In conclusion; if it is found that the excitements of a town-life hasten on the catamenia by one year, as is proved by the researches of Szukits in Vienna, and of Brière de Boismont, in Paris; if, as the latter observer states, amongst the upper classes of Parisian society the average age of puberty is so early as 13 years and eight months; and finally, if the stimuli of sensational novels and of theatrical entertainments are everywhere accused by thoughtful observers as the hotbeds which force on the menstrual molimen, how much more shall an indescribable looseness of morals goad on the sexual instincts of the oriental female to an early recognition.

Dr. ROBERT HARRIS replied to these remarks as follows:The more I investigate the question of the causes of early menstruation, the better am I satisfied that the influence of moral training has less to do with it than that of climate and

for if this was the case, then we ought to find in England and Wales numbers of very young mothers amongst the lower classes, not only in the large cities, but also to a great extent throughout the country, which we find not to be the case, the youngest well authenticated instance being more than two years older than the youngest reported in the United States. There is no question but that the Hindoos, Turks, Japanese, and other inhabitants of warm countries, are trained from early childhood in the most immoral manner conceivable; but this is also, and to an equal extent true, of a large class in Great Britain. The dark races of the earth appear to be more precocious than the white, even when under the same climatic stimulus. The negroes of Africa menstruate at a very early age, as will be learned from the records made in Sierra Leone and Abyssinia; and it has also been observed in our Southern States even where the climate is not hot, that numerous example of menstruation at the ages of ten, eleven, and twelve years, are met with in the

same race.

From a work entitled, "The White Slaves of England," compiled from original documents, by John C. Cobden, I extract the following, with regard to the moral training of the laboring classes, in that kingdom.

Beneath the wing of a government professedly Christian, there is sheltered a vast number of people who must be characterized as heathen, whose moral degradation it is appalling to contemplate, and whose code of morals is the creature of their sensual inclinations. The English peasantry are more demoralized than those of any country of Europe, if we except Russia, Turkey, South Italy, and some parts of

the Austrian Empire. People of both sexes, and of all ages, parents, brothers, sisters, and strangers, sleep in the same room, and sometimes as many as six in a bed; undress and wash in each other's presence; and women are delivered where men, women and children are crowded together. The children consequently lose all sense of the indecency of such a life, adultery and incest are common, and illicit intercourse is thought of as nothing, the woman not losing caste by it.

In the "public lodging houses," where the vile of all ages hire a night's shelter, the most disgusting immoralities are practised, children of both sexes, from ten to fifteen years old, sleeping naked together, a dozen in a bed, indulging in promiscuous sexual intercourse, and often dancing upon the floor as many as two dozen at a time in the same nude state.

Mr. MAYHEW reports: "I have seen fathers and mothers place their boys and girls in positions of incipient enormity, and command them to use language and gestures to each other which would make a harlot blush, and almost a heathen tremble." "In Liverpool, Manchester, and Birmingham illicit sexual intercourse among the lowest class seems to prevail almost universally, and from a very early period of life; to this common conclusion witnesses of every rank give testimony."

That

Surely, if a highly immoral training induces an early maturity in the uterine system, then we ought to find numerous instances of precocious menstruation and pregnancy among the peasantry of England, but we do not. mental excitement does have some influence over the age of puberty is generally believed, but in my opinion, too much credit has been awarded to it. It is a little singular that out of four cases which have recently come under my notice, aged nine years and five months, eleven years and nine months, twelve years and two weeks, and twelve years and six months, not one had been subjected in the least degree to any moral or mental exciting cause. To moral influence is generally attributed the earlier menstruation in cities as compared with the surrounding country; but in my judgment, this is only one of many exciting causes, which, like the heat and moisture of a hot-house, conduce to early fructification, associated with delicacy of growth.

In determining the influence of race upon early maturity, it will be necessary to observe the effect produced upon the same people in different climates, which is a matter as yet of very difficult accomplishment, except as regards the negro, and some few of the white races; for the indoo, Arabian,

Turk and Orientals generally confine themselves to their own countries, and seldom remove to cool climates. Where the white and the negro live in the same country, especially where the climate is hot, or very mild, the latter is evidently the more precocious of the two, though not very markedly so, the difference on the average, being a fractional one. In cold climates, I do not believe that there is any difference, as then the negro is subjected to the depressing effect of a low temperature, which has a more proportioned influence over her than upon the white, she being evidently intended for a hot country.

QUARTERLY REPORT ON OBSTETRICS, & DISEASES OF WOMEN AND CHILDREN.

