Membranous Dysmenorrboea. 
ALEXANDER J. C. SKENE, M. D,, 
BROOKLYN, 
PROFESSOR OF THE MEDICAL AND SURGICAL DIS- 
EASES OF WOMEN IN THE LONG ISLAND COLLEGE 
HOSPITAL. 
BY 
iIEPBINTED FROM 
SHjc Neta Yorft ifEebical Jotmial 
for November 21,1885. Reprinted from the New Yorlc Medical Journal 
for November 21, 1885. 
MEMBRANOUS DTSMENORRIKEA. 
ALEXANDER J. 0. SKENE, M. D., Brooklyn, 
PROFESSOR OF THE MEDICAL AND SURGICAL DISEASES OF ’WOMEN IN THE 
LONG ISLAND COLLEGE HOSPITAL. 
Membranous dysmenorrhcea is an affection which, al- 
though rather rare, commands very urgently the attention 
of the gynaecologist, because of the dreadful suffering which 
it gives rise to, and the obstinacy with which it has hereto- 
fore resisted treatment. There is a marked uniformity 
about this disease. In its pathology and clinical history it 
varies but little in different cases. A number of affections 
resemble this one to a limited extent, but it stands out well 
defined, and is easily detected by the experienced diagnos- 
tician. 
Membranous dysmenorrhcea is an exfoliation in mass of 
the mucous membrane of the cavity of the body of the uterus 
at the menstrual period. Microscopically, the mass presents 
all the histological elements of the true mucous membrane 
of the uterus, including the utricular glands, unchanged by 
any new or abnormal elements. When it is expelled entire, 
it represents a complete cast of the cavity of the uterus, 
and is triangular, with an irregular opening at each of the 
angles, the one representing the internal os uteri, and the 
other corresponding to the ostia of the Fallopian tubes. 
* Read before the Medical Society of the County of Kings, Septem- 
ber 15, 1885. MEMBRANOUS DYSMENORRIKEA. 
This membrane is rather ragged on the outer surface, but 
smooth on the inner, and looks exactly as the lining mem- 
brane of the uterus does when in position. The size is 
usually about an inch long and less than that in width, and 
is generally somewhat larger than the normal proportions 
of the cavity of the uterus; but this is not always the case. 
In this respect it is apparently like the decidua of preg- 
nancy ; in fact, in general appearance it closely resembles 
the decidua vera, but there is a decided difference in its 
microscopic elements, sufficient at least to differentiate. 
This similarity of the two membranes has led to their being 
called the decidua gravida and the decidua menstrnalis, 
the former being the mucous membrane as seen in abor- 
tion at a very early stage of gestation, the other the mem- 
brane as thrown off at menstruation in this morbid form. 
Comparing the behavior of the mucous membrane in 
membranous dysmenorrhoea with its changes in normal men- 
struation, the difference is as follows; In normal menstrua- 
tion, if we accept the views of Dr. Williams, of London, 
the whole mucous membrane undergoes fatty degeneration, 
disintegration, and elimination, whereas in membranous 
dysmenorrhoea the mucous membrane becomes separated 
from the walls of the uterus without being changed or dis- 
integrated ; exfoliation and expulsion simply occur. The 
way in which the separation of the mucous membrane takes 
place is not positively known. It is presumed, however, 
that fatty degeneration in the deeper structures of the 
membrane takes place, and thereby it becomes detached 
from the uterus. It is possible, also, that the capillary 
haemorrhage, instead of occurring on the free surface of 
the membrane, takes place in the deeper structures, and in 
that way dissects off the membrane. This, however, is hy- 
pothetical, and needs confirmation. Sometimes the mem- 
brane is expelled in shreds, which suggests that the exfolia- MEMBRANOUS DYSMENORRHCEA. 
3 
tion either occurs in spots or sections, or else that the mem- 
brane is completely separated from the uterus, but becomes 
broken up either during expulsion or in handling it after- 
ward. It is much more probable that it is completely ex- 
fuliated and broken up subsequently than that it is sepa- 
rated in circumscribed patches. All these facts lead to the 
conclusion that the affection is a perversion of nutrition 
and function rather than an organic disease, inflammatory 
or otherwise, which gives rise to this peculiar behavior 
of the mucous membrane at menstruation. It is clearly 
evident that there is nothing pathological in the condition 
of the mucous membrane itself, but that the whole morbid 
process consists in the separation of the membrane in mass, 
in place of disintegration, which is the normal behavior of 
the mucous membrane in menstruation. There are other 
views regarding the pathology of this affection: one, that 
it is the result of gestation, which is arrested at a very early 
stage, and the membrane thrown off is really a decidua 
vera. That this theory is fallacious will be seen when we 
come to discuss the physical signs of this affection. 
