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It is not difficult, in this case, either to discern the cause of the trouble, or to trace its influence, through the varying phases of disease, from Miss A---'s school-days, to her matronly life. She was well, and would have been called robust, up to her first critical period. She then had two tasks imposed upon her at once, both of which required for their perfect accomplishment a few years of time and a large share of vital force: one was the education of the brain, the other of the reproductive system. The schoolmaster superintended the first, and Nature the second. The school, with puritanic inflexibility, demanded every day of the month; Nature, kinder than the school, demanded less than a fourth of the time, -- a seventh or an eighth of it would have probably answered. The schoolmaster might have yielded somewhat, but would not; Nature could not. The pupil, therefore, was compelled to undertake both tasks at the same time. Ambitious, earnest, and conscientious, she obeyed the visible power and authority of the school, and disobeyed, or rather ignorantly sought to evade, the invisible power and authority of her organization. She put her will into the education of her brain, and withdrew it from elsewhere. The system does not do two things well at the same time. One or the other suffers from neglect, when the attempt is made. Miss A--- made her brain and muscles work actively, and diverted blood and force to them when her organization demanded active work, with blood and force for evolution in another region. At first the schoolmaster seemed to be successful. He not only made his pupil's brain manipulate Latin, chemistry, philosophy, geography, grammar, arithmetic, music, French, German, and the whole extraordinary catalogue of an American young lady's school curriculum, with acrobatic skill; but he made her do this irrespective of the periodical tides of her organism, and made her perform her intellectual and muscular calisthenics, obliging her to stand, walk, and recite, at the seasons of highest tide. For a while she got on nicely. Presently, however, the strength of the loins, that even Solomon put in as a part of his ideal woman, changed to weakness. Periodical hemorrhages were the first warning of this. As soon as loss of blood occurred regularly and largely, the way to imperfect development and invalidism was open, and the progress easy and rapid. The nerves and their centres lacked nourishment. There was more waste than repair, -- no margin for growth. St. Vitus' dance was a warning not to be neglected, and the schoolmaster resigned to the doctor. A long vacation enabled the system to retrace its steps, and recover force for evolution. Then the school resumed its sway, and physiological laws were again defied. Fortunately graduation soon occurred, and unintermitted, sustained labor was no longer enforced. The menorrhagia ceased, but persistent dysmenorrhea now indicates the neuralgic friction of an imperfectly developed reproductive apparatus. Doubtless the evil of her education will infect her whole life.

The next case is drawn from different social surroundings. Early associations and natural aptitude inclined Miss B--- to the stage; and the need of bread and butter sent her upon it as a child, at what age I do not know. At fifteen she was an actress, determined to do her best, and ambitious of success. She strenuously taxed muscle and brain at all times in her calling. She worked in a man's sustained way, ignoring all demands for special development, and essaying first to dis-establish, and then to bridle, the catamenia. At twenty she was eminent. The excitement and effort of acting periodically produced the same result with her that a recitation did under similar conditions with Miss A---. If she had been a physiologist, she would have known how this course of action would end. As she was an actress, and not a physiologist, she persisted in the slow suicide of frequent hemorrhages, and encouraged them by her method of professional education, and later by her method of practising her profession. She tried to ward off disease, and repair the loss of force, by consulting various doctors, taking drugs, and resorting to all sorts of expedients; but the hemorrhages continued, and were repeated at irregular and abnormally frequent intervals. A careful local examination disclosed no local disturbance. There was neither ulceration, hypertrophy, or congestion of the os or cervix uteri; no displacement of any moment, or ovarian tenderness. In spite of all her difficulties, however, she worked on courageously and steadily in a man's way and with a woman's will. After a long and discouraging experience of doctors, work, and weaknesses, when rather over thirty years old, she came to Boston to consult the writer, who learned at that time the details just recited. She was then pale and weak. A murmur in the veins, which a French savant, by way of dedication to the Devil, christened bruit de diable, a baptismal name that science has retained, was audible over her jugulars, and a similar murmur over her heart. Palpitation and labored respiration accompanied and impeded effort. She complained most of her head, which felt "queer," would not go to sleep as formerly, and often gave her turns, in which there was a mingling of dizziness, semi-consciousness, and fear. Her education and work, or rather method of work, had wrought out for her anemia and epileptiform attacks. She got two or three physiological lectures, was ordered to take iron, and other nourishing food, allow time for sleep, and, above all, to arrange her professional work in harmony with the rhythmical or periodical action of woman's constitution. She made the effort to do this, and, in six months, reported herself in better health -- though far from well -- than she had been for six years before.