true test of its usefulness, and of the time for each sitting. Five to fifteen minutes, gradually lengthening the period with those who are feeble, may be taken as representing the average time. If the patient cannot bear a hip-bath for five minutes, she is not arrived at that stage when it is conducive to health.

Suitable vaginal injections, in cases of displacement, are best administered by means of that compact apparatus known as Dr. Kennedy's syphon douche. A multiplicity of instruments have been devised for the same purpose, and it is rather with respect to general convenience that this may be adopted, since the apparatus described by Aetius (A.D. 380-300) for administration of the vaginal injections was just as efficient as the best modern device. In cases of uterine disorder of place, the douche should be used at night; either with cold water, or some simple vegetable astringent, a tannic acid lotion being one of the best. Unless there be leucorrhoeal vaginal discharge, or some abnormal and relaxed condition of the mucous membrane, the saline astringents, alum, lead, zinc, &c., are counter-indicated. In such cases they only tend to produce vaginal irritation, if the mucous membrane of the tube is healthy. I have seen cases where casts of the whole length of the vaginal tube were thrown off from the use of saline astringents injudiciously employed.

Careful attention to the symptoms which herald and attend the menstrual periods is very necessary in the treatment of all disorders of place; for it is at those times that the natural renovation of uterine structure is

chiefly determined, and the good effects of mechanical restoration of place secured and rendered permanent. In treating of disorders of uterine function and structure, this important influence will come under more immediate consideration.

The method of the medicinal treatment must be arranged in accordance with the particular exigencies of each case. I have already particularly referred to the special value of the hydrochlorate of ammonia, but it may be used in combination either with bichloride of mercury, with sesquichloride of iron, or with the direct alkaline preparations of ammonia, according to the exigencies of individual cases. It is especially important, before thus pursuing a definite course of medicinal treatment, to assure that the digestive organs be in such good order that medicines may be able to exercise their influence. So long as the digestion is disordered, neither food nor physic can duly do their work; and the time spent in setting the stomach to rights, and thus obtaining its valuable co-operation, is certain to be regained, for thereby it is insured that the remedies advised produce the intended therapeutical results. In all chronic cases of Disorder of Uterine Place, the wear of constant pain, the inability to take exercise, the broken sleep, and the deep mental depression, tell upon the digestive powers. In addition to the ordinary symptoms of dyspepsia, there follow those sympathetic headaches which are so intimately connected with functional disorder of some part of the digestive apparatus, either nutritive or eliminative, and are too frequently accredited

to the brain itself. The importance of carrying through the inquiry until the original cause of such Headaches is fully determined has been pointed out in my work on this subject.1

Where there is disturbance of order in the working of any important system we must consider the functions of every organ, whether digestive or eliminative, the conditions of individual life, the history of foregone disease, whether climacteric, local, or hereditary. Each and all of these must be investigated, and their respective influence considered, before the proper course of medicinal treatment can be satisfactorily determined; and this method of research is especially important before determining to adopt any mode of local treatment of disorders of uterine place.

1 Headaches, their Causes and their Cure. 4th edition.

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CHAPTER III.

DISORDERS OF FUNCTION.

THE Conditions of healthy pregnancy and natural parturition represent the completed physiological duties of the organs which compose the female generative cycle; the thorough carrying out of that ordained purpose in view of which the correlative endowments of all these organs were arranged. But the functional life of the uterus and its associated organs comprises a very important series of changes, which commonly precede and mark the aptitude for impregnation. Menstruation is the most important of these; the catamenial flux being apparently a subsidiary process in the female economy, established as a means of keeping in repair the organs charged with the duty of continuing the species.

A reasonable explanation of the phenomena and purpose of menstruation has only been practically possible since physio_ logical research demonstrated the changes that take place and the order of their succession. Wanting such precise knowledge, ancient authors fell into evil ways of theorizing; dwelling only on those facts which were best adapted to nourish their particular notions. The menstrual flux in a healthy adult, such as the law recognises by the term "femme sole," occupies

H

about the tenth part of her whole life. A condition so peculiar could not fail to attract attention very early in the history of the race. The first direct reference to the subject (Leviticus, ch. xv. v. 19 et seq.) indicates much foregone observation. It had long previously been recognised that at the time of the œstrum, or rut, in animals there was great susceptibility to impregnation (Genesis, ch. xxx.), yet experience taught the lawgiver that in the human female the rule which obtains in animals must be abrogated. And it was probably as a result of the severe injunctions so plainly put in Leviticus (ch. xx. v. 18) that there gradually arose the many curious fancies in reference to the menstrual flux which Pliny1 notices as received matters of faith in his age, and of which the relics yet survive in the folk-lore of our own time. For in many districts of England it is still believed that a menstruating woman cannot salt meat, make the butter come in the churn, &c. These are but fables, derived originally from Pliny, and disseminated throughout this country in the earliest times of monastic rule. Indeed, one of the most learned of these clerical instructors improved the occasion to enforce a lesson of humility. In his work, "De Naturis Rerum,” (circa 1200) Alexander Neckam wrote:

"Nutritur etiam humilitas in homine, si attendat se natum de muliere, quæ sola animal menstruale est, cujus profluvia inter monstrifica merito numerantur. Contactæ his fruges non germinabunt, amittent arbores fœtus, ferrum rubigo corripiet,

1 Nat. History, lib. 7, § 13.