=Vicarious menstruation= is an escape of blood from other parts of the body coincident with menstruation. Blood may ooze through the skin covering the breasts; also from hemorrhoids or from the surface of ulcers. Or there may be nose-bleeding, vomiting of blood or pulmonary hemorrhage, particularly among tuberculous patients. Vicarious menstruation usually occurs among nervous, high-strung women and may be regarded as an evidence of ill health. The amount of blood lost in this way is much less than the amount of the menstrual flow. =The menopause=, also termed the climacteric and the change of life, marks the permanent cessation of menstruation and of sexual activity. It occurs ordinarily between the ages of forty and fifty; the majority of women stop menstruating at their forty-sixth year. The menopause has occurred as early as the twenty-fifth year, and as late as the eightieth or ninetieth year. But such cases are, of course, extremely rare and their infrequent occurrence is of interest rather than of importance in an effort to ascertain the general average. As the child-bearing period is normally about thirty years in duration, the prevailing belief is that the menopause comes earlier to women who began menstruating early, than to those who did not reach puberty until later. Some authorities contend, however, that early menstruation indicates extreme vitality, and that this vitality tends to prolong the child-bearing period. According to this theory, then, the menopause would come late to those who matured early and vice-versa. As the menopause approaches, menstruation occurs irregularly; the discharge sometimes increases slightly but usually diminishes in amount and finally disappears altogether, while the generative organs all undergo atrophic changes. Bearing in mind the disquieting effect of adolescence, and of ovulation, upon the general nervous, mental and physical state, we may reasonably expect that a complete cessation of the ovarian function would be attended by more or less disturbance of the general well-being. It is true that very many women suffer a certain amount of nervous instability at the menopause; they tire easily; have “hot flashes” and possibly headaches. But under ordinary conditions the discomfort is not great, and after the function has entirely ceased and they become physiologically adjusted to the new order of things, these women often enjoy better health than ever before. Unfortunately wide currency has been given to exaggerations concerning the symptoms of the menopause. The result is that serious organic diseases which are in no way related to the climacteric are not infrequently attributed to it. For this reason excessive bleeding, heart symptoms and what not are all too often accepted as a matter of course, and accordingly neglected until the patient is beyond medical aid. This is particularly and tragically true of cancer of the uterus.