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All physicians are aware of the frequent dependence of menorrhagia upon anemia, not only acquired, but congenital. The existence of anemia, or of an imperfect elaboration of the blood and vascular system, previous to the occurrence of the first menstruation, is a possible condition of menstrual disorder that must always be very carefully eliminated before any other cause be assigned.
Van Swieten mentions a young lady who from her twelfth year at her menstrual periods had hemorrhages from pustules in the skin, the pustules disappearing in the interval.
Unless conception takes place these preparations, which represent the most important phase in the menstrual process, are without value; and therefore failure to conceive means that the mucous membrane will return to the same condition as existed before the preparations were begun.
Since miscarriage often occurs about the time a menstrual period would ordinarily be expected, there is unusual opportunity for confusing the symptoms. At all events women err much more frequently in suspecting that they are pregnant than in overlooking the condition.
Chemical changes in the blood and tissues are constant vital phenomena; increased oxidation causes increased activity of the circulation, increase of temperature, increase of urea and carbonic acid in the economy from retrograde changes, and, finally, during menstrual life the flow of blood from the uterus carried off the effete materials from the highly charged system.
Special studies in many parts of the country, especially during the war, have made it clear that girls in the adolescent stage are definitely aware of the need for clean and trustworthy instruction on matters pertaining to the relations between the sexes, to the control of the emotions, to the care of the body during the menstrual period, and to other problems arising from the facts of sex.
+Variations on the Rule.+ It should never be forgotten that all these rules are subject to variation, and that where one woman may have a series of miscarriages so close together that she mistakes them for heavy, irregular menstrual flows, and never realizes she is pregnant, another may bear a living child the first time after her infection, or still another woman after one miscarriage may have a child so nearly normal that it may attain the age of twenty or older, before it is suspected that it has hereditary syphilis.
And the days, with Sundays at their head, formed into hebdomadal squads; and the weeks, captained by the full moon, closed ranks into menstrual companies crying "Tempus fugit" on their banners; and the months marched on toward the vast camp-ground of the years; but Webb Yeager came no more to the dominions of his queen.
"And Girika, the wife of Vasu, after her menstrual course, purifying herself by a bath, represented her state unto her lord. And the king, thinking that the command of the Pitris should not be disobeyed, went a- hunting thinking of Girika alone who was gifted with great beauty and like unto another Sri herself.
It must be remembered also that the time when the menstrual flow is beginning to cease is probably, more than any other period of the month, the biologically proper time for sexual intercourse, since not only is intercourse easiest then, and also most gratifying to the female, but it affords the most favorable opportunity for securing fertilization.
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