The idea that it is an inflammatory affection can not be 
sustained. No such product or result of inflammation is 
found elsewhere in the mucous membrane of the body, nor 
is it necessary that inflammation of any part of the uterus 
should be present in order to produce membranous dys- 
raenorrhoea. 
Associated with this membranous dysmenorrhoea we oc- 
casionally find inflammatory conditions, but not of the mu- 
cous membrane of the cavity of the body. There may be, 
and often is, a general hypenemia of the uterus and vagina, 
but usually it is not greater than that which is seen in nor- 
mal menstruation. 
There is occasionally, in cases of long standing, cervical 
endometritis, but this does not extend to the body of the MEMBRANOUS DYSMEXOREIICEA. 
uterus. In fact, I believe that a well-defined endometritis 
can not occur at the same time as membranous dysraenor- 
rhoea. This affection, then, is certainly sui generis, and is not 
the result of inflammation in any form or any stage of the in- 
flammatory process; neither is it a utero-gestation ending 
in abortion at a very early stage of pregnancy, as some have 
maintained; neither does the membrane partake of the na- 
ture of any of the morbid neoplasms -which occur in mucous 
membranes elsewhere in the body. 
The mucous membrane in this affection is developed in 
the natural way after each menstruation, and the gross ap- 
pearances and histological composition of this structure 
show that it is normal, and differs in no way from the mu- 
cous membrane of the uterus up to the time when the men- 
strual flow is about to begin. Perhaps there is, in some 
cases, an increase in the quantity of the membrane, but only 
to a very limited extent, if at all. In short, the only patho- 
logical lesion in this affection is in the manner in which the 
membrane is thrown off. 
Symptoms.—This affection occurs in single and married 
women—about as often in one class as the other, perhaps. 
It also occurs in those who have borne children, but in most 
of the cases that I have seen in married women the patients 
have been sterile. The recurrence of the menstruation is 
generally regular; sometimes it is delayed, and sometimes 
there is a sense of pelvic discomfort before the menstrual 
flow, but not always. The chief symptom is the pain which 
comes on usually during the first day, sometimes later, and 
increases in severity and is somewhat intermittent in char- 
acter until the membrane is expelled, when it rather abrupt- 
ly subsides. 
The flow sometimes is scanty previous to the expulsion of 
the membrane, and after that it is generally quite free; at 
times abnormally so, and occasionally small clots are passed. MEMBRANOUS DYSMENORRIKEA. 
5 
Sometimes there is a leucorrhoeal discharge succeeding 
the menstrual flow, the discharge being occasionally tinged 
with blood. In other cases the menstrual flow subsides 
after the expulsion of the membrane, and no leucorrhoea of 
any account occurs afterward. 
There is really nothing in the clinical history of this 
affection by which it can be positively distinguished from 
dysmenorrhoea due to other causes. Hence the diagnosis 
must always depend upon the physical signs. 
Physical Signs.—ln order to make a diagnosis, it is 
absolutely necessary that the membrane expelled should be 
preserved and examined. The gross appearances of the 
specimen are usually all that is necessary to satisfy the diag- 
nostician regarding the nature of the affection, but in cases 
where there is a doubt the microscope must he called in to 
aid in the diagnosis. 
The morbid materials expelled from the uterus which 
simulate the membrane produced in this affection are the 
decidua expelled in abortion in the earliest stages of preg- 
nancy; the masses of fibrin which have formed in the 
uterus in menorrhagia ; very dense masses of secretion from 
the cervix; and the membranous-looking shreds expelled 
from the cervix and vagina after astringent or caustic appli- 
cations. 
