is arrested; but should the catamenia be checked, there will be an increase in the evolution of carbonic acid until they are restored.

We perceive, then, the important connection between the uterine functions and the organs of respiration, and also that if there exist any of those circumstances which have just been enumerated as preventing the development of the latter, an irregularity in the former must tend greatly to aggravate the ill effects which may be anticipated. And that such is the case is confirmed by experience, cases having occurred in which, from early rheumatism and carditis, there had been narrowing of the mitral valve, menstruation became established, and the pulmonic obstruction was relieved, and the patient has gone on in tolerable health till the age when that function might be expected to cease, and then the dyspnoea, engorgement of heart and liver, and subsequent dropsy, quickly followed.

Independently, however, of structural lesion, there appears in the female to be sometimes a want of power in the system to establish the catamenial function; in other cases, again, it is arrested when so established.

Hence we have two varieties of amenorrhoea, which are termed in the former case emansio mensium, and in the latter suppressio mensium; but there is besides another distinction of equal or even greater practical importance, and that is between amenorrhoea with anæmia, and amenorrhoea in a plethoric subject. The former is termed amenorrhoea with chlorosis, and the latter simple amenorrhoea.

Amenorrhoea with chlorosis, when appearing in the form of emansio mensium, is characterised by delayed development of the mammæ and general anæmia; with suppressio mensium there may be full development.

Amenorrhoea with chlorosis, then, is associated with anæmia, and is probably its effect; the feeble powers of the system, as evinced by the deficiency of red corpuscles not being adequate to the supply of blood for the purpose. These cases are characterised by the white lips and white cheeks, with sometimes a sallow, greenish hue, thè pearly conjunctivæ, the dark areola round the eyes. There are commonly dyspnoea and palpitation; there is an anæmic murmur in the ascending aorta, plainest, according to Dr. Hughes, where that vessel overlies the pulmonic artery. There is general weakness and inability for exertion, and the legs and feet are commonly oedematous towards night; the nervous system is highly susceptible, and such patients are morbidly timid, and often hysterical. As an additional cause of weakness, there is often leucorrhoea.

This form of amenorrhoea is most common in towns, and is no doubt much favoured by the want of pure air and sunshine.

It must obviously be unreasonable to attempt to relieve such cases by any measures calculated directly to induce or restore the uterine functions, since their non-performance is often a conservative precaution on the part of nature, to save the power of the system. Iron, indeed, has the reputation of being emmenagogue; but it is because it is tonic, and promotes the formation of red corpuscles, and the strength and material being given, the function is performed. The

iron may be exhibited in the form either of ammonio-citrate or ammonio-tartrate, or the compound iron mixture of the Pharmacopoeia. The two former are the least offensive, and are not so apt to induce head-ache. They may be given in solution, and as the bowels are generally costive, some aperient pill should be given every night or every alternate night. For the latter reason an excellent form is the combination of the iron mixture with the compound decoction of aloes. Where there is much leucorrhoea, the solution of alum and zinc should be used as an injection per vaginam.

In the cases of amenorrhoea without chlorosis, the cause of the nonperformance of the function is probably dependent upon congestion. The subjects are generally florid, stout, full-bosomed girls, who, nevertheless, have often a feeble circulation. Exercise, free purging, the application of a few leeches to the groins or to the inside of the thighs, when the period comes round, are the best remedies. Many practitioners have faith in the madder and hellebore as emmenagogues. Hysteria is another affection closely connected with uterine derange ment in females, it is from thence that it derives its name. To describe its various phases, would exceed our limits; there is no disease which it may not simulate, but it should be remembered that there is none which it may not mask. The well-known hysteric fits are perhaps the effect of excessive polarity of the spinal cord, that of the brain being diminished; such a state of things is more apt to exist in the female than the male, especially if there be a tendency to chlorosis; and when we consider the vast supply of nerves distributed to the uterus, we cannot be surprised at the ready excitement of spasm or convulsion from irritation of that organ. Another remarkable phenomena in hysteria is a strange perversion of the moral feelings, evincing its presence in fondness for simulation. Thus delicate females will not only feign disease of the bladder, rectum, or uterus, but even some which may subject them to painful operations. Sometimes, again, there is a species of delirium, of which one of the most remarkable characteristics is that young females, often young ladies, will use obscene expressions, and sometimes sing songs with which we could hardly believe that they were acquainted.

In the management of hysteria we must look first to the natural functions, and especially those of the bowels and the uterus, and there are few better remedies during the paroxysm, than cold effusion.

In the intervals of the paroxysms, the valerianate of zinc, in doses commencing at about a grain, and gradually increased, will often have the effect of preventing them.

In the hysteric mania the combination of camphor and henbane, and the occasional use of assofoetida injections, will be very serviceable. After the maniacal excitement has subsided, the valerianate, or sulphate of zinc may be employed; but more important than these are moderate exercise for the body, and rational employment for the mind. We have already hinted that in several spasmodic diseases the automatic functions are in undue action, whilst the voluntary power is in abeyance; and this is the case in hysteria; but beyond this, there is an increase in the emotional susceptibilities, and dimi

To subdue the former,

nution in the controlling power of the reason. and strengthen the latter, should therefore be a leading object. For this reason, moderate intellectual exercise is to be encouraged; but the stimulus of much that is termed light literature is to be discountenanced. Rational society is to be sought, but dissipation shunned. Religion, in its truest sense, is as healthful, as sentimental religionism is pernicious.

its diagnosis and treatment, 457, Cancer of stomach, 320.

effects of retained secretion on, 34. Circulation, derangements of, 36.