The _treatment_ consists in rest in bed, the application of warm fomentations to the lower abdomen, and hot foot-baths. Especial care of the general health should be observed at the following menstrual period. =Scanty Menstruation.=--Scanty menstruation occurs when the menstrual flow is much less than normal. It must be remembered that individual peculiarities in this respect may be within the limits of health. When one or more periods are missed, and the flow shows a continual tendency to diminish in amount, treatment may be demanded. The causes and the treatment of scanty menstruation are those which have already been considered under Amenorrhea. =Vicarious Menstruation.=--Vicarious menstruation is the discharge of blood, at the menstrual periods, from some part of the body other than the uterus. In some cases, instead of a discharge of blood, a secretion of another character takes place. The vicarious discharge may be the only phenomenon present, or it may occur supplementary to the normal uterine bleeding. The vicarious bleeding may take place from almost any part of the mucous or cutaneous structures. It occurs from the nose, the throat, the lungs, the stomach, the bladder, and the anus. It may occur from an ulcer or other lesion of the external surface. Sometimes the cutaneous hemorrhages appear in the form of ecchymoses. Various secretions may take the place of the bleeding. A monthly flow of milk from the breasts has been observed, and a periodical diarrhea or leucorrhea has taken place. Vicarious menstruation is a rare condition. It may occur in defective development of the uterus and ovaries. It is usually found in debilitated nervous women, and accompanies a deficient menstrual discharge from the uterus. _Treatment._--Direct local treatment should be applied to the vicarious bleeding only when it becomes excessive. The general health of the woman should receive attention. Treatment should be applied to any local lesion of the genital apparatus that may be discovered. The directions given for amenorrhea are also applicable here. CHAPTER XXXV. THE MENOPAUSE. The menopause is the final cessation of menstruation. The age at which it occurs is dependent upon a great variety of conditions--nationality, climate, mode of life, constitutional and local diseases. In the northern countries of Europe the menopause is said to appear later than in the southern; in England, later than in America. It has been observed that country women menstruate to a later age than city women. The woman who bears a number of children in rapid succession and suckles them not infrequently has a premature menopause. The menopause may appear early in very fat women and in women who are the victims of tuberculosis, nephritis, and diabetes. Disease of the uterus, tubes, and ovaries may retard the menopause. In fibroid tumor of the uterus the menopause may be delayed for several years.