ANOMALIES OF MENSTRUATION. 161 



rence of menstruation, or cause its arrest. It is not always easy 

 to determine, in these cases, whether the ovum does not ripen, or 

 whether only the haemorrhage that usually accompanies the expul- 

 sion of the ovum is absent. If, at intervals of four weeks, we no- 

 tice more or less decided molimina, accompanied by swelling of the 

 breasts and increased discharge of mucus from the genitals, it 

 would seem as if only the haemorrhage were wanting ; in the reverse 

 cases, we may suppose that ovula do not ripen. Among the dis- 

 eases of the sexual organs, degeneration of the ovaries rarely causes 

 amenorrhoaa, and only does so when both ovaries are at the same 

 time the seat of organic disease. Among the various diseases of 

 the uterus, chronic catarrh, and especially chronic infarction, in 

 which the blood-vessels are compressed by the shrinking connective 

 tissue, most frequently induce this disease. Amenorrhoea occasion- 

 ally occurs in strong, .healthy girls, in whom the genitals have not 

 developed O rapidly as the rest of the body. Lastly, Scanzoni 

 concludes, from the cases where the menses (which had previously 

 been normal) ceased on the occurrence of paraplegia, that amenor- 

 rho3a may result from abnormal innervation. 



The sudden arrest of the menstrual flow suppressio mensium 

 is most frequently the symptom of acute metritis. It depends on 

 the same injurious influences that we mentioned in the etiology of 

 that disease, and is accompanied by the same symptoms. More 

 rarely the menses cease suddenly, if the amount of blood in the 

 uterine vessels be lessened by a diminution of the entire amount of 

 blood in the body by venesection, or by excessive fluxion to some 

 other organ. 



[Sometimes, at the period when the menstrual flow should appear, 

 instead of it a bleeding occurs from some other region, from a 

 haemorrhoid, from a wound or ulcer, from the nose, the bronchi, or 

 the stomach. Such bleeding, it would seem, might properly be 

 called " vicarious " so long as it was supposed that the menstrual 

 flux had the effect of evacuating effete matter from the system. 

 It might then have been inferred that refuse which was not voided 

 by legitimate methods might be advantageously got rid of by un- 

 usual processes. Nowadays, however, with our present conceptions 

 of the nature of menstruation, it is difficult to find a reason for a 

 vicarious menstrual haemorrhage. When we remember that the 

 amount of the flow in all is only from about eight ounces to (at the 

 utmost) about thirty ounces, the theory that the omission of an 

 habitual menstruation can give rise to a general plethora must seem 

 very rash. Most probably vicarious haemorrhages stand in close 

 relation to a very active general nervous and circulatory excite- 



