On diseases of menstruation and ovarian inflammation, in connexion with sterility, pelvic tumours, and affections of the womb

Contents

PRELIMINARY QUESTIONS :— I. Why should Medicine be uncertain? . . . xv II. What are Diseases of Menstruation? . . . xix III. Whatis MenstruationP . . se ME IV. What are the Organs of Mensimtion ig RE V. Whatis Inflammation? .. wey 5 VI. By what influence does faayiations in the ovarian tissues produce Diseases of Men- SUPMaLIOW! 2 tess ag ee ape te et RR PROLEGOMENON.

Extraordinary confusion relative to the history of ovarian inflammation . . 1 Its frequency proved by that of inflammatory mori lesions in the ovaries . . ass 4

Reasons for the past neglect of ovarian pathology ee 6 Ignorance of ovarian physiology, and the pre-eminence traditionally assigned to the uterus ee the organs ofreproduction . . . Say) Difficulty of exploring organs so al wid so deeply seated. |.) Gs 9

Chapter II. Causes Of Sub-acute Ovaritis

Predisposing causes :— Structure and functions of the ovaries—Lymphatic temperament—Over stimulation of the ovaries ; or their total deprivation of a natural stimulus . Exciting Causes :— Some are of a permanent kind; others produce arrest of menstruation, as damp, cold, or sudden moral

PAGE

12 16 19 21

24 27

CONTENTS.

impressions—Transmission of inflammation from the uterus to the ovaries—Uterine injections, injudicious cauterization of the uterine neck, pessaries, stem-pessaries— Dangerous tendencies of the present mechanical school—Meddlesome surgery interfering with the uterine organs . Specific Causes :—

The puerperal state—Blennorrhagic infection and

Rheumatic diathesis

CHAPTER ITI.

SYMPTOMS OF SUB-ACUTE OVARITIS.

Common ovarian symptoms

Pain and its differential phinaoberisties genoa onl! tended to; and the disease attributed to the uterus by some, and by others called “inflammation of the bowels”

Frequent desire and nayekabiher to pia ates or ies

Effects caused by the descent of the swollen ovary into the recto-vaginal cul de sac :

Confused notions entertained by sions conedpaltig ovarian pathology, proved by their considering nymphomania as a symptom of ovaritis

Peculiar insidiousness of puerperal sub-acute vavtlid has caused it, until very lately, to be overlooked

Special symptoms characterizing each type:

Amenorrheal type—Necessity of combining local depletion with tonics and steel—Chlorosis caused by the diminished power of the ieee System . .

Dysmenorrheeal ie oeuica none of ia ovaries over the womb, as shown by their causing the painful secretion of false membranes from its inner surface, and by determining inflammation of the cervix-uteri

Menorrhagic type—Obstinacy of Sie cases as are accompanied by ovarian swelling ill

PAGE

75 78 lv CONTENTS.

Hysterical type—Strange connexion between nervous phenomena of variable intensity with the fulfilment of each act of the great drama of reproduction—Hysteria peculiar to the reproductive period of the life of both sexes—A_ disease almost peculiar to woman—Concurrence of modern with ancient experience in proof of hysteria being produced by some deranged ovarian action

Chapter IV. Terminations Of Sub-acute Ovaritis

Sterility — Most frequently caused by inflammatory action in the different tissues of the ovaries—Dr. Oldham’s case—Sub-acute ovaritis causes sterility. (1) by accelerating the shedding of imperfectly developed ova; (2) by the retention of blighted ova in the ovary; (3) by placing mechanical impediments to their transmission from the ovaries to the uterus

Uterine inflammation — Sub-acute ovaritis frequently produces uterine engorgement and erectile swelling of the cervix—Concord of opinions of modern observers in support of these views—Cases in illustra- TIGTi ae Ph ches MEME mee! Tho homie IOR de ae Jigen ulema

New light thrown on uterine pathology by this explanation of the persistence of the patient’s sufferings after the cure of uterine inflammation . |

Chapter V. Treatment Of Sub-acute Ovaritis

Blood-letting — Purgatives — Injections — Blisters — Inunctions—Habituation to use of drawers Treatment of— .

