 
orrhoeal inflammation. 
In a certain ratio of cases, the best-cliosen remedy that is 
prescribed on these, or similar indications, will fail to complete 
the cure without manual assistance of some kind. This is 
more especially true of the treatment of membranous dysmen- 
orrhoea when it coexists with retroflexion (not retroversion) of 
the womb. Under these circumstances the reposition of the 
organ, as a condition for the prompt and ready exit of the 
flow; allays and averts the tendency to a moulting of its nidal 9 
MKMBRANOT78 DTSMENORRHCEA. 
membrane. And the effect of this expedient is still more de- 
cided if a free dilatation of the cervical canal is also secured 
at the mouth. 
It is possible that this disease may arise as a sequel to diph- 
theria, when it would require to be treated accordingly. But 
the off-hand method of prescribing for it as though it were 
always and strictly a pseudo-membranous affection, is not only 
unsatisfactory in theory, but unsuccessful in practice.