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Menstruation (The Menses—Monthlies—The Periods— The Courses) is the term applied to the process whose external evidence is the dis charge from the genital organs. The word is derived from the Latin menstrualis, meaning monthly, from mensis, a month.

The discharge comes mainly from the inner surface of the womb, and while it lasts the womb is in the condition of having a greatly increased blood supply, and of being in con sequence fuller and heavier than during the interval between two periods. These changes in the womb, as already noted, are coincident with similar conditions in the ovary, attending the ripening and discharge of an ovum. In the virgin condition the ovum passing down the fallopian tube into the womb undergoes no change except that of breaking down and be coming dissolved.

Time of Appearance. — It is some time between the ages of twelve and sixteen years that the appearance of the monthly discharge indicates that the internal generative organs have arrived at some degree of maturity. Even before that occurrence various other signs indi cate a change coming over the girl. An altera tion takes place in the figure and gait owing to expansion of the hips and fuller and more rapid development of the breasts. The whole figure becomes more plump and rounded, and the girl less awkward and angular, and more graceful. Her manners also change. She be comes more sedate and less wayward, more timid and bashful, but also more gentle and loving. The actual period of the first illness varies with the climate and other circum stances. In Britain the age of sixteen is that at which it most commonly begins ; in France it is earlier. The general rule is that it ap pears earlier in warm countries and later in cold countries, the mean being in a temperate climate. The date of appearance is also affected by the conditions of life. It is earlier among those who live in towns, and later among country girls. Luxurious habits of living, the use of warm, stimulating foods, &c., hasten it ; while among those whose lives are more simple and primitive, or who live among conditions of hardship, it is delayed. It is also influenced by the constitution, and its appearance may be long delayed in a delicate girl. There are also exceptional cases on record, cases where the illness has appeared remarkably early, or where it has not appeared for many years past the usual time.

Symptoms. — The first monthly illness is frequently accompanied or preceded by some degree of feverishness, pains in the back, a sense of fulness in the abdomen, and feelings of great weariness. It is also a time when a girl may

manifest a variety of nervous symptoms, and may be liable to hysterical attacks. The first portion of the discharge is clear, later it is tinged with blood, and gradually it becomes almost pure blood, the blood then gradually diminish ing till finally the discharge becomes free from blood and then ceases. The symptoms which preceded and accompanied the discharge pass off, and in a few days the girl is in perfect health.

The regular illness is not established all at once. The girl may suffer from some of the preliminary symptoms, which lead the mother to conclude her illness is going to begin, and after a few days they may pass off without any or but a very slight discharge appearing. And this may occur at one or two periods without any flow of blood. Or one illness may occur in the regular way, and one or two periods may then pass with only a threat of its occurrence. Parents must not be alarmed at such irregular occurrences. Nor are they to take, as is too often done, any steps to force the discharge, such as administering drastic purges and other kinds of medicine. The general health of the girl remaining good, no alarm need be enter tained, and in any case no haphazard methods should be resorted to. (Refer to p. 622.) One thing it is desirable to notice here. The external passage (vagina) is almost closed in the virgin by a membrane called the hymen, which stretches across it near its entrance. Through a narrow opening in its centre, or through several smaller openings, the discharge from the womb escapes externally. In rare cases no opening exists, and the discharge does not escape, but is pent up within. The girl may, at the usual time for the appearance of the discharge, have the symptoms that have been noted, but there is no flow ; and thus one period after another may pass, the discharge accumulating behind the barrier. The accumulated discharge will in time form a swelling, even though it gives rise to no other symptoms, and there will be the appearance of a tumour in the abdomen enlarg ing with each returning period. This, taken with the absence of any discharge externally, has more than once given occasion for most unjust suspicion. In such a case as this the point to note is that on no occasion has the discharge ever appeared. If any discharge had at any period appeared, it would have proved that the way was open.

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