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,

women endure nervous disturbance from removable causes for years, erroneously thinking they are still undergoing" change of life," and silently suffer, often unnecessarily. A physician should be consulted. Ordinarily, women soon recover their poise and enjoy life, putting on more flesh, and becoming less sensitive, and somewhat less active.

Treatment. During change of life a woman should be protected from worry, heavy responsibility, and overfatigue. Her digestive organs should be kept in order, the diet being plain and not abundant, while tea and coffee should be reduced to a minimum. Crowded or ill-ventilated rooms should be avoided. Few drugs are needed, if the suggestions given are followed. General nervousness, with sleeplessness, will be controlled by five-grain pills of asafetida, one taken after each meal and at bedtime. Laxatives at bedtime, and the compound sirup of the hypophosphites, a teaspoonful in water before each meal, will assist digestion. It is a bad habit to take stimulants or sedative drugs as a routine matter at this time of life.

PAINFUL MENSTRUATION; DYSMENORRHEA. As a result of the unnatural conditions of civilization, the majority of women suffer some local discomfort, if not actual pain, at each menstrual period, though usually without interference with the pursuits of their daily life. Absolutely painful menstruation that needs treatment is caused by gout or rheumatism, neuralgia, congestion of the maternal organs, or ob

struction, unless due to arrested development of or deformity of the sexual organs. Neuralgia as a cause operates in those who suffer from hysteria, malaria, syphilis, poverty of the blood, excessive amount of blood, or neurasthenia. It may also be the cause in those who live lives of excitement, if not of actual dissipation, or who are devitalized by mental or physical overwork, by masturbation, or by excessive sexual indulgence. Congestion and resulting inflammation are frequently a cause of dysmenorrhea, as a result of childbearing or frequent sexual intercourse, and also as a result of disorders of the pelvic organs and viscera.

Obstruction may result from displacement of the uterus or the existence of a narrow passage through which the flow escapes, retention of the fluid permitting clotting, and clots being painful to discharge.

Symptoms. The symptoms are pain below the pit of the stomach and above the pubic bone, in the loins and back, and possibly shooting down the thighs. Rarely the breasts are tender. The pain may be dull and constant, or intermittent, sharp, and piercing; and there may be a dragging, heavy feeling about the waist and abdomen. The general health may suffer, and there may be nervous symptoms, due to the severe pain and also to preexisting nerve disorders. Nausea and vomiting may accompany the pain, if severe, and derangement of the digestion may be added, to continue after the flow has ceased and the attack is over. Rarely