corpuscular development. A section of the endometrium of a girl thirteen, who had menstruated twice, shows more elaborately developed columnar epithelium, and the beginning of a corpuscular layer. The menstruating uterus of a woman at twenty shows abundant corpuscular development, constituting a thick endometrium, with its endometrium, in process of casting, while a senile uterus at sixty shows merely the skeleton of the endometric structure, with almost complete exhaustion of its corpuscular elements and a total absence of epithelium. S. and J. both agree that in menstruation the epithelium of the tubes is not shed.

Mr. Tait argues from these facts that we have an explanation of the coincidence of impregnation and menstruation, the plain fact being that an impregnated ovum adheres only to a surface denuded of epithelium. When desquamative salpingitis has destroyed the tubal epithelium, the ovum may be impregnated in the tube, and may adhere to the exposed tissue and tubal pregnancy result. Tait claims that ovulation is going on constantly from childhood into old age, but it is necessary that the ovum when fertilized should pass over the endometrium where it is denuded of its epithelium, and in a condition of turgescence fit for the subsequent process. For one thus secured there are probably a hundred that perish either dropping into the peritoneal cavity or passing out through the uterus. The menstrual process is necessary, or such parts of it as involve the preparation of the endometrium are necessary for impregnation, but menstruation has nothing to do with ovulation further than being a means to the end of gestation. Tait further argues that the singular discrepancy between the uterus and ovaries in their pathological tendencies is due to two facts, the first discovered by Ritchie that from infancy to death the glandular function of the ovary is never quite at rest, so that ovarian tumors are met with at all ages, the second displayed for the first time by Johnston that the truly glandular function of the uterus begins with puberty and ends with the elimateric, therefore we have myoma practically limited, indeed in origin. the limitation is absolute to the time between these two incidents of woman's life. J. claims in support of his theory that the endometrium above the internal os is not a mucous membrane but belongs to the so called adenoid tissue, and that menstruation is for it what the lymph stream is to the lymph gland, or the blood current to the spleen. The explanation for the occurrence of this phenomenon in women only, and in some of the higher apes in a partial way is thus explained. “In two of the ruminants I have shown that nature has supplied this tissue with an abundant lymph stream, which, in the unimpregnated state washes away the ripe material to the general circulation exactly as it does any

other lymph corpuscle, but in woman, where on account of its erect position the uterus has to depend on the tonicity of its own fibers for the preservation of its shape the loose tissue of lymphatic net-work can not be depended on. So to preserve the integrity of the uterine wall the emulgent stream is poured into the cavity of the body and got rid of by the vagina.-Buffalo Med. and Surg. Journ. Abstract from Brit. Med. Journ. Jan. 22, 1887.

In the annual address to the Obs. Society of London Jan. 12, 1887. Dr. J. B. Potter said that one of the highest points we should aim at is the prevention of disease, and he who can prevent the occurrence of diseases of women will be a greater benefactor to his race than the operator, however skilled he may be, who treats them. The tendency now, seems to grow more and more surgical until to some minds abdominal section and the removal of internal organs seems the panacea for all the ills that woman is heir to. Statistics on these matters, however carefully tabulated, have to be received with caution, the distinction between cases that have recovered or become well, and those that can be truly said to have only just escaped death, or have lived too frequently with their suffering unrelieved, has not always been clearly shown.

In estimating these matters much depends on character. A reputation for truth and logical precision is of more permanent value here than the statement of brilliant results that will not bear the test of investigation. If I have spoken strongly on this matter it is owing to the fear that some may be apt to forget the sacredness of human life in their zeal for operating, and this must be my excuse.—Am. Jour. Obs., April 1887.

A Case of Unilateral Galactorrhea.-A lady, age 23, who had ceased nursing for six weeks had a flow of twenty ounces of milk in twenty-four hours from the left breast. She at first nursed with both breasts but the milk disappeared from the right one, and she continued with the left one for four months and then discontinued, as it was thought that her milk disagreed with her child. Menstruation had not reappeared, she was not pregnant, and there was no uterine disease. She was anæmic, but the milk was of good character. The usual remedies as used by the old school had failed. Arsenic, iron, strychnine, iodide of potassium, bell., brom. of potassium, quinine in large doses, compression of the nipple, opium, galvanism, Faradism, rest, and a dry diet. Menstruation appeared eleven months after the birth of the child, being preceded by a gradual diminution of the flow of milk, which continued over the second period and then ceased altogether, and the patient's condition became one of natural health. The galactorrhoea was unilateral, the milk was of normal quality and quantity; there was no stimulus of nursing or of

the genital organs; while resisting all treatment, it ceased spontaneously on the recurrence of menstruation. Authors were quoted as to the value of certain drugs in galactorrhoea and cases were given illustrative of treatment by galvanism and Faradism. Reference was made to the experiments of Roehrig to determine whether the nervous or vascular element has the greater influence over the secretion of milk, and resulting in favor of blood pressure as the chief factor. Sinéty was also quoted, and in conclusion the writer said that he had failed to find a record of a similar case. (J. B. Potter, M.D. Obst. Soc.: London, Feb. 1887. Am. Jour. Obstet., April, 1887.)