BLOODLETTING AS A THERAPEUTIC RESOURCE IN OBSTETRIC MEDICINE.* By FORDYCE BARKER, M.D., Clinical Professor of Midwifery and Diseases of Women, in the Bellevue Hospital Medical College, Obstetric Physician to Bellevue Hospital, etc. (N. Y. Med. Journal, Jan. 1871.) THE day following my return to the city, after my summer vacation, I was called to see a young married lady, in the sixth month of her first pregnancy, whose symptoms were such that I considered bloodletting indicated. Not being yet in full professional harness, I had no lancet in my pocket, and, as the residence of my patient was nearer the surgical instrument shop at the corner of Broadway and Thirtieth Street than it was to my house, I went there to procure a lancet, where my demand was politely answered by an expression of regret that there was no lancet in the shop. The fact that a lancet was not to be obtained in the only shop for the manufacture and sale of surgical instruments within two miles and a half of the centre of residence of the populalation of this great city struck me as most amusing, and, at the same time, as a most significant commentary on the change of practice which has taken place in the profession within the last thirty years. I presume that I should be correct in saying that our predecessors, in the same class and

* Read before the N. Y. County Medical Society, December 5, 1870.

number of cases, bled more frequently in a month, perhaps in a week, than any of us now do in a year. In all the consultations in obstetric practice, with members of the profession during the last fifteen years, I cannot recollect a single instance where bloodletting had been resorted to, or even alluded to as a therapeutic measure to be discussed, except in a few cases of puerperal convulsions. Thirty years ago, the standard authors who guided the practice of obstetrics, both in Great Britain and in America, were Denman, Clark, Burns, Hamilton, Gooch, Collins, Ryan, Conquest, Lee, Ramsbotham, Rigby, Gordon, Hay, Armstrong, Dewees, Velpeau (translated by Meigs), Francis, and Meigs. I find, from a careful examination of all these authors, that bloodletting is recommended as a therapeutic measure by one or all of them, for the following conditions, which occur during gestation, parturition, and the puerperal state. During gestation, this measure was advised by many of the above authors, and was not objected to by any, for the following symptoms; namely, uterine irritation and uterine plethora, erratic pains, cramps and numbness of the inferior extremities, spasmodic cough, palpitation, pruritus, varices, inquietude, loss of sleep, solicitude and anxiety, headache, drowsiness, vertiginous complaints, hemiplegia, anasarcous swellings of the inferior extremities, to prevent abortion, and also to promote expulsion where abortion is inevitable.* Velpeau quotes from Mauriceau the case of one woman who was bled from the arm eighty-six times in one pregnancy, and from De la Motte another case, in which, during the latter months of pregnancy, the woman was bled eighty-seven times, and each of the women was delivered at full term of a fine, large child.

During parturition, bloodletting was inculcated for false pains where the patient is plethoric or with a feverish disposition, for irregular uterine contractions, when the pains are feeble and the patient has feverish symptoms, for rigidity from premature escape of the waters, for extreme rigidity of the os or of the perinæum, to overcome cicatricial adhesions, to prevent abdominal inflammations, and to prevent and cure convulsions.

In the puerperal state, it was urged as the most essential part of the treatment for the arrest and cure of all the postpartum inflammations; as mammitis, metritis, phlebitis, and

* Francis recommends moderate venesection for the leucorrhoea of pregnancy. Francis's Denman. New York, 1825, p. 243.

peritonitis, and by many it was taught to be the principal therapeutic resource in phlegmasia dolens, puerperal fever, and puerperal mania.

Now, as some one of the above large catalogue of symptoms was pretty sure to occur during gestation, parturition, or the puerperal period, it came to pass that formerly a large majority of women were bled some time during the above periods. I dare say that all of us in active obstetric practice now and then meet with a jolly, vigorous grandmother, who tells us with a good deal of complacency that she has had eight, ten, or twelve children, as the case may be, and that she was bled from the arm once, and sometimes twice, "with each of her children." If my recollection be not at fault, the general sentiment of the profession brought about a reaction from what had become almost a routine in practice, long before the change was apparent in the doctrines taught by the standard obstetric authors.

It is an important question, however, to decide whether the reaction in this point of practice did not go too far. Were our predecessors all wrong, and has the recent practice been all right? For my own part, within a few years past, I find that, as my clinical experience becomes more enlarged, I am gradually getting to bleed more frequently; and this change of practice has not arisen from any belief on my part in a change of what has been termed "the constitutional type" of the diseases incidental to child-bearing. My convictions, that this resource in practice had been too much neglected by myself and others, had been progressively growing for some years, when they received a new impetus from reading a paper by one of the most original investigators and philosophical observers now living in England. I refer to the Introductory Address before the Medical Society of London,* by the President, Dr. Benjamin W. Richardson, "On Bloodletting as a Point of Scientific Practice." This paper is so full of thoughtful and practical suggestion, that I have been surprised that it has not been generally copied by the medical journals in this country. Whether the views of the author be accepted in full or not, no man in active practice can read this paper who will not find himself interested and instructed by its perusal.

I purpose in the following paper to study bloodletting as a remedy, exclusively in obstetric practice. It was in obstetrics

*The Practitioner, edited by Francis E. Anstie, M. D., F. R. C. P. November, 1868. Macmillan & Co., London.