only the base, to do with it what is right, of which their organical entelechia can judge better than any man. I have come to a conclusion that, since we have obtained the beautiful preparation of Messrs. Quévenne and Miquelard, I shall never hereafter think it necessary to prescribe my chalybeate doses in any other form than that of the impalpable powder procured by hydrogen from the oxides of iron; and that I shall always intrust to the vital chemistry the task of making up the salts for itself.

Let us now advert to other circumstances that may prevent a young woman from menstruating when she has reached the usual age for the appearance of the menstrua.

I need not here speak of those cases in which some considerable disorder of another and important organ or part serves to concentrate upon itself the powers of the living economy, which they divert from a general to a particular use or determination. Among these are all those affections that tend to set up a hectical irritation in the system, such as consumption, chronic rheumatism, or painful and long-continued inflammations of the articulations. These causes of amenorrhoea are too self-evident to require more than an allusion to them; and any sensible man, even in the very beginning of his career, might be supposed capable of seeing in them the causes of the failure, and of trusting upon the cure of them to find the function in question at liberty to establish itself.

It is of more importance that the Student should know that some women are now and then met with who have emansio mensium from the want of a womb with which to menstruate, or of ovaria to provide the sources of menstruation in a regular periodical ovulation.

It happens that organs become blighted, during the embryonal or the foetal life, and never grow nor develop themselves after the birth of the child.

If these organs are not essential to the mere animated existence of the infant, it may grow up in the apparent possession of all its faculties and attributes. Should such a blight or abortion of an ovary, a womb, or vagina occur, it would be very likely to escape detection until the age of puberty, and then disclose the remarkable truth by a state of emansio mensium.

I have already mentioned several married women, neither of whom had ever menstruated, and both of whom were wholly destitute of any discoverable traces of a womb. Yet each of them was in all other respects a highly sexual creature, being fully provided with all other sexual attributes and marks. But they can never admit of the consummation of marriage, nor menstruate. Their strong sexual pro

pensities gave evidence of the perfection of their ovaries. I have no doubt that all those women performed, with the utmost regularity, the monthly acts of their ovulation, nor that they were the subjects of the monthly ovarian and vaginal hyperæmia; but they gave no visible signs by the mensual discharge of blood. Such cases admit of no medical treatment.

Again, certain women grow up and attain to a good old age, without experiencing any, the least sexual excitement, and without once menstruating during their whole lives. Upon examination after death, it is found that the ovaria were wholly wanting, or that their development having been arrested in the foetal stage, they had never been evolved beyond their foetal form and nature. Such cases are also beyond the powers of the medical art.

In some young women, the canal of the neck of the womb, or the cavity of the body and fundus uteri, is found to be annihilated in consequence of inflammation, that has filled the cavities with plastic exudation resulting in a fusion of the walls into one common substance. Such women cannot menstruate, save where the astresia affects only the canal of the cervix. When that is the case, the womb may pour out the blood of the menses, which is retained within its distended cavity. Another and another menstruation adds to the accumulation, until the uterus, pregnant as it were, and distended with the product of repeated menstruations, either causes the barrier to give way through over-distension, or until the surgeon, become aware of the truth, perforates the obstructed canal with his bistoury or his trocar, after which the courses are regularly seen to return with every ovulation.

The uterus and ovaries may be healthy while the vagina may be closed by want of development in the embryonal stage, or in consequence of inflammation ending in cohesion and artretism. Here, as in the case last spoken of, the menstrua are regularly poured into the womb and vagina, and retained until relieved by accident or by means of the surgeon's art. The same may be said as to the cases of imperforate hymen.

All these causes of e mansio mensium are to be remembered in extraordinary examples of failure to menstruate at the proper age; and when the time arrives to make the needful inquiries, those inquiries should be made with the greatest care, in order to avoid mistakes in diagnosis.

Such are my views in general as to emansio mensium. But I do not intend to deny that some of the cases of it do depend upon a torpid, sluggish, or obtuse nature of the bleeding organ, the womb

itself. It must, however, be always a very difficult task to verify such a diagnosis, except by means of experimental prescription.

If, upon scrupulous inquiries as to all the possible causes of the emansio hereinbefore described or alluded to, the Student should be left to the reasonable and indeed only remaining conclusion, that the fault rests with such a torpid and insensible uterus, then he might well attempt to excite within it a more active, vigorous life, by means of the stimulating articles that are called emmenagogues. Let him provoke a frequent, moderate tenesmus, by means of aloetics and gum-resins of various kinds; let him stimulate the nerves of the pelvic region, both internal and external, by baths, fomentations, cataplasms, embrocations, sinapisms, dry cupping or blisters, used as the endermic part of the treatment, while, at the same time, he stimulates the internal nerves of the pelvic region with Dewees's vol. tinct. of guaiacum, compound tinct. of aloes and canella, elixir proprietatis, Lady Webster's pills, tincture of black hellebore, tinct. of cantharides, etc. etc. Forasmuch as all the above-named medicines and means do tend to increase the vital activity of parts about the pelvis, a reasonable probability exists that they may usefully coincide with general constitutional measures in arousing the dormant sensibilities of the womb, and placing them in just relation to the powers of the ovary in its acts of ovulation.

