The first statement that menstruation in woman is analogous to œstrus in lower animals is one which is entirely wrong, and from it many of the subsequent errors have sprung. In the last edition of my book on "Diseases of the Ovaries," I dismiss this question with the sentence, (p. 27) "that menstruation is a new feature in sexual life introduced high up in the scheme, and has no analogy to the oestrus or rut among the lower animals, is surely proved by the close reasoning of Arthur Farre (article "Uterus," Encyclopædia of Anatomy and Physiology)." In such a work it was not necessary to argue this question at length, and in thus giving my authority I thought I had discharged my duty. Not so, however, think some of my critics. One of them recently, in a well-known English journal, has attacked me on my ignorance of the physiology of menstruation; and I am therefore disposed to make one more effort to uproot the mistaken views on menstruation still held almost universally, as if Ritchie, Kesteven, Farre, and Jackson had never written on the subject. In the article I have just referred to, Arthur Farre shows that with the facts of congestion of the organs and periodicity of return, with an occasional coincidence of an extrusion of an ovum, as ascertained by a few rare post-mortem examinations, the analogy between menstruation and rut ends; and here I may add, that even in the matters of periodicity and congestion the analogy is faulty. The congestion which in women reaches such a degree as to permit of free loss of blood, in animals goes so far as to permit only of the exudation of a quantity of mucus for the lubrication of the passages and the discharge is rarely tinged with blood in some of the higher domesticated animals. In such an animal as the guinea-pig, where the whole process can be watched with ease, and where I have watched it in hundreds of instances, not a blood corpuscle can be found in the mucus, unless the examination be made just as the cohesion of the vestibule is being undone, that is, really before the rut has begun. The periodicity of the rut in animals is far too faulty to be compared with the regular menstruation of the majority of women. Dr. Farre points out that it is during oestrus, and then only, that the females among the lower animals will receive the males. I may add to this, that there are some animals whose anatomy is so peculiar that it is possible for them to receive the male at the oestrus only. Thus, in the guinea-pig there is no vagina at all, save for about forty-eight hours, at the period of heat. It is also very well known that in many animals the male is equally affected, and that it is during the heat of the female only that semen is secreted by the male. Save during the oestrus of the female, the testicles of the male rat are hardly perceptible, whilst during this period they are of enormous size. "Now," says Dr. Farre, with regard to the human subject, whatever may be possible during menstruation, yet essentially the intervals of the menstrual act are the times of fertility in women." This is absolutely proved by the fertility of the Jewish women, with whom intercourse is suspended for eight days after the appearance of menstruation, and in strict observers of Rabbinical rule for thirteen days. 66 The correlative statement made in the extract, with which I opened this paper, that it is at the menstrual period that women have stronger sexual desires, is one for which, I think, there is not the slightest foundation. It is manifestly a point on which it is difficult, almost impossible, to obtain evidence, either accurate or extensive; but what evidence I have been able to procure directly and very emphatically contradicts the statement. What I allude to is the statements of men with whom it has been necessary to discuss their marital relations, and I find that neither in man nor in woman is there any other than a distinct feeling of repulsion to the marital act during menstruation. Here, then, we have not only an absence of analogy between oestrus and menstruation, but an absolute indication that they are distinct functions; and in women we have no indication whatever of an œstrus, so far as the sexual life is concerned. Let us see if we have any indication of it as far as the maturation and egress of ova are concerned, since these processes form prominent features of the oestrus of animals. The main question of the enquiry is really this has the so-called ovarian excitement, alleged to arrive at the ripening of a follicle, anything to do with the process of menstruation? Subsidiary to this is another issue raised by the consequent assertion that the follicular discharge occurs once a month. Finally, we have to give an answer to the very pertinent question of Dr. Reeves Jackson :— "Will the ovulation theory of menstruation stand?” Toiling through the writings of physiologists and physicians previous to 1843, seeking for information on the development of our knowledge of the anatomy, functions, and diseases of the ovary, is, I think, one of the most unsatisfactory employments in which anyone can engage. It is perfectly true