No physician would dare to bleed a man or woman once a month, year in and year out for thirty years; but, through ignorance or folly, this is what many girls do for themselves.

This excessive flow, aside from actual local disease, is brought about by excessive muscular exercise during menstruation; by the use of all stimulants, whether alcoholic beverages or quinin; as well as by the thinness of the blood.

When the flow is excessive, it must be considered a pathologic condition, which needs the physician’s attention.  Rest in the recumbent position is the first essential; the diet must be plain and unstimulating, and attention must be paid to the condition of the blood.

The general diseases which generally cause this condition are anemia, Bright’s disease, malaria, the early stages of tuberculosis, and heart disease.

The local causes may be reflex, as powerful emotions; or due to local disease of the uterus and its appendages, as the various inflammations and displacements of the uterus, fibroid tumors, polypi, and cancer.

Dysmenorrhea is painful menstruation.  The most frequent forms are due to uterine congestion; to mechanical causes, as a narrowing of the cervical canal, particularly at its internal opening, or to a constriction caused by the bending over of the uterus at the junction of the body and the neck; or to ovarian irritation.

The pain varies in intensity from slight discomfort to the most intense uterine colic, which is experienced in the lower part of the abdomen.  In severe cases the general health becomes undermined, the nervous system gives way, and hysteria and other disorders of the nervous system result.

The congestive variety usually occurs in patients who have previously menstruated painlessly.  The pain comes on suddenly with the flow and ceases when the flow stops; it is very severe and is generally accompanied by a diminution or a cessation of the flow.  There is severe headache, marked diminution in the secretion of the kidneys, and general restlessness.  The patient frequently experiences pain in walking, is easily fatigued, has leucorrhea and an irritable bladder.

In ovarian dysmenorrhea the pain precedes the flow for several days and ceases when a free flow is established.  The pain is of a dull aching character, and may be felt on one or both sides of the abdomen, according as one or both ovaries are involved.

Amenorrhea.—­ In amenorrhea the menstrual flow may not appear for some years after it is normally due; or the flow may cease after some months or years of continuance; or the flow may be abnormally scanty or even absent.

The menstrual flow is much later in appearing in some families than in others, so that this may be considered as a family idiosyncrasy; and if the girl’s health is good, it need cause no anxiety.  If, on the contrary, the girl has severe headaches, or suffers in any way, the physician should be summoned at once, as the absence of menstruation may be indicative of some serious pathologic condition,