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fective vision should be examined, before beginning school life, by a competent oculist (not an optician), in order that they may not suffer damage from eye strain (refer to p. 35). The offspring of the nervous and tuberculous need to be reared so as to strengthen their general resistance against disease by an outdoor life, good food, exercise, and proper mode of existence, with freedom from worry, nervous strain, and dissipation or excesses of any kind.

With the assistance of the advice of an intelligent physician it will usually be found that children may be so reared that the weak points or predispositions likely to be inherited by them from their parents can be in large measure combated by proper environment, training, and education. The subject of heredity is a vast, intricate, and little-understood matter, and we have herein merely touched on some of its more salient features. The view taken by those most conversant with the study is, however, much more hopeful than formerly, as regards the inevitable, or even probable, transmission of taints, predispositions, weaknesses, or disease to the offspring when these can receive intelligent care.

CHAPTER II

Menstruation

Causes and Symptoms-Age of Puberty-Change of Life-Dysmenorrhea-Amenorrhea-Cessation or Scanty Menstruation

-Excessive Hemorrhage-Leucorrhea.

MENSTRUATION is the term used for the flow of fluid from the private parts of women, occurring every twenty-eight days during the period of their sexual activity, from puberty to the "change of life." Several causes have been assigned for the appearance of this flow, such as Nature's effort to rid the body of alleged noxious humors, or the relief of a supposed full-blooded condition, or congestion of the uterus following activity of the ovaries, or a shedding of the mucous membrane lining the uterus, which had been prepared for a pregnancy that did not occur. All these explanations are open to argument, and the fact is, that it is not known why menstruation occurs. It is known only that a nerve influence, starting in the sympathetic nerve system in the pelvis, causes stimulation of the maternal organs periodically. It is probable that the flow would not appear at all, were it not for the erect position of human beings.

The accepted term for menstruation is "being

unwell" or "indisposed." Race and climate influence the approach of puberty, or the time of life when sexual activity begins in the young woman. At this epoch there are several bodily changes in the girl. Her bust becomes larger, her hips become broader, she puts on more fatty tissue, and hair grows rapidly in the armpits and at the lower part of the abdomen. Her manner becomes more reserved, and in all respects she shows the advance of maturity, including more care of her personal appearance as well as a more serious view of life. The approach of the menses, or flow, is accompanied by trifling discomfort, headache, slight irritability, a feeling of weight about the loins, and a little restlessness, if, indeed, there is any premonition at all. There is no more discomfort than that just described, unless some uterine displacement or disease exists. Mothers should calmly instruct daughters concerning the menses, so that they may not be alarmed when it is first seen, and needlessly worry about a natural condition. Among Germans and Anglo-Saxons, puberty, with the first menstruation, usually occurs in the fifteenth year; Hungarians about the same age; Slavs a year younger; Hungarian Jews at thirteen; Laplanders and dwellers in arctic climates at eighteen; while the girls in Egypt and Sierra Leone menstruate at the age of ten years. The social condition influences the function; for girls reared in the city, with more association with the opposite sex, and more sexual temptation, menstruate earlier than girls reared in the

greater seclusion of country localities. There are also strong family traits which influence the function. The women in certain families are all precocious in menstruating, as are women of very strong sexual passion.

In women in whom the function is established, there may be, at each period, swelling of the breasts, with sometimes a production of a little milk; the thyroid gland may enlarge as well as the tonsils, with the result that the voice is altered, and singing is impossible during the period; the heart may beat faster; the temperature may be elevated a half degree; the skin may be unusually rosy, and there may be brown discoloration here and there, especially under the eyes in brunettes. The discharged fluid consists of blood principally, with some mucus. It should be dark red, and should not clot. The flow lasts from three to seven days, and in most women a slight mucus discharge follows for a day or two. With an ordinary period, the woman wears three napkins a day; if more are needed, or it be necessary to wear them double, the flow is excessive. At the forty-fifth year, in most women, the "change of life" occurs; the menstruation ceases, and the period of possible childbearing is at an end. This change is reached after an irregularity in the recurrence of menstruation, covering from six to twelve months. There is some discomfort during this period of irregularity, but it is not to be dreaded or feared.

If the menstruation began after the age of fifteen,

it will probably cease at forty-five. While if it began earlier, it will probably persist till nearly fifty. Menstruation has been seen in an infant of two years, as well as in an aged woman of eighty years.

While the rule is to menstruate once in twentyeight days, some women have an interval of only twenty-one days, while others are unwell at the end of every thirty days. When a woman conceives, that is, becomes pregnant, or "in the family way," menstruation ceases, and does not return till after the child has been born. It usually reappears after the mother ceases to nurse the child. When the maternal organs have been removed by surgical operation the woman is never unwell again, and the changes that would naturally come at the change of life, appear speedily.

CHANGE OF LIFE; THE MENOPAUSE, OR CLIMACTERIC.-As has been said, this period is reached between forty-five and fifty years, and some nervous disturbance is commonly experienced. Hot flashes, shortness of breath on exertion, slight faint feelings, restlessness, irritability of temper, dread or depression, especially in the morning, digestive disturbances with loss of appetite, constipation or diarrhea, may all occur, and interfere with the enjoyment of life. After the flow has finally disappeared, following an irregularity of several months, there may be a mucous discharge, at intervals. If profuse flow occurs at this time, there is some uterine disorder present which demands the attention of a surgeon. Commonly,

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