that, here and there, as in the pages of Morgagni, we get a perfectly accurate observation, yet, on the whole, the story is but a wearisome repetition of what we experience now-a-days. No sooner is a bacillus discovered, than it is ridden to death, and every disease is ascribed to its omnipotence and omnipresence. So was it in Leeuwenhoeck's time, that the discovery of the spermatic animalculæ raised a cloud of false theory, and still more false observation, the obstructive results of which have not yet passed away. No completely accurate statement of the function of ovulation was made till the appearance of the papers by Dr. Ritchie, of Glasgow, in the old London Medical Gazette of 1843. These papers were epoch-making, and from them dates also the inception of accurate views of ovarian pathology. It has always been to me a matter of wonder that those papers have had so little influence. They have not been neglected; they have been and are now frequently quoted, and their conclusions have been often and I believe completely confirmed, yet the majority of the writers on physiology and gynecology wander on as if the papers had never been published. The papers are of the most business-like character; a dry detail of facts, and from the conclusions there is no escape. The first of these which may engage our attention is that "the ovaries of newlyborn infants and of children are occupied sometimes numerously by Graafian vesicles or ovisacs, which are highly vascular as early as the sixth year, and vary in size from the bulk of a coriander seed to that of a small raisin; in the fourteenth year, at which time also they are filled with their usual transparent granular fluid, their contained ova can be detected, and their coats are so elastic that their contents on their rupture may be projected to at least twelve inches; the existence of menstruation not being essential therefore to these conditions, either as a cause of them, or as an effect, and the possibility even at this age, should rupture of the follicles occur, of their contained ova being conveyed to the uterus along the Fallopian tubes, kept patent by their peculiar secretion, will be admitted." "The Graafian vesicles found in the ovaries prior to menstruation are found, as they also are in every other period of life, in continual progression towards the circumference of the glands which they penetrate, discharging themselves by circular-shaped capillary sized openings in the peritoneal coat, the presence of the catamenia being thus no indispensible pre-requisite to their rupture." The establishment of menstruation does not neces 66 sarily give rise to any immediate modification in the Jewish people with such force that I give his words in manner in which the ovisacs are discharged, or in the full. subsequent changes which these bodies undergo. The According to the Mosaic law, sexual intercourse is ovisacs of the human female do not require the estab- prohibited until after the eighth day after the appearlishment or presence of menstruation for their develop-ance of the catamenia; to this strict Jewesses add five ment or rupture. Graafian follicles of some size were found in the ovaries for fifteen years after the critical age, and the discharge of attenuated minute vesicles, apparently simple cells, from the surface of the glands appeared to terminate only with life. Dr. Ritchie gives an extremely interesting account of the development of the ovular theory of menstruation having risen apparently in one of the essays of Sir Everard Home. When this author confined his original researches to hunting up some unpublished memoranda of John Hunter, he never went very far wrong, but when his originality was intrinsic his blundering became intense. Dr. Power, in 1820, assumed and apparently confirmed the correctness of Sir Everard, and various writers followed suit till an apparently genuine contribution appeared in the Traité Philosophique de Médecine Pratique, by M. Gendrin, and established the theory. Dr. Robert Lee appeared on the scene and then began the great battle of the true and false corpora lutea, a battle based on the assumption of the ovular theory of menstruation, having for its object the establishment of a corollary as false as the main proposition, and constituting a quarrel as bitter, as fruitless, and as foolish as any to be found in the record of medical amenities. The struggle was only fading away when I entered college. days more in obedience to a Rabbinical precept, and yet these women are equally if not more prolific than other females. Thus, if the ova be discharged only at the monthly period, these individuals become pregnant before the discharge of the ova. But the rigid observance of these injunctions by a large number of Jewesses, coupled with the known experience of accoucheurs generally, that impregnation may and does take place immediately before the menstrual periods, affords a much stronger proof that the maturation of ova occurs at any time, than the occasional and infrequent observation of recently ruptured ovisacs concurrently with menstruation affords of the menstrual