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The accuracy of routine sonar scanning of patients attending the antenatal clinic of a general hospital before the 19th week of pregnancy was calculated and compared with the potential accuracy of the techniques used. Out of 200 patients who went into labour spontaneously, 164 delivered within nine days of the sonar prediction, and 152 delivered within nine days of the date estimated from the menstrual history. The discrepancy between the mean of the expected date of delivery from the sonar examination and that derived from the menstrual history was 2.24 days. When the two estimations differed by a week or more the sonar estimation was more accurate, and all 44 patients in this group delivered by the sixth day after the sonar prediction. These findings emphasise the need for those providing a similar service to review the accuracy of their own work.

Out of 255 patients with threatened abortion 67 gave a regular menstrual history and at ultrasound examination had a live fetus with a crown-rump length (CRL) of 10-65 mm, equivalent to a gestational age of 7-13 weeks. The CRL of these fetuses was smaller than expected from their menstrual age (P less than 0.01). For this phenomenon we suggest the term early fetal growth delay. Seven patients aborted and one experienced intrauterine fetal death. These eight fetuses had on average smaller CRL than the remainder 59 fetuses (P less than 0.05). Fetal growth delay may therefore be considered a risk factor in threatened abortion.

Summary A reliable assessment of the date of confinement is often important in early pregnancy. In many pregnancies the menstrual history is in doubt or the size of the uterus does not correspond to the last menstrual period. During early pregnancy the rise of serum diamine oxidase (DAO) is confined within narrow limits to certain weeks of gestation. In a series of 189 patients from the 6th to 16th week of pregnancy, the date of confinement was estimated by enzyme determination, and was also calculated by Naegele's formula. Dating by serum DAO was found to be more accurate than the menstrual history, and this technique is recommended for use in routine clinical practice.

To the Editor.— Exercise-associated amenorrhea (EAA) has been associated with the endurance activities of distance running, 1 ballet, 2 and competitive swimming. 3 We want to add our findings regarding weight training to this list. All female participants at the Pacific Northwest Body Building Competition were surveyed as to their menstrual history, other sport participation, and drug use. Their height, weight, and skin-fold thickness were measured. Thirty-three percent of the women (6/18) not taking oral contraceptives had oligomenorrhea or amenorrhea, one third of whom had consulted a physician for this problem. The percent of body fat was low in all women (18%), but no difference was found between those women with regular and irregular menses. Amenorrheic women did not participate excessively in other forms of exercise, and, unlike surveys of runners, 1 prior pregnancy did not protect them from EAA. No female competitors used anabolic steroids. Exercise-induced amenorrhea has been

Dysmenorrhea is a symptom found in many healthy women. It is important for the physician to make an accurate diagnosis determined primarily by an accurate and detailed case history. There are 4 basic types of dysmenorrhea; 1) primary spasmodic dysmenorrhea; 2) secondary spasmodic dysmenorrhea; 3) congestive dysmenorrhea; and 4) obstructive dysmenorrhea. Secondary spasmodic dysmenorrhea can occur with the use of an IUD. Usually dysmenorrhea is severe only during the first 1 or 2 menstrual periods after insertion of the device. If pain continues to be severe after 2 months the device should be removed. The case history of a 19-year-old girl who had dysmenorrhea for her entire menstrual history is given here. She was diagnosed as obstructive dysmenorrhea and a laparotomy was performed. She was found to have a 7 cm hematometra and 3 pedunculated hydatid cysts of Morgagni. No urological malformations were noted.

Sclerocystic ovarian disease is primarily a clinical diagnosis, since there is no pathognomonic physical finding or laboratory study. The purpose of this study was to evaluate in a planned manner consecutive patients suspected of having sclerocystic ovarian disease. Fifty-five consecutive clinic and private cases diagnosed by this plan were carefully studied in relation to menstrual history, physical findings, laboratory studies, and clinical follow-up. Criteria for operation were outlined. In this group of patients, 54 patients had secretory endometrium on first postoperative period, 44 continued regular ovulatory period for one year, and 63 per cent of patients with patent tubes became pregnant in the first 2 years postoperatively.