The decidua in early abortion is most difficult to dis- 
tinguish from the menstrual membrane. In the early abor- 
tion the membrane expelled is usually larger and more 
ovoid or round, and not so markedly triangular as the de- 
cidua of menstruation, and is also thicker, and usually is 
accompanied with villi of the chorion. If there is still a 
doubt, the microscope reveals that the menstrual membrane 
shows only small cells, while those of the decidua-vera mem- 
brane are so great as to he easily distinguished. There is a 
decided microscopic difference in the epithelium, the tubes, 6 
MEMBRANOUS DYSMENORRHCEA. 
and the inter-glandular tissue. This difference between the 
two membranes is not only in the decidua of early abortion, 
but also in the decidua of extra-uterine pregnancy. In 
being thus able to distinguish between the decidua of preg- 
nancy and the membrane of menstruation, the only great 
difficulty in the diagnosis is overcome. 
The shreds of fibrin expelled from the uterus sometimes 
look membranous in form, but have none of the structure of 
the mucous membrane, and hence can be detected on cur- 
sory examination. The same may be said of the masses of 
unusually dense secretion of the cervix. The membranous 
shreds that come from the cervix and the vagina as the 
result of astringent and caustic applications resemble at 
first sight the menstrual membrane. The most perfect of 
these exfoliations from the vagina I have seen after the use 
of the persulphate of iron; these specimens, however, are 
much thinner and differ entirely in structure, being made 
up mostly of epithelium, and therefore need not be mis- 
taken for the menstrual membrane. 
With due attention to the membrane expelled, the diag- 
nosis can be made with great certainty. 
Causation.—Discarding the current views regarding 
membranous dysrnenorrhoea—that is, that it is due to in- 
flammation, or else the result of gestation—one is left with- 
out any very rational views to offer regarding the causation 
of this disease. While it is not, perhaps, the part of wis- 
dom to discredit the accepted views on any question in 
medicine until one has something more reliable to offer, 
still, if the causes assigned can be readily shown to be in- 
correct, it is infinitely better and safer to be entirely in 
ignorance of the causes of things than to attribute them to 
the wrong causes. Fortunately, however, while I find ray- 
self at variance with most of the recent authorities regard- 
ing the cause of this affection, I am in perfect harmony MEMBRANOUS BYSMENORRIKEA. 
with the views of Dr. Oldham, who was the first to discover 
dysmenorrhoea membranacea. 
Dr. Oldham distinctly pointed out the characteristics of 
this affection and stated that the membrane was formed 
under the ovarian stimulus, and I am fully satisfied that he 
was not only the discoverer of the disease, but also con- 
ceived the true idea regarding the cause of it—viz., some 
undue or abnormal ovarian influence or sexual excitation. 
In other words, it would appear to be some derangement of 
innervation and nutrition. 
Taking this view of the causation, I expect to find my- 
self in harmony with the neurologists at least. This class 
of specialists manifest a willingness to trace many diseases 
originally to some derangement of the nervous system, when 
they find anything like good reasons for so doing. Hence, 
I expect their support in choosing, as I do, to believe that 
the starting-point in the pathology of this affection must be 
some derangement of innervation produced by disease of 
some associated organs like the ovaries. We might find con- 
firmation of this view regarding the cause of membranous 
dysmenorrhoea in studying the agencies which give rise to 
other morbid states of the uterus, like the fibroid growth 
for example, which in its anatomical elements does not differ 
especially from the tissues of the uterus from which it 
springs; and, if we could find the cause of this deviation 
from healthy nutrition, it might be applicable to the disease 
under discussion. But, unfortunately, the causes of fibroid 
tumors given in our literature are unsatisfactory and by no 
means well sustained. 
From the fact that uterine fibroids are more common in 
sterile women than in others, it would appear that sterility 
predisposes to their development, and perhaps no better ex- 
planation of the cause of these growths has ever been given 
than that of my somewhat humorous friend, who said that 8 
MEMBRANOUS DYSMENORRHCEA. 
“ the uterus, being prepared for normal work and not finding 
it to do, took up the development of fibroids as a sort of 
outlet to its formative powers.” May it not, then, be that a 
wTell-defined predisposition to reproduction, uncalled for by 
gestation, excites this morbid action on the part of the 
uterus which leads to this abnormal exfoliation of its mucous 
membrane ? This view might at least be entertained, be- 
cause in other cases, when we are unable to detect the cause 
of a disease in something that is tangible, we usually attrib- 
ute it to deranged innervation and consequent malnutri- 
tion. This view of the causation is, to some extent, sus- 
tained by the effects of medicines upon the lesions. This 
affection has always been recognized as one that is often 
difficult to cure, many times incurable, in the hands of the 
most competent physicians and surgeons. This possibly 
may have been due to misapprehension of the nature and 
cause of the disease, and hence fallacious therapeutics, 
rather than to the incurable character of the disease. 
