merely be delayed. If the girl be otherwise well, it is questionable how far it is desirable to attempt to stimulate the reproductive organs. To do so may be to develop or encourage feelings which may exist and be troublesome enough without any such encouragement. Speaking broadly, it may be said that the older the organism, and the greater its experience, the less the perturbation produced by the inrush of new ideas which are cotemporaneous with the physical development. When these new feelings, with their accompanying changes in the physique, come upon a budding organism at an early period, they produce a profound impression; and sometimes sweep all before them. Consequently we, as medical men, must bear all this in mind when asked to prescribe for a girl with amenorrhoea. Frequently it is desirable to assure the mother, or guardian, that it is well to wait and see what Nature will do. Until the age of sixteenthe age at which the present law of England allows to a woman any rights in her person-is reached, probably it is well to do nothing; unless there are very distinct reasons for interference.

When the appearance of the menses is delayed, mothers-especially of the humbler ranks of life-become uneasy. Poverty has its disadvantages, as we all know; and limited accommodation means a mingling of the sexes more than is desirable; with such consequences as can readily be imagined. When a girl has menstruated and the flow ceases, a certain misapprehension pervades the maternal mind. The cessation of the flux may mean pregnancy, or it may mean the oncome of consumption. These are the two great objects of the mo ther's disquiet. The reappearance of the discharge at once eases her mind

as to the first, and lessens her anxiety as to the last. If menstruation be a "surplus wave of nutrition," it is quite clear that an imperfectly nourished organism simply can not afford the loss. Rapid growth, with its demands upon the system, will arrest the menstrual flow. Malnutrition will produce the like result. Nature steps in with a conservative design, as if she could reason. "The system can not afford it," is my common remark to mothers who are anxious. As physician to a Chest Hospital, this aspect of amenorrhoea is constantly presented to me. Anæmic girls commonly are the subjects of amenorrhoea, partial or complete. The system can barely sustain itself, let alone have anything to spare for a

surplus wave of nutrition." The mother asks "Can not you bring on her courses?" It is a very natural question; but how about our answer? "The system when able will set them up" is a truthful, if not quite satisfactory reply. We have no means, with which I am acquainted, by which we can start a uterine flux. Certain drugs-as savine, senega, and the true unicorn-are credited with a direct action upon the reproductive organs. But how about the precise facts? Steel will help to make blood, and so aid in bringing about the menstrual flow. But does it not do this indirectly, rather than directly? In the days of my youth, a certain pill of my father's enjoyed a great local reputation in amenorrhoea. It consisted of iron, savine oil, black pepper, and aloes and myrrh pill. It was an admirable combination. The aloes had a stimulant effect upon the vascular supply of the pelvic organs, while the savine acted upon the uterus. That the desired result was frequently attained by persiste ith the pill, is credible enough,

But how are we to determine how far abortion is or may be set up by such measures? It is claimed for the aletris, or unicorn, that it is a uterine stimulant, which wards off abortion rather than tends to produce it. "Fucts are stubborn things," says the old adage. But how about the facts? The constituents of the above-mentioned pill are certainly oxytocic, and used to procure abortion. It seems to me that amongst the cures wrought by that pill, a certain proportion of them were in reality abortions, of which nothing was said by the patient. It certainly presents a combination of agents eminently well calculated to produce such a result. In dealing with these remedies for amenorrhoea, we can not lose sight of the mental element involved in their exhibition, if attended by the desired result. We must remember, imitating the language of Hughlings Jackson, that vascular congestion of the uterus and its appendages, in which lies hidden much erectile tissue, is the anatomical substratum of lust. Sensations founded on physical conditions are persistent and recurrent. Local conditions of the reproductive organs are accompanied by corresponding thoughts linked with the feelings experienced. In all probability the viscera are represented in the posterior lobes of the brain-just as we find the limbs have their cerebral area, and the special senses their own localities. More solid facts than the acute speculations of the phrenologist point in this direction. And emmenagogues, while exciting the menstrual flux, probably have a tendency to excite sexual thoughts, which in ill-regulated minds may flood the brain with lewd images. This is an aspect of the subject which ought, in some cases, to induce us to hold our hand when asked to prescribe for a girl with loss

or non-appearance of the menses. If there be any mental deficiency, any lack of will, it may be well to decline; just as much as in precocity. It is a notorious fact that female idiots are given to self-pollution in the most determined manner, as superintendents of asylums for imbeciles well know. Where the lower centres are not well controlled by the higher centres, it is scarcely desirable to stimulate those lower centres into greater activity.

