structures are renewed at least once each year. This generally occurs in the spring, because the light coat is necessary for the warm and the heavy coat for the cold weather.

In birds the rutting season begins in the spring, and the principal part of the moult occurs in the autumn after the rutting season is over. Some birds, however, have two moults, one in the very early spring before the breeding season begins, when they lose a few of the protecting feathers and in some cases grow most fantastic plumage, which is really a part of the sexual ornamentation and plays quite a rôle in sexual selection. Darwin has emphasized this point and uses it as one of the foundation stones in his classical work on sexual selection. He shows that many birds then get a special nuptial dress and that many queer freaks occur for this purpose. One of the strangest of these is found in the auk, which grows special parts of his bill to be worn only during the rutting season. After the fledglings begin to care for themselves the parent birds begin to lose their feathers, and in a comparatively short time the new dress begins to form. The feathers, however, grow for a long time, which must be when the creature has nothing else to do.

I wish to repeat here that menstruation is only a shedding; that it is a process for getting rid of over-ripe material, which is formed for a special purpose and must be disposed of to make room for newer and stronger material.

In the study of human menstruation it must be remembered that woman is the only animal in which the "rut" is omnipresent. The endometrium of woman is, however, different even from that of the monkey, in the sense that it must always be kept in readiness to receive the ovum. The best authorities say that the monkey generally has but one breeding season each year, though some of them, it is said, have two. This usually occurs in the autumn in monkeys with the longest period of incubation; but in some, in which the gestation is comparatively short, a secondary breeding occurs in the spring. The endome

trium consequently does not have to be kept in the rich protoplasmic condition. in the monkey as in the human being. I believe this difference is entirely one of development. In the human being nutrition is kept at the highest point all the time, and is not affected by climatic and other conditions which affect the lower animals. Our nervous and circulatory systems are normally always in good condition, and consequently the human female is the only animal always ready for copulation and her endometrium is continuously in a higher state of development than that of any other animal. In order to keep her endometrium in this condition the over-ripe material is frequently thrown off, and this is all menstruation means.

I have intentionally omitted the consideration of menstruation in domestic animals. This I described in a paper which I prepared for the British Gynecological Association in 1887, and which appeared on page 379 of the British Gynecological Journal for that year. This paper contained a systematic study of the cycle of the "rut" in the dog. was extremely interesting to observe the gradual growth of the protoplasm of the endometrium of the dog as the "rut" approached and large masses of rich corpuscular development were formed to receive the ripening ova.

It

I wish especially to mention at this time that Nature gets rid of that material, when conception is missed, by the lymphatics. The corpuscles undergo granular degeneration, are reabsorbed, swept away through the lymphatics, and used up in the economy. This process is identical in all horizontal animals. The method in erect animals I have already fully described. When an animal becomes domesticated he is fed regularly, his nervous system is always in good condition, and he is thus prepared for more frequent "rut" than when in the wild state. The changes in the endometrium necessary to the reception of the egg require a longer or shorter interval.

Only two papers of value have been written upon the menstruation of monkeys. The first was read by Bland Sut

ton before the British Gynecological Society in June, 1886; the second, by Walter Heape, M. A., Balfour Student of the University of Cambridge, was published in the Philosophical Transactions of the Royal Society of London, Form B. 101, 1894, and is the most important paper that has yet appeared on this subject. Heape says that the Semnopithecus entellus menstruates with fair regularity, at least five or six times a

year.

He adduces one of the strongest arguments for the separation of ovulation and menstruation - namely, that although these animals menstruate five, six or more times a year, they have but two breeding seasons. The only criticism I have to offer on his work is that he has not examined the monkey during the rutting season. His description of the endometrium is indentical with my observations on the little girl who was just beginning to menstruate, and on the dog in the mid-interval of the rut. He regards the endometrium as an undifferentiated tissue, lying ready for sudden action, and capable of making immense amounts of protoplasm on short notice. Had he studied it at the time when the uterus must receive the impregnated ovum, I am sure he would have found the protoplasm far more abundant. His description of the shedding of the epithelium coincides exactly with my original paper on the menstrual organ, but is much better presented. The only difference between us, I believe, relates to the method of production of the protoplasm, but he did not observe this structure when it was in the most rapid stage of development.

