None can appreciate the weight attaching to the words of a distinguished member of an honored profession, as well as the younger members of that same profession. They know something of the toil needed to achieve a worthy reputation, and of the talent implied by the capacity for toil. They know how to discriminate between the careful opinions of mature and deliberate judgment, and the headlong assertions of rash busy-bodies and amateurs. They understand, because they feel, the inevitable esoterism that must persist at the kernel of all democracies, unless these degenerate into mere rabble and intellectual mob: they are the last, therefore, to maintain that one person's word is as good as another's; that common sense is competent to solve all questions; that freedom of thought means the right of all to think as they please. Knowing, on the contrary, the extreme complexity of all problems, and the facility with which the most upright judgment may become warped in meditating upon them, they are prepared to exact a long apprenticeship in thinking from those who assume the right to think in public, and a minute familiarity with facts from those who undertake to defend any opinion in regard to them. Whenever a writer, by previous and just reputation, offers conclusive proof of such apprenticeship, familiarity, and ability to judge, his conclusions must be examined with care, and disputed, if at all, with respect.

Yet such examination is as essential to the interests of truth as is the just ascendancy that may be acquired by repeated success in the difficult task of investigation. Those who reject it as superfluous or impertinent, or who decry opposition as shallow obstinacy, are always those least competent to measure the weight of arguments on either side, and whose approval of authority must be as valueless as the dissent from authority certainly may be.

The singular avidity with which the press and the public have seized upon the theme discussed in Dr. Clarke's book on Sex in Education, is a proof that this appeals to many interests besides those of scientific truth. The public cares little about science, except in so far as its conclusions can be made to intervene in behalf of some moral, religious, or social controversy.

In the present case, a delicate physiological problem has become as popular as theories on epigenesis, spontaneous generation, or Darwinian evolution, and for an analogous reason. As the latter are expected to decide in the doctrines of natural or revealed religion, so the former is supposed to have a casting vote in regard to the agitating claims for the extension of new powers to women. On the one hand, the inspiration of scripture, on the other, the admission of women to Harvard, is at stake, and it is these that lend the peculiar animus and animation to the discussion. In both polemics, arguments are not accepted because they are demonstrated, but enlisted because they are useful; ranged with others recruited from the most distant quarters, with nothing in common but the regiment into which they are all thrust, to be hurled against a common enemy.

A remarkable change has taken place in the tone of habitual remark on the capacities and incapacities of women. Formerly, they were denied the privileges of an intellectual education, on the ground that their natures were too exclusively animal to require it. To-day, the same education is still withheld, but on the new plea that their animal nature is too imperfectly developed to enable them to avail themselves of it. Formerly, psychology was widely separated from physiology, and the study of the mind began and ended with demonstrations of the immense gulf by which it was separated from the body. To-day, psychology has become a section of physiology, and mental philosophers busy themselves with searching out in all its details, the close dependence of the mind upon the body. Insanity has become an inflammation of the cortical substance of the brain: idiocy results from a foetal meningitis: genius is a form of scrofula closely allied to mania: in sleep, the brain loses blood, in intellectual excitement, attracts blood; in the illumination of the death-bed, or the delirium of drunkenness, the circulation through the brain is quickened; in torpidity, melancholy, stupidity, the circulation slackens and stagnates.

With this tendency, whose legitimacy we are certainly far from disputing, it is inevitable that the old doctrine of the mental inferiority of women should be defended, if at all, on a new basis; a basis organic; structural, physiological, hence incontrovertible; on an analysis, not of her reasoning faculties, her impulses, her emotions, her logic, her ignorance, but of her digestion, her nerves, her muscles, her circulation. It is inevitable, therefore, that the two great functions of parturition and ovulation, of which the latter is peculiar in form,[33] and the former altogether peculiar to the female sex, should assume peculiar importance in all discussions about women—inevitable, that to these should be attributed the inferiority of mental calibre or of mental achievement that few care more openly to maintain.[34]