flow." Mr. Kesteven's statement about the general experience of accoucheurs is confirmed in Merriman's synopsis. I have made a very diligent search for other contributions to this subject in the medical literature of the last 25 years, but with singularly barren results. Everywhere I am met by the accepted tradition that menstruation is due to the period of ovarian excitement due to the ripening of a Graafian follicle, and that the termination of this is the grasping of the ovary by the infundibulum of the oviduct at the precise spot where the follicle is ready to burst. Here and there, however, an occasional authority breaks away from the tradition, and gives an independent statement. Thus, Professor Hirsch (Schmidt's Jahrbuch for 1850), concludes that menstruation in women has no analogy with the heat of beasts, that fructification can be accomplished at any time, not at the period of menstruation only, as in the lower animals, and that the function of the ovary is to be continually producing mature ova. During the whole of the controversy upon these two points, lasting over fifty years, of course there were innumerable experiments upon animals. That these experiments were wholly useless is beyond doubt, and that they were entirely misleading is now universally admitted. Lest I should be charged with expressing a prejudiced opinion on this much debated subject, I shall content myself with quoting the ipsis- In the Archives de Physiologie for May, 1874, Dr. sima verba of Dr. Ritchie, written in 1842; "but un- K. Slavianski states, as the result of his observations, fortunately for science, and for multitudes of suffering that the development and maturation of the Graafian quadrupeds sacrificed in a mistaken line of investiga-vesicles do not take place in any regular periodical tion, this conclusion did not happen to be verified by fashion, and that there is no connection between these actual dissection." He further on speaks of the various conditions and menstruation. This latter physiological misconceptions to which this method of investigation phenomenon is entirely independent of the former. gave rise, and shows conclusively that by no experi- Dr. De Sinèty, to whom we owe an immense debt for ments on animals could the enigmas of human ovula- the elucidation of very many important points in the tion and menstruation be solved. It was by post-anatomy, physiology, and pathology of the ovary, in a mortem dissection that he made his discovery, and it is by ante-mortem dissection that I am in a position completely to confirm it. After Ritchie's papers, the next contribution in order of date is in the Medical Gazette for 1849, by Mr. W. Bedford Kesteven, a very well known practitioner in the north of London, still living, I am glad to say, in honourable and well deserved retirement. Mr. Kesteven has made some notable communications in the direction of original research, and though there is little that was really new in the paper now under notice, it confirmed the views of Ritchie in very terse and convincing language. Thus, in answer to the one argument used against Ritchie, that in a few instances follicles had been found either just ruptured, or on the point of rupturing in women who had died during menstruation, Mr. Kesteven says, "As ovulation is a constant function of the ovaries, and menstruation an occasional function of the uterus, the two may be expected to be found occasionally concurrent." paper communicated to the Société de Biologie on December 2nd, 1876, narrates a case of great importance by which menstruation without ovulation is established. Dr. A. Reeves Jackson published a very important paper in the American Journal of Obstetrics for October, 1876, in which he summarised what had been done by Ritchie and others, and he deals in a most forcible fashion with some of the more recent advocates of the ovular theory. Thus, at page 147 of Dr. Robert Barnes' book on "Diseases of Women," is a series of facts given, but singularly perverted, and of this kind of treatment Dr. Jackson most justly says, "Such a course as is indicated in the foregoing instances, is more reprehensible than reasoning without facts; it is reasoning against them. Yet these are only samples of the sort of argumentation which is frequently found in connection with this subject." He sums up in a sentence the experience of ovariotomists in which I entirely concur, and the quotation of He also points out that if the maturation of ova which will spare me saying much more on this point. occurred as the rule at the menstrual period, preg-It is their experience, he says, that in many cases in nancy would not occur so often as it does in the absence of the catamenia, as in the amenorrhoea of lactation and other conditions. He also argues from the case of the which both ovaries have been removed, those organs have been found so thoroughly diseased as to preclude the idea that they could possibly have performed their functions of ovulation normally, if at all, and yet the regularity of menstruation has suffered no interruption. To this I may add, that the most diligent search in the ordinary cystic