fourteenth year of her age. Indeed, it cannot be esteemed an uncommon circumstance for girls to have their first change as early as the thirteenth year of their age. It does not, however, invariably happen for the first menstruation to take place so early as the fifteenth, and not a few young women are advanced to the end of the sixteenth, or even far into their seventeenth year before they have their first sign. The precocity or lateness of the first eruption is connected with circumstances so various that it is often very difficult to say why one young person should begin far too early, or another postpone to an inordinately late season the performance of an office having so intimate a connection with woman's whole nature.

The menstrua do not in all cases obey the rule that ordains their return once during each lunation, and many women go to the full extent of the calendar month, or even beyond it, while many others come far short of the lunar revolution, being regular every three weeks, or oftener.

Hence, it appears that though the catamenia are governed by a principle of periodicity, that periodicity is not invariable for the whole sex, and the Student should, therefore, be ready, in any case submitted for his judgment, to decide whether the periodicity as to such special case is or is not normal. My experience as a practitioner has afforded very numerous opportunities to observe erroneous interpretations of this matter, and to confirm my long settled convictions, that every woman, though under this general law of lunar month periodicity, is in fact ruled by a cyclical law of her own individual nature.

In deciding concerning alleged cases of menstrual irregularity, one should not lose sight of the fact, that every sanguineous discharge from the genitalia of unmarried or non-pregnant women is not of necessity to be held as a menstruous evacuation; because it may, and often does happen for women to bleed from the womb or vagina irrespective of their catamenial nature. Yet it is so natural for one accustomed to the periodical flow, to suppose every such flowing somehow dependent on the menstrual office, that we need not wonder to find so many misinterpretations. For example, a woman affected with polypus uteri, is very likely to have some bloody show during consecutive months, or even years, and yet when she consults with the physician on the subject, she is almost sure to speak of the issue as her courses, and say that she has had her courses without interruption for so many weeks, months, or years. An educated physician, however, who knows that menstrual discharges are nothing more than the signs of the monthly ovulations, ought to make no such mistake in diagnosis, nor do I presume to think he would do so except from carelessness.

If the mean duration of each menstrual act is from three to five, or at most seven days, then all the instances in which women complain to us of courses lasting for two or three weeks, or more, should be considered due to some other cause than the ovulations, and treated accordingly.

Women, as has been already shown, develop and discharge a ripe ovule from the Graafian follicle once in every twenty-eight days; but there ought to be no surprise on finding now and then a person in whom the ovulative power is so vigorous as to repeat the oviposit every fourteenth day, or every twenty-first day, and I conclude that all those persons who complain to us of menstruating twice a month, or once every three weeks, do actually mature and discharge their ova every fourteenth or every twenty-first day. Such examples as the above, though to be placed among the instances of menstrual irregu larity, are not necessarily to be regarded as cases of bad health, but rather as the proofs of uncommon power of reproduction in the individual. They do not in general require any medical treatment, because they contain within themselves a power of cure, and it will be found that their continuance is not greatly prolonged; since if the too frequent returns result in some degree of weakness, the redoubling of the ovulations ceases with the loss of power; such, at least, are my views of the circumstance, and such are the results that I have many times witnessed. I hope, therefore, the Student will carefully discriminate between sanguineous genital discharges caused by ovulation, and such as arise from polypus, inflammations, cancers, and other disorders that women are liable to.

Ever since the revelation made in 1825 by Purkinje of the existence of the germinal vesicle, which led to the plenary discovery and publication of the physiology of menstruation, the old superstitions on the subject have been decaying and fading out of sight. At the present day, it is almost universally admitted that the last days of the maturing or ripening process of ovarian ovules are attended with a positive affluxion of sanguine humors-not to the laboring ovary alone, but to the entire system of the reproductive organs. In this sanguine molimen the womb largely participates, and becomes the seat of a considerable capillary engorgement. In most women this engorged condition of the blood vessels of the womb is betrayed by that sense of fulness, weight, and even aching, of which they generally complain. To know the anatomical structure of the womb, particularly its tubular glandules and the extremely delicate vascular network that exists there, is enough to convince any one that a considerable engorge ment of those vessels would be likely to exhibit itself not only in the

weight, tension, and pain above mentioned, but in actual extravasation of blood from those delicate vessels. It is hardly too much to say, that the tenuity of those coats is so great as scarcely to exceed the thickness and strength of a soap-bubble, so that they easily yield to the vascular engorgement, and bursting, allow the monthly-engorged womb to discharge its surplusage of circulation in the form of women's courses or menses. Such, at least, is the best interpretation of the circumstances that can be at present given, and as it is one that satisfies all the demands and conditions of the case, I have long ago accepted it, and do now believe I shall never change it for another.

