be taken every hour, or every two hours, according as the flow is greater or less. She was allowed cold lemonade.

At 10 o'clock at night I was recalled and found a great alarm; a night-vase was filled with napkins deeply stained, and with many clots. The pulse was weakened, the face pale, but the patient not at all disconcerted. There seemed to be no hemorrhagic nisus discernible in the action of the pulse. There was no pain.

The parents were deeply concerned, and asked me many ques- + tions as to the danger, and the means to obviate it. I told the mother that the arrest was in my power at any moment. "Well, sir, why not use at once the means that may put a stop to so frightful a discharge?"

In reply I stated that I did not deem it necessary now to act; + for, there was reason to expect that the hemorrhagic propensity would soon be exhausted-that there were many therapeutical remedies of considerable force, and that I preferred not to resort to a chirurgical measure until compelled by the stress of circumstances; for I should deeply regret to subject so young a lady unnecessarily to the Touch, without which the remedy in question was not to be applied.

You will think it strange that I passed the whole night, until + daybreak, in that apartment, and that I suffered the child to faint. again and again; opening the windows, using the fan, applying iced vinegar cloths to the hypogastrium and thighs, administering opium, sulphuric acid, and rose-infusion, taking the pillows occasionally from under her head, and vainly endeavoring to reassure the mother, who repeatedly entreated me to use the tampon, but I would not. Towards morning a remission occurred, and I went to my home. She was calm until after breakfast, when, upon my return to her chamber, she began again to flood and to faint, so that I was compelled to say to the mother that the time was now come to put a definitive stop to the hemorrhage, whose longer continuance would compromise the young lady. This information she joyfully received.

When she had provided me with a bundle of old linen, and cuti it into squares of four inches, many of them, I pushed them one by one, to the bottom of the vagina, out of which I first turned a handful of coagula. As soon as I had filled the vagina with the squares, I applied a napkin, folded up thick, in shape a

parallelogram, that was carefully adjusted to the genitalia; and having secured the compress by the usual bandage very firmly drawn, the hemorrhage ceased. In twelve hours I withdrew the tampon; no flooding came on. In a few days the discharge ceased completely. I gave her broths and meats, and wine and iron, and she has been ever since in excellent health.

There, gentlemen, is the unexaggerated history of the conduct of a case of menorrhagia in a virgin. I am ready now to say, that if I had such a case at this moment, I should treat it in the same way, as far as to the chirurgical part of the treatment. I do not regret that I allowed her to bleed so much and so long. I would permit another young lady to do the same thing, because, having confidence in the power of the tampon to suppress such a flooding, I would let her go very far towards a dangerous state rather than subject her to the mortification of the surgical intervention.

As to the mortification which overtook her at last, you ought to reflect that it was sunk in the hazard. There was not, and there cannot be, any mortification for the mind when the consciousness. of extreme distress or peril becomes the paramount sentiment. I have no doubt that the very perilous condition into which I allowed her to fall, had the effect of removing wholly the shock, and the vexation, and the shame, that would have wounded her had I, like a remorseless barbarian, subjected her unnecessarily to the Touch.

I hope you will read this case with care. I say with care, and I mean to urge you, on the one hand, not to be too hasty with your chirurgery, and on the other hand, not to let your patient sink so low as to make it out of the question to restore her. You ought, in the beginning of your career to be ever thoughtful, ever circumspect, never in a hurry to decide-always allowing yourself time to study the state of the case, in all its bearings both present and prospective. A young man is as capable of doing this as an old one; the only difference is, that the old man has learned to look about him, while the young man will not, in his hot and hasty temper, take time to think, but snaps at his conclusions like a duck at a June-bug, as we used to say when I was a boy-excuse the homeliness of my simile; many of you have known it to be a common parlance, especially at the south; at least it was so forty years ago.

Styptics, in uterine hemorrhage, are not of very great power. +++ The mineral acids are about as good as any of them; ten to fifteen drops of elixir of vitriol, diluted with a wineglassful of infusion of roses, makes a very good dose that may be repeated every hour or two. Five grains of powdered alum, with two grains of nutmeg, made into a powder and mixed in syrup, is a good dose, to be repeated hourly. I think, upon the whole, this is one of the best of the styptics. It is a very safe one. If you should make use of it in some bad case, and should find the flowing to continue notwithstanding your administration, take my word for it that you ought to make the patient swallow a large teaspoonful of the alum for a dose, and repeat it several times. It readily excites vomiting; indeed, there is hardly to be found a more powerful emetic. But, an emetic is a good therapeutic against a hemorrhage or menorrhagia, because the state of nausea, and the emulging influence of the act of vomiting, are capable of changing the determination of the blood, whilst it powerfully. modifies the rate, not only of the heart's action, but also the rate and distribution of the innervative or Biotic force.

