which I have passed over in silence, because I have wished to avoid expressing an opinion upon subjects, on which I have had no practical or clinical knowledge. Others I have postponed to a future page, in order that I might not be compelled, on the one hand, to anticipate, nor, on the other, to separate subjects that have a sort of natural alliance. For example, ruptures or lacerations of the womb and vagina, it appeared to me, might better be arranged under the head of those diseases and accidents of pregnancy of which it is my intention to treat. It will be my duty to say much upon the subject of the menstrua, an important item in the history of the female, and one whose modifications and disorders exert a mighty influence on her health and happiness. In order to approach this subject properly, I ought to make remarks on that important and interesting crisis, which is called puberty in the female, and, therefore, my next letter shall be on the subject of puberty, or the puberic age. C. D. M.

LETTER XXVII.

GENTLEMEN:-I know not whether I shall in this letter succeed in setting forth with clearness, the views I have long entertained, or rather those which I have supposed myself to entertain on the subject of puberty in girls; I fear I shall not. A man may think he has clear views on points in physiology, or in general philosophy, and particularly in any metaphysical contemplation, while, in fact, his notions are not clear, but confused, indefinite, dim, and not readily explainable in words. In such a state of his mind, a man will be found unable to set forth a lucidus ordo of thoughts, for there is no such characteristic order in his opinions on the special topic; and if a writer doth in this way fail, you have fair inference that he fails to be distinct and clear and coherent in his exposition because he is himself indistinct, confused, and incoherent in his appreciation of the subject in discussion.

If you had happened to be eye witnesses of a certain historical event, you would, doubtless, expect to be able to relate all the

successive incidents thereof in a regular order, as they occurred; but should you not be able to do so, it would be because you had observed badly, and kept no memorials or records worthy to be depended upon; in fact you would not know or understand the events of which you had been eye witnesses, and which you supposed yourself to understand and remember perfectly well. We see constant examples of this uncertainty and imprecision of knowledge in testimony daily given to our courts and juries by witnesses called in the case. The truth is elicited only by cross

examination.

Now, when in this letter I come to speak to you on the subject of puberty in girls, I consider myself as having been an eye witness in the cases to be taken up, as to the events and circumstances that attend upon the puberic age; for, the major part of a long professional life has been past amidst such scenes and histories. During many years, I have frequently been charged with the conduct of the health of young females entering upon, passing through, or already gone beyond the puberic age; yet, notwithstanding I have witnessed so many cases requiring medical interposition, I confess that to write you a letter on the subject of puberty appears to me a most difficult task. Certainly it is one I should prefer to avoid, both because of the doubts existing in my own mind as to the peculiar nature of the puberic affections, and of the jejune and little practical notions upon it that I find in the authorities, which I take to be a proof of the difficult nature of the subject. I must pray you, therefore, beforehand, to scan very closely the sentiments that I shall express in this letter, and if you find them to coincide with what is true, or probably true, to adopt and apply them; whereas, if they should prove to be hypothetical and unfounded in truth, you ought to reject and condemn. them. I desire only that they should be useful, not merely that they should be acceptable.

The writing a letter upon puberty would not be a difficult undertaking, were one to confine himself to pointing out in the usual manner the period and general phenomena of the change from the girlish to the womanly estate. Nothing is easier than to say that at the age of fourteen or fifteen years the pelvis becomes expanded and consolidated, that the internal and external genitalia and the lactiferous apparatus become completed, &c. &c. But such statements, that are to be found in all the books

on these matters, serve to throw but very little light on the abstruse subject of puberic disorders.

I shall endeavor, then, to relate to you what are the opinions I entertain on the subject, and point out to you the indications of treatment for those young people, who approach dangerously and pass with risk through the great and important crisis of the puberic age. What is meant by the word puberty?

Stephens, in his Thesaurus, says: "Pubertas. Aetas in maribus qui est annus xiv., in foeminis xii. Pubertas plena xviii. annus est. Pubertas est emissio pubis, a qua anni pubertatis dicti sunt. Pubertas, generandi vis.

Dr. Noah Webster, in his Dictionary, says, "Puberty. The age at which persons are capable of procreating and bearing children. This age is different in different climates; but is with us considered to be at fourteen years in the males, and twelve in females."

You see that Stephanus and Webster, I shall not take the trouble to examine any others, agree that puberty in females is the age of reproductive power just begun, and that that power is acquired at twelve years of age; Stephanus says, plena at eighteen ; but you, even as young students of medicine, know that neither of these Dictionaries speaks truly, for the reproductive power is not attained at twelve years in the average of cases, nor does the average come at all near to twelve years-it is beyond fourteen years in this country. The first true and veritable eruption of the menses may be taken as the evidence of the girl having reached her puberic age, for that eruption is the evidence of germ evolution in the ovary, and even of the ovi-posit. This occurs between fourteen and fifteen years of age.