The diagnosis of changes in endometrium obtained by curettage depends not only on a thorough microscopic examination of the histological preparations; the diagnosis actually starts in the clinic. The close interplay between structure and function that is so apparent in the human endometrium requires we ask about or determine what the patient’s hormonal state is. We need to know about her menstrual history, previous pregnancies, basal temperature, and any hormones she may have received. What we learn will help us in evaluating the microscopic sections and in detecting abnormal changes.

One hundred newborn infants of low birth weight were examined neurologically in the neonatal period to determine their gestational age. Comparison of this assessed gestational age with the maternal menstrual history, in the 80 cases in which this was known accurately, showed a good correlation, particularly if neurological assessment was deferred until the infant was 5 days old. It is suggested that neurological examination is a useful method of assessing gestational age when the mother's menstrual dates are in doubt.

To the Editor.— The recent articles on unilateral agenesis of the thyroid gland 1,2 prompt us to report our recent experience. We were able to conclude from thyroid scan studies that asymptomatic agenesis of a single lobe was a reasonable diagnosis without surgical intervention. Report of a Case.— A 35-year-old woman was admitted to the hospital for fever, cough, and malaise of several days duration. Physical findings were not remarkable except for acrocyanosis and a few rales in the right upper chest. Chest roentgenograms revealed a small infiltrate in the right upper lobe. Treatment with tetracycline was started, and the pneumonia resolved over several days. She had received iodide therapy for six months at the age of 12 and again for a similar period at age 18. Menstrual history was normal. Her thyroxine levels were 9.7μ g and 8.1μg/100 ml (normal 4.0 to 11.0) and triidothyronine resin uptake 33% and

Having read with interest Mcfarlane's article 1 on "A Graphic Menstrual Chart," I tried to introduce her method of graphically recording the patient's menstrual history in the gynecologic ward of the Hospital O'Horan of this city, of which I am the surgeon. I soon found that it was difficult to keep a daily record of the menstrual state of all the patients because it was necessary to ink one or more square spaces of each chart every morning. Furthermore only blood, clots and pain could be recorded. Therefore I ventured to formulate another method which would permit at the same time the recording of other vaginal discharges, such as simple leukorrheic, serosanguineous, mucopurulent or watery, in a simpler way. To that end I reserved the three spaces corresponding to the one hundred and seventh degree of our temperature chart to the vaginal discharge records. Taking the line of that degree

The specimen presented is one of an apparently normal human ovum which from menstrual history and state of development is probably just beginning its twelfth day of growth. It compares very closely in development with one described by Hertig and Rock (Carnegie No. 7699) and presents features very similar to those of that specimen.

Seventy-one first year nursing students were given an MMPI and menstrual history questionnaire in order to explore relationships among menstrual irregularity, premenstrual and menstrual symptoms, and personality. The results indicated that menstrual irregularity is associated with several psychological and physical premenstrual symptoms and with a few menstrual symptoms. From correlational and factor analyses, results were obtained that demonstrated relationships between psychological maladjustment and menstrual irregularity, and between psychological maladjustment and specific premenstrual and menstrual symptoms.

SYNOPSISA number of studies have attempted to explain obstetric difficulties on the basis of psychosocial conditions which exist during pregnancy. In addition, recent research in the field of life event stress has indicated that life experiences occurring prior to a pregnancy may influence pregnancy outcome. The present study examines the ability of life event stress as well as a variety of medical, social and psychological variables to predict complications of pregnancy. In contrast to previous small-sample research, the present study examines 782 subjects. Multivariate statistical techniques are employed to analyse the numerous variables measured. Results suggest that ‘age at birth of first child’, ‘education level’, ‘menstrual history’, ‘attitudes to pregnancy’ and ‘age at menstruation’ best predict obstetric difficulties. However, only a small percentage of the variance of pregnancy complication scores is explained by these factors.