ovary has failed ever to discover ova in the cysts, with the exception of three cases, clearly of a special variety of tumour described by Rokitansky, Ritchie (younger) and myself. This ova-bearing kind of tumour is fully described and figured in my last edition. Dr. Jackson brings most valuable evidence on the subject from an examination of cases of hernial ovaries. In a case of Dr. Oldhams', published by the Royal Society, the periodic enlargement of the glands due to the process of ovulation, as was reasonably supposed, occurred at irregular intervals from three weeks to three months. such as this; indeed, it is not creditable to the art that its settlement has been so long in abeyance. Sir Spencer Wells has performed over a thousand ovariotomies, in the great majority of which a healthy ovary was left. In the performance of the operation it was his duty to ascertain that the second ovary was healthy, and if the simple expedient had been resorted to of noting the appearance of the organs and the time of the menstrual month in which the operation was performed in each case, the ovular theory of menstruation would have been settled long ago. The custom arose in the removal of an ovarian cystoma of selecting the time for the operation as nearly as possible equi-distant from two periods. There was no really good reason for this, and in some cases arguments against it might be found. But when abIn another case of Dr. Meadows', the tumour in-dominal sections came to be performed for other creased in size, and became painful at every menstrual purposes, such as the removal of the uterine appendages period, but when it was removed it proved, according for bleeding myoma, pyo-salpinx, or chronic ovaritis, to Dr. Meadows, to be a cystic tumour in which "there it soon became evident that it was best to operate were no proper Graafian vesicles to be seen." just before or even during the menstrual period. The Dr. Jackson proceeds to show, from a mass of mate-reason of this is that by this selection the patient is rial drawn from numerous sources, that (a) menstrua- saved the pain and loss of blood of an additional tion goes on under a variety of circumstances under period, for the operation brings on a period almost which ovulation is wholly impossible; and (b) con- always, and if one is made to do for two, it is better. versely that ovulation may occur without accompanying In the case of myoma there is the additional argument menstruation. that the rest between the last period and the operation should be as long as possible. It has, therefore, come to me to be a rule to select the immediate approach of menstruation as the time for operation in many cases, and to be in others quite indifferent on the subject. Further, quoting Goodman and others, he shows that the statements of Barnes, Leishman, Spencer Wells, and others, to the effect that removal of both ovaries arrests menstruation are entirely wrong. He goes so far as to say that men who make such a statement now subject themselves to charges either of ignorance or want of candour. With this I quite agree, for I have added to the evidence abundant proofs that removal of the ovaries without injury of the tubes has often no influence on menstruation at all, that removal of the tubes, even when the ovaries are left, arrests menstruation in the great majority of cases, but that (as in one of Baker Brown's cases) even removal of the ovaries, tubes, and greater part of the uterus may not arrest or influence in any way the menstrual periodicity. In the British Medical Journal for 1881, I published a letter, in which I said, that "Evidence is rapidly accumulating in my hands pointing to the conclusion that ovulation and menstruation have no necessary connection; and that corpora lutea are not a necessary result of the maturation and shedding of true ova." At page 25, in the last edition of my book on the "Pathology and Treatment of Diseases of the Ovaries," I give the following summary of my conclusions:I have, during the last few years, had the opportunity of seeing the ovaries of a number of women whose abdominal cavities I have had to open for various conditions not connected with diseased ovaries, and I have always found that during menstruation the tube is fastened on the ovary, whether there be a ripe follicle at the point of adhesion or not; that both tubes were generally fastened to their respective ovaries, though in one ovary there may have been no appearance of a ripe ovisac; that I have very frequently seen a ripe ovisac on the point of bursting, or just burst, when the patient was midway between two menstrual periods. Finally, I have removed in two cases ovaries with the tubes fastened on them, during menstruation, in none of which were there any ovisacs approaching ripeness." The chief purpose in the present paper is to draw attention to the above conclusions by giving in detail the evidence upon which they are based, conclusions which are being strengthened as the evidence accumulates. First of all let me say that abdominal surgery affords abundant opportunities of settling a question In the evidence about to