In favor of this line of thought I may state that the 
patients whom I have treated in years past, on the theory 
that the cause was inflammatory, have derived little benefit, 
while those who were treated for deranged innervation, 
malnutrition, and undue ovarian excitation, have made very 
much better progress. I am inclined to attribute most 
of the trouble to ovarian influence, the condition of the 
ovaries being that of an undue nerve excitation and possible 
congestion. I have been led to this belief by two facts: 
that the majority of the patients that I have seen have been 
subjects of a highly nervous organization, and in most of 
them there has been tenderness of the ovaries, and pain at 
times in them, without there being any evidence of their 
having ovaritis. 
The rheumatic diathesis is said to favor this affection, 
and it is possible that that may be so, although I am unable MEMBRANOUS DYSMENORRHCEA. 
9 
to recall any of my patients as being rheumatic ; neither have 
I been able to trace this to the tubercular or strumous dia- 
thesis, nor to syphilis. It is certain, however, that, if either 
of those conditions existed, they would liave their influence 
in helping to keep up the uterine trouble, and every effort 
should be made to relieve them by treatment. 
Treatment.—The treatment of this affection is neces- 
sarily both palliative and curative. While the patient is 
suffering during the expulsion of the membrane, it is very 
necessary to relieve the pain as far as possible. This, of 
course, can be most promptly done by the use of opium, 
which should be avoided if possible, however, because of its 
after-effects. 
Chloral hydrate answers fairly well in some cases. I 
was induced to try this agent by the accounts given of its 
effects in relieving the pains of the first stage of labor. I 
am not sure that it has any advantages over chloroform, 
camphor and belladonna, or conium and Cannabis indica ; in 
fact, in the majority of cases, one has an opportunity to try 
several agents, and, of course, the patient will decide which 
gives most relief. Indications for general treatment are to 
quiet all nervous disturbance and to improve the general 
nutrition of the mucous membrane. It so happens that 
when the first part is attended to the latter will follow in 
due order. 
To quiet the nervous irritation and disturbance there is 
nothing that equals the bromide of sodium. This should 
be given in twenty- or thirty-grain doses three times a day 
for ten davs or two weeks before the menstrual period. 
And, if the pain is not severe enough to require the addi- 
tion of some of the remedies already named to relieve pain, 
it may be continued throughout the menstrual period and 
several days after. From this it would appear that the 
bromide is to be used continuously; but one or two weeks 10 
MEMBRANOUS DYSMENORRHOE A. 
in each month it can he omitted. When the bromide has 
been employed for some time, and it seems desirable to 
give it up, conium may be given in moderate doses com- 
bined with camphor, if the patient is weak. If there is 
any evidence of the rheumatic diathesis, the bromide of 
lithium should be given. Next to quieting the nervous sys- 
tem, any debility that may exist should be overcome by 
nerve tonics. Undue nervous excitation so often goes hand 
in hand with nervous depression that in many cases it is 
necessary to combine the tonic and sedative treatment. All 
the remedies which may be used need not be here men- 
tioned. In regard to the modification of nutrition, it need 
only be said here that any accompanying derangements of 
the digestive organs that may be found should receive care- 
ful attention; but this hardly need be mentioned in this 
connection. 
My rule of treatment has been, after subduing all nerv- 
ous disturbances, to put the patient upon the iodide of 
sodium in case she is in fair strength and inclined to 
flesh. If there is anaemia, I prefer the iodide of iron. If 
these did not accomplish the object, I have employed raer- 
cury, giving it in small doses, never continued long enough 
to produce salivation, carefully watching to avoid this. In 
cases of anaemia, where I have feared the debilitating effect 
of this alterative, I have given the bichloride of mercury 
with iron. After keeping them upon this treatment until I 
could see some evidence of its effects, I have then put them 
upon iodine and arsenic. 
In regard to local treatment, I have been entirely guided 
by the views of pathology expressed above, and have there- 
fore employed alteratives and sedatives almost exclusively. 
Of these I have found iodoform most effectual. I have also 
used iodine and mercury with advantage. In cases where I 
have found any complications I have carefully attended to MEMBRANOUS DYSMENORRIKEA. 
