REPRESSION OF MENSTRUATION 
AS A 
CURATIVE AGENT IN GYNECOLOGY. 
BY 
EUGENE 0. GEHRUNG, M.D., 
St. Louis. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XXI., November, 1888.] 
N E W Y 0 R K: 
WILLIAM WOOD & COMPANY, PUBLISHERS, 
56 & 58 Lafayette Place. 
1888. REPRESSION OF MENSTRUATION 
ZS A 
CURATIVE AGENT IN GYNECOLOGY. 
BY 
EUGENE C. GEHRUNG, M.D., 
St. Louis. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XXI., November, 1888.] 
NEW YORK: 
WILLIAM WOOD & COMPANY, PUBLISHERS, 
56 & 58 Lafayette Place. 
1888. REPRESSION OF MENSTRUATION 
AS A 
CURATIVE AGENT IN GYNECOLOGY.1 
Menstruation is a periodical, usually sanguineous flow of 
variable quantity and duration, to which most women are sub- 
ject for a shorter or longer period of their lives. 
This short definition of menstruation shows at a glance the 
great uncertainty surrounding every phase of this process. In 
fact a search through literature on this subject shows as many 
different opinions as there are authorities consulted. A certain 
degree of order may, however, be brought into this chaos, suffi- 
cient for our present purpose, and without the necessity of 
quoting the different opinions at length, by choosing the outside 
limits of the various estimates, which will read as follows: 
Menstruation returns every twenty to thirty-one days; lasts 
from two to eight or ten days, causing a loss of blood of from 
two ounces or less to eighteen ounces or more. 
To encompass the irregularities of menstruation, a still greater 
latitude must be allowed, as the following quotations will show : 
" The fluid is not in all cases sanguineous; indeed, its bloody 
character may be regarded as accidental, though present in the 
infinite majority of cases.2 . . . 
"Another observation of great interest has been alluded to 
by Dr. James Stirton3 to the effect that in certain barbarous 
tribes of South Africa, whose habits of life closely approach 
1 Presented to the American Gynecological Society, Sept., 1888. 
2 Diction, of Medicine, Quain. 
8 Glasgow Medical Journal and Annal. Univ. Med. Science. 4 
Gehrung : Repression of Menstruation 
those of the brute creation, the women menstruate only at ir- 
regular periods and in a very scanty manner. And further, that 
menstruation itself is slowly inaugurated with a discharge of 
mucus, as in the case of what may be termed the menstruation 
of the inferior animals. In these women it is said that nothing 
like normal menstruation takes place until after indiscriminate 
intercourse has been practised. 
" Dr. Stirton believes that menstruation is a product of civili- 
zation, supporting his theory by facts drawn from a study of 
comparative physiology. . . . Complete suppression of the 
menses is alleged to take place very frequently among the 
women of Greenland, especially during the winter season, and 
that, too, without entailing the slightest disturbances of health. 
Similar conditions are said to prevail among the inhabitants of 
the higher mountainous regions'of Switzerland and France." 
There has been no lack of observation of the phenomena of 
menstruation, and these have led to a tolerably fair understand- 
ing of this process as it occurs at present, though little or 
nothing is definitely known as to Nature's original intentions. 
The mechanism of menstruation, considered in the light of 
this essay, is as follows : 
From some yet unknown or insufficiently known cause a 
gradual retention of blood in the venous plexuses of the pelvis 
takes place, causing a hyperemia or engorgement of all the pel- 
vic organs and tissues. The blood for this purpose is withdrawn 
from the general circulation, producing lassitude, malaise, etc., 
while in the pelvis heaviness or fulness, so generally complained 
of, is produced, constituting what is called the menstrual mo- 
limina. Only a slight discharge is necessary, usually from the 
endometrium, to relieve the over-tension, when the balance 
returns to the general circulation from whence it came. 
It is not the amount of blood in the body which conditions 
the amount of engorgement, nor is it the amount of engorge- 
ment that determines the amount of the flow ; it is the complete 
or incomplete balance between the engorgement and the resist- 
ance to it, whereby the amount of the flow is regulated. The 
engorgement itself is regulated, and stands in direct relation to 
the tonicity or atonicity of the respective nerves and muscles. 
