cause and effect he speaks of those only which lie at the very threshold of diseased action. Tracing back these morbid acts to their remote causes, he says a few words of those which we have all heard so much about—late hours and suppers, idle and luxurious habits, improper dress and exciting literature. I have no disposition to deny these conditions their just value in the cause of ovaritis. I acknowledge the importance of the diseases which he describes in the production of ovarian derangement. But, he speaks of the woman and ignores the child; the accidents of completion are all, and the accidents of formation nothing. There are causes of ovarian derangement other than those which are given by Dr. Tilt. Inflammation is not the only error of structure which may so result. There are conditions which must be assigned to the formative years of life. Relative excess or deficiency is one, and nervous action, radiating from the central or ganglionic systems, exerts a potent and unmeasured power for weal or woe upon ovarian periodicity. Dr. Tilt is not alone in assigning undue importance to the accidents of puberty. Dr. Meigs has had great influence upon the forming of opinion in this country, and his influence has been the more deeply felt from his having clothed with the graces of rhetoric some stern pathological facts. In describing the advent of puberty he has indulged in a sort of physiological antithesis. The child-life of woman is the material which is suddenly transformed into a being clothed in beauty, veiled in modesty, pulsating with charming passion and the divine consciousness of possible maternity. This is what the doctor says: "The earliest years of her life are occupied then in bringing her up to that point of perfect development of her alimentary, respiratory, innervative, and circulatory life, that may fit her for exerting the great reproductive force" ("Diseases of Women," p. 373); and "the transverse and antero-posterior diameters of the pelvis have suddenly and visibly increased" (p. 375); and "it seems as if the forces which had been employed to perfect the beautiful machine, by arranging and completing the quantitative synthesis of its organism, were now occupied, in a sort of paroxysmal intensity, with adorning it with all its graces and attractions, and setting upon it the seal of perfection" (p. 376); and, lastly, "this occurs between fourteen and fifteen years of age" (p. 372). This is certainly leaving a good many physiological facts unnoticed for the sake of dramatic unity. Leaving out the manner, the above is about the substance of what has been written by gynæcological writers upon this period of woman's life. Anatomical writers are also guilty of coming to hasty conclusions upon what ought to be regarded matters of fact rather than of opinion. Mr. Gray, in his "Anatomy," says, that "about puberty the pelvis in both sexes presents the general characters of the adult male pelvis, but after puberty it acquires the sexual characters peculiar to it in adult life" ("Anatomy, Descriptive and Surgical," p. 158).