Amenorrheeal type Dysmenorrheeal type Menorrhagic type Hysteric type .

PAGE

138 139 139 140

CONTENTS.

Should marriage be sanctioned? and when? .

Treatment of sterility

Fallopian catheterism ‘

Opinions of Sir B. Brodie toa De Otaham—Opinion of the Author . | a ee a as

Chapter VI. Acute Ovaritis

Synonomy and Definition—Morbid anatomy of idiopathic and puerperal forms er :

Chapter VII. Causes, Symptoms, And Diagnosis Of Acute Ovaritis

Causes, vide Chapter IL.— Symptoms — Pain — Mechanical disturbance caused by the neighbouring organs—Pelvic tumours—Termination by sub-acute ovaritis, or gradual wasting of the vital powers— Tubal acute inflammation—Blennorrhagic ovaritis —Rheumatic ovaritis—Diagnosis—from metritis, from cxco-iliac abscess—Feculent collections

Chapter VIII. Terminations Of Acute Ovaritis

Resolution—Elimination—Cutaneous opening—Vaginal opening—lIntestinal opening—Vesical opening —Peritonzal opening—Partial ovarian peritonitis— Peritoneal effusion—-General peritonitis—Effusion of pus in the peritoneum—LEffusion of menstrual blood in the peritoneum — Cases in proof — Dr. Paget’s report on post-mortem appearances of Mrs. DD sce aaiaes —Result of obliterations of the Fallopian tubes—Mechanism of retention of menstrual blood —Bursting of the Fallopian tubes—Great advantages of Dr. Simpson’s plan of dilating the os uteri

a2 vi

CONTENTS.

Chapter IX. Treatment Of Acute Ovaritis

Bleeding, leeches, calomel—Case of cure by resolution

—FElimination of pus—Great advantage of the early opening of pelvic tumours—Case showing fatal consequences of procrastinating this opening— Vaginal opening always to be preferred—Anatomical considerations—Professor Recamier’s mode of operating —lIllustrative cases —Rectal opening—Cutaneous opening—lIncision as proposed by Dr. Graves and Dr. Begin — Plan of Professor Resa US cation of Vienna paste—Cases

Conclusion

Is the Author’s answer to the sixth introductory question satisfactory ?—Important practical deductions —Additional confirmation of the Author’s views— A description and delineation of an extraordinary machine found in the vagina of an English lady in the year 1850 . ee

PAGE

Preface

_ Ir is not without some degree of diffidence that I have ventured to add even a small volume to the number of those which overload medical shelves, for I feel that the flattering reception of an ephemeral production* offers no guarantee of similar success for a work addressed to the profession on the treatment of important diseases. Urged, however, by a conviction that books are not only useful to diffuse the knowledge of great discoveries, but also to connect those facts which, although steril so long as they are left disjointed, assume importance when connectedly put together, I have here more methodically arranged, and more fully developed,

* The Serpentine as 1 1s, and AS IT OUGHT TO BE; and the Board of Health as iv 1s, and as 1T OUGHT TO BE. 1848.

Vill PREFACE.

views first expounded in a series of papers on the sub-acute forms of ovarian disease, which appeared in The Lancet in 1849.

I am further induced to do so, because those contributions were favourably noticed in various organs of the medical press,* and also on account of the gratifying concurrence in my views which has been spontaneously offered to me by many of my brethren engaged in practice.

Perhaps it would not be unbecoming for me to state, that whether as pupil or house-physician to the Paris hospitals, I have (from the beginning of my career) enjoyed the full advantages of the widest field for uterine investigations which can ever be afforded by a medical school; and that whilst practising in Paris and in various other capitals of Europe, I not only had abundant opportunities of testing the value of my views relative to diseases

* Edinburgh Monthly Journal, 1849; Dr. Ranking’s Retrospect, January and June, 1849; Braithwaite’s Retrospect, January and June, 1849; American Journal of Medical

Science, vols. 43 and 44; London Journal of Medicine, December, 1849.