The resistance consists in the amount of obstruction placed in 
the way of the flow, especially the contractile power of the 
uterus. as a Curative Agent. 
5 
If the degree of engorgement and the opposed resistance are 
equally balanced, there will be little or no sanguineous flow ; if 
the engorgement predominates over the resistance, the flow will 
be correspondingly profuse ; on the other hand, if the engorge- 
ment be feeble, and the resistance marked, there will be little 
loss, if any. Again, a slight engorgement opposed by little or 
no resistance will result in a considerable flow, while a pro- 
nounced engorgement meeting with a strong resistance may be 
followed by scarcely any flow. There are many degrees and 
variations between these extremes. 
From what has been said, it is not difficult to see that in weak 
and nervous women, on account of the imperfect innervation, 
the engorgement should run high in proportion to the amount 
of blood in the system, and, on account of the weak musculature, 
the resistance would be small and, in due proportion, the flow 
great, while in a strong and healthy woman, from opposite con- 
ditions, the flow would be small. 
The engorgement having subserved its purpose, the blood 
that has not been wasted will slowly return into the general 
circulation. How much was Nature's intention to be wasted in 
this process ? 
My answer is: Little in the strong and healthy; little or 
none in the weak and anemic. 
The menstrual flow with women of the present day is greatly 
in excess of the actual want, even though it be confined entirely 
within the so-called physiological limits, because of the increas- 
ing engorgement and the decreasing resistance in consequence 
of the depressive influences of civilization, the effects of the 
constant repetition of menstruation, the effects of pregnancy 
and labor, and finally from the transmitted habit by inherit- 
ance. 
Strong and robust women stand the loss of great quantities 
apparently well during a long period of their menstrual life, 
yet the final result is that their constitution is undermined, and, 
despite their healthy appearance, their vital power is sapped, 
and on closer investigation it will be found that that appearance 
of health-plethora, corpulence, etc.-is nothing more than a 
mask for the underlying group of symptoms denoting anemia. 
If the great losses are tolerated badly even by strong and 
apparently healthy women, if this waste leads even with them 
to constitutional depravation, how much more must this be the 6 
Geiirung : Repression of Menst/rnation 
case with the nervous, weak, and anemic women. These having- 
a far greater propensity to excessive bleeding, because of their 
weakness and impoverished blood, favoring a greater degree of 
engorgement, accompanied with diminished resistance. 
Some of the evils consequent of this uncalled-for waste are: 
Neuralgia, neurasthenia, melancholia, anemia with all its neu- 
roses and circulatory disturbances; chlorosis (?); uterine dis- 
eases, such as flexions and versions, vegetations and even in- 
flammations, diseases of the uterine appendages, etc. AU of 
these troubles may prove incurable without removal of the 
cause. 
Every practitioner will recall a number of those pitiful cases 
of broken-down constitution, nervous to the verge of insanity, 
complaining of all ills flesh is heir to, who under appropriate 
treatment improve for a while until the next return of the 
menses mercilessly destroys all that has been gained. The 
woman's whole existence is spent in making blood enough to 
be again uselessly spilled at the next menstrual period, while 
the physician is driven to despair of an ultimate success. Ton- 
ics, hemostatics, styptics, diet, travel, hydrotherapeutics, rest, 
etc., are prescribed heroically, and the result is usually disap- 
pointment. 
The poor, thus afflicted woman passes from the hands of a 
neurologist into those of a gynecologist, and again from the lat- 
ter to the former, until exhausted in confidence, blood, and 
means. Each in his turn has honestly done the best in his 
power ; all that teachers and books have taught him. All are 
more or less conscious that each recurring menstruation destroys 
again the fruits of their labor. Yet, who has the courage to 
interfere with that almost sanctified function (?), menstruation 1 
The physician is convinced that his patient should not lose 
blood, in fact that she cannot afford to lose any, but that inex- 
orable menstruation, that noli me tangere, will exact a certain 
amount of this vital fluid, while the physician is Pegging nature 
to relent, by means of the routine treatment, where indeed, if 
he possesses the courage to destroy this idol, he can corn/mand 
by the tampon. 
