In my own practice a woman fifty-four years of age, who had not menstruated for two years, came to me complaining of pain during inter course. She felt every time as if the vaginal orifice was being torn. On examination contraction was found to be beginning In a strong peasant woman, aged fifty-two, whose menses had for the first time ceased for six months, and some weeks before had reappeared in the normal way, I noted' the following: Uterus clearly diminished in size, vagina pale, contracted and smooth, with the characteristic reddish islets, labia extremely atrophied and flabby. The changes in the external genitals had already begun, although the woman was only in the midst of the menopause. A more or less complete involution of the mammary gland accompanied the above-mentioned change. The more rounded form of the breast, which sometimes developes later, depends entirely upon an increased deposit of fat, which is also observed during and after the change of life, either in spots or generally diffused throughout the entire subcutaneous tissue. Of this, more will be said later.
We must now touch upon a point which to some extent stands opposed to the conditions which we have thus far described, although in my opinion it may nevertheless be harmonized with it—cases of so-called " late conception." These are divided into two classes. The first class includes those cases in which the periods recur regularly and conceptions occur after the usual age, until finally the true climacteric is reached, often much earlier than usual. That which we said some time before, with regard to persistent normally-recurring periods and the late meno pause, applies to some extent to these cases. We can, with Krieger, attribute this prolonged fruitfulness to " an unusual vital activity and energy on the part of the ovaries, which commonly goes hand in hand with a peculiar activity of the general constitution." Cases of this char acter are reported in rather large numbers by some of the authors who have already been quoted here. Quite recently Rodsewitsch collected from Russian literature (1872 to 1881) eleven cases in which women from fifty to fifty-five years of age, had borne children. John Kennedy men tions a woman who was delivered normally at sixty-two (November, 1880), having begun to menstruate at thirteen, who since her twentieth year had borne twenty-one children, the ones before the last being born when she was forty-seven, forty-nine, fifty-one, fifty-three and fifty-six re spectively. During the intervals she always menstruated regularly. The same author cites similar cases from Taylor's " Medical Jurispru dence." The second class of these late conceptions is especially interesting, including as it does those cases where menstruation ceases more or less promptly, the menopause is apparently established, and then within s shorter or longer period thereafter conception again occurs, with or with out previous recurrence of the menstrual flow. A number of such cases have been reported. Ilegar refers to cases of Puech's. From Kisch's
collected series I quote only that of Renaudin, in which a woman sixty one years of age was delivered after the menses had ceased for ten or twelve years. Krieger mentions a Mrs. C. II., whose menses ceased at forty eight; two years later irregular menstrual flow returned, conception took place, and finally a healthy girl (the ninth child) was born at full term. Deshayes, of Rotten, observed a case of confinement in a woman of fifty, whose menopause had occurred regularly two years before. The question is, how to explain correctly such phenomena. Does this class really belong with the former, or should it be sharply separated ? To express it exactly, is this simply a question of persistence of the ovarian function, attended with int,ercurrent or positive cessation of the menses, or do both fanctions actually cease and only return (either ovarian activity alone, or both this and the menstrual flow) in consequence of this or that influence. If we adopt the latter, it is certainly most natural to seek for this cause in a return of the sexual function. Krieger laid stress, especially with regard to late conception, on the later period at which marriage was con summated. The procreative power of the husband generally seemed to have a predominating influence, but the reason for the persistent capa bility for conception, as viewed from this standpoint, remained unex plained. Moreover, by reason of the fact that those women who bear children late in life often have a numerous progeny already, this author was led to the opposite conclusion, that late marriage can not be the cause of prolonged fruitfulness. Now as regards particularly the cases in our second class, I do not find among them any special mention of late mar riage. In one of those cited above, the child was even the ninth, from which alone it is shown that early wedlock may also be assigned as a cause. If then late marriage is not necessarily a causal factor even in this second class of late conceptions, then it must, in my opinion, be self-evident that the influence of coitus also upon the condition can not be very great. llegar writes with reference to this second class of late conceptions, " How the function of the ovary is again renewed it is always very difficult to explain; perhaps through coitus." He himself points to this possible solution, but at the same time he acknowledges that it seems to him at least questionable. Equally questionable must be every other theory by which we would explain the return of the departed activity of the ovary. Other observations in the realm of Nature furnish no parallel occurrences which correspond sufficiently to the one in question. The comparison made by Burdach and Busch with regard to the appe,arance of new birth in old people, is only referable to the recurrence of menstruation in ad vanced age. We may allow this to be applied as far as it goes.