PREFACE. 1k of menstruation, but also of strengthening them by the practice of those who so well represent our noble profession in each country.

I might even add, that since my return to England I have found abundant opportunities of confirming my peculiar views on the diseases of menstruation, while attending the numerous patients at the Farringdon General Dispensary and Lying-in Charity, and also those of the Paddington Free Dispensary for Diseases of Women and Children, to which institutions I am attached in the capacity of Physician.

My aim has been to perform, for the ovaries, the principal organs of menstruation, what has been successfully done for other organs by many eminent men, and I feel assured, that although some of my deductions may be contested, my practice will be admitted by all to be indubitably safe, and necessarily destined to diminish the number and intensity of female complaints.

I can lay claim, unfortunately, to no discoveries; but from an acquaintance with the literature of that branch of the profession to which x PREFACE.

I have devoted my chief attention, I feel justified in affirming, that in no other work will the reader find so complete an account of the various ways in which sterility is produced by the action of inflammation on the ovarian tissues, of the great importance of ovarian peritonitis as a cause of disordered menstruation, or of the influence of ovarian inflammation in the production of uterine disease—facts forcibly exemplified and proved to be, not mere conventional possibilities, but events of frequent occurrence.

I must also observe, in reference to the numerous cases with which I have enriched my work, that I have given them more with a view of illustrating, than of establishing, each particular point of ovarian pathology. I have therefore taken from my own case-book only those select cases which bear forcibly on the subject, borrowing from authors and contemporary observers, facts, rendered much more valuable by their not having been collected under the influence of the views which they will be found

PREFACE. X1 so admirably to exemplify. If I have derived my cases more from foreign than from British practitioners, it is simply because Continental obstetricians, having been the first to investigate scrupulously the diseased organs of generation by the combined assistance of the touch and of the eye, have been able in many instances to detect _ the hidden causes of those diseases which, until late years, were only guessed at, and could only be treated symptomatically.

As a fitting introduction to this work, I intended to prefix an essay on the natural history of woman, but finding the matter to grow rapidly under my hands, and the vast importance of the undertaking becoming every day more perceptible, I have, for a time, desisted from the accomplishment of what must be considered the only rational introduction to any treatise on the diseases of women.

In noticing the many deficiencies of this work, the reader will also remember that it is the first systematic attempt to do, for the principal organs

X11 PREFACE.

of generation in women, what has now been done for every other important organ of the body, and that, considering the rapid progress which has lately been made in ovarian physiology, it cannot be wrong if some one should seek to give to the pathology of the ovaries a development which would be greater and more satisfactory if the labourer were better able to accomplish his selfimposed task.

I am fully aware that by the very title of the work I lay myself open to criticism. It will doubtless be said that it should have been “ Diseases of the Organs of Menstruation,” as we say diseases of the “organs of respiration ;” but rather than prejudge a question, I prefer being censured for an imperfect, although received and _ pretty well understood, phraseology.

I cannot record the progress of ovarian physiology without testifying my admiration for the illustrious Regnerus de Graaff, who, nearly two centuries since, originated a movement which has only been followed up within the last few years.

Can I better conclude this address than by bor-

PREFACE. Xill rowing the words in which he ends the preface to his immortal work ?*

animo, castoque pervoluve.”

Epwarp Joun Tit.

March 25th, 1850.

. as “

Introduction

** An introduction, like unto a ladder, should lead us step by step to the main object of our research.” QuaRLes’ Enchiridion.