11 
them, restoring displacements and correcting flexions, and 
so on. When the canal of the cervix has been at all con- 
stricted I have enlarged it by incision and dilatation. 
When the congestion which occurs at the menstrual 
period does not subside in a few days, I have employed the 
warm-water douche. After this, I have applied to the 
cavity of the uterus small bougies of cocoa-butter with as 
much iodoform as it would take up. Three or four grains 
of iodoform mixed with vaseline that has been liquefied by 
heat, and introduced through the pipette, is perhaps the 
best method of applying it. These have been introduced 
once a week or once every five days. When there has 
been much tenderness, and the use of the pencils has caused 
pain, I formerly used aconite and opium and iodine; this I 
have introduced into the cavity of the uterus. lam now 
trying cocaine to subdue the tenderness as a preparatory 
means to the use of the iodoform. But so far this new 
remedy has not been a perfect success. 
In cases where this has failed and the uterus was not 
especially sensitive to intra-uterine medication, I have in- 
stilled into the uterine cavity a few drops of a five-per-cent, 
solution of carbolic acid, making one application a few days 
after the menstrual flow and not repeating it until the next 
period. In the interval I have used the iodoform. I have 
also used the fluid extract of conium and Hydrastis canaden- 
sis ; but this I have found gives more pain than any of the 
other applications that I have used; and so of late I have 
used an infusion of the hydrastis alone, which appears to 
answer as well and gives less pain. 
Case I.—Membranous Dysmenorrhcea in a Married Lady 
who was never Pregnant.—This patient was forty-one years of 
age, of good constitution, and had been married eight years. 
She began to menstruate at thirteen, and continued to do so 
regularly and normally until she was twenty-one; then she be- 12 
MEMBRANOUS DYSMENORRIKEA. 
gan to have occasional pain, about the menstrual period, in the 
region of the ovaries. About a year after this she began to 
have severe uterine pains during the menses, and states that she 
occasionally passed masses that looked like membrane from the 
uterus; they were small, however, and did not occur at each 
period. 
After her marriage the pain at the menstrual periods became 
worse, and almost every month she passed a membranous cast 
of the uterus. The usual history of each menstruation is that 
the flow begins not very free, and, after continuing for about 
five hours, the pain becomes very intense and lasts from three 
to eight hours, when she expels the membrane and the pain 
subsides, the flow continuing for a day or a day and a half after 
the membrane has been expelled. 
The flow, taken altogether, is not profuse, and only lasts 
from two to two and a half days, while formerly—that is, be- 
fore her dysmenorrhoea began—it used to continue from four to 
five days. When first seen, her general health was good, but 
she was rather hysterical and nervous, and was somewhat de- 
pressed and disappointed because she had not had children. 
She described her suffering at her menstrual periods as 
something unbearable, although it did not last more than a few 
hours at a time. She was first examined midway between the 
menstrual periods. The uterus was then found to be normal in 
size and in good position. The internal os was rather sensitive 
and appeared to be slightly contracted; there was also an ex- 
tended Nabothian gland in the middle third of the cervical 
canal, but the uterus presented a normal appearance in every 
other respect. There was no congestion ; in fact, at this time 
the mucous membrane appeared rather anaemic. 
The diagnosis was left an open question until the next men- 
strual period, when I obtained the membrane expelled and had 
it examined by my friend, Professor Frank Ferguson. Ilis re- 
port stated that the specimen was uterine mucous membrane 
unchanged in its histological composition. This settled the 
question of diagnosis. 
Careful inquiry elicited the fact that she had never been 
pregnant, so far as I could rely upon her testimony, which I be- MEMBRANOUS DYSMENORREKEA. 
13 
lieveto be accurate because of ber great desire to have children. 
I also learned that on several occasions she had lived apart from 
her husband, who was of necessity absent on business for sev- 
eral months at a time, and that she suffered just the same, and 
at each month there was an expulsion of membrane, showing 
conclusively that there was no possibility of mistaking this affec- 
tion for pregnancy and abortion. 
The treatment consisted, first, in placing her upon the follow- 
ing mixture: Half a grain of the bichloride of mercury, one 
drachm of the solution of the chloride of arsenic, three drachms 
of the tincture of iron in a three-ounce mixture of syrup and 
water. A teaspoonful of this W’as given, well diluted, after each 
meal. At the same time the internal os was incised superficially 
in three places, dividing equally the circumference of the canal, 
and the distended Nabothian follicle was punctured and evacu- 
ated. 