A mysterious interest has indeed always attached to these functions. From the Mosaic law to Raciborski, from the denunciations of the school-men to the rhapsodies of Michelet, they have been invoked in every theory on the nature of women; that is, in every theory on the organization of society. In virtue of them, the woman has been considered, now unclean, now angelic, now touchingly (but irredeemably) helpless. In this connection, the association of ideas has been almost always too powerful and too varied to admit of a dispassionate examination of facts. Yet to-day, as already said, the old conclusions may be urged with even greater force than before, because apparently based exclusively upon such cool and impartial investigation.

The issue is certainly serious. From all sides surges testimony to the importance of physical conditions as the basis of mental and social life. According to many, it is by the absence of a few grains of iodine from the water of drinking fountains, that the people of the Alps are turned into cretins. According to others, it is by the presence of a few grains of ergot in the bread, that the people of Tuscany lose their limbs in gangrene. Endemics of abortion depend on the impalpable vapors that arise from the quicksilver mines of Spain. So delicately poised are the forces of life, that an apparent trifle suffices to entirely turn the scale. It is therefore not a priori improbable, that the marked peculiarities of physical organization that distinguish the female sex, should determine a radically different mode of mental existence, and exact radically different conditions of mental activity.

The whole question, however, is not one of probability or of possibility, but of fact. Hence, the last persons capable of judging in the matter, are those who have been vividly impressed with those circumstances that furnish, or may be made to furnish, food for the imagination. Of these, Michelet is perhaps the type, but certainly many of the reviewers who have been occupied with Dr. Clarke's book, must be ranked in the same class. Would it be disrespectful to Dr. Clarke's far better informed judgment and technical knowledge to suggest, that he himself does not seem to be perfectly free from the influence of the glamour that invests the study of physiological peculiarities in women, wherever these can be made to tell upon any social or moral relations? Dr. Clarke does not indeed affirm, with Michelet, that women are essentially diseased. “La femme est une malade.” Where Michelet leaves to the healthiest women but a single week of every month for normal existence, Dr. Clarke believes that one week out of the month alone requires any special precautions, and that, with decent care at this time, “an immense amount of work” can be accomplished in the remainder. He is careful to say, and even to repeat, that the intellectual labor to which such disastrous results are attributed, is not in itself incompatible with the nature of the woman, nor, even when improperly pursued, can it be considered as the sole cause of the delicate health of American girls. Dr. Clarke indeed guards his every assertion with a care and precision that is worthy of imitation by those who draw such large deductions from his book. When, however, all illegitimate inferences have been set aside, and we come to the propositions really and categorically maintained, we find the following:

In regard to these propositions we wish to try to show—that the first contains a certain exaggeration of fact: that in the second a certain sequence of phenomena has been attributed to the wrong cause, and that much more important causes can be demonstrated: that in the third, a precaution needed for many has been unduly generalized for all: finally, that the fifth proposition entirely annuls the inference contained in the fourth.

We believe the exaggeration of fact to be twofold, that is, first, in regard to the number of girls to whose health the menstrual period makes any sensible interruption. Second, in regard to the duration of such interruption, among the majority even of those who are indeed obliged to submit to it.

Dr. Clarke himself admits that the susceptibility he describes in a certain number of cases, is not universal, but he claims that this is the rule, and the reverse the exception. Such a claim can only be substantiated by an appeal to relative statistics, which are well known to reverse many conclusions drawn from general impressions of facts. Statistics are reliable only when compiled on a large scale; but in an inquiry of this nature, a few contributions from various sources are not useless. Among twenty persons, not considering themselves invalids, of whose cases I have taken notes, in six only, had menstruation ever been the cause of any suffering whatever. The ages of the persons questioned ranged from eighteen to thirty, but the inquiry referred to the entire menstrual life. Several among these young ladies had attended mixed schools, and had never been compelled to absent themselves for a single day. Several had been engaged for three or four years in the study of medicine; some, for a much longer period, had engaged in its practice.