Instead of limiting the application of the word puberty to the state of the girl at the first mensual manifestation, I prefer to use it as referring to a long stage of preparation for the menstrual office, and to a stage, also, which extends far beyond the date of the first show, into the period when the function has become regularly established; so regularly and firmly, I mean, as to leave no doubt on the mind as to the permanent and normal acquisition of the power; a pubertas plena. The fact is, that many persons are to be met with, in whom it has never been perfectly established; persons in whom the power to menstruate exists, but

exists feebly, morbidly, interruptedly. All such persons have failed to pass through the crisis of puberty.

A girl may have a sanguine discharge from her genitalia without having any pretension to be menstrual. I have observed such discharges in children at birth, in the month, and in little children under six years of age. When I have been consulted about these cases as extraordinary samples of precocious menstruation, I have been far from joining in such a preposterous notion.

The young child is but the sketch, the ebauche, the mould in which are to be formed the organs of the woman. She employs some fourteen years of her life in consolidating and forming her body, in order to fit it for its high destiny as a reproducing agent: but the apparatus and the force necessary for the fulfilment of that destiny are not added, except as the last and crowning power of her constitution. Her weak and tender tissues, in the early years of life, could not possess the strength and solidity, nor could they furnish the materials, for the evolution and perfecting of the new being, which is for a series of following years to represent its parent, as one of the integers of the immortal genus, man.

The earliest years of her life are occupied, then, in bringing her up to that point of perfect development of her alimentary, respiratory, innervative, and circulatory life, that may fit her for taking on the last great reproductive force. The time for taking up that force is the time of puberty. Puberty is the term of preparation to produce and mature ovarian ovules or germs, and discharge them from their capsules in the ovary.

Having duly acquired this power and faculty, she has passed through the crisis of her puberty. She has transcended the puberic age, and has become a woman. She has become possessed of a faculty that she is destined to enjoy for nearly half of her lifetime, and then, losing it again, she turns on the reverse of the path of life, and begins to descend to the bosom of the dust from whence she originally emerged.

It might be true to say that the whole menstrual period of life, extending from fifteen to forty-five years of age, is a continual crisis for the female; yet, when once fully formed and established in the economy, it is become a nature and a habit, and ceases to have that character of crisis which more truly applies to the stage of preparation or inception of this great power, and its positive and firm establishment as a part of her life-offices.

A girl grows up from infancy, and from childhood, continually developing, confirming, and consolidating her tissues and organs appropriate in their magnitude and their density to the particular stage of existence through which she is passing. In weight, stature, proportion, vigor, and intelligence, there is a continual conformable progress-not a non-conformable progress. The last faculty she acquires is the reproductive, the crown and glory of them all-it would be an unconformable progress in development, should its acquisition be either greatly anticipated or postponed in point of time.

In growing up from the infantile to the womanly estate, she passes through many crises, great and important ones; but the greatest and most important of all is the puberic crisis.

In the beginning is the crisis of establishing the new alimentary, and respiratory, and circulatory life, at birth. This being effected safely, and it often fails, she passes through another critical stage at the eruption of the infant or milk teeth, which are brought forward by a series of vital paroxysms, if I make not use of too strong an expression. There is a stage of excitement, often diseased, at the eruption of the incisors; a second one at the bringing forward of the molars; a third, attendant on the cutting of the cuspidate teeth, and another with the second molar eruption.

Thousands, and tens of thousands, nay, millions of young children fail to escape the dangers of the age of their first dentition; and the bills of mortality are swelled with the returns of death in children. The first, or milk set, having served their turn, the child incurs great hazard at the quasi paroxysm that waits upon the second dentition. Many children now lose their appetite, their embonpoint, their gayety; they cease to play, and utter the glad voice among their shouting and laughing companions. The pulse becomes compressible and frequent, and, upon the slightest motion, the heart beats with redoubled haste, and soon subsides again into a habitual languor of action. Fretfulness of temper, and frequent crying for any slight cause, or for no perceptible cause, mark what is very commonly, in families, known as the "cry-baby" age of children in their second dentition.

Children suffer frequent distressing pains in the decaying and loosening out of their first teeth; and a strange erethism of the parts about the mouth attends the tension of the gums coincident with the bringing forward of the permanent set. I have had