ecreation, no exercise was enforced. It was therefore frequently
neglected, and the girl, with hereditary predisposition to menorrhagia,
increased by malarial infection, and also by certain rheumatic
tendencies, was allowed to expend upon elementary text-books an amount
of time, attention, and nervous energy, that would have been deemed
excessive for the most valuable intellectual pursuits.

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. It is, moreover, extremely frequent. Others
exist, but are more rare--as peculiar congenital predisposition to
haemorrhages, with or without true hemophilia[45].

With such causes (anemia, rheumatism, malarial infection, hereditary
predisposition), the observance of rest during the menstrual week would
be quite ineffectual so long as the _regime_ of the other three weeks
remain uselessly unhygienic. If the menstrual crisis finds the uterine
blood-vessels already deprived of tonicity through nervous exhaustion
or other cause, haemorrhage is as likely to occur as if that tonicity
were only exhausted at the epoch of menstruation. In the cases described
by Dr. Clarke, the cure was effected, when at all, not by an
intermittence of study, which does not seem to have been tried, but by
its complete cessation, together with that of all the conditions by
which it was accompanied.

Again, therefore, it may be said, that wherever such intermittence is
not superfluous, it would be inadequate for the purpose for which it is
designed.

But this conclusion may seem to be much more severe, and, to those
interested in the education of girls, much more disagreeable than that
formulated by Dr. Clarke. We firmly believe, however, that truth never
can be disagreeable when it is really understood in all its bearings and
all its consequences, and conversely, that any proposition framed with a
view to supposed desirableness rather than veracity, is almost certain
to lead in the end to consequences quite undesirable. We will not,
therefore, try to decide whether it may be more agreeable to believe
that the health of adolescent girls requires general and permanent
supervisio