Qurstion L—Why is medicine so uncertain? Notwithstanding the immense progress which has been made within the last fifty years in every branch of medicine, we must still admit, to a marked extent, the fact of its uncertainty; and it seems to us that the want of precision in medical language is one of the principal causes of this uncertainty. Why should there be such obscurity in our nomenclature, since it is in our power to give a definite value to every term we employ? Perhaps we attach too little importance to words, considering them as the mere garment of our ideas, to be assumed or cast off, as we like, and when we like. But are not names (we speak of those which embody doctrines) the offspring of the mind, participating in its power, inheriting itsgenius? Like our children, when they are conceived, incubated,

XV1 INTRODUCTION, and once fairly brought forth, must they not be considered as living things, impregnated with a vital principle, endowed with human power ?

They were meant to be the mere symbols of man’s conception of things, but soon they assume the place, and usurp the potency, of tangible existence ; it is by their means that man acquires a kind of terrestrial immortality, for by them he extends his sway over future generations. During the prolonged lifetime of such words, they strenuously oppose all new discoveries, because they are at a loss to express them; and even when the doctrines they once effectually supported are defunct—ghosts of what they were formerly, they still are able, either to give rise to interminable discussions, or else to weigh with undue force on the thoughts and actions of ourrace. It is in the indolence of human nature to be led by any phantom-power that will but take the trouble of walking first. In religion, in politics, in science, are we not led by names? they show the way, and on we follow, with blind impetuosity, as the soldier does his flag—it may lead to truth, or to error; to glory, or to destruction !

It appears from the history of medicine, that words and names have always governed practice, and they will no doubt always augment, or diminish, our bills of mortality. At one time, vitalism was the ruling word, and the patient was often left to struggle on as he could against disease, while the

INTRODUCTION. XVI physician was philosophizing on the autocracy of Nature. At another period, the profession hoisted a yellow (not the quarantine) flag, and bile was the prevailing word. The art of medicine dwindled into the art of exhibiting emetics, and illustrious doctors talked of the human body as if it only consisted of one gigantic liver.

What have we not seen lately in a neighbouring country, under the influence of the word inflammation? Almost every disease was considered inflammatory. Patients were bled to the verge of exsanguinification. Drs. Sangrado rejoiced in the deadly paleness of their patients’ features, and when the relatives complained of their interminable convalescence, they were quietly told that it was in the nature of the Divine infliction, and not the result of a most pernicious treatment. Such, in medicine, has been the power of mere words, and when such words have become tenantless of their former spirit, they still meet us at the patient’s bedside, where an old crone often thinks she knows as much about the hot and cold things as Galen himself, and can theorize as well about peccant humours as the ultra-humorists of the middle ages, or exhibit an aptitude of deducing every disease from inflammation, which would have even fascinated Broussais. At the bedside, then, we have not only to guard against the exaggerated influence of the words under which we ourselves have been

XVill INTRODUCTION.

educated, but also against the influence of those symbols of old doctrines tumbled from their high estate, into the brains of anurse. The analytic spirit of this age, however, does not so willingly bow to words, and we now ask them for the title-deeds of the power they assume. In medicine, the general — terms under which superficial knowledge hopes to find a comfortable shield, are taken to pieces, and we love to grapple with those assemblages of symptoms which have long been called by common names, and to submit them to a cautious analysis, in order to discover, if possible, to what organ of the human body they may be specially referred, and through which their treatment may be the most successfully directed.

The diseases of most important organs of the body have been specially studied, and severely analysed; and when we merely assert that a patient is suffering from disease of the head or of the chest, or from morbus cordi, we no longer think to impose on a fellow practitioner a very clear idea of the case, or of the extent of our own information. It seems to us necessary, that what has been effectually done for other diseases should likewise be done for the diseases of menstruation, distinguishing the different meanings of the terms by which they are described, in the hope that a greater precision in definition may lead, not only to better practice, but also to the prevention of a great proportion of those complaints to which women are liable.

INTRODUCTION. XIX

Question II.—What, then, are the principal diseases of menstruation?

AMENORRH@A, or suppressed menstruation ;

DysMENoRRH@A, or painful menstruation ;

MENoRRHAGIA, or profuse menstruation ;

Lrvucorru@a, or various discharges ; and

Hysrerta.

We shall briefly examine into the meaning of these substantives.

