in constant active rhythm. It is the seat of the menstrual blood.

The oviducts, hyperemic, enlarge, their tissue softens, their spirals become more extended, they swell from congestion and edema. From their increased size they feel thicker and stiffer, and extend more distalward from weight and following the uterus. The venous congestion of the mesosalpinx is extensive. The lymphatics are engorged. The oviducts are in a constant state of peristalsis during menstruation from active congestion, bathing the automatic menstrual ganglia with an extra amount of blood. The vagina becomes blue, hyperemic, swollen, edematous. The rugæ vaginæ thicken, and the vaginal lumen narrows. The vaginal secretions are increased. The proximal end of the vagina is forced distalward by the heavy, enlarged uterus and portio vaginalis. Blood and mucus are found in the vagina. The vulva is enlarged and edematous from active congestion. The labia minora thicken, appear erect and become reddish blue. The labia majora swell and manifest more pigmentation. The vulvo - vaginal and peri-urethral glands increase in activity, extra mucus appearing in the vulva. The characteristics of the vulva during menstruation are hyperemia and glandular secretion and more coloration.

The genital glands secrete more actively, producing a peculiar odor, a remnant faricient of animal sexual life.

The genital apparatus (vagina, uterus, oviduct and ovary) is supplied by the spiral segment of the utero-ovarian artery, and each segment shares in the menstrual congestion, because the tractus genitalis lies along the periphery of a vascular circle. Now all structures adjacent to the genital apparatus which are supplied by the utero-ovarian artery will share in the menstrual congestion.

The cause of menstruation is stated especially by recent German authors to reside in the ovary. Strassman considers that his experiment of injections in the ovary, increasing blood pressure, causing hyperemia of the uterus and external genitals, proved that menstruation is caused by ovulation. This experiment does not conclusively bear out the theory, because the utero-ovarian artery is a distinct circle whose arcs and arcades

were originally found in the Wolffian body, and hence if one segment (the spiral segment) of the genital vascular circle be stimulated, the remaining or adjacent segments will share in the stimulation and congestion. Menstruation depends on the integrity of the whole genital apparatus, nerve, vessel, muscularis and mucosa, and especially its two special organs-the menstrual organ (uterus and oviducts) and the ovulating organ (ovary.)

The excessive articular glandular activity is especially noted by excessive mucus in the pre-menstrual and post-menstrual phases, i.e., at the beginning and ending of the bloody flow. Mucus flows with the menstrual blood, but the blood obscures it. The menstrual blood is normally fluid; it coagulates-is perhaps hardened by the alkaline cervical secretion. If the menstrual blood be large in quantity and rapid in flow, the alkaline secretion is insufficient to prevent coagulation, and hence clots of various sizes may become formed in the cavum uteri or vagina.

Microscopically the menstrual blood shows red and white blood corpuscles, epithelium of the tractus intestinalis, mucous cells, and numerous microorganisms. The average quantity is 2 ounces.

The monthly rhythm occurs under certain types—as 28 day or 31 day type. In some women the menstruation recurs punctually, almost to the hour, in others its recurrence shifts one or two days in both directions. During gestation the bloody flow ceases from the genitals, but the woman may manifest symptoms of recurrence, as congestion and secretions from the genitals and nose. Also the breasts may swell, become sensitive, and premature parturition may occur. During nursing of the child the monthlies nearly always cease.

Molimina menstrualia, or physical (and rarely mental) disturbances of a general or local nature, occur in most subjects during menstruation. A woman may be otherwise perfectly well, but suffer disturbances. The menstrual disturbances are mainly in the pre-menstrual, but occasionally in the intra-menstrual, phases. They are easy tiring, burning, dragging. I remember one woman of 25 who had almost exactly three hours' pre-menstrual pain at each month, for which, unfor

tunately, a general surgeon performed hysteropexia. The patient was worse, but fortunately, in about a year, the uterus became freed, when she began a rational treatment for her endometritis and myometritis.

The pain which occurs during the intra-menstrual phase is mainly due to myometrial contractions caused by blood coagula in the cavum uteri. The mammary parenchyma shows slight nodular thickening. Mainly the disturbances of the breast occur in the pre-menstrual phase, and disappear with the beginning of the flow; the nipple projects erect, the areola darkens, the glands enlarge, and ill-defined pains exist, due to nerve pressure-trauma, from congestion.