One of the greatest objections to the acceptation of my idea of menstruation has been Remak's law. Nine years ago, in my paper on the menstrual organ, I stated positively that the epithelium lining the endometrium is reproduced directly from the tissues beneath it, and that it does not always grow from epithelium as we had been taught heretofore to believe. Mr. Heape has beautifully demonstrated the validity of my position, which none can gainsay. I have reproduced several of his drawings, which show accurately the connection between

the epithelium and the tissue underneath it.

Twenty years ago, when I was a medical student, Remak's law appeared to me absurd; that the epiblast and the hypoblast exist in continued separation throughout life, that they have a dual existence, and that they are two separate and distinct entities living side by side in the same body throughout life, is undoubtedly a reductio ad absurdum. I undertook some original studies in the winter of 1876-1877 to find out how the lymphatic corpuscle is manufactured, and herewith exhibit a drawing enlarged from that which accompanied my first article on the subject. This work was very difficult, as you all know how proverbially hard the immersion lens is to handle. After working one winter I succeeded in establishing beyond a doubt that the granules in the threads of this reticular tissue gradually grow, become full-grown corpuscles, separate from the threads, and float away in the lymph. For two winters subsequently I worked on the same subject with reference to the epithelium, but the idea of karyokinesis so fully dominated my thoughts that my results were not at all satisfactory, though at that time I made a drawing, which I still have in an old sketch-book, showing that the hyaline layer is sometimes extremely granular, and that there are all forms of gradations, from the little granule up to a young epithelial cell, protruding from it into the rete Malpighii. This I first saw in an ordinary section of skin, again in the frog of a colt's foot, and afterward in the matrix of the nail; but the idea of cell division still so strongly possessed me that I was not satisfied, and never understood the correct idea of the reproduction of the epithelium in the adult state until 1886-1887, when, by the study of feather development, I found that the little granules in the hyaline layer gradually grow and protrude into the rete Malpighii until the full-grown epithelial cell of the deep layer is made. The only difference between the epithelial and connective tissue is that at a certain point the undifferentiated protoplasm begins to secrete gluey substance, which

marks the line between sustentacular and protective tissue. To demonstrate this, my friend, Mr. Walter Berry, a graduate of the Worcester, Mass., Technical School, has made me two drawings, one of the feather papilla in the quiet statenamely, when the plumage is full grown -and the other in the moulting condition, when the young feather is just beginning to extend through the skin. In the first the feather papilla is ordinary mucous tissue, with large nuclei and corpuscles branching in every direction. The feather papilla contains a number of blood-vessels even in the quiet state, because the tissue is so abundant that transudation is not sufficient to nourish it and a better blood supply must be had. In the active state, where plenty of rich protoplasm is necessary, every function is found intensified; the granules in these threads are enlarged and grow until the whole lower part of the papilla is a mass of protoplasm divided up into corpuscles, very closely resembling a lymphatic gland. The black lines higher up are the mature epithelial columns which build up the feather.

Observation of the gradations from the beginning, at the bottom of the feather, up to the columns, will demonstrate the gradations of the neutral protoplasmic corpuscles into the full-grown epithelial cells. This, I believe, illustrates the law of supply for the waste of all epithelial tissues in adult life. The other drawings represent various forms of epithelium. Some of them are copied from Quain's latest edition, which is not yet complete, and show the young cells, which undoubtedly are buds from the sustentacular hyaline layer surrounding each gland. In this group of ciliated epithelium, down next to the hyaline layer, the young cells are just growing away from the hyaline layer. My belief, therefore, is that our ideas of the reproduction of epithelium in adult life must be completely reconstructed. The conditions in adult life are very different from those in embryonal life. In the embryo growth, destruction and repair take place rapidly. In the rapid changes of development from the metazoic age up to the highest development of ani

