ficial action of the sexual stimulus, which in all these cases is the one, that is ultimately to be relied on. When the system is chlorotic and enfeebled, a bracing treatment is necessary along with sexual intercourse; which should be used (here as in other cases where the sexual organs are in a weak state), in moderation, so as not to over stimulate he weakened ovaries. This is evidently too the treatment requisite for the very frequent cases of irregularity or complete suppression of the menses, brought on by sexual abstinence. Mustard hip-baths or other auxiliaries may be needed in many cases, and would probably be frequently beneficial. Epilepsy, St. Vitus' dance, and other nervous diseases, are sometimes dependent on chronic menstrual suppression, and are cured by the return of the discharge.

In order to prevent amenorrhoea, care should be taken by women, not to expose themselves to cold or wet while menstruating. Habit however accustoms the body to this, and bathing women go into the sea, whilst menstruating, without injury. Other causes, which are said sometimes, suddenly to arrest menstruation are, sexual intercourse or violent emetics or purgatives during menstruation, and these causes should be carefully avoided. Dr. Tilt says, that if women were generally in the habit of wearing drawers, the number and severity of sexual diseases would be greatly diminished. These articles of dress are gradually coming into use, but are still not nearly so much worn as they should be. Cotton stockings too, and thin shoes, expose the feet to cold and wet, and are said by one of the French physicians to be among the chief causes of the universal prevalence of white dis charges among the Parisian women. To prevent chronic suppression, the great means is a due amount of the proper stimulus for the ova ries, and a healthy life in other respects.

VICARIOUS

MENSTRUATION.

THIS is a curious affection that sometimes occurs in the absence of natural menstruation, and has been termed "a freak of nature." A quantity of blood is discharged from some other organ, generally the stomach or the lungs, and sometimes this discharge takes place periodically at the menstrual epochs. It causes much alarm to the patient, but is not dangerous, and ceases after a time. It is sometimes difficult to distinguish it from true primary hermorrhage; but the guiding facts are, the presence of amenorrhoea; the occasional periodicity, and the absence of the signs of disorder and disease, which accompany primary hemorrhage. White discharges sometimes take the place of absent menstruation, occurring at the usual periods, lasting the usual time, and attended by the usual catamenial effort. This is most common in delicate girls at the beginning of menstruation.

The treatment of these vicarious affections is, to restore natural menstruation.

DYSMENORRHEA

OR

PAINFUL MENSTRUATION.

THIS is, as Dr. Ashwell says, a very common disease, and causes intense suffering. In fact the disease, in its aggravated form, is something like the pains of child-birth occurring every month. It not only causes intolerable suffering, but very frequently sterility likewise; so that a celebrated physician said of it, "one half of the life of such a patient is devoted to suffering, and the other blighted by sterility." Single women are particularly prone to it," says Dr. Ashwell, and it often seems to be associated with a tendency to strong mental emotion."

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The symptoms of painful menstruation are as follows. Menstruation becomes irregular, and is sometimes excessive, but generally scanty. The discharge is emitted with indescribable pain, and is shreddy or clotted ; lancinating and shooting pains are felt in the womb and vagina. Severe pain is also felt in the loins, shooting towards the groin and down the inside of the thighs; expulsatory throes, like those of labour, occur, and the patient bears down, and sometimes, after expelling a clot, experiences a temporary relief. In some cases where there is considerable congestion of the womb, what are called "spurious abortions occur. These are

membranes containing a clot of blood, which are expelled from the womb with agonising throes. Acute pain in the breasts sometimes precedes menstruation for some days; and in other cases headaches, flushing of the face, weight in the pelvis, full and quick pulse precede the attack, showing that there is inflammatory action going on, and foretelling the coming storm. Sometimes the menstrual pains, after lasting a day or so, go off, and the remainder of the period is easy; but frequently they last throughout.

In the intervals there is often no suffering, and at first but slight constitutional disturbance. But gradually the health becomes impaired ; the bowels become now constipated, now loose; there is loss of appetite, emaciation, and pallor. Profuse white discharges occur during the menstrual intervals, and sometimes amenorrhoea ensues. The breasts now become flaccid, and almost quite disappear.

The causes of this excruciating malady are various. It is sometimes co-existent with menstruation from puberty upwards; but often arises at a subsequent period. It lasts in many cases throughout the whole

sexual life of the woman, and only ceases at last by the cessation of menstruation. Hysterical and irritable single women are especially its victims. It very frequently comes on gradually from impairment of the general health, as amenorrhoea does; and in the most of these cases in single women, doubtless depends mainly on the want of healthy exercise of the organs. It sometimes, but very rarely, arises from a congenital narrowed state of the os uteri, and cervical canal. In this case it begins with the commencement of menstruation. It is also frequently dependent on ulceration of the mouth of the womb, or ovarian disease.