Among the six exceptions, one had been healthy until twenty-one, and then had suffered from ovaritis, so that, although engaging in the work of a healthy woman, she should really be classed apart. One was subject to epileptic convulsions, and may therefore be fairly ruled out for the same reason. The remaining three were in good, even robust, general health. In two, pain was experienced for two days, and a certain diminution of capacity for mental exertion, which, however, had never been sufficient to necessitate its interruption. One of these cases was a woman of thirty, who had been married for ten years without child-bearing. In the third case on the list, pain had never lasted more than six or twelve hours, and had been very greatly diminished during four years that the young lady had engaged in constant medical study. Finally, in the fourth case, the early years of adolescence were marked by quite severe dysmenorrhea, the pain only lasting, however, twelve hours. Between twenty-five and thirty, the pain disappeared, but the menstruation became menorrhagic (excessive). This was the only case on the list where no constant intellectual exertion had ever been made, but where the nervous system had been subjected to the strain of much moral emotion and anxiety. The girl belonged, moreover, to a family in which uterine disease was almost universal among the female members.

While at first glance, therefore, it would appear that the proportion of women invalidated by menstruation was nearly as high as one-third, closer inspection shows that among these cases selected at random, the proportion is only one-fifth or one-sixth, if the calculation be confined to persons who had received much intellectual training.

Among these cases, moreover, there is not one in which the period of suffering is as long as would be indicated by Dr. Clarke. Six, twelve, forty-eight hours is the outside limit. If extended beyond this, or even if very severe during this time, there is always reason to suspect actual disease of the uterus or ovaries, and the cases must be excluded from considerations only applicable to persons in average health. From this point of view, the week of rest demanded by Dr. Clarke, is as excessive as the three weeks' disturbance so imaginatively described by Michelet.

But it is true that the stand-point in Dr. Clarke's book is somewhat different from this. He scarcely alludes to the presence of pain in menstruation, because this is presumed, when existing, to itself constitute a sufficient warning against over mental exertion, indeed, to render such exertion impossible. But the warning in question is directed against a more insidious accident, that may occur without pain, and which is more easily and imprudently defied. This imminent danger is hÆmorrhage, or an increase of the physiological flow to such an extent that the vitality of the patient is drained as from an open vein. The constant repetition of such hÆmorrhage may lead to uterine congestions, or even to amenorrhea, i.e., entire absence of menstruation. But it originates in functional disturbance, in exhaustion of the nervous system by intellectual exertion. On account of the imminence of this danger, the period of real incapacity for mental effort lasts much longer than conscious discomfort is likely to do—lasts, indeed, as long as the physiological afflux of blood to the uterus—which, by the means described, may at any moment become excessive.

Dr. Clarke alleges but one kind of proof of this assertion. He relates a certain number of cases, interesting in themselves, but whose histories are lacking in many important details, where healthy girls, whose menstruation was at first perfectly normal, became, after two or three years' study at school, liable to monthly hÆmorrhages, so excessive that their health was completely undermined. No organic cause for such disorder could be discovered. By interruption of study, rest, amusement, travel, the hÆmorrhages were diminished, the health restored. In several of these cases, however, resumption of study on the old plan was followed by the immediate return of all the previous accidents, and often the constitution was entirely ruined.

We think that this argument might be exactly paralleled by the following, which should prove whisky drinking to be an efficient[37] cause of yellow fever. A physician might select twenty cases of men, personally known to him, who had lived twenty and thirty years in New York or Boston, and never had yellow fever. During this time they had taken little or no whisky, but afterwards, removing to New Orleans, they fell into the habit of drinking, and, at varying intervals from that date, caught the fever, and in many instances, died. Therefore, fever was due, at least in these cases, to the newly contracted habit of drinking whisky.