mals, time is a great desideratum, and it would be impossible to wait for the growth of the cell from a little granule. Karyokinesis is therefore the process used in cell production in the embryo, but in adult life the cell is produced from the granule and is the source of supply for the tissue waste from the wear and tear of every-day life. This method of cell production has not been described before. At the time Remak's law was formulated our ideas as to the condition of the tissues of the body were chaotic, and some such formula as this was necessary to hold back too exuberant ideas and to tie down students until the origin of every organ and every tissue was thoroughly understood. thoroughly understood. Remak's law has accomplished a purpose, and, like the scaffolding around a building, it must come down after the building is completed, for as long as the law stands the study of the source of the supply for the repair of the tissue waste of the body must remain stationary. Remak's law takes no cognizance of the fact that the mesoblast is made up from both hypoblast and epiblast. A point which has not received enough attention is that the hypoblast undoubtedly makes connective tissue. The epiblast, mesoblast and hypoblast have three great functions.

1. The epiblast makes the sensory apparatus; it has to receive impressions, reason, and issue orders. In order to accomplish this the epiblast must enter very largely into the composition of the skin, and very few realize how much information the skin really imparts. Next to the eye it gives us the most impressions that we receive, and consequently the epiblast must be its principal component. The millions of touch corpuscles and nerves which the skin contains could not develop from the other membranes. The epiblast, if you will allow the simile, is the general to whom all information must come and from whom all orders are issued.

2. The mesoblast forms the muscles, bones and everything that goes to make the locomotive apparatus, and, with slight assistance from the epiblast, it makes all the muscles, bones, connec

tive tissue, and the generative and the renal and other excretory organs. The mesoblast, then, is justly compared to the army proper.

3. The hypoblast simply deals with the food that is supplied to it, and is therefore only the commissary department.

By keeping the functions of these three great subdivisions in view all the time in future study, a far clearer understanding would, I believe, be obtained of what these three membranes mean, and how it is possible from this original trinity to form one great whole.

My belief is that the reticular tissue found everywhere in the body has the function of producing protoplasm, and that this protoplasm in turn makes tissue epithelium, bone, or whatever may be needed. After shedding, it manufactures a new set of antlers for the whole stag tribe once every year. The procreation of the race very largely devolves upon it, for it manufactures not only the organs with which impregnation is accomplished, but it goes further and makes the organs of sexual attraction, and in this way is an important factor in the preservation of the race. In a paper before the British Medical Association, in 1889, on "The Sexual Ornaments," I stated "that from the horn of the stag to the beard of the Aryan, the sexual ornaments are only a kindred process to the manufacture of the endometrium."

Summary.1. The hyaline layer, with its various modifications, is the matrix of all epithelial tissues, and from it spring all the varied sexual ornaments.

TREATMENT OF HYSTERIA IN THE MALE. Dr. Dandridge states (Boston Medical and Surgical Journal) that it is less frequent than in women, dependent on anemia and want of proper nourishment, and therefore the question of a sufficiency of nourishing food is not so important and so hard a difficulty to meet. In those cases, however, where excessive use of stimulants and anodynes or narcotics have been indulged in, proper feeding is of extreme importance, in order to place the individual in

2. The feather papilla, the hair papilla and the endometrium are only local hypertrophies of this same structure for specific purposes, and that only upon the wearing out of this structure does extreme old age appear.

The one great pathological doctrine to draw from this is that we have at last a key to what cirrhosis really is, because the hyaline layer, with all its reduplications in the capsules of secreting organs, can easily, as a result of slight irritation, instead of forming secreting cells, take another course and form connective tissue.

In closing let me express my appreciation of the honor you have conferred upon me, and the pleasure it gives me to lay before you the results of about twenty years of work. I have been led along roads that were not of my own planning, and have, as it were, stumbled upon these conclusions along most unexpected routes. Although many months of my life have been spent in laboratories, the greater portion has been spent at the bedside, in the ward, and in the study of nature in its wild haunts. I am more than ever convinced that the only way to study any subject thoroughly is not in the laboratory alone, and not to work it from the artificial sources forced upon us by civilization, but, like the bacteriologists, to go back to original sources and watch it in its growth and development through all the varied changes up to its mature state. Then, and only then, can we obtain the complete picture of any tissue, structure, or being.

a position to combat the cravings to which he has yielded. Massage, especially in connection with Turkish baths, will often have a happy effect, but prolonged rest in bed is not, in his experience, of frequent benefit. Relief from the anxiety of wearing and anxious duties, combined with prolonged and even severe out-of-door exercise, is more likely to restore the healthy condition of mind and body than anything else. The ability to take refreshing sleep is the first step towards improvement.