Although the menopause is generally considered to be the consequence of follicular exhaustion, the relationship between follicle number and the menopausal transition has not been explicity studied. We addressed this question in 17 women, aged 45-55 yr, who were undergoing elective total abdominal hysterectomy and salpingo-oophorectomy. The women were divided into 3 groups according to their menstrual history: 1) menstruating regularly (n = 6), 2) perimenopausal (irregular menses; n = 7), and 3) postmenopausal (greater than 1 yr since last menses; n = 4). The mean ages of the 3 groups were similar. Menstrual histories were confirmed by plasma hormone levels and endometrial histology. One ovary from each woman was serially sectioned for determination of follicle numbers. The mean number of primordial follicles in the ovaries of women who were still menstruating regularly was 10-fold higher than that in perimenopausal women [1392 +/- 355 (+/- SEM) vs. 142 +/- 72]. Follicles were virtually absent in the postmenopausal ovaries. Comparison of these data with those obtained by others in younger women suggests that follicular depletion accelerates dramatically in the last decade of menstrual life. These results support the view that declining follicular reserve is the immediate cause of both the perimenopausal and menopausal transitions, and indicate that the rate and, therefore, the regulation of follicular depletion change during the final phase of reproductive life.

The prevalence of polycystic ovaries (PCO) in normal women of reproductive age was determined by pelvic ultrasound scanning of 257 volunteers who considered themselves to be normal and who had not sought treatment for menstrual disturbances, infertility, or hirsutism. All women had completed a menstrual history questionnaire. 99 women were on oral contraceptives at the time of the study. Of the 158 subjects who were not on oral contraceptives 18% had irregular cycles. 116 (73%) women had normal ovaries and 36 (23%) had PCO. 5 women had multifollicular ovaries and 1 had small, unstimulated ovaries. Only 1 woman with normal ovaries had an irregular menstrual cycle. Of the women with PCO, 76% had irregular cycles, and 6 of the 8 with regular cycles were hirsute. Women with and those without PCO differed in distribution of serum LH concentrations although the median values were similar. 25% of women with PCO had LH concentrations which exceeded the upper limit of the normal range. Thus PCO are common in normal women. Some of these women may have clinical and biochemical markers of PCO, which suggest that PCO in women who consider themselves to be normal is part of the same clinical spectrum as the classic Stein-Leventhal syndrome.

THIS note should have been written a year ago, but during the preceding two years I was working at the Anthropoid Experiment Station of Yale University, in Orange Park, Florida, U.S.A., in a rather isolated place without adequate library facilities, and therefore had no opportunity to read Dr. R. C. Clarke's notes on the birth of a chimpanzee1, in which he states: ” Although the preconceived idea is that the period of gestation [in the chimpanzee] is nine months I cannot help feeling that it is five months, at any rate all the evidence points to it in this case” (1, p. 732). Dr. Clarke does not give either the menstrual history of his female preceding the time (December 1, 1933) when she was ” properly served” or the date of the infant's birth. On the basis of information given in the article by J. M. Wyatt and G. M. Vevers2 and the time of acceptance of Dr. Clarke's publication one can surmise that the infant was born in the first half of May, 1934. The parents of the infant had lived together for a period prior to the first observation of proper mating, during which time there was a ” certain amount of sexual play”. Because of this fact there is a possibility that the date of conception assumed by Dr. Clarke is not correct. The female may have been fertilised during one of sexual play. The December swelling and acceptance of the male do not preclude this possibility, for there are records proving that chimpanzee females may have swellings of the sex skin and be receptive during the gestation period4.

To the Editor.— We recently saw a 25-year-old woman who had previous surgery for benign nodular goiter. The patient had a normal menstrual history. She was 132.5 cm tall and weighed 34.2 kg. Her face was rounded, and she had short fourth metacarpals and metatarsals and a high, arched palate. The patient also had chronic otitis media. Her breasts were thin but definitely showed evidence of estrogen effect. There was no galactorrhea. Although there was no history of other members of the family with similar appearances, the patient indicated that another endocrinologist made the diagnosis of pseudopseudohypoparathyroidism one year earlier. We requested the records from the hospital in which the patient was previously studied. This diagnosis was apparently based on the fact that she was menstruating regularly, had a normal serum calcium level, and yet had some of thephysical characteristics of a patient with either Turner's syndrome or pseudopseudohypoparathyroidism.

