the purpose of determining whether there is any obstruction to the escape of blood. This is very unusual; when girls pass the age of menstruation, and show no signs of entering this phase of life, it is because they are poorly developed sexually, through deficiency of blood.

Entire absence of any symptoms of menstruation extending into adult life may indicate an absence of sexual organs-a most rare occurrence. The cccasional absence of flowing at the expected periods, during the first year of menstruation, is natural; but after the function has become once established, it may cease owing to many causes.

Any disorder or circumstance which so reduces the general health as to impoverish the blood and weaken the nervous system will lead to stopping of the monthly periods. Among these are overwork, overstudy, insufficient food and exercise, exposure to cold, sitting on stone steps or cold ground, or wearing damp clothes, or bathing in cold water at the beginning of menstruation. So at this time will powerful emotions, as great fright, anger, or anxiety produce cessation of the usual periods. An overfat condition or obesity tends to end in early suppression of menstruation, so that, unless it be overcome, a fruitless marriage may result. Displacements of the womb and local disorders occasionally give rise to scanty or delayed menstruation. Anxiety lest pregnancy may occur, in the newly married especially, or in the woman who has immorally exposed herself

to the possibility of pregnancy, may also cause a delay in the monthly flow. Conversely, a strong desire of the young wife to bear children may also occasion a stoppage of menstruation, which may be accompanied by a flatulent distention of the bowels simulating pregnancy, giving rise to what is known as "phantom tumor."

Many diseases which greatly lower the general health produce a suppression of the monthly periods, such as Bright's disease, heart disease, and tuberculosis. The last does not generally lead to stoppage of menstruation till late in the disease, and there is no basis for the popular belief that a cessation of menstruation is a cause of tuberculosis. Pregnancy is the most frequent cause for the arrest of menstruation. Among the signs and symptoms of pregnancy, besides the stoppage of the periodic flowing, are nausea and vomiting, more commonly in the morning. This differs from the vomiting of indigestion in that the patient often feels hungry as soon as the vomiting stops, the appetite being good at other times, and no pain in the stomach or other symptoms of indigestion.

Enlargement and slight tenderness in the breasts is common; a darkened area about the nipples appears and increases in size, and the veins on the breasts become visible. Slight puffiness of the skin about the nipples is particularly suggestive of pregnancy. Movements of the child are first felt by the mother from the latter end of the fourth month of pregnancy (on an

average, at the twenty-second week), but are frequently imagined. A radical change of climate and circumstances may stop the monthly flow for several periods, and often occurs in women immigrants who come to this country from Europe.

Treatment.-Absence of menstruation in young girls who are pale and listless, thin and poorly developed, should be considered as merely one of the symptoms of their debilitated condition. This state demands treatment, and the menstruation will appear in due time, and it need cause no anxiety if the general health is improving. Such girls should be taken away from school or relieved of the demands of society, and be sent into the country, or be made to live an outdoor life, to have ten hours daily sleep, to take nourishing, simple food, and not worry about the nonappearance of menstruation. The taking of some emulsion of codliver oil in cold weather, or iron at any time—if there is pallor in the form of Blaud's pill, three times a day for six weeks or so, is beneficial.

CESSATION OF MENSTRUATION.-Later in life, before the menopause, after menstruation has been well established and regular, its cessation is commonly due to debility with anæmia. We see the following picture, with some variations: there are paleness, loss of appetite, dyspepsia, constipation, flatulence, palpitation or fluttering of the heart, cold hands and feet, colorless or pale yellow discharge from the front passage, and a feeling of weight in the lower part of the

abdomen. This condition is common in overworked and underfed young women, and in others as well. The treatment consists in the taking of a “modified Blaud's pill," three times daily for several months, stopping the pill for a week at the end of each month; in the keeping of early hours, with plenty of sleep and outdoor exercise; in a nourishing, simple diet, avoiding sweets, cakes, pies, fried food, tea and coffee, and fresh hot bread, and in correcting constipation (p. 505) and in relieving the leucorrhoea (p. 358).

SUDDEN ARREST OF MENSTRUATION. If the monthly flow has begun, and is suddenly checked by fright, exposure to cold, etc., there may be a chill, fever, headache, backache, bearing down pains in the lower part of the abdomen, and pains in the legs, together with frequent urination. The patient should take a hot sitz bath or full bath for twenty minutes; she should take a teaspoonful of Hayden's Viburnum Compound in a wineglass of water every two or three hours, and go to bed. If the pain continues and a physician is not available, a suppository containing one-quarter grain of belladonna extract should be introduced into the rectum. The regular periods may be suppressed for several months following such an attack.

SCANTY OR DELAYED MENSTRUATION. -When the monthly flow is scanty, or delayed in appearing, there are often symptoms like pain low down in the abdomen, thighs, and legs; backache, pain and fullness in the top and front of the head, and cold

hands and feet. All the symptoms which generally indicate that menstruation is coming on are present, and yet no flow; and this condition may last for days, or even a week or more, before it occurs. Or, in other cases the flow is very scanty and affords but little relief. In these cases it is best for married women to take douches, as hot as the elbow can bear, of six quarts of water, lying flat on the back with the hips raised on a douche pan, and using a fountain syringe. These should be taken night and morning every day between the periods, and stopped when flowing occurs. Young girls should not take them. The general health must be improved in every way possible, as suggested in the previous section, and if relief is not speedily obtained recourse should be had to a competent physician.

Delayed menstruation in women who are conscious of the possibility of pregnancy should receive no treatment. If the condition is actually one of pregnancy, there is no drug or other means known to the medical profession by which it is possible for a woman to bring on a miscarriage without greatly endangering her life, apart from the great immorality and crime of the proceeding. The same difficulty of causing a harmless abortion, the same danger to the patient's life, and the same degree of crime obtain if the patient is but a week pregnant. Persons who perform abortions are usually as incompetent as they are criminal, and blood poisoning and death of the patient are not infrequent results. The very secrecy required is of itself sufficient to pre