manageable; that the temperature may be increased or lowered according to the patient's feelings and the practitioner's discrimination; that while the patient is in warm or tepid water, cold applications may be made to the head, and a stream of cold water directed to the abdomen through a vulcanized Indiarubber tube, so as to quell local congestion, it is not surprising that the greatest men have, at various times, vaunted the utility to be derived from baths in nervous affections, and that, lately, they have been revived in France for the treatment of mental diseases. As a general rule, I tell my patients to take a warm bath every week, and to stop in the water for an hour. The prejudice against baths, except as a means of cleanliness, is so great in England that I am afraid of asking patients to do more, but when I wish to obtain the full sedative effects of baths, I direct highly nervous patients to take them, heated to about 93°, and to remain in one, two, or three hours, having warm water added at times, so as to maintain a grateful temperature. A greater sedative effect will be obtained by letting the water gradually cool down to 90°, or even lower, and the amount of water absorbed will be to a certain extent proportionate to the low temperature of the bath.

MINERAL WATERS.-Cold sea-bathing is out of the question at the change of life. I have not advised warm sea-baths, but several patients have tried them without deriving benefit, while others have thought themselves worse for their use. Gardanne states, that the effects of mineral waters are rather disadvantageous than otherwise; but he does not say how or where they are taken, and it stands to reason that if there be truth in what I have just stated respecting the value of sulphur, alkalies, purgatives, and steel, in the treatment of diseases at the change of life, these remedies must be likewise useful when combined in mineral waters to be taken internally or used as baths, the more so as these mineral agents exist in a state of combination with other substances so as to

be inimitable by our chemistry. Besides this important consideration, the total freedom from domestic cares, the complete change of air; food, habits, and scenery, must enhance the value of mineral waters. Sulphurous waters may be good, not only in cutaneous affections, but in many

cases of congestion of the internal organs, and in anomalous ganglionic neuralgia, alkaline waters like Vichy or Ems, cannot be overrated in cases of obstinate biliousness, dyspepsia, vomiting, and gout. The saline waters of Homburg and Kissingen serve in cases of dyspepsia and obstinate constipation. Chalybeate waters, like Schwalbach and Tunbridge Wells, are useful in chronic debility, chlorosis, and in the after part of the treatment of many of the gastro-intestinal affections. Hot sulphurous baths, like those of Aix in Savoy or Harrogate, may be made serviceable in the cure of rheumatic affections, lumbo-abdominal neuralgia, local paralysis, paraplegia, and in most neuralgic affections. To whichever of these watering-places the patient may be told to proceed, she should never begin a course without consulting one of the resident medical men, who will be best able, by local knowledge, to advise her respecting the kind of mineral water to be taken, as well as the best mode of its administration in her case.

Issues. I should not mention these if Dr. F. Churchill had not expressed his agreement with Fothergill, as regards the utility of applying issues and blisters to those who, in early life, have been relieved from cutaneous or other disorders by the establishment of the menstrual flow. He says, "I have repeatedly tried caustic issues, or perpetual blisters, and with the greatest advantage. They certainly aid the action of the remedies already mentioned, and, I think, prevent the recurrence of those irregular congestions which Dr. Fothergill has described." Gardanne and B. de Boismont likewise speak confidently on the utility of issues in preventing disease at the change of life, but I agree with Dr. Ashwell that they are seldom necessary, except when cutaneous eruptions are troublesome, and have been so in youth.

In perusing this work the reader will bear in mind that the 500 women of whom I have traced the varied modes of suffering at the change of life only constitute a minority when compared to those who pass through the change with little or no suffering. Well-regulated hygienic habits are all they require to assist the silent operation of natural laws, and I shall therefore treat of hygiene in the next chapter.

CHAPTER V.

PRINCIPLES OF HYGIENE OF THE CHANGE OF LIFE.