Yes, the tampon is the remedy (assisted or not by other means, 
as may be desired) which stands at the disposition of every 
practitioner, whereby he may regulate the amount of loss in 
menstruation, according to the necessity of the case, to the best as a Owrati/ve Agent. 
7 
of his judgment. However little the amount lost in a given 
case may be, it may be far greater than is admissible for the 
welfare of the individual under consideration, and it should be 
lessened or arrested without fear. The blood thrown into the 
pelvic reservoir, constituting the menstrual engorgement, is 
certainly not intended to be cast off in toto. If the engorge- 
ment is great, only a small amount is destined to flow away to 
relieve the over-distention until the determination to the pelvis 
is past, when the blood may safely return to the general circula- 
tion. Since it is not bad blood, as has formerly been imagined,, 
but the same as is used in the balance of the economy, the 
quantity so reserved is fully as useful as a similar cpiantity 
gained by the use of tonics or transfusion. 
These are not theories, but facts, well proven by the results 
of my practice, covering a space of nearly two years, and gained 
from a great number of cases. 
Despite the great reluctance of gynecologists of even the 
present day to interfere with a menstruating woman, it will 
not be long ere, in appropriate cases, the time of the catamenia 
will be selected for gynecological treatment, in preference to 
the intermenstrual period. 
The amount of blood thus saved not only lessens the anemia 
with its sequelae, but diminishes the tendency to waste in the 
future, by lessening the tendency to transudation on account of 
the improved quality of the blood, and by increasing the resist- 
ance in consequence of improved tonicity of the uterus, etc., 
and by destroying the habit of great losses. 
In cases of delayed menopause from the habit of excessive 
engorgements and losses, this termination of the great menstrual 
cycle may be enhanced, to the great advantage of the patient, 
in whom the continuance might have been a source for the de- 
velopment of tumors, cancer, etc. 
Besides these immediate benefits of repressed menstruation, the 
direct benefits of the tampon are gained at a time when the tis- 
sues are in the best condition to receive them. The pressure, 
support, and medication of the tampon will frequently bring 
about results which have been sought in vain to be obtained at 
other times and by other means. 
In opposition to this treatment, the bad results of amenor- 
rhea, suppression of menstruation, etc., may be mentioned, but 
these are the results and not the causes of some local or general 8 
Gehrung : Repression of Menstruation 
diseases, and besides this treatment is not intended to be a sup- 
pression, but merely a repression of menstruation, in appropri- 
ate cases. 
The tampon is preferably made of absorbent cotton ; that 
made by Johnson & Johnson, for the use of surgeons and den- 
tists, consisting of a thin, endless layer, is the most convenient 
to handle. This may either be made in little balls of the size 
of a pecan to that of a walnut, or torn lengthwise in two to four 
slips of twelve to twenty-four inches in length. These being 
squeezed dry from a solution of 1-100 to 2-100 alum and 
water are packed, the former in lumps, the latter in strips 
around and upon the cervix secundum artem, until the vagina 
is filled. Either a Sims' speculum or a bi- or tri-valve specu- 
lum may be used. I prefer a short bivalve speculum for ordi- 
nary cases, and for virgins a small trivalve, which I had 
expressly constructed for that class of cases, and which can be 
used without stretching the hymen. To make the tampon solid, 
I use two pairs of uterine dressing forceps, the one to press the 
tampon in the opposite direction from where I intend to make 
the next application by the other. In this manner a very effi- 
cient tampon can be applied, without much inconvenience to 
the patient or the physician. When complete, the tampon can 
be fixed by the two points of an open pair of forceps, while the 
speculum is withdrawn. Of course variations may be made in 
the kind of speculum used, the medication of the cotton, and 
manipulation in placing the tampon to suit the operator. The 
tampon is then left untouched for forty-eight hours, unless the 
bleeding should recur sooner, when it should immediately be 
applied fresh. This does not only lessen or stop the bleeding, 
but also the duration of menstruation; as a person habitually 
bleeding for eight or ten days may be entirely through in two 
or three days. Nothing should be introduced into the cervix or 
uterine cavity. During this treatment rest is desirable, though 
not absolutely necessary. 