be given in detail, I have not thought it worth while to tabulate the cases of double cystoma, because they go almost in a block to support the views of Ritchie. In a very few cases of double cystoma, and equally so in a few cases of single cystoma, the disease is associated with the arrest of menstruation, but in the great bulk of the cases menstruation goes on uninterruptedly. No one has yet. claimed, save in the three published cases of Rokitansky's peculiar tumours, to have found ova in the cavities of ovarian cystoma, nor do we ever see anything like a ripening follicle; and in Rokitansky's tumours the ova are retained, not discharged. We must conclude, therefore, that in those cases of double ovarian cystoma, in which menstruation goes on during the growth of the tumour, that process cannot in any way be dependent on the ripening and discharge of ova. In cases of single cystoma, the argument for one ovary, that is half the work of ovulation, is just as conclusive. If menstruation depended on ovulation, we ought to expect that, during the growth of a single tumour, about half the periods ought to be suppressed, but they are not. In such cases, the condition of the healthy ovary is a matter of interest, and therefore I have noted it. Probably cases of parovarian tumours will prove to be the most satisfactory field for this enquiry, as in them the uterus and its appendages are wholly free from disease. In the following narration, all cases of irregular and deficient menstruation have been omitted, as also all cases where the history was defective : 1 August 7th, 1880.-Cirrhotic ovaries removed, age 31; menstruation regular, not a trace of vesicles of any kind in the glands; had menstruated five days before the operation. 2. August 10th.-Cirrhotic ovaries removed, age 28; menstruation regular, only one old vesicle to be found; had menstruated thirteen days before operation. 3. August 17th.-Appendages removed for severe menorrhagia, age 49; operation performed immediately after menstruation; one follicle about half matured, no trace of one having recently burst. 4. September 1st.-Right ovary removed for cystoma, age 17; operation performed midway between periods; no trace of recently burst nor of ripening follicle in remaining ovary. 5. September 1st.-Appendages removed for bleeding myoma, age 47; both ovaries cystic, and entirely without traces of normal vesicles; the hæmorrhage was periodic (menstrual), and lasted from ten to twelve days. 6. September 24th.-Appendages removed for double pyo-salpinx, age 28; menstruation had been regular, profuse, and intensely painful; the tubes were glued on to the ovaries, and no vesicles could be found in the latter. 7. October 5th.-Appendages removed for double hydro-salpinx, age 32; menstruation had been regular, profuse, and intensely painful; both ovaries were disorganised by chronic inflammation, and no vesicles of any kind could be discovered in them. 8. October 6th.-Parovarian cyst, age 48; had not menstruated for a year; one well-marked follicle observed in left ovary. 9. October 12th.-Appendages removed for menstrual epilepsy, age 23; operation performed four days before an expected period; one follicle had just burst (probably did so during the operation) in the right ovary, and another was nearly ready in the left ovary. 10. October 26th.-Appendages removed for menorrhagia due to myoma, age 35; operation performed midway between the periods; one large follicle quite ripe in left ovary, another not so far advanced, and two evident, though smaller, in right ovary. 11. December 7th.-Left ovary removed for cystoma, age 21; operation performed just after a period; follicle recently burst in right ovary. 12. December 18th. Appendages removed for menorrhagia, age 44; operation midway between periods; fully ripe follicle in right ovary, ruptured when grasped, and shed yellow body; one immature follicle in left ovary. 13. January 13th, 1881.-Appendages removed for myoma, age 32; operation performed during menstruation; both tubes grasping the ovaries, but no follicles ripe. 14. February 5th.-Appendages removed for myoma, age 41; menstruation regular and very profuse; operation performed between the periods; both ovaries cystic, and no follicles apparent anywhere. 15. February 12th.-Appendages removed for most terrible menorrhagia, due to myoma, age 43; operation performed just before a period; no traces of follicles anywhere. 16. February 17th.-Left ovary removed for cystoma, age 23; menstruation quite normal, operation performed just after a period; one immature follicle in right ovary. 17. March 2nd.-Removal of appendages for persistent menorrhagia, age 25; both ovaries cystic, but of small size; no follicles discoverable. 18. March 20th.-Appendages removed for myoma just before menstruation, age 35; a fully ripe follicle in right ovary, and one almost as advanced in left. 19. March 29th.-Left ovary removed for cystoma, age 30; operation performed twelve days after period; fully ripe follicle in right ovary, and two others ess mature. 20. June 15th.