hat actually ravage their nervous system; efforts that
but slightly fatigue stronger organizations, are completely exhausting
to theirs; health, indeed, is only possible to them while they may be
sheltered from exposure, saved from exertion, and carefully screened
from excitement and shock.

The method, therefore, suggested by Dr. Clarke for enabling young girls
to master Latin and Greek without sacrifice of their health, seems to us
to be addressed to the wrong element in the group of supposed causes.
In the cases related by Dr. Clarke, there is nothing to show that the
menorrhagia was occasioned by study during the week of menstruation,
rather than during the three weeks that preceded it. Nor that even then,
the true cause of disease was to be found in the intellectual exertion
of mastering the school text-books, rather than in the moral excitement
due to competition, haste, and cramming, or the close confinement
necessitated by prolonged school hours, and unhealthy sedentary habits
out of school.

The complexity of causation in such instances may be well illustrated by
the following case, that I select on account of its great resemblance to
the type described by Dr. Clarke.

A young girl of sixteen consulted me on account of menstrual haemorrhage
so excessive as to induce complete exhaustion, bordering upon syncope.
She had menstruated for two years--during the first, in quite a normal
manner--but during the second, had become subject to these menorrhagic
accidents, since residence at boarding-school. It would have been easy
to decide that the disturbance was directly due to the severity of the
mental efforts exacted by the _regime_ of the school. But on further
inquiry it appeared: first, that the mother of the girl had always been
subject to menorrhagia, and it is well known that this often occurs
exclusively as the result of hereditary predisposition. Second, that
just before the entrance to school, and the disturbance of menstruation,
the girl had been living in a malarial district, and had suffered from
malarial infection, which is again a frequent cause of menorrhagia.
Third, that the studies pursued at school were unusually rudimentary for
a girl of sixteen, and indeed, below the natural capacity of her
intelligence, had this been properly trained. But the hours of study
were so ill-arranged, that the pupils were kept over their books, or at
the piano, nearly all day, and even in the intervals allowed for
r