The prognosis of dysmenorrhoea varies in the different classes. In the obstructive form it will depend upon the curability of the lesion upon which it depends, and the same may be said of the congestive. The neuralgic cases do not yield readily to treatment, especially when dependent upon a peculiar and perhaps inherited nervous constitution. Caution should be exercised, however, in expressing an unfavorable prognosis. {198} Like all nervous diseases in the female, it is subject to great mutations without apparent adequate cause, and will sometimes suddenly disappear in an inexplicable manner. The membranous form affords still less promise of cure: the unsatisfactory results of treatment are generally acknowledged. During an attack of dysmenorrhoea the patient should remain in bed for the benefit of rest and warmth. In those cases where the flow is not too free, and especially when relief follows its appearance, active measures to promote this end may be instituted by hot drinks and hot fomentations. In married patients a hot sitz-bath, during which the vaginal syringe is used to douche the uterus, is an efficient measure. Pain being the prominent symptom, and remedies for its relief being at hand and reliable, the indication is clear and the treatment can be briefly stated. In execution, however, it is not a simple problem: immediate relief is not alone to be considered. If opiates be resorted to for frequently-recurring pain, a habit will soon be formed that is no less a calamity than the disease itself. While, therefore, opium and its preparations are reliable remedies, and in many cases indispensable, they should be administered as seldom and as sparingly as possible, and always with an appreciation of possible injurious consequences. Many cases can be successfully managed with chloral hydrate, or belladonna, or Indian hemp. When opiates are resorted to, they should be combined as much as possible with other medicines by which their effects are modified, and relief afforded with the smallest possible dose. Thus in cases attended with vascular excitement these ends may be attained by the union of opium with tartar emetic or aconite; when there is marked disturbance of the nervous system, it may be combined with an antispasmodic, as the compound spirit of ether. Administration by the rectum will produce a local as well as a general effect, and injections of starch and laudanum or suppositories of opium and belladonna may be administered. The speediest and most certain relief is afforded by the hypodermic syringe. Resort to it should, however, be rigidly controlled; it should be used as a miser uses his gold, and it need scarcely be added that only very exceptional, if any, circumstances will ever justify placing the syringe in the hands of friends or attendants, no matter with what restrictions. Unfortunately, this is sometimes done, but very rarely without great injury resulting.