Suppressio mensium. When the habit is established, and the discharge continued monthly from this cause, it cannot be broken with impunity. The most frequent causes of suppression arc exposure to cold, frights, falls, sometimes fever, anxiety of mind, or confinement. Suppression from falls is a peculiarly obstinate disorder, and the discharge is seldom restored; for, as in other shocks, the irritability of the vessels is apparently injured. The attack of fever is often attended with the appearance of the catamenia, and this, if at or near the regular period, is a favourable symptom. If at the intermediate part of the interval it is less favourable, though it affords no dangerous or fatal prognostic, as some practitioners have alleged: suppression in consequence of long fevers is from weakness only, but the return is often protracted. We have thought, that, when the menses appear, on the attack of fever, out of their usual period of recurrence, the following suppression has been more obstinate. In general, the return of the discharge, after any violent degree of either cause, must not be soon expected. Suppression in weak, delicate habits differs little, either in symptoms or remedies, from the species of emansio first described. In plethoric habits the symptoms are very different. If the>cause occurs during the discharge, a feverish attack often supervenes, the face is flushed, the eyes red; pains in the head and back come on, with sometimes a bleeding from the nose. If a similar cause, occurring in the intervals, is continued in its effects to the usual period of its appearance, symptoms of the same kind are observable; and they recur at each expected return, gradually, however, declining, till the chlorotic state comes on. In general, the sudden causes bring on the inflammatory, those more slow in their action the chlorotic, suppression.

It has been usual, in cases of inflammatory suppression, to bleed copiously, and this is sometimes necessary, to prevent a vicarious haemorrhage either in the brain or lungs; but, if it can be avoided, we shall also avoid the danger of establishing a new and dangerous habit. We gain much, in such complaints, by determining the vol.. I.

fluids to the skin, by the relaxing diaphoretics; and the sedative, or antispasmodic power of camphor renders it a valuable medicine in this complaint. With either the antimonials, or with camphor, opium is also highly useful; nor should the practitioner neglect to invite the circulating fluids to the hypogastric region, by interposing active purgatives. About the period of the expected return, a smart emetic will prevent the recurrence of the spasm, especially if followed by the camphor, with opium; and the discharge will appear with its former regularity. It sometimes happens, that at the usual period of the return a fever comes on, which, as none of the causes of suppression had preceded, or at least been observed, is usually considered as a common fever. If, however, it is at the period of menstruation, a circumstance which every prudent physician will keep in view, and the fever is of the inflammatory kind, it is highly probable that it proceeds from some spasmodic obstruction in the uterine vessels, and must be treated according to the directions already detailed.

The Dysmenorrhea, Or Menstruatio Difficilis, is a similar disorder, and a very important one, as it prevents the completion of the anxious wishes of those"who love their lords." The pain, on the occurrence of the discharge, is peculiarly violent; accompanied often with an obstinate constipation, or a suppression of urine. In fact, until the spasm of the uterine vessels is relieved neither the kidneys nor the bowels yield, however powerful the medicine; and the violence with which each returning discharge is attended, loosens the hold of any embryo, which, in the interval, may have been attached. No disease is more distressing in its symptoms or its consequences; and the regularly returning confinement is disguised by a variety of ingenious inventions, while the consequences in advanced life are all the diseases of celibacy. The remedies are those of suppression, attended with violent pains, but the dysmenorrhoea does not require bleeding. An active laxative at the expected period of the return, followed by a full dose of camphor and opium, will often succeed; and, if repeated at the next period, seldom fails to induce the discharge without the preceding pains. When these have been once and again conquered they seldom recur. In the inflammatory suppression and dysmenorrhoea, pediluvia, and sitting over the steams of warm water, are highly useful. The warm bath, raised to the heat of 94° or 96°, and continued so long as to produce slight faintness, will be often successful; but the laxatives, joined with the relaxants, are not only conducted with more ease, but more certainly effectual.

In the whole of this consideration it will be obvious, that the great object is to correct the deviations from health. When the healthy state is restored, the discharge will return. Medicines therefore should not be too frequently nor too constantly employed; and, on the other hand, too much should not be trusted to nature. It requires a minute discrimination to determine when art should interfere, and how long artificial means should be continued. If our exertions are too violent, the constitution will sink under the double powers of the disease and the medicine: if we are too remiss, the obstruction gains force, and years are required to restore the tone and the general health.

There is, however, a period when the discharge will naturally cease. It is not that the constitution does not supply the fluids as before, but that the diminished irritability of the vessels, or the diminished resistance of the veins, no longer permits the haemorrhagic effort. This critical period of the female life, menses ces-santes, must be attended to with care. The future health depends in a great degree on our conduct at this time; and we are required to be peculiarly attentive, as female prejudices lead them to attribute every future complaint to some error at this time. The disappearance of the catamenia is preceded by a temporary suppression, continuing perhaps for two or three months, followed by an increased, and unusually continued, discharge. The discharge will sometimes recur at very short intervals, and in profuse quantities, leaving, when absent, a considerable degree of leucorrhoea. The increased evacuation is not always attended with proportional debility, nor the temporary suppression with the symptoms already described. The blood, in these instances, is apparently poured from ruptured veins, without any haemorrhagic effort. In this way the change is effected, often without disease, and almost unobserved; but the suppression is sometimes attended with general load, with headach and wandering pains; and the excessive discharge with considerable debility. Generally speaking, however, art should seldom interpose. The whole is the work of nature, which, as we cannot imitate, we cannot always assist. Experience, however, in the former variety, goes hand in hand with popular prejudice, and the general fulness is successfully relieved by laxatives. The domestic remedies are not, however, usually well chosen. Women, attached to their early experience, prefer the aloes, in their warmest preparations, but the object is to lessen the proportion of fluids in the abdominal vessels, and whatever effects this purpose with the least irritation succeeds best. The salts alone are in general too cold, but they may be warmed with the tinctures of the more active purgatives, as of senna, rhubarb, or jalap. These, with the relaxant diaphoretics at night, particularly camphor and opium, will restore the circulation to its proper balance without inconvenience.