-Both tubes removed for myoma, ovaries being left, age 43; the right ovary was not seen, but the left had an almost ripe follicle; the operation was done almost midway between the periods; the patient has never menstruated since, and the myoma has almost disappeared. removed about eight days before period; an almost ripe vesicle was noted in left ovary; no vesicles at all in the right. 23. August 19th.-Appendages removed for pyo-salpinx, age 27; operation performed the first day after menstruation; no traces of follicles in the disorganised ovaries; menstruation had been regular and profuse. 24. August 22nd.-Right ovary removed for cystoma, age 18; menstruation just over; no trace of follicle in left ovary. 25. August 25th. - Appendages removed for persistent menorrhagia, due to myoma, age 38; both ovaries cystic; no trace of normal follicles. 29. November 30th. Appendages removed for hydro-salpinx, age 37; operation performed midway between periods; no traces of follicles in the ovaries; the patient has menstruated regularly ever since, more than three years. 30. December 19th. Appendages removed on account of intense pain produced by dislocation of ovaries into the cul de sac, age 29; operation performed about midway between periods; a perfectly ripe follicle in each ovary, both of them discharging their contents during operation. 31. January 4th, 1882.--Appendages removed for persistent menorrhagia, due to myoma, age 36; operation performed about ten days after a period; a perfectly ripe follicle in one ovary, several quite immature in the other. 32. January 10th.-Appendages removed for myoma, age 37; operation performed during menstruation; each ovary was grasped by its tube, but there were no ripe follicles. on 33. January 29th.-Appendages removed for myoma, age 46; the left ovary was grasped by its tube, and very near the point of grasping was a perfectly mature follicle, but the ovum on its escape, when the follicle ruptured, could never have been passed into the tube. 34. February 18th. Appendages removed account of persistent pain, age 43; operation midway between periods; ovaries quite cirrhotic, and not more than one-third of the normal size; menstruation had been perfectly regular, and normal in amount; there were traces of vesicles throughout the ovaries. The removal of appendages arrested menstruation, and has cured the patient. 35. February 22nd. Appendages removed on account of persistent pain and excessive menorrhagia, due to chronic pyo-salpinx, age 27; no trace of vesicles could be found in the ovaries; they were quite disorganised. 36. March 16th.-Appendages removed on account of persistent pain, age 33; menstruation regular; operation performed just after a period; not a trace of vesicles in the ovaries, which were shrivelled and deeply grooved in all directions. 37. March 31st.-Appendages removed for myoma, age 40; operation performed on second day of menstruation; ovaries both cystic; no normal vesicles, nor any appearance of embracement of the ovaries by the 38. April 5th. Right ovary removed for large Parovarian cyst of right side myoma, age 33; menstruation regular; operation 21. July 2nd.-Right ovary removed for cystoma, age 38; menstruation regular; operation performed four days after period; when left ovary was being ex-tubes. amined, a fully ripe follicle burst. 22. August 8th. eighth day after period; perfectly ripe vesicle in left Ovary. 39. April 20th.-Appendages removed for myoma, age 21; operation performed during menstruation; both ovaries grasped by tubes; no ripe follicles in either ovary. 40. April 25th.-Appendages removed for menstrual epilepsy just before a period, age 25; ovaries contained a few cysts, but no follicles approaching ripeness. 41. May 5th.-Parovarian cyst removed ten days after period, aged 28 ; patient pregnant two months; a perfectly ripe vesicle in right ovary. 42. June 24th.-Parovarian cyst removed on third day of menstruation; right tube embraced its ovary, a ruptured follicle in left ovary, but left tube did not seem to be anywhere near it. 43. July 21st.-Left ovary removed for cystoma, age 22; operation performed eleven days after menstruation; a perfectly ripe follicle in right ovary, which burst and discharged its contents when handled. 44. July 24th.-Appendages removed for persistent pain, age 32; ovaries adherent and quite disorganised; no trace of follicles in them; menstruation had been perfectly regular and profuse. 45. July 25th.-Appendages removed for persistent pain, age 37; ovaries adherent; several follicles found in right ovary, but not approaching ripeness; operation performed four days after period. 46. July 27th.-Left ovary removed for cystoma, age 38; menstruation had been quite regular, and patient had borne the last only two years before the operation; there was no right ovary in this patient. 47. October 7th.-Parovarian cyst removed during menstruation, age 26; left tube embraced its ovary, but no follicle on that side; a perfectly ripe follicle in the right ovary. 48. November 6th.