In the treatment of dysmenorrhoea, great care must be taken to arrive at the cause of the particular case before us, and an examination with the finger and speculum is almost always necessary, else the treatment may very probably be erroneous. By the use of these means of investigation it will be seen, whether there be ulceration or ovarian disease. If found, these must be treated, and their cure, which can generally be effected, if they are recognised, will probably remove the dysmenorrhoea. If there be congenital narrowing of the canal, it must be dilated by sponge tents, and this has in several instances produced a cure. If no inflammatory disease be found, sexual intercourse, along with a general bracing hygienic treatment should be used, and is by far the best remedy. Healthy exercise is always the best treatment for organs which are in an irritable nervous state, calming and soothing the nervous excitement, and gradually training the disordered parts to a regulated and healthy discharge of their functions. "Idleness is the root of all evil," in the various organs, as well as in the whole being; for when these are not healthily employed, each in their own special manner, pain and disorder are certain sooner or later to mark their dissatisfaction. Dr. Ashwell says that "dysmenorrhoea is often cured by marriage and child-bearing; but not always, and aggravated cases occur in married women." Of course sexual intercourse cannot be expected to produce a cure, if there be ulceration or subacute ovarian inflammation; in these cases it will rather do harm. Impregnation frequently takes place in this disease, and is even more powerful than sexual intercourse in producing a cure; for during the period of pregnancy and lactation, menstruation is stopped, and the sexual organs have time to escape from the habit of morbid action; and they receive fresh impulses and a more healthy tone from the new train of actions during pregnancy. Frequently however, the patients are barren, and this great natural curative process unavailable

But it is of great importance also to give relief in the menstrual attack. At the first onset of pain, the patient should take a hip-bath at 96 degrees, for from half an hour to one hour, and repeat this thrice a day, going into bed after it, till warmth is restored. Small nauseating doses of Ipecacuanha, such as half a grain every hour, should also be given, which greatly ease menstruation. The injection into the rectum of 15 or 20 drops of laudanum in a little warm water, is also very good. To prevent this disease, we must endeavor to eradicate throughout society, the causes which lead to it. Of these by far the most important is sexual abstinence. It is chiefly in single women that it occurs. and whether it be merely a functional disease or depend on ovarian imflam

mation, it is sexual abstinence, ungratified sexual desires, and doubtless in many cases masturbation arising from these ungratified desires, which chiefly cause it. It is also very important, that the slighter pain and uneasiness in menstruation, so universally neglected, should be met at the beginning, and should not be allowed to assume an aggravated form. This is especially requisite, if these pains be not co-existent with menstruation, but come on later; if menstruation becomes gradually more painful than it has been, it is a certain sign that there is growing disorder, and the causes which lead to this should be investigated and removed. In many women menstruation is habitually attended with more or less pain and disturbance throughout the whole of sexual life, and in these cases the morbidity may be so much a part of the original constitution, as to be irremediable. Dr. Bennett says "It is only with the patient herself in health, that you can compare her in disease;" and thus when menstruation, having been previously easy, becomes difficult, we may be certain that some morbid cause is at work, which should at once be attended to, and removed.

Dr. Ashwell says "Every case of painful menstruation is not to be called dysmenorrhea; if the pain and tightness in the head and loins, which have preceded menstruation, pass away as the secretion increases, it is not dysmenorrhoea." Although in some women menstruation takes place without the least pain, yet it is generally accompanied and preceded by symptoms. These are, fulness in the pelvis, pains in the loins and ovarian regions, and sometimes bearing down pains of an expulsive character. These are very general, and constitute what is called the "usual catamenial effort." But these symptoms are not to be looked on as natural, because they are general. They are a sign of the common deterioration of the female constitution in our society, and as such are a sign of error. In the same way child-birth is known to be very much more painful among civilized nations than among savages. Savage women bear children with little pain, and I presume that menstruation, which is a kind of parturition, is in them usually attended with no pain, as it is with the most healthy women among ourselves. It should be our endeavour, therefore, to elevate this function in woman to the natural and typical standard of health, just as in the case of all the other organs and faculties of our being. The causes of the general sexual deterioration are the peculiarly unhealthy sexual life of our society, and especially of its female part; and also the generally imperfect state of all the physical virtues, in which respect civilized man stands in such marked inferiority to his savage brother. It is not our part to pique ourselves on possessing a different and a higher class of virtues, but to aim at the equal developement of all, knowing that all are equally necessary to our health and happiness; nor to neglect the valuable knowledge we may get, by comparing ourselves with a ruder part of our race. The female reproudctive organs, moreover, are the work-shop of life; all of us are in fact secretions from these organs, and from the testes of the male; and if the secreting actions of these most important organs be allowed to be habitually in a disordered and vitiated state, the effect on the health of all of us must be most injurious.