Hamerton, in his little book on the intellectual life, accuses women, even the bright and intelligent among them, of a “plentiful lack” of intellectual curiosity. If their attention is attracted to a phenomenon, they rarely inquire as to its cause. If an assertion is made, they accept it with enthusiasm or repel it with indignation, but rarely analyze the conditions upon which the assertion is based. This remark seems justified, though perhaps not exclusively among women, by the total absence of curiosity that has been shown in regard to the physiological facts in question. The assertion that nervous excitement, produced by intellectual work, is capable of affecting an apparatus apparently so remote from the organ of the intelligence as is the vascular system of the uterus, certainly implies some most interesting physiological facts and a mechanism the reverse of simple. Into these facts and this mechanism it behooves all to inquire, who assume the responsibility of either accepting or rejecting Dr. Clarke's theory and the deductions that have been made from it.

This theory concerns exclusively one class of uterine hÆmorrhages, those, namely, which may be traced to the influence of the nervous system. Before analyzing such influence it is important to notice two other causes of menorrhagia, that are very frequently present in just such cases as Dr. Clarke describes. These are prolonged sedentary position, and deficiency of physical exercise. Either may determine anemia, or impoverishment of the blood, a condition which alone is sufficient to induce excessive menstrual flow.[38] But, in addition, each has a special action more direct. By long continuance of a sedentary position the equilibrium of the circulation is disturbed, the blood is driven from the limbs to the internal organs and the dependent portions of the trunk, hence to the pelvis; but almost equally to the head, that is hanging down over the school-desk. Hence, the uterine hÆmorrhages, that are necessarily confined to girls, are paralleled by the nose-bleeding, common to girls and boys, and very frequent in such circumstances. The cramped position of the chest interferes with respiration; the bowels are generally constipated, and both conditions again favor congestions of the visceral organs, including the uterus, but not confined to it. To deficiency of physical exercise is due, besides the disturbance in the equilibrium of the circulation, first, a loss of heat that should be evolved during the chemical processes of muscular action; second, a loss of stimulus to the spinal cord, which has, therefore, less power to control ganglionic action. This latter, therefore, becomes irregular, and the consequences of this irregularity will be presently described. The influence of these two conditions—cramped sedentary position, and deficiency of muscular exercise—either sufficient to induce uterine hÆmorrhage, must, therefore, be eliminated, before such accident can be attributed to any other cause less simple and direct. The first criticism to be addressed to the “statistics” contained in Dr. Clarke's clinical chapter, is, that this necessary elimination has not been made, and one possible cause arbitrarily selected out of an entire group of known causes.

As far as may be gathered from his book, Dr. Clarke's theory may be thus formulated. Two intense nervous actions cannot, without detriment, be sustained at the same time by the same organization. The mental labor demanded by school studies on the one hand, and the physiological process of menstruation on the other, are each connected with intense action of different parts of the nervous system. They are, therefore, incompatible with each other; and from the attempt to sustain them simultaneously, results, first, the imperfect accomplishment of each; second, the general exhaustion of the over-burdened nervous system. To this exhaustion is to be attributed the uterine hÆmorrhages upon which Dr. Clarke insists as the accident particularly liable to be induced by any continuous, i.e., non-intermitting, system of education.

For non-medical readers it is important to develop the ellipsis and explain the facts upon which, if anywhere, this theory is based.

The nervous system, though in many respects a unit, consists of two great sections, called respectively, the ganglionic system, and the cerebro-spinal; the latter formed by the brain, the spinal cord, and the medulla-oblongata, that connects them; the former, constituted by smaller masses of nervous matter distributed in three ways: First, in a double chain lying on each side of the spinal cord, from the upper part of the neck to the pelvic cavity that terminates the trunk. These masses are called especially the sympathetic ganglia. Second, in so-called plexuses, occupying different positions in the cavity of the trunk, and standing in especial relation to various organs; the solar or coeliac plexus to the stomach, liver, and spleen; the two renal plexuses to the kidneys; the mesenteric plexuses to the intestine; finally, on each side of the pelvis, the hypogastric plexus to the bladder, uterus, and ovaries—the so-called genito-urinary organs. Third, besides these principal ganglia exist others, much more minute, imbedded in the muscular walls of certain organs—as the heart (intro-cardiac ganglia), the intestine (intestinal ganglia).

