during that time, and how quickly they disappear when menstruation has become regular. Baron Alibert relates having observed some cutaneous eruptions to appear twice only in life-once before first menstruation, and once at its cessation, and I have twice seen these epochs preceded by an abundant eruption of boils.

CASE 31.-M. B., aged fifty, first menstruated between her eighteenth and nineteenth years with little previous disturbance, and continued regular until twenty years of age, when she married. She has had nine children, the last when forty-four years of age. At forty-eight she had several floodings, but without much increase of pains in the head. The catamenia ceased at forty-nine; this was followed by no disturbance of health, except by a severe attack of nettlerash, three months after, on the chest and body, which disappeared on the proper medicines being administered; twice, however, it has occurred at irregular periods, and on the 28th of March she applied for relief, at the Farringdon Dispensary, for a fourth well-marked attack of the disease, on the lower part of the body and thighs. As this patient had never before had the slightest rash, and as this nettlerash has appeared four times in the year which followed cessation, I may believe it to have been caused by this crisis, as in the case cited by Tissot, of erysipelas of the face occurring fifteen times during the two first years after cessation, less frequently during the two next years, and only once during the fifth year. These are, however, rare instances, and, generally speaking, cessation takes place without any cutaneous eruption.

THERAPEUTICAL INDICATIONS.

1. To relieve the irritability of the nervous system by the sedative preparations already recommended.

2. To relieve the vascular plethora resulting from the cessation of a periodical flow of blood, by taking from three to four ounces of blood from the arm at successive months. 3. To relieve the skin itself by tepid baths.

4. To direct to the kidneys the saline matters which are otherwise removed by perspiration.

CHAPTER XIII.

VESICAL SYMPTOMS AND URINARY DEPOSITS.

THE close proximity of the womb to the bladder sufficiently explains why the womb, by the morbid performance of its duties and by its various diseased conditions, often causes vesical symptoms; exactly as it still more frequently gives rise to a diseased condition of the rectum. There is sometimes a real transmission of inflammation from the womb to the bladder, and an habitually more frequent secretion of mucus, but generally the vesical distress is of a nervous nature, indicated by the frequent desire to micturate, although the bladder be almost empty, and by the tenesmic character of the pain, as well as by the frequent efficacy of simple means, such as hot fomentations or poultices, and anodynes applied above the pubis. These symptoms almost invariably disappear on the abatement of the uterine disease; sometimes, however, they persist, as in a singularly nervous lady, now under treatment. In this case, frequent desire to micturate, with exquisite pain on passing urine, has continued unabated for seven months. The patient was told by an eminent surgeon, that it was caused by uterine ulceration, but the vesical symptoms were not cured by uterine treatment. Other advice was likewise inefficacious. Beyond habitual congestion and dysmenorrhoea, there was nothing amiss with the womb; the urine, analysed by Dr. Beale, contained bladder epithelium and pus; its specific gravity was 1015, and 1000 grains contained 20 grains of urea, showing that the patient suffers from chronic cystitis. I gave sesquichloride of iron with tincture of hyoscyamus in an infusion of quassia-a combination most suitable to such cases-injections of acetate of lead and laudanum, a strong belladonna ointment to the pubic region, and subsequently I ordered eight leeches to be applied above the bladder. Under this treat

ment the patient very much improved, but had she not done so, I should have applied a solution of nitrate of silver to the urethra and meatus urinarius.

It is scarcely necessary to observe, that distressing urinary symptoms may be caused by irritable tumours of the meatus.