A week after this a sound was introduced of full size, and 
there was less tenderness; the tincture of iodine was then ap- 
plied from just within the internal os downward. At the next 
menstrual period she had less pain, but it lasted just as long, and 
she passed a membrane unchanged, except it did not appear so 
thick as formerly. 
From this onward the local treatment consisted in passing 
a full sized sound just beyond the internal os right after the men- 
strual period, and again in two weeks, and in nearly every six 
days about two grains of iodoform mixed with vaseline was 
passed into the cavity of the uterus, well up toward the fundus. 
This local treatment was continued without interruption for 
three months, and the first prescription, after it had been taken 
for two weeks, was followed by the iodide of iron, a grain and 
a half three times a day. 
After the second month, and at her third menstrual period 
from the time that treatment began, she had no pain and passed 
no membrane. At the next period she passed several shreds, 
but nothing like a complete cast of the uterus. 
The constitutional treatment, that is, alternating between the 
first prescription of mercury and arsenic and the iodide of iron, 
giving the first one for two weeks, and then the other, was con- MEMBRANOUS DYSMENORRHOEA. 
tinned for two months longer. The application of the iodoform 
was continued for one month longer, once every week, and once 
after her menstruation, at the end of the fourth month of the 
treatment. Since that time she has had no farther trouble; her 
menses are regular, lasting about three days and entirely with- 
out pain or any discharge of membrane. 
That was her record at least one year after she gave up treat- 
ment, since which time I have not heard from her. 
Case ll.—Membranous Dysmenorrhcea occurring after Treat- 
ment for Anteflexion and One Miscarriage.—A lady of very high 
culture and over-refinement, of a well-marked nervous tempera- 
ment, but otherwise of good constitution, came under my obser- 
vation when twenty-eight years of age ; she had then been mar- 
ried a year and a half. She menstruated first at fourteen years, 
and continued to do so regularly, but with pain from the very 
beginning. The pain usually began a day or so before the flow 
and gradually diminished after. Her suffering at each period 
gradually increased until her marriage, when it became more 
severe. This, and the fact that she remained sterile, induced 
her to seek advice. I found her suffering from anteflexion of the 
body of the uterus and cervical endometritis; there was also 
tenderness of the left ovary on pressure. She was treated for 
the flexion and completely recovered. The dysmenorrhcea was 
entirely relieved and she became pregnant. During her preg- 
nancy she suffered very much from morning sickness, and at the 
end of the third month began to show some signs of septicaemia; 
she then miscarried, and the ovum was found to be macerated, 
and probably had been dead in utero for two weeks. She recov- 
ered from this and was quite well for about a year, when her 
dysmenorrhcea returned; she then returned to be treated for 
what she supposed to be a recurrence of her former trouble, but 
I found no evidence of the former flexion. But, on inquiry, I 
found that she passed at each period a membranous cast of the 
uterus. The patient thought little of this, because, in former 
years while suffering from the dysmenorrhcea caused by flex- 
ion, she occasionally passed small clots which looked some- 
what membranous in character, but no doubt were simply 
blood-clots. MEMBRANOUS DYSMENORRHCEA. 
15 
She was placed upon treatment similar to that employed in 
the first case reported, except that there was no necessity for 
enlarging the internal os as in the former case, the only differ- 
ence in the local treatment being that I used iodine in place of 
iodoform during the last two months of the treatment; and 
once, immediately after her menstrual period, 1 applied a mild 
solution of carbolic acid to the uterine cavity. 
She did not again pass any membrane after the third month of 
treatment, and her pain from menstruation entirely disappeared. 
She was dismissed at the end of four months, and two months 
afterward reported that she was pregnant. Three months after 
that time she was examined and found to be so, and was pro- 
gressing well. Since that time I have not seen her, but heard 
that she gave hirth to a healthy child. 
Case 111.—Membranous Dysmenorrhcea treated by Dr. For- 
dyce Barker, of New York; Complete Recovery.—l give the his- 
tory of the following case for two reasons: First, to show that 
iodoform was employed in the local treatment, and that the pa- 
tient’s recovery was complete ; and also to take the opportunity 
of stating that I believe that Dr. Barker was the first to employ 
this agent. 