Each of these nervous masses contains nerve-cells as well as nerve-fibres, and is capable of generating nerve-force. Each, therefore, acts like a minute brain; and, in fact, the entire ganglionic system of nerves is analogous to the nervous system of certain among the lower animals—the crustacea and mollusks. These possess neither brain nor spinal cord; their nerve-centres, instead of being concentrated in a cranium and vertebral canal, are entirely disseminated through the cavities of the trunk, as are the visceral plexuses in vertebrated animals. In these, however, the addition of a brain and spinal cord to the original rudimentary nervous system, powerfully modifies and controls the action of the latter. The degree of control is variable, according to the relative predominance of the one or the other; and this predominance varies, not only according to different species of vertebrated animals, but also according to different individuals, in that which presents the most conspicuous capacity for individual variation—the human species. Up to a certain point, increased development of the cerebro-spinal system, attended by an increased development of the osseo-muscular framework of the body, is also accompanied by greater elaboration of the ganglionic nerves supplying the viscera, upon whose efficient action the nutrition of this frame depends. But beyond a certain point in the ascending scale, the exactness of this correlation ceases. The muscles and bones are smaller; yet the structure of the cerebro-spinal organs, especially the brain, becomes more elaborate; and hence the control exercised over the functions of the ganglionic system is more complete, although the relative size of the two systems is not much changed.

Such control or predominance is manifested in the following ways: First. The functions of animal life, presided over by the cerebro-spinal system, become proportionately more important than those of vegetative or nutritive life, carried on by the ganglionic. That is to say, the acts of locomotion sustained by the spinal cord and the nervo-muscular apparatus, and the intellectual acts of the thought and will, sustained by the brain—are relatively more prominent than are the acts of digestion, respiration, circulation, etc., dependent on the functions of the ganglionic nerves. Second. These latter functions are themselves effected with more regularity and more force, when the activity of the cerebro-spinal system predominates over that of the ganglionic. Within certain limits, this is so true, that human beings possess over lower animals a superiority, not only of intellect, but of capacity for digesting various articles of food; and of maintaining their temperature in more various states of the external atmosphere. Third. Finally, the actions of the cerebro-spinal system, intellectual and muscular, are more regular and powerful when not liable to interruption from the operations of the ganglionic nerves, and the visceral functions presided over by them. When the boa-constrictor digests, he falls into a state of torpor that exceeds in degree, but not in kind, the drowsy rumination of a cow chewing her cud. Such animals are slaves to their nutritive functions, by which those of the brain and spinal cord may at any time be, as it were, oppressed and overwhelmed. The capacity for independence increases with every rise in the hierarchical scale of vertebrates, until it culminates in man—able to think and talk over his dinner; to manufacture heat in his limbs while drawing blood to his cerebral hemispheres; to sustain in complete unconsciousness innumerable delicate and complicated chemical metamorphoses in all the tissues of his body, while concentrating every conscious effort of his mind upon equally delicate processes of thought and will.

The peculiarities that, when coarsely emphasized, serve to distinguish different species of animals from one another, are repeated in more subtle gradations, as varieties among the different classes, and even different individuals of the human race. Here may be found, at least, faint echoes and distant reminiscences of facts that stand out in bold relief throughout the animal kingdom. The classification of sex is certainly one of those that offer an interesting opportunity for such comparison, especially in regard to the relations existing between the operations of the ganglionic, and those of the cerebro-spinal system. As the authors who have asserted the complete subordination of the brain to the instincts in woman, have thus, perhaps unconsciously, reduced her to the anatomical level of the crustacea; so those who, like Dr. Clarke, insist on the incompatibility between cerebral action and the process of ovulation, imply a predominance of ganglionic activity in women that must render them the physiological inferiors of the animals or individuals in whom no such incompatibility exists.

