1286 T 58 1871 PREFACE. THERE are many milestones on the road that leads from the cradle to the grave-seven, fourteen, and twenty-one are clearly written on the first; forty-two, forty-nine, and sixty-three are distinctly visible, though less deeply cut, on those that mark the last part of the journey. These dates point to periods of the human life characterized by very important changes, many of which give a peculiar aspect to the physiology of the human being, and impart a family likeness to the diseases of epochs justly deemed critical. No division of labor is so praiseworthy as the study of these great periods of human life; and if many of those who fritter away their meritorious energy in writing monographs would devote it to thoroughly investigate the physiology and diseases of the great periods on which nature has put a special stamp, they would very much increase their fame and greatly contribute to the progress of medicine. When the last census was taken in 1861, 1,177,535 of our fellow-countrywomen of the age of forty-five and under fiftyfive were living in Great Britain and Ireland, and I can scarcely exaggerate the importance of a work which tells their history, records the probabilities and the inevitabilities of their fu ture, and investigates the many diseases by which it may be chequered. This volume professes to do so, and it is founded on the tabulated estimates of the symptoms and of the diseases of five hundred women who were at the change of life, or who had passed the ménopause. In this new edition I have kept to the original plan, giving a paramount importance to physiology, without which, the diseases of any critical period cannot possibly be understood. Although I have retained the statistical information on which the work was based, I have drawn largely on my experience among the upper classes of society during the last thirteen years, so as to rectify any pathological one-sidededness that may have arisen from the statistics having been principally derived from dispensary practice; and I trust I may be permitted to state that, partly because the importance of the subject was recognized by the profession, but chiefly because my work was the only one on the subject in the English language, I have been consulted by a very considerable number of women suffering from diseases of the change of life, since the publication of the second edition thirteen years ago. To review the labor of rewriting this book is to comment on some of the events of the last few years; thus I have gathered valuable materials for my physiological study of the change of life from the contributions to the International Medical Congress that was held in Paris. The chapter on the Diseases of the Reproductive Organs has been greatly increased, for I have lost no opportunity of taking careful note of whatever might illustrate this part of the subject, and the reader will there find information he will seek for in vain elsewhere; at least, Dr. Barnes said so of a sketch of the chapter that I read before the Newcastle Meeting of the British Medical Association in 1870. A reviewer of the second edition, in the Archives Générales de Médecine, stated that, although the chapter on diseases of the brain extended to a great length, it was not long enough to do justice to the subject. This is an answer to those who may complain that the chapter is too long. In the preface of the second edition, I mentioned that "the present century has witnessed magnificent discoveries in the pathology of the brain and of the spinal cord; but it will be obvious to those conversant with medical literature that the pathology of the ganglionic nervous system has received comparatively little attention, neither can it be much advanced until experimental physiologists have accurately investigated many points connected with the physiology of the ganglia and their nerves. My object has been to prepare the ground for other laborers, by throwing on an intricate subject all the light I could collect. I have, moreover, attempted to trace the boundary-line between cerebral and ganglionic affections, now considered entirely dependent upon cerebro-spinal disturbance, largely illustrating the varied relations in which cerebral disorders stand to ganglionic diseases." Since then, Claude Bernard discovered that congestion, heat, and redness of sur rounding tissues resulted from the section of the cervical ganglionic nerves; and Brown-Séquard has made us understand that this was caused by paralysis of the vaso-motor nerves, thus giving us the key for the right comprehension of the pathology of the ganglionic nervous system, and enabling pathologists to raise it from the slough of wild or silly hypothesis in which it has slumbered up to the present time. Since the appearance of the last edition, Dr. Beale has published, in the Philosophical Transactions, a remarkable paper on the microscopic anatomy of the ganglia. Dr. Handfield Jones has repeatedly made valuable contributions to our medical journals, in which he has shown how fully one of our best pathologists is alive to the importance of distinguishing the diseases of the ganglionic nervous system from those of the cerebro-spinal nerves. Dr. Edward Meryon has recently entered the lists, and promises another valuable paper to the R. M. C. Society's Transactions. Like these esteemed fellowlaborers, my study of diseases of the ganglionic nervous sys tem, has been clinical, but I have moreover attempted to give a general sketch of ganglionic pathology. I have not, however, the presumption to think that I have done otherwise than reason more or less correctly on what is known of this recondite subject, and if those who take interest in diseases of the nervous system will criticize this chapter to the utmost, they will do good service to me as well as to science. So far for the book; and now, as I have come to that time of life when a man is frequently startled by learning that another fellow-laborer has rested from his labor, and has forever done with ambition, I myself wish to state in a few words what has been my object and my course of work. Early in life I was struck by the wise remark of Goethe, that if a man wants to make his mark he must set bounds to his work, beyond the limits of which he must not suffer his steps to stray, and work to the uttermost of his power within those appointed bounds. I took to myself the physiology and the diseases of women as my field of labor,-no limited specialty, I trow! In my Elements of Health and Principles of Female Hygiene I have given the rules by which the health of women might be maintained at each successive period of life; it is a treatise of preventive medicine, for I am more and more convinced that most diseases of women are preventible, and that their frequent occurrence depends on the lamentable ignorance in which young women are brought up concerning all that relates to those very functions by which they are constituted women. The physiology of puberty and its diseases were treated of at considerable length in the work last mentioned, and it forms the subject of the first half of my work on Uterine and Ovarian Inflammation, and on the Physiology and Diseases of Menstruation," in which I endeavored to show that the best way to commence the study of, and to rightly understand the |