In my opinion, though the causes now enumerated are not rarely to be regarded as lying at the foundation of amenorrhœal affections, most of the examples are dependent, not on the womb, but upon a lessening or cessation of the force by which ovarian vesicles are evolved and matured. Patients suffering with chronical maladies, attended with protracted amenorrhoea, exhibit, in the ovarian stroma, no vestiges of the Graafian vesicles. I lately examined the ovaria of a girl who died after some eighteen months of severe chronical ailments, during which she did not menstruate. Those ailments had no primary connection at all with any state of the reproductive organs, yet, upon carefully examining the ovarian stroma of both the ovaries, it was found to be a compact, whitish tissue, very similar to that which we observe in women long past the change of life. No trace of the ovarian vesicle existed in either of them. It is generally so.

It was clear from the dissection that this lady could not possibly have menstruated, if the doctrine be true; and further, that, in case her health could have been restored as to her chronic malady, many days, weeks, or months must have elapsed before the ovarian stroma could have developed the vesicles, or matured and discharged them, so as to give rise to the sanguineous sign of the mensual act. It is useless to

ask, in this place, what powers are possessed by the menago speedily to restore the discharge in such cases of amenorrhoea.

Having in the earlier part of this chapter expressed the opini that most of the cases of emansio ought to be regarded as results of real hydræmia, or watery state of the blood, I feel disposed, before close the subject, to lay before the Student some further views, ar especially certain opinions on that subject, that appear to me likely t throw light upon his path in the study of those strange disorders, an I therefore proceed by calling his attention first to a few simple propo sitions.

I beg him to weigh them, and judge whether they appear to him to be consistent with truth, or with a high degree of probability as to the truth, which it should be the object of all men to know.

These opinions, that I am now to utter again in this place, have not been favorably received in certain quarters, though in others they have made such impressions as I expected them to make. But, whether accepted or not, all that I desire in regard to them is that they may be received and spread abroad if they be true, while I hope they may be utterly confuted and rejected if they be untrue. Truth belongs to no man. Truth is God's; he is the sole source and fountain of truth. Any man who boasts, saying this is my truth, this is my fact, is a fool and a braggart; since the utmost that man can do is to perceive and recognize truths which, themselves, are mere procla mations or acknowledgments of God's law and will as to physical and psychical things.

The first proposition that I shall here offer to the Student is this, videlicet:

The living body consists of fluids and solids-which might be otherwised expressed by saying that it consists of the tissues and the blood.

The blood contains all the materials out of which the tissues are to be constructed; so that it is true to say, with a celebrated physiologist, the blood is the fluid body, the body is the solidified or concreted blood.

The body is separated from the blood by a membrane or tissue which serves as its outward boundary, and prevents the blood from mixing with the whole mass of the tissues. So that, while the blood permeates all the tissues, it is confined within certain strict channels of the bloodvessels.

This delimitary membrane is generally known as the membrana vasorum communis, or common membrane of the vessels, and is the inner lining of all the arteries, veins, and sinuses of the living body.

might be regarded as a multilocular cyst or sac-the several arteries, eins, or capillaries representing each a separate loculus or cell of the general sac. This sac is the only living tissue with which the blood ver comes in contact.

As long as the blood remains in contact with, or in normal relation to this sac, it retains its health, its vigor, and crasis; because, as the blood exists only by its connection with and through its dependence upon the nervous mass, this membrane is the organ of induction into it of the nervous force, or life-force.

It is certain that, whenever the connection betwixt the blood and the living solids is destroyed, the blood perishes.

Whether we regard the blood-disks as cells or not, we cannot deny that they are living entities; but their life is rather epizootic than selfsubstantial, there being but one circumstance in which they can maintain their existence, and that is the one above mentioned, to wit: they cannot exist save in the presence of the membrana communis, since through that organ they receive their inducted life.

If that organ of induction be perfect, the corpuscles may become perfect: if the organ become imperfect, or if it lose its vitality, they fail or they die along with it.

From the foregoing, I deduce that the membrana communis is charged with the faculty, not only of restraining the course of the blood in the bounds of circulation, but that it contains within itself the power to make the blood, and is indeed the blood-membrane.

If it may be healthfully constituted; if it may enjoy in perfection its crasis and its powers; then it may also, under certain circumstances, be subject to modifications of both crasis and power that shall affect the state of the blood-corpuscles, and render them unhealthy, or imperfect; for, inasmuch as the membrana communis is occasionally affected with inflammation, with weakness, with contusions, wounds, and other disorders, and as it is capable of those vital processes that are called adhesions, inflammation, suppuration, etc., it is impossible to deny not only that it may be strong or weak, or healthy or unhealthy, according to circumstances, but that the crasis of the blood must depend upon the state of the blood-membrane.

I have been condemned for using in my writings a word which I derived from the illustrious Professor Burdach, who ought, it should seem, to be held sufficient authority for the introduction of a word into our medical terminology. The very persons who have railed at me for using Burdach's word have no hesitation daily to employ a similar one. Such, for example, as the words endo-cardium and endo-carditis, from