When should the tampon be applied 't 
I give the patient directions to call at my office or send for 
me on the first sign of the coming menstruation. I find that 
even with this precaution, as much or more blood is usually 
lost before the tampon is applied than is necessary or desirable; 
if not, the latter may be applied more or less loosely, so that 
a sufficient quantity can soak into the tampon. as a Curative Agent. 
9 
If a tampon lias been used during the full time of the usual 
duration of menstruation in a given case, and if, after the 
bleeding had ceased, it recommences again, one may almost be 
sure to find intra-uterine vegetations, tumors, or other compli- 
cations that may have formerly been overlooked, as the cause. 
My first attempts were of course made hesitatingly, and al- 
most unconsciously, because I was held in abeyance by the 
same dread which everybody else possesses, that any inter- 
ference with menstruation is fraught with danger. Who has 
not, at times, studied with anxiety a sanguineous flow from the 
uterus, for the purpose of distinguishing whether it be a 
hemorrhage or menstruation, to enable him to treat the same 
correctly, that is, to arrest a hemorrhage or to let the menstrual 
flow alone. At times, this distinction is not easy, if at all pos- 
sible, but the differential diagnosis is not so important, since 
both will come under the same treatment. There are certainly 
exceptions to this rule, as for instance when there is hemorrhage 
from a possibly pregnant womb, etc. 
" I would not touch a woman during menstruation with a 
forty-rod pole," is the warning ejaculation of a prominent 
gynecologist of this city, and the majority of the profession 
doubtlessly sympathize with him on this subject. The laity 
is possessed of still greater awe for the mysteries of menstrua- 
tion. At times it is not an easy task to overcome the super- 
stitious fear of a woman so as to gain her confidence and per- 
mission to interfere with her menstruation. 
It is, however, gratifying to see with what facility the better 
class of women will recognize the soundness of the practice 
when explained to them. With the lower classes, the less 
reasoning the better. 
One of my first cases was that of a plethoric and well-de- 
veloped lady, set. 48 years, widow of a physician, who had been 
menstruating profusely.for eight to ten days at each period all 
her menstrual lifetime, but is still the picture of health. For 
several years she suffered from occasional hemorrhages, caused 
by vegetations on the endometrium, for which I curetted the 
uterus several times with temporary benefit, as the vegetations 
were constantly reforming, apparently on account of the great 
relaxation of the entire uterus. These attacks became rather 
more and more frequent and it appeared as if a malignant 
degeneration had set in, as even curetting ceased to give lasting 10 
Geiirung : Repression of Menstruation 
relief. After a hemorrhage that lasted from one menstrual 
period to nearly the next, only controlled by the vaginal tam- 
pon (intra-uterine tamponing made matters worse, as the uterus 
relaxed so completely that the blood would find its way around 
the ping, no matter how tightly packed), the cessation of the 
flow was finally accomplished. 
The patient, instead of being gratified with the result, ex 
pressed her displeasure in the following words: " Doctor, 
what is to become of me ? I am completely discouraged. Now 
we have succeeded in stopping the hemorrhage and in two days 
from now, my menstruation is to come on again, with a good 
prospect for another month's bleeding." I said to myself and 
to the patient that it could not be possible that, after a hemor- 
rhage of nearly four weeks, there can be any need for more 
loss of blood, though it may come under the pretense of men- 
struation. So I gave directions to inform me of the first symp- 
tom of the expected flow, to enable me to use the tampon 
from the very outset, so as not to lose one drop of blood if it 
could be prevented. This appeared quite rational to the 
patient, but soon superstition gained the upper hand and she 
raised all possible objections against such a proceeding. 
These were reasoned away one by one and finally I succeeded 
in getting her consent and promise to send for me in due time. 
The tampon permitted but an insignificant loss and the lady 
felt stronger than after any menstruation for many years past, 
besides she began to recover rapidly from other complications 
which before had resisted all treatment directed against them. 