What does AMENORRHG@A imply?

Absence of organs of ovulation, their destruction, their chlorotic arrest of development.

Sub-acute or acute ovaritis ;

Or it may represent the inflammation, or the obliteration, of the Fallopian tubes;

Undersized womb ;

Inflammation of the womb;

Morbid stricture, or obliteration of the neck of the womb;

Ulceration of the neck of the womb (Dr. H. Bennet); |

Its induration (J. P. Frank);

Retroversion of the womb (Dr. Rigby);

Or the organs of reproduction may be perfect, but, under the influences of various acute and chronic diseases, the menstrual flow may be impeded or suppressed.

This word Amenorrhcea, which answers to so many conditions, can, then, be no longer admitted as a substantive term. It means so much that it means nothing.

XX INTRODUCTION.

But what does DysMENoRRH@A indicate ? Sub-acute ovaritis ; Ovarian peritonitis; Effusion of the ovum and menstrual blood into the peritoneeum ; A neuralgic ovarian affection ; Tubal inflammation and partial obstruction, with flow of blood into the peritonzeum ; An undersized womb; Deviations of the womb; Inflammation of its body, or of the inner surface, producing false membranes ; Stricture of the neck of the womb; Its induration ; Ulceration of the neck of the womb; Cancerous affections of the neck of the womb; Coarctation of the vagina; And constitutional diseases, such as a rheumatic or gouty habit ( Rigby).

Dysmenorrhcea, as the name of a disease, ought therefore to be expunged from every medical work, for it has no definite meaning, and must lead to hazardous practice.

What does Mrenorruacia represent ? Sub-acute ovaritis ; A neuralgic affection of the ovaries; Uterine catarrh ; Cancerous affection of the womb:

INTRODUCTION. Xxl

Ulceration of the neck of the womb; Retroversion of the womb; Irritable uterus.

Menorrhagia, likewise, should be discarded as one of those words which mightily entangle and pervert a true judgment.

But let us now take Leucorrua@a, which stands for—Hypersecretion of the mucous follicles; Chronic catarrh of the Fallopian tubes — (Rokitansky) ; Uterine catarrh ; Ulceration of the neck of the womb; Various inflammations of the vagina or external organs.

Again too many different significations to be adequately represented by one word.

The words AmMENoRRH@A, DysSMENORRHG@A, Menorruaacia, and Leucorrue@a, then, cannot be received as things substantive, because vague and injudicious treatment must spring from vague and general terms in medicine. Such words can only ‘be applied in an adjective sense, to point out the different morbid conditions of the organs of generation, which produce in so many different ways the diseases of menstruation. |

We presume to protest against names imposed by high authorities, because under their pernicious influence we have too often seen women doomed

a3

XXll INTRODUCTION.

to long years of continued suffering; sometimes receiving no sort of treatment, at other times treated in a way which would disgrace those who dispense nostrums to barbarous tribes. The continued study of menstruation, and everything connected with that function, has convinced us that there is no reason why the flower of woman’s lifetime should remain blighted by intolerable misery, if those organs which stamp the physical character of woman were studied as minutely as the other organs of the body, and if the diseases of each particular portion of the organs of reproduction were investigated with adequate perseverance.

Such maladies have been the engrossing study of our life. Wherever we have resided, whether in the Paris hospitals, or in those of Germany or Italy, or in the East, our uppermost thought has been to investigate thoroughly the phenomena of the diseases of menstruation, and at some future day we trust to show that our efforts have not been destitute of good and useful results.

At present we do not intend to treat of all the organic lesions enumerated as causes of diseased menstruation, but to confine ourselves to the consideration of the organic diseases by which we consider them to be very frequently produced—inflammation of the ovaries and oviducts; But before inquiring into the diseases of menstruation, we - must glance at the function itself—although the

INTRODUCTION. XXill boundaries we have proposed do not permit us to go deeply into the subject.

Question III.—What is Menstruation ?