I have repeatedly compared the morbid functions of the ganglionic system with its healthy function-fevers with menstruation. Nature gives its warrant to the comparison, for in both fever and menstruation the critical discharge is frequently met with in the urine. My attention was first drawn to the subject by a patient telling me "that she always knew when she was going to be poorly, by her urine being so very muddy;" and indeed many women state that their water is generally thick and muddy two or three days previous to menstruation. I have found the sediment to be generally composed of phosphates. Dr. Rigby has remarked that the urine of dysmenorrhoeic patients frequently contains lithates, as it does also in cessation cases; but this inquiry could only be carried out in hospital practice, and is certainly worth doing, for who will not admit with Sir H. Holland, that although much light has been thrown on the functions of the kidneys, still the relation of the urine in its quantity and properties to the various changes occurring in other parts of the body still offers singular difficulties to the physiologist? The administration of alkalies, so useful an addition to the treatment of such cases, improves digestion, and by their action on the blood they doubtless neutralize some of its noxious elements. Their utility will be still further understood, if it be admitted, that notwithstanding the use of diuretics, the urine previous to, and at cessation, is often secreted in smaller quantity, and deposits abundantly. I often give liquor potassæ or the bicarbonate of soda, because it is a convenient form of administering it, and not unpalatable. After the first few days, I give it only once a day.

CHAPTER XIV.

If type be important in pathological, is it less so in physiological phenomena ?

ON TYPE IN MENSTRUATION.

THE observation of the type is as important in menstruation as in the pathology of intermittent fever, or any other disease. In making this assertion, I know that I lay myself open to the charge of presumption, in giving so much importance to what is considered of slight moment by physiologists, and by those who have even recently written upon diseases of women. Whether the menstrual crisis returns at the second, third, or fourth week, they consider it to be physiologically of little consequence, whereas I believe, that whenever menstruation. occurs more frequently than once a month, it is the indication of morbid action either in the ovario-uterine organs or in the nervous system. The language of many nations implies that this function should recur every month, and it is well known that it does so in the majority of instances. Thus, if one refers to B. de Boismont's statistics, it will be found that out of a hundred women—

In 6b, the menses occurred monthly;

دو

28, they occurred every three weeks;

10, they occurred at variable periods; and

1, a healthy woman of twenty-three years of age, they occurred regularly every fortnight.

On referring to my notes, I find that in twenty-three per cent. it did not follow the monthly type; in seventeen per cent. the type was three weeks; in five per cent. it was every six weeks; in one per cent. it occurred every fortnight. Having established these exceptional cases, I sought their explanation, and found that, in one-half of the three-weekly cases, the type was explained by ovario-uterine disease of an organic nature, or by chlorosis; and in more than one-half

of the six-weekly cases, the patient's health was habitually bad, owing, in two instances, to uterine disease, which was also the case with the one that assumed the fortnightly type. If it be argued that, in some women, menstruation assumes from the first the three-weekly type, I reply that this only proves that it is morbidly performed from the first, or it would retain the same type through life; whereas I have often found that in such women, after successive fluctuations of type, the menstrual function was performed once in every lunar month after marriage, parturition, or an improvement in the general health. Nature, animate or inanimate, is full of periodically recurring phenomena. The diurnal periodicity of our planetary system is felt by man, for he experiences, by insensible perspiration, a constant periodical loss, which was first discovered by Sanctorius, who established-"That even those who are in a perfect state of health, and observe the utmost moderation in living, once a month increase beyond their usual weight to the quantity of one or two pounds, and at the month's end return again to their usual standard in the same manner as women do; but then by a critical discharge of urine, it being either increased in its quantity, or more turbid."

From a patient investigation of the phenomena of menstruation, I am convinced that women are not free from the changes noticed in the male sex by Sanctorius. Previous to each menstrual flow there is generally an unusual deposit of saline substances in the urine; so that instead of viewing the menstrual function as altogether peculiar to women, it should, on the contrary, be regarded as the extension of a phenomenon common to both sexes. Thus, by an admirable. simplification of means, that which serves in man to prevent disease or an extension beyond the normal size, is made subservient in women to generation; that is, to the extension of the human race in time and space. A further analogy between menstruation and the monthly oscillation in the urinary discharge of man, as observed by Sanctorius, is that, "before the aforesaid crisis happens, there is felt a heaviness in the head, and a lassitude all over the body, which symptoms are afterwards removed." These symptoms are analogous to some of those which precede menstruation.