In this view, then, I am to teach the Student that the menstrual fluid of women is blood, and that their courses consist in a monthly repeated uterine hemorrhage, and nothing more nor less. The Student, I am well aware, is urged by many able writers and teachers to consider the discharge in question as a secretion, and not as hemorrhage; but it appears to me that no advocate of the doctrine of secreted menstrua will now deny that those discharges do contain a large proportion of true blood, nor that they do coagulate like blood drawn from a vein. I leave it to the Student, therefore, to settle with his own judgment the question, how can blood-disks be subjects of secretory action? Can solids be secreted? Could not a woman as well secrete a watch or a diamond ring as one single blood-disk? Nothing can be secreted that is not fluid. A blood-disk is a solid, and not a fluid. The menstrual discharge is a hemorrhage, and it is the sign that the woman is affected with her monthly ovarian engorgement that has extended to the vessels of the womb: menstruation, therefore, strictly interpreted, is ovulation, and the sanguineous discharge that is vulgarly considered as the principal point, is far less principal than the ovarian ovulation, of which, indeed, it is only the outward mark or symptom. To fail in giving discharge to the monthly outflowing blood, is thus far less important as relates to the woman's health than to fail in the ovulation. The latter failure is evidence of serious embarrassment of the vital forces; whereas failure of the former is due to some want of sympathy between the womb and its ovaries. There are constantly to be met with women, especially school girls, who ovulate with perfect regularity, but who do not give out the sign thereof in a bloody evacuation from the womb; and I may venture confidently to assert that such amenorrhoeas are of little import, and demand nothing beyond some judicious hygienic directions. Inasmuch as I have thus confidently stated the opinion that the menses consist of extravasated or hemorrhagic blood, it seems proper here to compare the analysis that has been made of these fluids, I

mean blood and menstrual fluid. It is universally known that healthy human blood consists of water 790, fibrin 3, blood-globules 127, and albumen 80, which equal in sum one thousand parts. The analysis of menstrual fluid made by Denis, and stated at p. 172, of M. de Boismont's Treatise on Menstruation, gave of water 825, while the other constituents, as globules, albumen, extractive matter, fatty matter, salts, and mucous substance, amounted to 175; so that while the solid constituents of healthy blood are 210, those of the menses are only 175. Rindskopf's analysis (Simon's Chem. of Man, 337) gave 820.830 of water for one trial, and 822.892 for a second trial; while Simon's analysis yielded 785.000 of water, only 5 less than that of healthy blood. In like manner an analysis by Dr. Letheby (Lancet, May 2, 1845) gave of water 857.4; so that, taking into consideration the circumstance that the menstrual fluid is destined to pass through the canal of the neck of the womb and through the whole length of the vagina, in which it sometimes lingers on its way, we may understand why the blood of the menstrual hemorrhage should contain somewhat more water than blood taken direct from a vein, since it could not but become more or less mixed up with the moisture of the genital passages. Perhaps these statistical statements are, after all, superfluous for those Students who agree with me that a blood-corpuscle, being a solid, cannot possibly be a thing secreted, but one that can escape from its containing blood vessel only by an act of hemorrhage.

As to our professional measures for ascertaining in our cases whether the patient has too much or too little of the menstruous discharge, it seems proper to put the Student in mind, that as women, while menstruating, usually apply a napkin in the form of a T bandage as a receiver, we can judge pretty correctly concerning the amount by learning how many receivers are necessary from the beginning to the ending of each menstruation. I believe it will be safe, as a general rule, to allow an ounce of blood to each separate receiver, so that if only six be required we may assume that the patient loses about six ounces; but if twelve or eighteen changes are considered necessary, then we may conclude that she does lose some twelve or eighteen ounces of blood monthly.

Though the above quantity seems to be very great, yet I doubt not that thousands of women do part with such a great amount at each catamenial return; and the strangest part of the case is the indifference with which the constitution tolerates so great a periodical waste. I even think it by no means a very uncommon thing to find women who never employ fewer than twenty receivers for each season of

return, and it is to be observed that they generally lose a great deal of blood besides what is absorbed by the napkins.

So great are the differences in the menstruation of different women, that while many of them part with eight, ten, or fifteen ounces without the least inconvenience, but become indisposed if they lose only two or four ounces, there are thousands of healthy women who are so sparing of their blood that they take no precautions against exposure -never making use of any other receiver than their chemise-and guarding their modesty against some possible blood-stain by putting on an extra thick petticoat. It is evident that this sort of women must bleed very little indeed, or the flowing would immediately run down to the shoes, or come as a broad stain through the outer garment. Yet these sparing women would, perhaps, be very ill if they should lose as much as those other copiously menstruating ladies, who would also esteem themselves to be sick if not flowing freely. How true, then, is it to say that every woman, in her courses, has a law unto herself, and how important for the Student to know and acknowledge that truth, as a guide in his practice.

In examining the subject of menstruation, the question must somewhere arise as to what is the precise relation of time betwixt the rupture of the Graafian cell and the commencement of the flow. Does the woman begin to bleed before or after the escape of the ovulum from the ovarium? This is a problem that remains to be settled by future observers. In the mean time, I consider it true to say that when a woman's body is examined by the Anatomist, he can always find the opened and emptied Graafian cell, provided the individual should have died while discharging the menstrual blood, or within some few days after its cessation; I have examined a considerable number of such subjects, and never failed to detect the open hila through which the little egg had passed outwards. The vestige is usually a bloody or reddish point. If a probe be pressed upon it, it passes downwards into the empty cell which contained the egg, and generally fills after its escape with some coagulated blood. The wood-cut that I subjoin (Fig. 47) represents the appearances in the womb and ovaries of a young girl who died here on the eleventh day after the eruption of her courses. As she perished with an acute disease, it may be that the healing or reparative processes in the opened vesicle may have been less rapid than is usual. On receiving the specimen, I perceived the open hila from which the egg had escaped, and inserted a probe deep into the deserted cavity of the vesicle. Upon cleaning the margin of the hila, it was plain that the opening had been made by the absorbents and not by any violent