A sero-sanguinolent secretion propelled by an ovarian influence from all or different parts of the generative intestine, and principally from the womb. It is a natural function peculiar to women; and if we estimate the reproductive portion of the lifetime of woman at thirty years, and admit that she menstruates during eight days in every month, it appears that she is subject to this natural infirmity for about seven out of these thirty years. If we, moreover, take into consideration even the most favourable results of pregnancy —child-bearing and lactation, we obtain an insight to a just appreciation of the influence of the organs of generation on the destiny of woman. But when we bear in mind that all these physiological functions are subject to multitudinous morbid derangements, we are obliged to own, with Van Helmont, that ‘“‘ propter uterum solum mulier est quod est ;” and with a still greater authority, Hippocrates, “ Propter uterum, mulier tota morbus est.”*

* But in this day we must accept these axioms with some qualification, and not be wholly led away by words, which, as we have already said, must be regarded as the mere symbols of ideas. By Hippocrates and Van Helmont, and nearly all their successors down to the present day, the uterus has been regarded as the fundamental portion of the female generative system —a distinction which in reality

XXIV INTRODUCTION.

Menstruation varies according as it is studied in the inhabitants of northern or tropical climates, or of those which enjoy a medium temperature : thus in very cold countries, almost all women first menstruate after the fourteenth year; while in hot countries, almost all women first menstruate before the fourteenth year. In this and in neighbouring countries, the period of first menstruation is pretty equally spread over the four years which precede and follow the fourteenth year; and we therefore consider it to be the general mean age of first menstruation. The difference in the time of first menstruation is to be attributed to the effect of temperature, for it cannot be accounted for by any greater libidinousness of the inhabitants of a southern or of an eastern climate. The warmth of man’s temperament is quite independent of climatorial influences, for our Arctic travellers have convinced us, that, in the midst of ice which never thaws, many of the Hisquimaux tribes live in a state of licentiousness which cannot be surpassed by that of the sunburnt natives of India.

Without venturing to explain why menstruation, belongs to the ovaries. We shall hereafter take occasion to remark that the uterus is an appendage to the ovaries, as, in an analogous manner, the bladder is to the kidneys. Still the presence of an uterus physiologically implies the presence of ovaries—and in so far, but no further—may we give implicit assent to the dicta of Hippocrates and Van Helmont.

INTRODUCTION. | KXV a natural function, should entail so much disease, we shall lay before the reader the statistical data whereby Dr. Briérre de Boismont has enabled us to appreciate the frequency of the symptoms of menstruation. Thus, with regard to its first appearance, out of 645 women, carefully questioned, in 357 the menstrual discharge appeared without previous symptoms, and in 228 its first appearance was preceded by pain and other symptoms. We give the figures as we find them. But of 654 women, in whom the menstrual function was fully established, in 496 each monthly return was accompanied by symptoms, in 360 cases the symptoms were both general and local, in 136 there were general symptoms alone,—whence we may infer, that in only 158 females out of 654, or in about 25 per cent., were the menstrual periods unattended by precursory signs and concomitant painful symptoms.

The frequency of diseases of menstruation also varies with climate, and as a result of investigations not yet concluded, we may state that they are infinitely greater in countries of medium temperature subjected to sudden transitions, than in those countries in which a permanency of intense cold or heat predominates. But if climate increases the frequency of diseases of menstruation, civilization does so to a far greater extent. Little known to the women of barbarous tribes, whether inhabiting glacial or torrid climes; more frequent amongst our

XXV1 INTRODUCTION.

