PUBERTY AND MENSTRUATION 771 



muscular action would be more or less intermittent. The time occupied 

 in the passage of an ovum from the ovary to the uterus has been esti- 

 mated at four to eight days. 



Puberty and Menstruation. At a certain period of life, usually 

 between the ages of thirteen and fifteen, the human female undergoes 

 a remarkable change and arrives at what is termed the age of puberty. 

 At this time there is a marked increase in the general development of 

 the body ; the limbs become fuller and more rounded ; a growth of hair 

 makes its appearance upon the mons Veneris ; the mammary glands 

 increase in size and take on a new stage of development ; Graafian fol- 

 licles enlarge, and one or more approach the condition favorable to 

 rupture and the discharge of ova. The female becomes capable of impreg- 

 nation, and continues so, in the absence of pathological conditions, until 

 the cessation of the menses. 



The age of puberty is earlier in warm than in cold climates ; and 

 many instances are on record in which the menses have appeared 

 exceptionally much before the usual period. Usually, at the age of 

 forty or forty-five, the menstrual flow becomes irregular, occasionally 

 losing its sanguineous character, and it ceases at about the age of 

 fifty years. The time of cessation of the menses is called the meno- 

 pause, climacteric, or change of life. Ova then are no longer developed 

 and discharged, and impregnation does not follow intercoufse. It is said, 

 however, that sometimes the menses return, with a second period of fecun- 

 dity, although this is rare. According to most writers, while climate has 

 a certain influence over the time of cessation as well as the first appear- 

 ance of the menses, this is not very marked. When the menses appear 

 early in life, they usually cease at a correspondingly early period ; but 

 this is by no means constant. There are, also, many exceptions to the 

 ordinary limits to the period of fecundity. An instance of childbirth 

 at the age of sixty-three years, with menstruation following at the usual 

 time, has been reported by Kennedy. 



In the human female, near the time of puberty, there sometimes is a 

 periodical sero-mucous discharge from the genital organs, preceding, for 

 a few months, the regular establishment of the menstrual flow. Some- 

 times, also, after the first discharge of blood, the female passes several 

 months without another period, when the second flow takes place and 

 the menses become regular. In a condition of health the periods recur 

 every month until they cease at the climacteric. In the majority of cases 

 the flow recurs on the twenty-seventh or the twenty-eighth day ; but 

 sometimes the interval is thirty days. As a rule, also, utero-gestation, 

 lactation, and severe diseases, acute and chronic, suspend the periods ; 

 but this has exceptions, as some females menstruate regularly during 



