METEOROLOGICAL REPORT for July, C. HENRI LEONARD, M. D. Observer for STATE BOARD OF HEALTH.

BAROMETER.-Highest, 30.169; lowest, 29.535; range, 0.632; average,

29.945.

TEMPERATURE.-Highest, 90 (two degrees higher than that of last, month); lowest, 53 (three degrees higher than that of last month); range, 37; average, 73 (only 2.3 degreees higher than last month). The same re mark applies to the temperature this mouth as I made last; viz: that the street temperature, owing to pavement reflection, etc., of heat rays, is higher than that of the thermometer from which our reports are read. This month, the general opinion to the contrary, has not been exceedingly hot. The mean temperatere for the month of July last year, was 76.1; thus showing our recent July was a cooler month by a daily average of over three degrees. If we take the average for the last five Julys (that of 1875 being the coldest, then 70.5), we find this year to be but one-half of a degree warmer than the average; not a very material increase of temperature certainly. Then why has it seemed so very oppressive? Because of the large excess of moisture in the air. This has been an exceedingly wet month, and the amount of vapor present has been immense; hence, the atmosphere has been heavier, and there has been a lack of transpiration. Sergeant Van Heusen, of the Signal Service, has observed this, and has so officially reported upon it. He also says that " Wednesday, the 12th, and Tuesday, the 18th, the very days upon which the heat was most severely felt, the absolute humidity (the number of grains of moisture in each cubic foot of air) was unusually great, though on neither of those days did the temperature approach so high a point as on other days when the heat was not so much complained of.

WINDS.-Greatest velocity, 36 miles per hour, the greatest velocity ever reached in the summer season at the Station since the Signal Service has been established here. This was on the 5th; the gale striking us at 9 a. m. and continued till I p. m. At quite a number of observations the velocity has been but 2 miles per hour. The prevailing direction was S. W., as last month, and the total number of miles travelled was 4,293; considerable less (over 300 miles) than for last month.

CLOUDS.-There were nine clear days this month, a gain of six over last; four cloudy, and 12 rainy ones.

RAINFALL.—Greatest daily, 1.68 inch; this was on the 10th. Next greatest, 1.52 inches; this was on the Ist. Greatest daily last month, one-quarter of an inch. Total amount for the month, 5.94 inches; almost a daily aver age (when it rained) of a half an inch. This fall has been unprecedented. In 1875 it was 3.73 inches; in 1874, 3.65; in 1873, 3.38 inches; in 1872, 2.63 inches inches. The total amount of precipitation this month was twelve times that of last.

MOISTURE.—The gross amount present at any one time was at the evening observation on the 12th; the day observations giving 8.20 and 8.40 grains. This was one of our memorable " oppressive days. The highest temperature that day was 88; the average, 80 degrees, Along the latter part of the month the amount has fallen off from this nearly one-half. It seems to me that the absolute humidity has much to do witn the abdominal troubles in children as well as adults. Throat and lung troubles also seem to depend something on it also. I am at present at work upon the problem.

OZONE.-There has been a gradual falling off of its presence. The maximum coloration was 2. This was at 2 p. m. of the 4th. The most of the observations have shown less than 1 (of the scale) present.

ТНЕ

PENINSULAR JOURNAL

OF MEDICINE.

SEPTEMBER, 1876.

Original Communications.

VICARIOUS MENSTRUATION: by C. HENRI LEONARD, M. D., Detroit, Mich. Read Before the Wayne Connty Medical Society.

To get at the question directly, I ask what is normal menstruation, and secondly what brings it about? If we can answer these intelligently, possibly the vicarious will be the easier of elucidation. I take no account now of ovulation, further than this: it is really the characteristic of the sexual life of woman, and of which the monthly passage of blood by the vagina is the regular symptom. This last clause, in brief, is my definition of normal menstruation-a symptom of ovulation. Now to understand the latter portion of the question, what brings this symptom about? The ovaries and uterus of woman are, of all her organs, preeminently in anatomical and sympathetic connection with that great nervous system, which is the general custodian of all animal life-the systema nervus sympatheticus. This sys

tem, by its vaso-motor apparatus, controls circulation, as well as the many other functions of the body that are not so intimately connected with our theme as to, at present, demand special attention. This apparatus as a whole, is constituted of two principal centres, and of nerve fibres. [Goltz, Masius, Van Lair, etc.] These centres are, 1st, the cerebro-spinal axis; 2d, the peripheral or vascular ganglions. I treated of these sufficiently in an essay upon the "Sympathetic Nerve " read you some time ago. The nerve fibres, are fibres of reunion of these centres, and are vaso-constrictor and vaso-dilator; in part centripetal, in part centrifugal. These fibres are often united in one trunk; the vaso-dilator are usually predominating.

