II/RMORRIIAGIE8. 299 



is commonly fruitless to employ them at other times, unless they 

 be such as require some continuance in their use to produce 

 their effects. 



MXIII. Nearly similar to the cases of suppression are those 

 cases in which the menses flow after long intervals, and in less 

 quantity than usual ; and when these cases are attended with 

 the disorders in the system, MX., they are to be cured by the 

 same remedies as the cases of entire suppression. 



MXIV. It may be proper, in this place, to take notice of the 

 dysmenorrhcea, or cases of menstruation, in which the menses 

 seem to flow with difficulty, and are accompanied with much 

 pain in the back, loins, and lower belly. We impute this dis- 

 order partly to some weaker action of the vessels of the uterus, 

 and partly, perhaps more especially, to a spasm of its extreme 

 vessels. We have commonly found the disease relieved by 

 employing some of the remedies of suppression immediately be- 

 fore the approach of the period, and at the same time employing 

 opiates. 



" I have frequently met with cases of dysmenorrhcea, with 

 all the marks of distention in the neighbouring parts, and partic- 

 ularly pains shooting through the belly, which sufficiently ex- 

 pressed that there had been accumulation and some haemorrhagic 

 effort, but a resistence in the extreme vessels. In these cases I 

 have constantly recourse to opium, and hardly ever without suc- 

 cess. And so far from opium being liable to suppress the men- 

 strual flux, or any other haemorrhagy, I maintain that, in many 

 respects, it has a tendency to increase them ; and, in so far as 

 the suppression of the flow depends on the spasm I speak of, we 

 must naturally suppose that opium is the proper remedy. I 

 have accordingly frequently obviated those pains that accom- 

 pany the haemorrhagic effort, as I call it, and not only produced 

 more immediately the menstrual flux, but in larger quantity 

 than usually attends those cases of dysmenorrhoea. 



" Before I dismiss this subjeet, I would observe, that the 

 constriction of the extreme vessels may be a simple nervous afM 

 fection, without any connexion with the rest of the system of! 

 the blood-vessels, which is probably the case upon many occa- 

 sions. But often it may be properly a phlogistic spasm, con- 

 nected with a phlogistic diathesis, which is, or may be, excited 