The history is not altogether complete, because I obtained it 
from the patient herself, who was unable to tell all that was 
done for her; but I know positively that she suffered from dys- 
menorrhoea, and that she entirely recovered under the care of 
Dr. Barker, and has remained well for a number of years. 
This was an educated lady of a well-marked nervous temper- 
ament ; she began to menstruate at thirteen, and continued to 
do so normally until she was twenty-six years of age. At that 
time she was said to have had an acute attack of ovaritis, and 
after recovering from that she had dysmenorrhcea. 
The character of the pain at her menstrual periods then ap- 
peared to he ovarian. After suffering in this manner for about 
four or five years she noticed the expulsion of membranous 
casts of the uterus at the menstrual periods. During this time 
and for a year afterward she was regularly treated by her family 
physician, but without relief. She then consulted Dr. Barker 
for her general ill-health, hut did not call his attention to her 16 
MEMBRANOUS DYSMENORRHCEA. 
derangement of the menstrual function. She improved in her 
general condition under his care, but found no relief from the 
membranous menstruation. She consulted him again and called 
his attention to the uterine trouble, and he immediately placed 
her under treatment. 
The constitutional remedies employed I do not know, but 
the local treatment consisted in dilatation of the cervical canal 
and the application of iodoform to the uterine cavity. 
She continued to pass membrane for several months; then 
the trouble ceased and has not returned. She now menstruates 
regularly and naturally, and has done so for over two years. 
Several other cases might he added, some showing fail- 
ure of treatment, and others where the patients were really 
made worse by being treated for inflammation of the uterus 
which was supposed to be the cause of the trouble, but un- 
doubtedly was not. Other cases might be given, also, in 
which recovery took place, and after several months or years 
the trouble returned, but they would add nothing to the 
views already given regarding the pathology and treatment 
of. this affection. The New York Medical Journal, 
A WEEKLY REVIEW OF MEDICINE 
Published by 
Edited bt 
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Frank P. Foster, 
M. D. 
The New Yoke Medical Journal, now in the twenty-first year of its 
publication, is published every Saturday, each number containing twenty- 
eight large, double-columned pages of reading-matter. By reason of the 
condensed form in which the matter is arranged, it contains more reading- 
matter than any other journal of its class in the United States. It is also 
more freely illustrated, and its illustrations are generally better executed, 
than is the case with other weekly journals. 
It has a large circulation in all parts of the country, and it is largely on 
this account that it is enabled to obtain a high class of contributed articles, 
for authors know that through its columns they address the better part of 
the profession; a consideration which has not escaped the notice of adver- 
tisers, as shown by its increasing advertising patronage. 
The special departments of the Journal are as follows: 
LECTURES.—The frequent publication of material of this sort is a prominent fea- 
ture, and pains are taken to choose such as will prove valuable to the reader. 
ORIGINAL COMMUNICATIONS.—In accepting articles of that class, regard is 
had more particularly to the wants of the general practitioner, and all the 
special branches of medicine are duly represented. 
BOOK NOTlCES.—Current publications are noticed in a spirit of fairness, and with 
the sole view of giving information to the reader. 
CLINICAL REPORTS are also a regular feature of the Journal, embracing clinical 
records from the various hospitals and clinics, not only of New York, but of 
various other cities, together with clinical contributions from private practice. 
EDITORIAL ARTICLES are numerous and carefully written, and we are able to 
give timely consideration to passing events. 
MINOR PARAGRAPHS.—Under this heading are given short comments and 
notes on passing events. 
NEWS ITEMS contain the latest news ©f interest to the profession, 
OBITUARY NOTES announce the deaths which occur in the ranks of the profes- 
sion, with a brief history of each individual when practicable. 
SOCIETY PROCEEDINGS are given promptly, and those of a great number of 
societies figure. At the same time we select for publication only such as we 
think profitable to our readers. 
REPORTS ON THE PROGRESS OF MEDICINE constitute a feature of the 
Journal which we have reason to think is highly valued by our readers. 
MISCELLANY includes matter of genera! interest, and space is also given for 
NEW INVENTIONS and LETTERS TO THE EDITOR. 
As a whole, we are warranted in saying that the New York Medical 
Journal is regarded with the highest favor by its readers and by its com 
temporaries. 
Subscription price, $5.00 per annum.