women of the poorer orders, although hardened by labour, by privations, and by exposure to the elements; they are mostly found amongst the spoiled children of fortune, who are brought up in the lap of luxury. The susceptibility of the skin and mucous membrane is increased to the utmost by the heat-generating influences of over-feeding and over-clothing, while the nervous system and the organs of reproduction are over-excited by the prurient incitements of passion-stirring pictures, statues, music, novels, and theatres. It might have been supposed, that the dangers incidental to menstruation, to pregnancy, and to childbirth, when added to those common to both sexes, would have considerably increased the mortality among women; but all such risks are amply compensated by those which men have to encounter on the battle-field, or wherever, by land or by water, their laborious enterprise exposes them to accidents; and although the number of men born always surpasses that of women, we still find that there is ever a greater number of women in the world than men. The vital tenacity of women is also superior to that of men, and is well proved by the greater facility with which they bear. deprivation of food, or submit to bodily torture and anguish of mind. It is still more practically illustrated by the Registrar General’s reports, which show the less per-centage of females than of males who die of diseases out of

INTRODUCTION. XXVl1l the same given number of each sex. This rule, which, with some slight oscillations, holds good throughout life, cannot be explained by the special influence of menstruation, because its action precedes the establishment of this function, and after the change of life is still proved to be in full activity, by the far greater number of women than of men who attain to longevity. But whatever may be the cause, it seems to us a providential arrangement; for as amongst the bees there is a large number of imperfectly developed females, called labourers, nurses, and, improperly, neuters, which are indispensable to the well-being and multiplication of the humming communities; so with us, that large proportion of women whose organs of reproduction always remain passive, are nevertheless most useful to the welfare and multiplication of the human race, to whose many wants they minister, and whose weaknesses they strengthen, their milder influence tempering and softening the harsher asperities of the stronger sex. We have thus spoken of menstruation without mentioning by what theory we explain its phenomena. A theory isan intellectual staircase; and as some kind of staircase is necessary to obtain a knowledge of the interior of a build-~ ing, to make use of its appurtenances, so must we have some kind of theory in order to catalogue and turn to account the innumerable facts of modern science; and as, moreover, we do

XXVIii INTRODUCTION.

not totally discard the staircase because a few of its steps do creak, we adopt the ovular theory of menstruation as the best, although it does certainly creak in some points. Menstruation and ovulation are parallel facts, originating in the same organ, and hereafter it may be shown that they stand related as cause and effect; but this is not yet proved, and we defy the staunchest supporters of the ovular theory to explain why the ovula floating in the fluid of fully-developed Graaffian follicles in girls of from two to four years of age, observed by Carus, (System der Physiologie, von Carl Gustav Carus, Leipzig, 1849,) did not in them produce a , who had begun to menstruate twelve hours before her execumenstrual flow, and why in Mrs. M tion, “no appearance of recent rupture of a vesicle, or of the discharge of an ovum, could be found in either ovary.”* But facts survive theories, and menstruation, however explained, must always be considered, if not absolutely as the sine quad non of generation, at least as the meter of the conceptive power; and it will always be admitted, that during the whole of the reproductive period of woman’s life, it is the “signum et presidium sanitatis.”

Having mentioned ovulation, and alluded to the ovaries, we must now inquire into their proper importance in the generative system.

* Vide Professor Paget’s report on the post-mortem examination of Mrs. M——, p. 190.

INTRODUCTION. XX1X

Querstion 1V.—What are the Organs of Menstruation ?

If the older physicians were so eminent in the practice of their profession, it is because they were no less versed in philosophy than in physic. Logic will doubtless suggest that no organ can derive its power of action from any other organ, the appearance of which is posterior to its own, whether in the development of the embryo, or in the successive complication of organs in the zoological series; we may infer, then, that the ovaries which appear first, impart unto the uterus its special power ofaction. It will likewise be recognised, that every organ receives its stimulus from that which follows it in the successive evolution of our organs, as seen in the development of the embryo. If so, it is the uterus which stimulates the ovaries to increased action. Moreover, in any series of organs constituting an apparatus, the middle organ is always placed between an organ anterior to itself, from which it derives its ratio standi, its final end,—and a third organ, whose development is posterior to its own, and from which it derives its appropriate stimulus. The uterus, therefore, derives its stimulus from the external organs of generation, and the reason of its existence from the ovaries. The relative importance of the organs of generation being clearly established, we shall briefly observe, with respect to the ovaries, that throughout the