Were such opposition between cerebral and ganglionic functions only noted when a rhythmical intermittence was introduced into the latter, and were such rhythm observed only in the phenomena of menstruation, it might indeed be possible to fix upon women a peculiar mark of physiological inferiority, almost sufficient to amount to a stigma. But rhythmical movement is characteristic of all physiological actions—of the beating of the heart, the secretions of the stomach, the congestion of the spleen, the circulation of the brain, quite as decidedly as of the ripening of cells in the ovary. The tidal waves described by Michelet have become the exclusive theme of his eloquence, mainly because his attention was not attracted to any but those connected with the more obvious phenomena of menstruation. But many tidal waves rise and cross each other in shorter or longer cycles—waves of pulse and of temperature, of sleep and wakefulness, intermittences of secretion and excretion. In regard to the latter, it is noticeable that an intermittent excretion, as of bile or urine, is provided for by a continuous secretion, and that the same is true of the excretion upon whose rhythm an erroneously exceptional emphasis has been laid—that of the menstrual fluid. Here, as elsewhere, the intermittent phenomenon is preceded by long-continued cell growth—effected by precisely such processes of cellular assimilation and metamorphosis as take place in the elements of the liver and the kidneys. The cell growth in question is effected in the ovaries; the final stage of the process, the rupture of the containing cell or ovisac, and escape of the ovule, is attended by a concentration of nervous activity in the ganglionic masses sending nerves to those organs—analogous to that which occurs in the solar plexus at periods of digestion; the fall of the ovule is itself analogous to the shedding of epithelial cells in the gastric follicles; the afflux of blood to the utero-ovarian veins, analogous to the periodical congestion of the gastro-splenic vascular apparatus. Only, in this last case, the congestion results in the elaboration of a fluid secretion, the gastric juice; in the utero-ovarian plexus, where no secretion is required, the blood itself is discharged. It is difficult, with these facts, to understand the assertion that. “Periodicity is the grand (i.e. exclusive) characteristic of the female sex.”

In normal conditions, the process of digestion and of menstruation are both accomplished without invading the consciousness of the individual whose body is the theatre of such extraordinary phenomena. Various abnormal conditions raise the one or the other to the sphere of consciousness—various stages in their evolution. Consciousness of nutritive functions is always painful, and digestion, quite as well as ovulation, may become a process most disturbing to cerebral tranquility and efficiency. The longer duration of the latter is compensated by the more frequent occurrence of the former. The ovaries are decidedly active during at least fifteen days of every month; the stomach, during three or four hours after each meal, or from nine to twelve hours a day. As a matter of fact the digestive function is much more often the occasion of conscious discomfort, than is the function of ovulation. Whenever it becomes so, the dyspeptic approaches the condition of the reptiles or ruminating animals, in whom the process of digestion so absorbs the powers of the nervous system that all other modes of its activity are suspended. But such a condition is universally regarded as an evidence of disease, nor could any considerations concerning the complexity and importance of the ganglionic nerves of the stomach, or the intermittent character of digestion, convert the misfortune of the dyspeptic into a physiological type for the race. At the most may it be admitted:

CÆteris paribus, these same propositions may be held of those suffering from abnormal modes of activity in another part of the ganglionic system—that connected with menstruation. A third proposition is, moreover, common to both, namely, that repose of the cerebro-spinal system is not required throughout the entire period of ganglionic activity, unless in exceptionally morbid cases. Thus, the process of digestion occupies from three to five hours, but an hour's repose after dinner is generally sufficient to avert discomfort. Similarly, the process of ovulation continues over fifteen days—menstruation lasts from three to six—but even in the cases that demand rest, six to twelve hours is usually enough, and more than enough.