-Parovarian cyst removed, age 44; operation on third day of menstruation; both ovaries grasped by their tubes, and under the left tube there was clearly a ripe follicle. clusive, but it is very suggestive that the association was one of mere coincidence. In such a case as this the want of proof is quite as strong for the purpose of a presumption as the presence of direct testimony. To the twenty-five cases of positive evidence against the ovulation theory of menstruation we must really add the fifteen negative cases, and then we know the overwhelming case against the theory that out of a continuous and consecutive series of observations we have the theory inapplicable in nearly 82 per cent. of the cases. To this also must we add the negative evidence of the cases of cystoma. Should further research confirm these conclusions, the ovular theory of menstruation must be given up; and in conclusion I must point out two curious inconsistencies between the facts of my observations and the theory I have been discussing. From the appearance in Case 9 it might happen occasionally that menstruation should occur twice within a very few days, with perfectly healthy uterus and ovaries, for in that case and in others it was quite clear that two ova would be discharged within a few hours of each other. The second inconsistency is that the most marked and proper menstruation has been in cases of disease of the tubes, just as the most profuse lachrymation occurs in inflamed eyes; but in these cases, as a rule, not only is there no ripe vesicle to be seen, but the ovaries are generally so disorganised that no vesicles of any kind are visible. These conditions clearly show that the ovaries have little or nothing to do with menstruation, and render it highly probable that the tubes are largely concerned in it. PRACTICAL NOTES ON THE ORDINARY DISEASES OF INDIA. By NORMAN CHEVERS, C.I.E., M.D., President of the Epidemiological Society of London. (Continued from page 519.) 49. January 28th, 1883.-Parovarian cyst removed I HAVE now published in the Medical Times and on second day of menstruation, age 29; no embrace- | Gazette-January 4th, 1879, to April 18th, 1884—what ment of ovaries and no ripe follicles in the ovaries. I made no notes of further observations, as I began to lose interest in the enquiry, being perfectly satisfied that the evidence so far has completely destroyed the ovular theory of menstruation. I am persuaded, however, that it is worth further perseverance, as I am not sure that some of my other conclusions are quite as secure, and therefore I shall resume it. As it stands, the evidence seems to me conclusive on the one point for which it was taken. Of course different people read the same evidence in different ways, and probably it will be so here; but in dividing the cases into three of the simplest and most natural groups, it seems to me that they arrange themselves as follows: 1. Cases, nine in number, where it was evident that menstruation and ovulation were concurrent (Nos. 9, 11, 18, 21, 28, 33, 42, 47, and 48). 2. Cases of negative proof against the ovulation theory of menstruation, fifteen in number (Nos. 1, 2, 3, 4, 5, 6, 7, 10, 12, 13, 19, 22, 29, 38, and 45). 3. Cases, twenty-five in number, affording positive evidence against the theory (Nos. 8, 14, 15, 16, 17, 20, 23, 24, 25, 26, 27, 30, 31, 32, 34, 35, 36, 37, 39, 40, 41, 43, 44, 46, and 49). Taking the average period of menstruation to be one-seventh of the month, and if we assume my theory of continuous ovulation to be correct, out of 49 observations we ought to have seven instances of ovulation observed during the menstrual period, and in the above table we have nine cases of menstrual ovulation. The close correspondence of these figures is not con I regard as the First Volume of this work, comprising Indian Fevers. The Second Volume, completing the treatise, stands nearly ready in MS. As I find that I have noticed the whole of the diseases prevalent throughout India, I have dropped in my title the words " Especially those prevalent in Bengal." Note on the Beriberi, or the "Kakke," of Japan. I am indebted to the kindness of Surgeon-General C. A. Gordon, for a sight of Dr. Duane B. Simmons's elaborate report. The author defines beriberi as a disease occurring during the summer months, especially in the seaport towns on the eastern and southern coasts of the Japanese islands, chronic as to form, but subject to exacerbations of varying degrees of severity, having for its characteristic symptoms anæsthesia of the skin, hyperæsthesia and paralysis of the muscles, anasarca, palpitation, cardiac and arterial murmurs (in the wet form), præcordial oppression, abdominal pulsation. It has two distinct forms, the wet (beriberia hydrops) and the dry (beriberia atrophia); cases of both are met with in the same locality, the former more frequently when the summers are attended by an unusual amount of rainfall and moisture, and the latter when the season is of unusual dryness. The wet form is by far most to be dreaded, as it frequently runs a rapidly fatal course in defiance of all known modes of treatment. The dry form is rarely fatal. 1 China Imperial Maritime Customs II. Special Series, No. 2. Medical Reports for the half year ended 31st March, 1880, 19th Issue, page 38. |