Cloacal Reversion in the Human Female.-Dr. G. S. Sykes, Galveston (Medical News) reports the case of a female in whom the vagina was absent, but coitus was performed, impregnation resulted, and delivery affected through the anus. The woman had borne three childrenall well developed-but all dead from protracted labor. The parts within the vulva were virgin; the clitoris normally developed and situated; the vestibule, the posterior commissure, were not distorted by child-birth. The urethra was in its proper place. The nymphæ and labia majora were virgin in symmetry of outline. Two fingers introduced into the rectum passed upward along the anterior rectal wall about two inches, where it was found the surface gradually sloped forward and separated and merged into the anterior vaginal wall, which at this point had normal anatomical relations. From half an inch to an inch below the os uteri could be felt the free edge of the membranous curtain which represented the upper third of the recto vaginal septum. There was nothing abnormal in the size, position, or the utero-vaginal relations. Speculum examination fully confirmed the digital exploration. The condition was congenital and was clearly a partial retention of the cloacal condition found in the foetus and the lowest mammaliathe monotremata. Similar cases are reported by Ogston, Siebald, Barbant and Morgani. (Med. Standard, April, 1887).

Venereal Diseases in Young Girls.-Mr. F. W. Loundes, (Lancet, Lon., Jan. 22), gives an account of twelve cases of venereal disease in girls of 5% to 141⁄2 years which were met with during eleven years while he was in charge of the Lock Hospital at Liverpool. In at least three of the cases, it was clearly proved that the accused persons were sufering from disease, and hoped to cure themselves by intercourse with their victims. The writer points out that the horrible superstition that coitus with a virgin will cure veneral disease is common in England, and accounts for many of the cases of rape on young children. "Disgusting as it may seem," Tidy says: "It is no less a fact that women doctresses not unfrequently prescribe this criminal attempt to

young men who consult them for urethral discharges. Many cases show this to be a fact. (Med. Abstract, from New Eng. Med. Monthly).

Lawson Tait's opinion of Lady Physicians.-Straws show which way the wind blows. We quote the following for the encouragement of our women in the profession: (Chicago Med. Times, April, 1887). In his recent address, as president of the British Gynecological Society. Tait, the great ovariotomist, said that for fourteen years women doctors had been upon his hospital staff, and during all that time there has not been the slightest attempt at friction of any kind. . . . I do not think it would be possible to keep these women silent, if it had been true, as was said of us, that we were performing unnecessary and improper operations upon their suffering sisters. It will be evident therefore, that I have always felt a sense of protection in the fact of my having a woman for a colleague, and that I felt this to the full, is evident in the fact that I have a woman practitioner of medicine as one of my regular staff of stipendiary assistants in private practice, without whose presence I very rarely perform any important operation.

Secondary Inflammation of the Parotid Gland.-(Buffalo Med. and Sur. Jour. April, 1887). As secondary inflammation of the parotid gland is thought generally to portend evil to the patient who has it, develop subsequent to injuries and operation wounds, the following may prove of solace. Mr. Steven Paget reports sixty cases in the London Lancet, in all of which the primary lesion was in the abdomen or pelvis. Most of the patients recovered. In many there were no signs of septicæmia or pyæmia. The author draws the following conclusions: 1. That the parotid gland is related to the peritoneum. 2. That it is also related to the generative organs. 3. That an abdominal or pelvic lesion may be followed by parotitis without pyæmia. 4. That such a parotitis, if it occurs later, and with healthy kidneys is usually followed by nursing. Among these, the parotitis followed: 1. The use of -a catheter or sound in four instances. 2. Several cases followed labor,

or induced abortion. 3. Several cases were from peritonitis, from injury or perforation. 4. Some followed operations, such as gastrotomy operations on the cervix uteri, and especially ovariotomy, following the latter, they are not unusual. 5. Following pelvic cellulitis and abscess. In one case reported, the woman had parotitis in six successive pregnancies, and one patient with amenonhoa, had a parotitis at each menstrual period.

New York, 219 West 23d Street.

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cases.

EXTRACTS FROM AN ESSAY ON MYXOEDEMA
BY R. VIRCHOW.

(Translated by DR. S. LILIENTHAL.)

'THE London Clinical Society ordered a bureau to study the question. of Myxoedema and so far collected about one hundred and ten Only a short while ago the thyroid gland was considered a blood gland, supposing that such a large gland must have an especial influence on the circulation. Some considered it as showing some similitude to lympathic glands, especially to the spleen and to the thymus gland, but those alveolar hollow spaces, which in the young gland are nearly filled up with cells, fail to find any analogy in lymphatic glands. Virchow rather compares the tissue of the thyroid with the cortical layer of the suprarenal tissue and the great lobe of the hypophysis cerebri; hence he calls tumors arising in these regions struma suprarenalis; struma pituitaria. Ord of the St. Thomas Hospital originated the name of Myxedema, as one of the characteristic symptoms of the disease consists in a gradual enlargement of certain superficial parts; especially of the face. The cheeks feel full and tense, the lids swell up, the lips protude more and more as also the alæ nasi. For grave cases the same is observed on the extremities, hands, forearms etc.; in some cases the whole physiognomy changes; which in its first development shows great similarity to anasarca. Such an apparent liorasaria from the face downward shows in some cases transition forms; which were named pachdermy and, Charcot therefore named such cases "cachexie pachydermigue."

Ord extirpated a small part of the afflicted skin and afterward several autopsies were made which gave the idea that the watery fluid does not consist in a moderate quantity of albuminatis, as it is usually the case in dropsies; but in a fluid containing mucine, so characteristic of catarrhal secreta, and which we find again in the so called mucous tissues in the vitreous bodies, in the umbilical cord. Myxoedema may be therefore characterized as a state of swelling, differing totally from anasarca by the mucine the swelling contains.

Horsley experimented on monkeys, and carefully extirpated under asepsis the thyroid gland and thus procured a mucinoid state, when the mucine is not only found in the most different tissues, but also in the blood. We thus would have a mucinoid dyscrasia, a kind of myxœmia. Horsley also found that the extirpation of the thyroid affects greatly the secretion of the salivary glands which contains more mucine than usual and that the parotis, which usually contain only a trifle of it, becomes now nearly saturated with it. He examined also the cutis,