As at puberty, from the total ignorance in which it is still thought right to leave young women, so at the change of life, women often suffer, from ignorance of what is to occur, or from exaggerated notions of the perils that await them. It would be well if they were made to understand that, if in tolerable health, provided they will conform to judicious rules of hygiene, they have only blessings to expect from this critical period. The change of life may be dangerous for those who are always ailing, for habitual sufferers at the menstrual periods, and for those affected with uterine diseases; and according as the sufferings of women were protracted, previous to the healthy establishment of the periodical flow, so may they expect its cessation to be attended by a corresponding period and intensity of suffering. Women should know, that unless they be pregnant or nursing, great irregularities in the monthly appearance, or its prolonged absence, coinciding with sensations of sinking at the pit of the stomach, with flushes and perspirations-even though their age may only be between thirty and forty-may, in general, be considered as warnings of cessation, particularly if they are accompanied by a corresponding amount of pseudo-narcotism. This knowledge would prevent cessation being considered in the light of temporary suppression, and forcing medicines and purgatives being taken without the sanction of medical advice. If, on the first indication of the change of life, women who are in fair health sought advice, carefully followed a regimen, and pursued a line of life in harmony with the physiological processes on which this change depends, I believe that almost all disease would be prevented; but as it is the end

of a natural function, it is thought right to leave it to nature; no additional precautions are taken, and advice is sought for when the mischief is done. It is, then, well worth while to place on record the rules of hygiene best calculated to prevent and to cure the diseases of the change of life, referring these rules to the great functions of the human economy. Hygiene of the Reproductive Organs. I have shown that there is something more or less anomalous and morbid in the reproductive organs and their action on the system during the first half of the change of life, and that in the latter part of this period these organs have a tendency to become atrophied. Can there be a clearer indication that until after the ménopause, their hitherto appropriate stimulus interferes with a natural process? Hence it is unreasonable to marry during this unsettled period. Experience, moreover, teaches me, that even in those who have been long married, connection at the change of life is a cause of uterine disorders, and that these have frequently occurred in women marrying during this epoch. I admit with some physiologists, that, as a flickering flame gives a final blaze, so in some women, sexual desire is strongest when the reproductive power is about to be extinguished: this, however, is not the rule, for I have been repeatedly made aware that a distaste for connection was the first sign of an approaching change. I therefore believe a marked increase of sexual impulse at the change of life to be generally an anomalous if not a morbid impulse, depending upon either neuralgic or inflammatory affections of the genital organs, thus corroborating B. de Boismont's assertion, that "whenever sexual impulse is first felt at the change of life, some morbid ovario-uterine condition will be found to explain it in nineteen out of twenty cases." At all events, I deem it imprudent for women to marry at this epoch without having obtained the sanction of a medical adviser. If this had been done in cases that have come under my observation, flooding would not have followed marriage, slight uterine disease would not have been considerably aggravated, the march of undetected cancer would not have been hastened, and others would not have become insane, as in the following case:

CASE 13.-Mrs. B. was fifty-one when she consulted me; she had been all her life an intelligent, active, and determined woman, eccentric but not nervous; and when about fifty, and during the dodging time, she married. In the wedding night she had severe abdominal pain, and flooded to a great extent during the following days, and then her mind. became affected, with occasional melancholy fits and suicidal tendencies. It was remarkable how her mind was infected with doubt; she could not make up her mind to anything, and was always doubting about right and wrong. When I first saw her she had not slept for a fortnight, and had sensations of burning in the breasts and the lower part of the abdomen, menstruation being irregular, scanty, and darkcolored. I gave morphia internally, ordered a succession of belladonna plasters to the pit of the stomach, effervescing draughts and warm baths. She got very much better in a fortnight, and was well in about six months, menstruation having ceased. This occurred in 1847, and since then there has been no return, notwithstanding the long illnesses and the deaths of her husband and mother.

The following case also shows how women sometimes seek to stay the inexorable hand of time by protracting the regular appearance of the sign of womanhood; but should they succeed in bringing on the flow, it arises from a diseased state of the womb, and can give no hope of progeny.

CASE 14. Some years ago I was consulted by a lady, aged forty-eight, who, when about twenty-five, formed a strong attachment, but family circumstances prevented a union taking place, till fortune smiled upon the parties, and the lady married at forty-five. The discharge had proceeded regularly as to time, quantity and symptoms, up to the period of marriage, but subsequently it never reappeared. As this sudden cessation coincided with gastric symptoms, with a distension of the abdomen, and, above all, with a great anxiety for children, the patient was considered pregnant, and carefully watched for many months. When the illusion was destroyed, the lady became disconsolate; and, punctilious in her notions respecting honor, she brooded over the possibility of her husband supposing that the