Take, therefore, into your practice, the assurance that alum is + one of your best medicines. See a paper on Croup, by my son, Dr. I. F. Meigs, in the Amer. Journal for 1847, for an account of the uses of alum as a remedy.

Again, you have in opium a powerful modifier of the circu-+ lation. Opium always modifies the pulse; it checks the hemorrhagic nisus of the womb very effectually; think, therefore, of the resources you have in your hands through this drug.

Sugar of lead is thought to be a very powerful article in the treat- + ment of these hemorrhages. I do not like it, nor do I believe much in it; perhaps I have not dared to give it in excessive quantities, and having very rarely exhibited more than three grains in combination with opium for the dose, I am not sensible that I have ever been much struck with its hæmostatic power, though I have made use of it many times, yet less frequently of late than in former years.

The secale cornutum is a good and safe remedy; I know of no objection to its use in menorrhagia; I ought, however, to say that if you make a false diagnostic, and give the patient secale when she is pregnant, while you deem her only menorrhagic, you will kill her child by making her miscarry. This you ought not

to do, for it is discreditable to you and to your art to make such a mistake. But having on a former page presented you my views on the use of secale, I shall not here iterate them.

When a patient has recovered of the actual menorrhagia, you should give judicious orders as to her exercise, dress, food, and medicines, and take care, on the one hand, that the cardiac forces of the circulation become not again predominant in their power, and on the other, that the density or tone of the tissues of the body may be restored to a normal condition by those hygienic and therapeutic remedies and conduct that are suitable in the case. In all anemias, pure anemias, iron is the best of the therapeutic remedies-the wine, meats, baths, &c., are of the greatest importance in the way of the adjuvant ordinances. Farewell. C. D. M.

LETTER XXXIV.

ON DYSMENORRHEA.

GENTLEMEN:-The Greek words dus μny pew mean-first, difficult; second, month; and third, I flow; so that out of dusunepew it was easy to make the word dysmenorrhoea, which might be translated absolutely, a difficult monthly flow.

Dysmenorrhoea is a more or less painful disease; sometimes not very much so, but not unfrequently so much so as to give a color of distress and affliction to the whole life of the patient. A lady said to me, some time ago, "Doctor, I have for fifteen years suffered invariably at my periods, such intense distress, that I can scarce think of anything else than that on a given day my pain is to be repeated; language is incapable of expressing the degree of torture which I suffer under the pain, the approach of which fills me with horror."

A woman who suffers dysmenorrhoea, is, ipso facto, unhealthy, as to the womb, and very likely to be unfruitful in the marriagebed. It is true, that dysmenorrhoea may last for many years, in

certain persons, without bringing about any visible change in the health of the constitution, which remains vigorous and retains the normal powers of development, notwithstanding the invariable. return of the pain at the mensual term.

You are not, however, from this statement advised to take up the notion that dysmenorrhoea is an indifferent matter viewed in the aspect of its influence on the health and security of the patient.

The pain, the irritation, the imperfect performance of the function, and the state of the tissues producing it, are, all of them, circumstances well calculated to excite the solicitude both of the patient and the physician, because it remains everlastingly true, that the disturbance of the health of the reproductive tissues is very likely to exercise a disturbing influence upon the soundness and healthfulness of the entire rest of the constitution.

The pain of dysmenorrhea, is a pain felt in the hypogastric region, in either or both of the iliac regions, in the tractus of the ligamenta rotunda, in the sacral region, in the thighs, and very frequently in the course of the distribution of the obturator nerves. This pain, not unfrequently, extends to the whole belly, and is at times insupportable, from its violence; compelling the patient to lie down in the bed, or on the couch; forcing from her both tears and groans, and producing so great a degree of restlessness, that she seems to writhe like a crushed worm.

As a general rule, it may be stated that, the pain is over in six or eight hours, and that it is rarely intense during more than twelve hours, while the painful sensations, however, may continue one, two, or three days, and in some women through the entire progress of the catamenial act. A person who is subject to dysmenorrhea, for the most part, finds herself relieved in the course of the first day, or as soon as the flow of blood becomes fully and freely established; and regards herself not subject to considerable pain or inconvenience, until the cycle shall have brought back to her the hour of her affliction.

There are hundreds and thousands of women, to whom the menses never bring any the least trouble or inconvenience; there are vast numbers of females, also, who are notified of the approach of their terms, by some sense of fullness and weight, or dragging, in the region of the pelvis; symptoms which disappear as soon as the nisus hemorrhagicus has effected the opening of the mouths