Then there comes the matter of cessation of the menses, after being fully and completely established. This is not at all an uncommon occurrence. The arrest may be acute, as by exposure to cold during the flux. Here warm baths may restore it; but commonly our efforts are directed to securing it at the next period of its appearance. If there be no acute disturbance of the system, then warm baths, sitting over a vessel of hot water, or the application of hot cloths to the vulva, may be sufficient. In other cases, it may be necessary to give the pill described above, or some chalybeate, especially the ammoniocitrate of iron, which bears the reputation of being the most potent of all the preparations of iron, as an emmenagogue. (I can remember my father once taking me to task for prescribing this form of chalybeate to a spinster recovering from an acute illness, as being undesirable for her.)

When amenorrhoea is found with impairment of the general health, then its treatment rests upon improvement of the systemic condition. As soon as the organism can afford a "surplus wave of nutrition," it will probably set up the flux once more.

Sir James Simpson tried certain little stem pessaries of copper and iron, to set up and keep up a certain electric or galvanic action; but obviously without satisfactory results, as they

are no longer heard of in gynecological practice. Electric currents may be applied to the uterus, as to any other organ; but on this matter I have no experience to offer to the reader.

Amenorrhoea is occasionally found in plethoric females, and here chalybeates and hæmatics are clearly contra-indicated. Indeed, local de

pletion by leeches placed to the vulvæ is found the best line of attack. The success of such plan will depend very much as to how far it becomes possible to calculate the period of the flux-if it was existent. This can often be done with an intelligent patient. A brisk purgative, to lower the tension in the vascular system, might appropriately precede the application of the leeches.

This bird's-eye sketch of the relations of amenorrhoea enables some readers to see their way, when sometimes the path is obstructed or hidden from sight. Indiscriminate administration of emmenagogues is to be deprecated in many instances, as calculated to do more harm than good. Each case must be treated according to its own indications and exigencies. And these vary materially in different cases. There is no doubt that the medical man is often an innocent, but, nevertheless, undoubtedly active participator in a little scheme of abortion; the abortifacient action of emmenagogues being a well-recognized fact.

[For the Brief.]

Permanent Stricture of the Urethra, its Pathology and its Rational

Treatment.

BY AUGUSTUS C. BERNAYS,

A. M., M. D., Heidelberg; M. R. C. S., England; F. R. M. S., London; Member German Society Surgeons of Berlin; Professor of Anatomy St. Louis College Physicians and Surgeons.

(Continued from page 209.)

EDITOR MEDICAL BRIEF: -Before proceeding further in the pathology of urethral stricture and its consequences, I desire to mention two alleged causes for urethral stricture which are given by Otis and Gross and Sir Henry Thompson. The two American authors have recorded cases of stricture which, in their opinion, were caused by masturbation. I have carefully inquired of all my cases as to what they supposed to be the cause of their stricture, unless they stated at the first examination that they had been afflicted with one or more cases of gonorrhoea. Of the twelve cases which I saw, that were not of gonorrhoic origin, I could always discover a cause, on careful examination, which obviated the necessity of falling back upon the masturbation onanism hypothesis. With all the respect I entertain for my colleagues, I am compelled to say that I can not see how either masturbation or excesses in venere can cause organic stricture in a person having normal sexual organs. On account of its

or

[For the Brief.]

Psoriasis-Pityriasis.

EDITOR MEDICAL BRIEF:- I would like some brother to give symptoms of psoriasis and pityriasis, and best treatment for both, and oblige a brother. I. M. DAVIS, M. D. Choctaw Corner, Ala.

patient, recently deceased, of cirrhosis. of the liver and delirium tremens, who became a sufferer from stricture by venereal depravity, in a manner not heretofore recorded in medical literature. The patient was only seventeen years old, but at that early age. had become notorious in the city because of his dare-devil ways and because of his shrewdness, which en