It is noticeable that a slighter disturbance of normal conditions is needed to render digestion painful than to cause painful ovulation, that is, pain preceding the menstrual flow. Pain in menstruation, which is much more frequent, is dependent upon other conditions than the activity of the ovaries, and lasts a very much shorter time than does either the function of ovulation, or even than the uterine congestion secondary to it. Outside of actual uterine disease, the pain at this moment is most often dependent on uterine cramp, itself excited by a spasmodic contraction of blood-vessels that interfere with its circulation. As these remarks are addressed to non-medical readers, a word of explanation is here necessary.

It has been shown by experiment that the sudden arrest of the circulation in muscular fibre is sufficient to induce in the latter violent contractions. Thus, the cramps of the legs in cholera patients are due to the stagnation of blood in their muscles. These cramps are even more easily induced in the muscular fibre of the viscera—the unstriped, involuntary muscles—such as exist in the intestine, bladder, and uterus. Anything that will cause a sudden contraction of the blood-vessels in the uterus will, therefore, by cutting off the supply of blood, cause the muscular fibre of the uterus to contract in painful cramps. The small blood-vessels are themselves provided with circular muscular fibres, whose contraction necessarily draws the walls of the vessels together, obliterates their canal, and shuts out the blood. This contraction is effected by stimulation of the fine nerves, called vaso-motor, that are distributed to these muscular fibres, and which are derived from the sympathetic ganglia, that form part of that same ganglionic system from which the nerves of the ovaries and other viscera are supplied. The utero-ovarian blood-vessels derive their nerves from the hypogastric plexus, which, formed by branches from both sympathetic ganglia and spinal cord, is the exclusive source of the innervation of the uterus and ovaries. The ganglionic nervous excitement coincident with the maturation of the ovule and the congestion of the uterus, is easily communicated to the vaso-motor nerves of the latter organ. At the very moment, therefore, that the uterine blood-vessels are dilated, and blood is being exhaled into the uterine cavity, an excessive stimulation of the vaso-motor nerves may cause the blood-vessels to contract; the flow is then temporarily arrested, the circulation in the uterus disturbed, and its muscular fibres thrown into cramps.

Or the opposite event may occur. As the stimulation of the vaso-motor nerves causes contraction of the blood-vessels, so their exhaustion or paralysis causes relaxation of these same vessels, consequently, over-distension with blood; and, if the door to hÆmorrhage be once opened by the existence of the menstrual nisus, an excessive flow of blood.[39] Such vaso-motor paralysis may depend on one of three circumstances:

Independently of the three conditions where excessive menstruation is connected with vaso-motor paralysis, a fourth may be found directly in the excitement of the ovarian plexus of nerves. This evolution of nerve-force which accompanies the maturation of the ovule, is the immediate cause of the afflux of blood to the utero-ovarian vessels. The effect upon the latter is probably due to the spinal nerve-fibres contained in the plexus, and upon which the ganglionic excitement acts like the galvanism in Schiff's experiment, already described. Direct stimulation of the vaso-motor nerves, alone, as has been said, contracts the blood-vessels. Stimulation of the spinal fibres associated with them exercises the contrary effect. An excessive stimulation of those fibres which enter into the ganglionic masses, would have an effect similar to that of excessive stimulation directly addressed to the cerebro-spinal system, and the blood-vessels would be not only dilated, but paralyzed.

Among the conditions, therefore, which may, by inducing either pain or excessive hÆmorrhage, render menstruation an abnormal process, and incompatible with active exertion, three are directly connected with the ganglionic system of nerves, the fourth indirectly, by the possible influence upon them of the cerebro-spinal. The first are excessive activity of the ovarian nerves, derived from the hypogastric plexus; paralysis of uterine vaso-motor nerves, as a secondary result of this excessive action: exhaustion of these same vaso-motor nerves, as an element of general nervous exhaustion. The last theoretical condition would be, excitement of the brain or spinal cord, in a manner analogous to what may be determined by a galvanic current, and followed, therefore, by the same consequence—paralysis of vaso-motor nerves, and excessive dilatation of the blood-vessels.