I succeeded in persuading the patient to permit the same 
treatment for several successive months, despite the prophecies 
by lady friends of the terrible consequences of such a practice. 
The result of the treatment is, that the uterus is now per- 
fectly healthy and the lady enjoys better health than she has 
done for many years past, in fact is well. 
This and many other cases of a similar character emboldened 
me to use the same remedy in cases of profuse menstruation 
with symptoms of anemia and its sequelae, and finally to use 
it even where menstruation was considered to be normal or 
even scant, where I had previously been attempting in vain to 
make blood by the usual means. 
I am at liberty to state that I have not met with any un- 
pleasant or detrimental effects, and certainly have not had cause as a Curative Agent. 
11 
to regret the treatment. On the contrary, in almost all cases 
which I have so treated, and their number is large, the patients 
have been as highly elated with the results as I was myself. 
In many cases which have been in my care, or that of others 
for a long time, the first signs of improvement in the otherwise 
incurable diseases have been noticed soon after this treatment 
had been instituted. 
It is easily comprehensible that it takes a long time to collect 
satisfactory results of a mode of treatment which can be used 
not oftener than about once a month in an exclusively private 
practice. Therefore, I shall not prolong this article unnecessarily 
by a report of cases and other minor details, but shall content 
myself by having thus broadly stated the results of my ob- 
servations with the remark that further study of this plan of 
treatment, by myself as w'ell as others, may develop even 
more encouraging results than those here reported; while on 
the other hand the results may have been overestimated or 
misinterpreted by me. 
Further observations will help to decide in what class of 
cases and to what extent the remedy is admissible ; to what ex- 
tent the flow may be repressed with benefit, and what benefits 
may be expected therefrom. 
Heretofore I feared that I was standing alone in the proposi- 
tion of artificially restricting menstruation, as a curative means 
for many diseases which have been a stumbling block to gyne- 
cologists, and felt great hesitancy to come before the profession 
with such a proposition, but to my great pleasure and relief 
my eye fell upon an abstract in the Medical Times for June, 
1888, of an article by Loewenthal in the Revue de Therapeu- 
tique which in a certain way serves to corroborate my observa- 
tions, and which, in the absence of the original article, I shall 
quote here in full. 
" Artificial Repression of the Menses in Chlorosis. 
" Loewenthal, of Lausanne, records twenty-three cases in which 
the artificial repression of the menses has been very advanta- 
geous in this disease. The method employed consisted in in- 
jections of warm water of about forty-nine degrees (Cent.), with 
absolute rest in bed. In some cases iced water was employed in 
preference to warm. Eighteen cases were chlorotic, and all 
were cured rapidly without other treatment than from three to 12 
Gehrung : Repression of Menstruation. 
five menstrual suppressions. Five were grave cases of hysteria, 
one of whom showed marked improvement, while three other 
cases were convalescent from exhausting illness, and in them 
the convalescence was much shortened. No bad effects were 
noticed." 
The means employed by Dr. Loewenthal to effect the repres- 
sion appear to me of doubtful propriety, because of their un- 
certainty and dangerous character. 
My rale for submitting a case to the use of tampon has here- 
tofore been based on the answer of the following questions: 
How much blood does the patient lose ? And 
How much can she afford to lose ? 
If the sum of the former question proved to be in excess of 
the latter, I did not hesitate to use the tampon to a sufficient 
extent to limit the loss to the amount calculated, to the best of 
my ability. 
I feel quite convinced from my observations that a loss of 
from two to four ounces (sixty-four to one hundred and twenty 
eight grammes) will satisfy the demand in any case ; while in 
anemic persons, from profuse menstruation or from any cause 
whatsoever, all should be saved that can be saved. Even where 
no flow at all was permitted in such cases, no bad effect has been 
observed; on the contrary, the benefits were marked in propor- 
tion to the completeness of the suppression. 
If my estimate of the quantity of blood which should or may 
flow during menstruation is correct, then it is pitiful to behold 
what rivers of life are wasted monthly. I sincerely hope that 
in the future much of this waste may be arrested and used to a 
better purpose in the economy.