MEDICAL PROGRESS.

WHAT SHALL WE DO WITH THE OLD WELL? Dr. Harvey B. Bashore of West Fairview, Pennsylvania, says (Medical News, September 7): What, then, shall be done with the old wells? We all know that in the absence of a public supply deep tube-wells would be the best remedy. Many, very many, people cannot avail themselves of this source of supply; and the next best thing is to treat these wells after a method devised by Dr. Koch, which is effective, cheap, and greatly lessens the dangers arising from the use of wellwater. An iron tube, two or three inches in diameter-with its lower end perforated-is placed in the center of the well, and the surrounding space filled with fine gravel up to the highest point of water level. This is then covered with sand to the top of the well; and a pump attached to the end of the tube makes a very effective tube-well. All water, in passing through the layers of sand and gravel, is effectually filtered, and the nitrifying organisms change the filth into harmless nitrates. A filter bed like this removes, too, from 80 to 90 per cent. of the bacteria, and greatly, very greatly, lessens the danger to which all are subjected who drink shallow well-water.

TUBAL PREGNANCY OF FOURTEEN MONTHS.-Stieber (American Journal of Obstetrics) says: The patient was married in November, 1891. Menstruation, previously regular, ceased in May, 1892, and later her breasts and abdomen showed the usual signs of pregnancy. In December, 1892, pains in the head and abdomen; breasts became hard, painful and secreted a quantity of milk. This lasted eight days, then fetal movements had ceased. In February, 1893, painful uterine contractions with a small flow of blood and membranes and secretion of milk. The abdomen diminished in size and gradually became hard. In March the menses reappeared, accompanied by pains in the loins and thighs.

On August 20 the patient, a primipara aged 20, entered the clinic. Examina

tion disclosed a median ovoid tumor the size of a fetal head at term, tender, irregular, and of varying consistence, one portion hard, another elastic. Moving the cervix laterally did not disturb the tumor; pressing the latter forward moved the uterus also.

Median laparotomy by Jeannel on August 25 showed an unruptured cyst of the right tube. The tumor was separated from the adhering omentum and opened. It contained a reddish sebaceous magma and a fetus. Total extirpation of the tubal cyst and right ovary, also cystic, followed by rapid recovery.

The right cornu was normal, as was also the insertion of the round ligament into the uterus, not into the wall of the cyst. The excision of the cyst did not open the uterine cavity. These points, and the fact that tubo-interstitial pregnancies have been known to continue until near term without causing rupture, confirm a diagnosis of tubo-interstitial pregnancy lasting fourteen months, with death of the fetus at six months, rather than that of a pregnancy in the uterine cornu. The absence of rupture is explained by the attachment of the placenta to the uterine flank of the infero-lateral wall of the cyst.

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TREATMENT OF TABES. -L. Wolff (American Medical and Surgical Bulletin, August 15) has studied three cases of tabes dorsalis, in which the so-called gastric crises were not only the first, but the dominating, symptoms of the disease. There was a constant lack of hydrochloric acid both during the crises and in the intervals between them. In order to lessen the sensibility of the nervous apparatus of the stomach, well as the entire nervous system, the author recommends nitrate of silver (0.01. gme.-1-6 grn.) and extract of belladonna (0.05 gme.-% grn.) to be given, during the free intervals, an hour before meals. He also recommends galvanization of the spine, neck and abdomen, in sittings of not longer than five minutes, every day or so for several weeks, with tepid baths, at a temperature never below 20 degrees to 22 degrees C. (68 degrees to 72 degrees F.).