The general manifestation of menstruation is an irritable debility. The woman of culture, as is shown by her nervous state, doubtless suffers more general disturbance than the woman of physical labor. There is no doubt that the menstruating woman conceals many of her subjective symptoms. It is frequently observed by the gynecologist that she is incapable of physical labor or persistent mental effort. As special but irregular symptoms are to be noted that she becomes easily physically and mentally tired or exhausted, she suffers flying pains and heat, palpitations, and especially headache or head pressure; nausea, but rarely vomiting, occurs; appetite is lessened, stools are retarded, the thyroid gland swells, the voice is somewhat hoarse, noticed especially in singers; the conjunctiva becomes slightly congested, tears easily arise, and dark shadows appear below the eyes; the field of sight becomes changed, the eye inflammations increase, asthenopia is intensified, and sweat secretion and salivation increase.

The general disturbances of menstruation are vaso-motor and reflex irritation. Woman's physical and mental condition is, in the vast majority of cases, changed during the four great functions of the sexual sphere-viz., menstruation, gestation, puerperium, and lactation. Ordinary functions are not accompanied with pathologic disturbances, but when a woman passes through the functions of menstruation, gestation, puerperium and lactation she is almost always afflicted with pathologic disturbances (physical and mental). Man has no sexual functions accompanied with pathologic conditions.

As regards the casual connection of ovulation, vascular waves, menstruation disturbances and climacteric symptoms, literature presents many hypotheses. Under one hypothesis is produced by the influence of ovulation in the sexual adult woman a continuous formation of substance for the nourishment of the fetus. This substance accumulates during the vascular wave ("flow"); we may represent the rhythmical vascular waves of woman's functional life by the ebb and flow of the ocean tides. If pregnancy does not occur the accumu lated substance passes away through menstruation (“ebb”).

In the climacterium the substance continues for some time to accumulate, and there being no ebb creates the pathologic symptoms of the menopause. However, we do not know the natural history of an ovarian follicle, its time of maturation or its exacerbation or checks by vascular waves.

An adult sexual woman is liable to become pregnant at any time. Therefore we are not in possession of sufficient data to say whether the ovum of the last menstruation or the ovum of the non-occurred menstruation is impregnated.

The entrance of menstruation depends on climate, race and condition of living. Climate has reference to temperature and its results. Race has reference to heredity.

Conditions of living has reference to labor, education, culture, customs.

CORRESPONDENCE. '

THE SARATOGA MEETING.

SARATOGA SPRINGS, N. Y., June 10-13.

Editor Memphis Medical Monthly:

In compliance with your request, I am jotting down a line here and there, of that which may be of more or less interest to our absent brethren, concerning the Saratoga meeting of the A. M. A.

First and foremost will be mentioned the reunion of kindred spirits, as they converged to meet at the different gateways along the line. Our Memphis party this year was shockingly thin; the whole contingent from the "Three States" might

easily have been counted on the fingers of one's two hands, and have had fingers to spare. And it was with such extreme persuasion that these were prevailed upon to go, that their names deserve a page in medical history: Dr. Frank A. Jones, Chairman of the Section on Practice, A. M. A., of Memphis; Dr. and Mrs. E. C. Ellett, Memphis; Dr. and Mrs. G. W. Hudspeth, Little Rock, Ark.; Dr. J. B. McElroy, of Stovall, Miss.; Drs. J. P. Runyan and J. A. Dibrell, Little Rock, Ark.; Dr. S. P. Collings, Hot Springs, Ark.; Dr. Adam Guthrie, Prescott, Ark.; Drs. Herron and Shannon, of Jackson, Tenn.; Dr. G. C. Savage, of Nashville, Tenn., and Dr. Hall, of Mississippi.

At Cincinnati there were six hours to make use of before we could get a through train out for our destination. These six hours were consumed in a very pleasant trolley ride to Eden Park and the famous Cincinnati Zoo. This latter place is only another of those extremely interesting resorts, where one might spend hours, and even days, profitably.

At 6:30 in the afternoon we joined with the Cincinnati and Louisville delegations, and embarked upon the Southwestern Limited, to remain nearly twenty-four hours. About an hour's ride brought us upon a settlement of well-kept farms and stately farm-houses, nestling among the hills and the valleys, made more peaceful and homelike by the deepening shadows of the fading day. This beautiful spot was pointed out by the gentleman himself as the early home of our former President. Dr. Charles A. L. Reed, of Cincinnati.

A point of interest along here is the old Miami and Erie canal, which now apparently serves no better purpose than that of supplying moisture for vegetation along its coursethis is especially true of the lower or southern extremity of this canal. The real and early use of the great canal system inaugurated by Gov. DeWitt Clinton, the canal governor of New York, 1817-28, was graphically exemplified to the casual observer by the presence of man, mule, tow-path, tow-line and canal boat on the Erie canal which connects Lake Erie atBuffalo and the Hudson river at Albany and Troy, and on the old Morris canal, between the Delaware and Hudson rivers. The latter was constructed by a Mr. Douglas, of New York. The length is 108 miles between the two rivers, and the whole