Tuto following case seems to be of sufficient importance from its rarity to warrant being reported : Mrs. E. H., Irisii American, twenty-six years of age and married four years, consulted me for the first time April 2, 1897. She had never menstruated, and had had no menstrual molirnen whatever. She had loBt her mother and one brother by phthisis ; her father had rheumatism, and auother brother had had rheumatic fever three times. Of three sisters, one (older than the patient) had four children,

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... and of the two younger, one (aged tweuty-two) had painful catamenia and weak spells, and the other had no uterine symptoms. The patient had varioloid when a baby, and scarlet fever at eighteen years of age. As a girl she had been healthy and of average strength. When seven years old she fell from the secoud story of a building to the cellar ; but from the accouut of her sisters, received no more serious injuries than a shaking up aud bruising. For five or six years Mrs. H. had suffered from periodical headaches comiug on about a mouth apart, but with no definite regularity ; and for the last year the headaches had been much more frequent, many times as often as once a week. The pain was in the top of the head aud coursed downward into the ears ; and an attack would last, at first, three days every month, and for the last year a day or two nearly every week. The headaches were accompanied by nausea aud great tenderness of the scalp, and were generally worse in the middle of the day and in warm weather. She had suffered off aud on for four years with pains iu the ankles, back and elbows. At times she walked lame because of the pain and swelling of the aukles. Had never had rheumatic fever. Digestion fairly good. Bowels regular. No periodic abdominal pains. No hemorrhages from the mucous surfaces of the body. Hot flashes of moderate severity had annoyed her of late, also sweating of the palms of the hands aud axillaaud au evanescent eruption appearing on the arms and legspapular reddened areas, circular iu shape, about two centimetres iu diameter and disappearing on pressure. No cough. No vesical symptoms. Coitus normal. Slight white vaginal discharge. No loss of weight. Uriue, strongly acid, slightly high iu color, 1.027, no albumin. Physical exatuiuatiou showed a well-developed, fairly nourished woman of average height and weight ; black hair and blue eyes and a rather muddy complexion. The hips were well proportioned ; the breasts small, with diminutive uipples. Pubic hair and vulva normal in every respect. Vagiua normal. Uterus small, symmetrical, retroverted aud retroposited in the back of the pelvis, conforming iu auteflexion to the curve of the sacrum, along which it lay aud to which it was fixed by firm posterior adhesions. Behind the cervix on the left could be felt a knuckle of the left Fallopian tube, about the size of a slate pencil in diameter, thickened and slightly tender ; and ou the right side it was poBBÍble to make out only a small mass of indefinite outline that was sensitive on deep pressure. The anterior lip of the cervix was somewhat flattened. The external os was patulous, and a probe entered the canal of tho uterus a distance of 4.7 centimetres, and after traction on the cervix aud using slight force, the point of the probe went by a tight constriction a farther distance of one centimetre, making the total uterine depth 5.7 centimetres, or two aud a quarter inches. The examination would show, then, evidences of an old inflammatory process about the tubes and ovaries, resulting presumably in atrophy of the ovaries, chronic inflammation of the tubes and stenosis of the uterine canal, besides anchoring the uterus iu a pathological position in the pelvis. It would seem that the initial inflammatory process must have taken place early in the patient's life in order so to crush the ovaries out of existence as to do away with menstruation altogether. Whether the varioloid, or the fall that she received, or tuberculosis, should stand in a causative relation to this process, we find it difficult to decide. It is certainly a very common occurrence to meet with an almost exactly similar uteriue condition due to inflammation of the adnexa following septic abortion and labor where amenorrhea is not an attendant symptom. The stenosis in the uteriue canal being so near the fuudus would point to an atrophied uterine body. It seems to me that this case is in a quite distinct class from those instances of amenorrhea from uou-developmeut or anomalous development of the uterus or vagina, for in the latter there is apt to be one or more attempts at menstruation, aud an infantile uterus, small vagina, hypertrophy of the clitoris or other abuormality pointing to a primary lack of development.