Leaving the nerves now for a moment, we turn to the consideration of the blood-supply of the internal sexual organs of woman. The ovaries and uterus, in the main, are supplied from the same source, and by the same system of vessels, so much as to lead anatomists to class the vessels as utero-ovarian. The veins are equally anastomotic, and at their several exits are finally so intimately connected as to constitute the utero ovarian meshwork. As to the uterus, it is to the inner coat of its muscular walls, and especially the mucus membrane that the blood-supply is most profuse.

At each returning month there is a growth and maturation of the ovule of Baer, the Graafian follicles enlarging and pressing upon the firm fibrous covering of the ovary, thus engendering a flow of blood to the part irritated by the pressure, and just as you have an immensely swollen finger and hand from a whit low, you find the irritation becomes so great that you get a maximum turgescence of the whole ovario-uterine blood-vessels ending in the bloody exosmosis and epithelial degeneration of the uterine mucosa that we call menstruation. It is, in fine, a vaso-constrictor paralysis, and vaso-dilator excitement induced

by the pressure of the maturing Graafian folicle upon the nerve terminations of the sympathetic in the stroma of the ovary, and hence there results the customary hyperemia of the whole genitalia as results in nervous irritations elsewhere.

By the establishment of the menses the peculiar normal reflex nervous symptoms developed in other organs than the uterus are at once ameliorated and are finally felt no more; not so much because of a relief of the so-called general "menstrual plethora," but because the local blood pressure is being removed from the sensitive nerve filaments of the sympathetic that are found in and about the uterus and ovaries.

This, gentlemen, to my mind is, physiologically, normal men

struation.

What, now, is vicarious menstruation? Gynecologically we understand the term to mean a sanguinolent discharge, accompanying the usual other symptoms of ovulation, but taking place from some other organ than the uterus. Understand me, a vicarious menstruation does not fully take the place of, but it assumes the place of a normal monthly uterine discharge of blood. Is such a discharge physiologically possible, knowing as we do the physiological process of a normal menstruation? Normally the process is in most part reflex, due to a hyperæmia induced by a pressure upon the nerve filaments, and their resulting reflex action. Normally the sickness at the stomach, headache, ennui, etc., etc., is due to reflex nervous impressions. In fact, you can get pain or disturbed functions almost any where from uterine or ovarian irritations.

This reflex field is not narrowed to the influences of the uterus, but the phenomena are observed as taking place from nerve irritation in any of the organs. a paralyzed bladder, and paralyzed of the clitoris, similar, phenomena.

A phimosis may give us extremities; an irritation Worms in the bowels may

give us convulsions; sexual intercourse, epilepsy; and so on with numerous other instances that I need not mention, except the latest, that of hypermetropia and strabismus as causes of chorea. Now all of these various conditions are dependent upon perverted nervous action. The peripheral filaments are irritated, the irritation is conveyed to one of the principal centers, and the normal nerve cell action is perverted and paralysis of certain nerves result, while others are the victims of an untoward stimulation. The circulatory system is most of all under the control of this great sympathetic system, and hence we herein find many of our strangest phenomena. Who but a physio-pathologist would think of looking for the cause of a red nose in a lady, not a prostitute or victim of venerial disease, at her uterus? Yet it is a well known fact that a suppression or obstructed menstruation is a common cause for acne rosacea; certainly a foreshadowing of the completed vicarious function in the common nose-bleeding of menstrually deranged women. Both of these are vaso-motor paralyses. Gynæcologists, gentlemen, are not alone "run mad" over a woman's uterus, as some narrow-minded practitioners seem fond of averring; our dermatologists are equally insane, you see, upon some of the occult causes of the common pathological phenomena observed in their special departments.

There is yet another allied condition to our vicarious menstruation seen in our migraine-our hemicrania sympathetic paralytica and tonica. You see the classical name for the disease is fully descriptive of the cause of the complaint; a paralyzed (most frequently) condition of the sympathetic vaso-constrictors, and the result is a hemicranial congestion, and pain. I have seen profuse watery discharges from one nostril, and one eye (the left generally) in these peculiar headaches. The cause of this peculiar complaint in women is attributable to perverted