If, on the contrary, we seek for the explanation of our second class of late conceptions in another direction, and assume simply that ovarian activity continues after we suppose that it has ceased, and thus conception occurs, then the probability becomes much stronger. It has been demon strated unquestionably since Bischoff's time, that ovulation may occur without menstruation. AmenorrImea may exist with a rudimentary as well as with a normally-developed uterus, and yet at the same time ovu lation may proceed regularly. De Sin(ty describes the post-nzorlent ap pearances in a woman thirty-eight years of age, who had never men struated. The uterine cavity was one and a half or two inches in depth, consisting principally of the cervix, the body being rudimentary as in the fcetus. In the ovaries were numerous corpora lutes. Normal pregnancy is the best proof of normal development of the uterus and perfect ovula tion, in spite of the absence of the menstrual flow. In fact, this may sometimes occur in young subjects even before the appearance of the tirst menstrual period. On the other hand, women can often conceive and bring forth normally-developed children without even having menstruated : A case was recently related to me in which the almost complete cessa tion of the periods (they appeared at irregular intervals during the year, or even more rarely) led the lady in question to doubt whether she could marry. Reassured by her physician, she married and straightway con ceived, aborting between the fourth and fifth month. In patients affected with lead-poisoning the menses are often absent for a long time. yet such women become pregnant. Finally,:cases are well-known in which nurs ing women have cOnceived without the reappearance of the menstrual flow.
If we consider all these facts, we are jastified in classing the cases of late conception after the cessation of menstruation with the observa tions above mentioned, and explaining them by the theory that in these instances the disappearance of the menses does not correspond with the actual change of life, but that the activity of the ovaries is here prolonged beyond the tinie of the menopause, and de facto has ceased at a later period and with different phenomena than usual. Krieger properly lays stress upon the practical importance of keeping this possibility before the eye, " partly in order to oppose the widespread popular error, that during the climacteric or soon after, conception can no longer occur, an error for which many a single woman has had to make a heavy atonement, and partly to guard oneself against monientous diagnostic errors." In our
own second class of late conceptions, therefore, just as in the first, it is only a question of " unusual vitality and energy of the ovaries," and both classes, as regards their essential character, should be considered IIS one.
13nt, as regards the early disappearance of menstruation before the cessation of the ovarian function, then, if we wish to adhere to the view that there is an intimate relation between menstruation and ovulation, the opinion (which Petit has recently defended) is at any rate valuable that sometimes the stimulation of the genital tract caused by ovulation is not sufficient to produce a periodical flow of blood, and that accordingly the supposed menopause in this case is merely the expression of the somewhat weakened effect of ovarian activity; on the other hand, this phenomenon of prolonged ovarian activity after the cessation of the men strual flow (if we include the before-mentioned observations on concep tion in amenorrh(ea, in the chlorotic, nursing-women, etc.), strengthen us more than everything else in the supposition referred to above, that both processes, ovutation and menstruation, are perhaps connected only loosely, or not even at all.' I would call special attention to the fact that these cases of late con ception, after the cessation of menstruation, are in no respect opposed to the comparison of the climacteric processes, to the disappearance of the gland and its excretory duct, and to the supposition that the atrophy of the ovaries precedes that of the uterus. The cessation of the monthly hemorrhages in given cases, as is self-evident, indicates in no way that atrophy of the uterus has already begun. Proof of the persistent func tional capacity of this organ is furnished by the occurrence of pregnancy, which may go on t,o term. Moreover, this supposition is perfectly tenable here, only the entire retrograde process has proceeded farther. The atrophy of the ovaries begins sooner or later after the last pregnancy, and only then does the final retrograde process begin in the uterus.