Of 1,020 consecutive admissions to a regional neonatal center, 38 infants were admitted following elective delivery in which no medical condition of the mother or fetus had necessitated immediate delivery. Twenty infants had problems that were not primarily the result of elective delivery, but hyaline membrane disease, which was clearly related to premature delivery, developed in 18. Fifteen of these 18 infants were delivered by cesarean section; in none of the mothers had any assessment of fetal maturity or size (other than the menstrual history and physical examination) been made. The infants remained in the hospital for an average of 12.7 days at a median cost of $2,678 per patient. One infant died. In the absence of pressing medical indications and without an objective assessment of fetal maturity, elective delivery remains potentially hazardous. ( JAMA 238:2036-2039, 1977)

Of 1,020 consecutive admissions to a regional neonatal center, 38 infants were admitted following elective delivery in which no medical condition of the mother or fetus had necessitated immediate delivery. Twenty infants had problems which were not, primarily, the result of elective delivery, but 18 developed hyaline membrane disease which was clearly related to premature delivery. Fifteen of these 18 infants were delivered by Caesarean section and in none of the mothers had any assessment of fetal maturity or size (other than the menstrual history and physical examination) been attempted. These infants remained in the hospital for an average of 12.7 days at a mean cost of $3456 per patient. One infant died. Elective delivery in the absence of pressing medical indications should not be undertaken without objective assessment of fetal maturity. Failure to utilize available techniques may produce a cost in morbidity and mortality which cannot be defended.

To the Editor:— Soskin Wachtel and Hechter reported inThe Journal(May 25, p. 2090) on the value of prostigmine in inducing menstruation in women who had missed their regular menstrual cycle. These authors stress the role that hyperemia may play in menstruation and attempt to correlate the parasympathetic nervous system with it. They write: This relationship of the nervous system to uterine hyperemia might readily account for the well known influence of mental, emotional and physical strain on the menstrual history of women. It thus appeared possible that cases of delayed menstruation, now generally ascribed to temporary endocrine dysfunctions, might in fact occur despite normal hormone secretion and be due to abnormally decreased vascular responsiveness. It therefore seemed worth while to attempt to treat such cases by pharmacologic [prostigmine] rather than by endocrine means. They showed that twenty-five women who had missed a menstrual period for from three to

The report of unusual cases, together with an acknowledgment of mistaken diagnosis, must always be a chief means in the advancement of our science. The rapid strides made in diagnosis of bladder tumors in the last three years through the aid of the modern cystoscope has tended to make us overconfident. For this reason I undertake to report a case of carcinoma of the bladder incorrectly diagnosed. I wish also to make a few suggestions which in the future may aid us in such cases. REPORT OF CASE History. —Mrs. F., aged 30, Jewish, complained of painful and frequent urination accompanied by hematuria. The family history was negative. She had always been well till the present illness. The menstrual history was negative. The patient had had no leukorrhea. She was married six years before I first saw her. At about this time she acquired gonorrhea and was treated with astringent

The rareness of this disease is my reason for reporting this case: History. —Mrs. R. J., aged 63, married, consulted me, April 7, 1915, complaining of constipation, gas in stomach and bowels, loss of strength and weight and pain in left side at margin of ribs. The patient had three healthy children, was doing housework and had always worked hard. The family history was negative. She had had children's diseases with good recovery, chronic cough for twenty years, had been constipated since childhood, and for the previous twelve years had suffered from periodic attacks of cyanosis involving the hands and feet. She had had malaria when a child, but no other fever. Menstrual history was negative. The menopause had occurred twelve years previously. There were no unexplained miscarriages. Present Trouble. —Although the patient had been constipated for years and had suffered much from intestinal putrefaction, she did not become incapacitated

