Finally, Tarnier and Chautreuil mention the cases of married women, who became pregnant without the reappearance of the menses, and the rarer cases where women conceive after the menopause.
According to Beigel these facts are conclusive; but the researches of Gusserow and Waldeyer show that in certain cases there is in the pedicle of certain ovarian cysts a quantity of ovarian tissue, and that even here are found traces of corpora lutea. Nevertheless some of these facts seem indisputable. Beigel does not hesitate to conclude from them that menstruation is absolutely independent of ovulation. For him, menstru ation ought to be considered as a genital impulse, repeated from time to time, and accompanied by an afflux of blood, and a great distension of the capillary vessels of the uterine mucous membrane, and very probably of the tubes, and terminating by a bloody discharge coming from these capillaries. The part taken by the ovaries would then be as passive as that of the uterus, the vagina and the tubes.
The theory of Gendrin, Negrier, Bishoff and Coste, is, nevertheless, as yet the classic theory.
[In many women who, apparently, do not menstruate, and yet certainly do ovulate, close inquiry will reveal the fact that, while they do not have a periodic red discharge, they do have a periodic white, the so-called white menses. These cases are not rare.—Ed.] First Appearance of the Menses.
If, in a number of young girls, the first menstrual hemorrhage appears suddenly, this is far from being the case always. This hemorrhage is usually preceded by malaise and local and general troubles, which may reappear for several months, until menstruation is definitely established. The child, which is to become a woman, each month experiences a weight in the hypo-gastrium, colic and swelling of the breasts; at the vulva there appears white mucous discharges, but it is not until after some time that the true menstrual discharge appears. The first appearance of this dis charge is subject to the influence of a certain number of conditions, which we will successively pass in review.
Among these conditions is one that Raciborski called the genital sense, and which he defines as: the greater or less vigor that nature displays in the development of the vesicles of de Graaf. If the menses generally appear in young girls from the twelfth to the sixteenth year, it is not rare to find a much earlier appearance. There are even cases where they have not appeared until the twentieth, twenty-second and even the twenty-fifth year. All writers have shown that very great differences exist in the de velopment of the ovaries in the fcetus, and these differences are accent uated with age, thus impressing corresponding changes upon the menstrual function. Raciborski cites a great number of facts that justify this asser
tion. Among these cases, there is one in which the ovarian activity seemed to begin from the very first years, not to say the first months, after birth, and it is sufficient to recall the cases of Dezeimeris, Comar mond (de Lyon), Le Beau, d'Outrepont, and Suservind. These cases, which Raciborski characterizes as anomalies, show clearly that, in certain indi viduals, this genital power is much more developed than in others, and that the menses appear much sooner. Besides these cases of precocious menstruation, there are, on the contrary, women in whom menstruation is delayed, and does not appear for the first time until the twentieth to the twenty-sixth year. There are other cases in which the menses never occur. In these women, the absence of the menses does not absolutely exclude ovarian evolution, hence they may become pregnant, but they are much less apt to be fecundated than women in whom the menses are normal and regular.
Next to the influence of the genital sense is that exercised by heredity and race. Heredity, the influence of which is felt in so many different ways, can not fail to exercise its action upon menstruation, and it shows it self in some cases in a most remarkable way. The cases of Courty prove this sufficiently. Not less is the influence due to race. In the East Indians the menses appear very early, but in young girls born in India of English parents they are retarded. The researches of Schukitz, which were car ried on in the different provinces of Austria, where the races are diverse, establish a difference of two years between the time of appearance of the menses in the Hungarians, and the people of other provinces. From this point of view, then, the Magyar race is more precocious than the German and Sclavic races. Lagneau tried to explain the differences between Paris and Strasbourg by the mixture of the two races which form the popula tion of the Lower Rhine. Finally, Raciborski has shown that among the Jews of Poland, who intermarry, and where, consequently, the nee is not mixed, the menses appear earlier than in other women. In the latter they appear, on an average, at fifteen years and nine months, while in, the Jewesses they appear at fifteen years, five months, and twenty-six days.