[I have repeatedly removed such growths from women between 45 and 55 years, who had suffered from profuse flowing for long periods under the im pression that it was a, natural accompani ment of the ehange of life, and that noth ing could or shonld be none to relieve it. E. W. CUSHING.] The menopause has very little, if any, influence in arresting the growth of uter ine fibromata in a large number of eases; indeed, many examples of their rapid in creased growth have occurred. One of the strongest indications for hysterectomy after the menopause is the tendency of the tumor to -undergo some form of de generation which, of itself, may prove fatal. Hysterectomy after the menopause should be resorted to whenever the usually-accepted symptoms present them selves which are acknowledged to be of sufficient gravity to require that opera tion in any other period of life. J. T. Johnson (Med. Review, May, '9S).
Of special importance is the condition of adenoma of the uterus, which attacks women of this age, often after they have ceased to menstruate entirely. Coming on with the symptoms of a simple hy pertrophie endometritis, it is, perhaps, treated by curetting, and apparently cured for some months, when the hlumor rhages commence again, and unless hys terectomy is performed the disease grad ually, but inevitably, passes into cancer of the body of the uterus. The diag
nosis is easily made on the first curette ment, by the abundance and the micro scopical character of the pieces of tissue which are removed. As soon as the diag nosis is certified hysterectomy should be performed.
Simple endometritis, with more or less thickening of the mucous membrane, is very frequent at the time of the meno pause; it tends to delay the cessation of the menses, especially if there is any polypoid formation, as above mentioned.
In some cases the menstruation either ceases or is very scanty, and the ineno pause thus occurring is accompanied with nervous symptoms, hot flashes, or even severe hystero-neuroscs. A local examination is also important, since some uterine trouble will generally be found to account for the symptoins. In some cases the uterns is retroverted, heavy, and sensitive; in others it is ap parently norm] in size and position, but it is tender on pressure, and if a sound is passed into it the endonictriiiin of the