g should be warm, to protect the system against
changes of temperature; especially should every precaution be taken to
keep the feet dry and warm. The patient should walk in the open air, and
the distance should be regularly lengthened at each succeeding walk. If
the course of treatment which we have suggested be faithfully pursued, a
permanent cure will be effected.

IN THE OBSTRUCTIVE VARIETY of dysmenorrhea, some organic impediment
hinders the exit of the menstrual blood from the uterus, which,
consequently, becomes distended and painful. The pain may be constant,
but is most acute when the uterus makes spasmodic efforts to discharge
the menstrual blood. If these efforts prove successful, there is an
interval of relief. Flexion or version of the womb may produce partial
occlusion of the canal of the neck of the uterus, thus preventing the
free flow of the menstrual fluid through it. Tumors located in the body
or neck of the uterus often cause obstruction to the free discharge of
the menses. Imperforate hymen and vaginal stricture also sometimes cause
obstruction and give rise to painful menstruation. As these several
abnormal conditions and diseases will be treated of elsewhere in this
volume, we omit their further consideration here.

Partial adhesion of the walls of the neck of the womb may result from
inflammation of the mucous lining, and prevent a free and easy exit of
the menstrual fluid. In many cases, the contracted and narrowed
condition of the canal of the cervix seems to be a congenital deformity,
for we can trace it to no perceptible cause. It is also true that
contraction and partial, or even complete, stricture of the cervix, or
neck of the womb, often results from the improper application of strong
caustics to this passage by incompetent and ignorant surgeons. Every
person has observed the contraction of tissue caused by a severe burn,
which often produces such a distortion of the injured part as to
disfigure the body for life. A similar result is produced when the neck
of the womb is burned with strong caustics. The tissues are destroyed,
and, as the parts heal, the deeper-seated tissues firmly contract,
forming a hard, unyielding cicatrix, thus constricting the neck of the
womb, through which the menses pass into the vagina.

[Illustration: Fig. 3.

THE UTERINE DILATOR.

This instrument is
introduced into the
canal of the uterine
neck with its blades
closed. By means
of the thumb-screw
the