The two first conditions among these four are most easily induced when the activity of the ganglionic system is habitually predominant in the organism, or when this activity is habitually irregular. This irregularity, marked by vaso-motor spasm, uterine cramp, and pain, represents the lowest degree of disorder, which, if long continued, passes to the next—of vaso-motor paralysis, accompanied by excessive hÆmorrhage; and finally may, as Dr. Clarke has pointed out, be followed by paralysis in the ovarian plexus itself, with consequent cessation of ovulation, and amenorrhea, or absence of menstruation.

This habitual predominance or irregularity of the ganglionic nerves implies, as has been seen, a relatively deficient innervation or generation of nerve-force in the cerebro-spinal system. It could not, therefore, be ascribed to excessive activity of that system, except in the cases where this has been pushed to the point of complete exhaustion. It is, in fact, a matter of common observation, that hysterical and anemic women, in whom disordered menstruation is most frequently observed, are conspicuously destitute of habits implying either cerebral or spinal activity—that is, they neither think much, nor take much physical exercise.

The last two cases, however, of cerebro-spinal excitement or exhaustion, may be supposed to imply a predominant activity of the cerebro-spinal system.

Inquiry into the effects of cerebro-spinal excitement is rendered extremely complicated on account of the following facts:

1st. Experimental excitation, by means of galvanism or mechanical irritation, causes different results when applied to spinal nerves, to different parts of the spinal cord, or to different parts of the brain. Galvanism applied to a spinal nerve, determines, it has been said, dilatation of blood-vessels, and increased secretion in glands. But galvanism applied to the spinal cord in the neck, causes contraction of blood-vessels. Mechanical irritation of other parts of the spinal cord, on the other hand, causes vaso-motor paralysis and dilatation of blood-vessels. This is especially true of that part lying in the loins, and which contains a peculiar nervous centre, that stands in special relation to the uterus and ovaries, and is involved in many of their diseases, either as a cause or effect. Systematic galvanic irritation of the brain has been little attempted, until in some very recent experiments; but its effects are already known to be most various, according to the part to which it is applied. The brain is not a single organ, but rather a collection of organs, differing from one another in function even more than in situation, and among them only some are really concerned in the production of thought.

2d. In the medulla oblongata exists a nervous centre called the vaso-motor centre, because of its close relations with the vaso-motor nerves. Stimulation of this centre causes contraction of the blood-vessels. Severing the same part causes paralysis of the vaso-motor nerves and dilatation of the blood-vessels. The conditions of the brain that have been most clearly shown to influence the circulation, are those that can be proved to take an effect on this vaso-motor centre. If, as is probable, different forms of cerebral action induce or depend on different cerebral conditions, or involve different sections of the cranial masses, this effect would necessarily be different, and the influence on the circulation vary accordingly.

3d. No experimental proof has hitherto been obtained that stimulation of the cerebral organs lying above the vaso-motor centre, and which include those possessing the function of thought, ever paralyzes this centre; but, as it is only by such paralysis that cerebral conditions can induce dilatation of blood-vessels, it must follow that no experimental proof at present exists that stimulation of the brain ever does cause such dilatation—that is, ever does become a cause of hÆmorrhage. The clinical facts for such a supposition are those in which the occurrence of an emotion is followed by flushing of the face, acceleration of the pulse, hot or cold perspirations, phenomena all indicative of dilatation of the blood-vessels, with temporary paralysis of their nerves and of their vaso-motor centre. It is not proved, however, that the emotions capable of causing these effects really result from a stimulation of the brain. On the contrary, they are generally accompanied by diminished activity of that cerebral function that most certainly does depend on such stimulation—the function, namely, of thought.