Soule: The Practical Value of Vaginal Cytology in Pregnancy. II. Vaginal Smears During labor, p. 368. A series of 414 smears taken on admission to the labor suite was studied to ascertain whether the patients were "at term," "not at term," or "regressive." At the completion of the cytologic study, the clinical histories were obtained and the laboratory interpretation was matched against the expected date of confinement from menstrual history, clinical course of the patient, and status of the fetus. It was concluded that: 1. Smears at term correlate with averagesized fetuses in the same degree as expected date of confinement from history correlates with fetal size. 2. Smears not at term correlate with infants weighing less than 2,500 grams with less accuracy than history. 3. Regressive smears did not correlate with fetal weight of more than 4,000 grams. 4. Vaginal cytology obtained during spontaneous labor is of less correlative value than clinical history. f. Edward Hall

Relapsing febrile nodular nonsuppurative panniculitis is a rare disease. Bendel 1 in an excellent survey reviewed 43 cases of this syndrome previously reported in the literature and added one of his own. This is not an attempt to duplicate his work, but merely an effort to bring this syndrome to the attention of medical men; we feel it is probably more common than the few reported cases would indicate. REPORT OF A CASE F. S., a woman aged 32, was seen regarding her present complaint on Jan. 16, 1950. This patient was previously seen in the clinic May 14, 1946, with numerous complaints which were considered to be associated with recent divorce proceedings. Her past personal history was essentially noncontributory. She had been married six years and had never been pregnant; her menstrual history was normal. She had had the usual childhood diseases, and an appendectomy was performed in 1946.

The debate about the efficacy of rhythm methods continues; yet the testimonials and confutations seem at times to be more the results of opposing zeitgeists than of scientific judgment - most of the available evidence is tenuous. The purpose of the present paper is to assess the theoretical efficiency of the systems of Ogino and Knaus. This attempt is prompted by papers by Tietze and Potter who have recently described a mathematical model which in some respects approximates to the processes of Ogino and Knaus. After analyzing the properties of their model they conclude: According to the model the formula of Ogino offers a 90 per cent chance of avoiding pregnancy for 5 to 10 years. Before this conclusion can be interpreted as an appraisal of the Ogino system itself it is necessary to examine whether their model approximates to the Ogino system in all important respects. In this paper I shall examine two features of the model in which so I will argue it differs from the Ogino system: [(1)] In the model it is posited that periods of abstinence are centered appropriately round the best estimate of the most fertile day. It will be maintained that in Oginos and in Knauss systems they are not so centered. [(2)] In the model it is posited that pre-ovulatory phases within the menstrual history of a given woman are distributed normally. Potter and Tietze are aware that this is a departure from the facts but it is worth examining the extent and implications of this departure. (excerpt)

Case 1. —Phrenicectomy for Bronchiectasis of the Left Lower Lobe by Dr. Graham. A woman, aged 28, was admitted to the hospital on Nov. 13, 1928. Her chief complaint was bloody expectoration of fifteen months' duration, most marked during the three weeks previous to admission. She had always been weak and susceptible to colds. She had whooping cough at the age of 5 years and mumps at the age of 12. Her menstrual history was negative. She had been married for eight years, but there had been no pregnancies. The onset of the present illness occurred at the age of 13, when the patient suffered from a cold which was associated with a purulent discharge from both ears. Her cough was then productive of grayish-white sputum. She was able to be up and about, however, and it was not until the age of 16 that she contracted what was considered

Occurrence of torsion in the fibromyomatous uterus is sufficiently rare and the complications are of such gravity that it would seem wise to report even a single new case. A survey of the literature reveals very few reports from this continent and no exhaustive work since the report of Peightal1in 1929. REPORT OF CASE Miss G. S., a nullipara, aged 34, admitted March 1, 1936, complained of "severe pain in the abdomen" of one week's duration. The cramplike pain developed in the right lower quadrant of the abdomen and felt like a weight pulling down. This pain was similar to, but more severe than, the pain she had been experiencing the past three years prior to her menstrual periods. The menstrual history had been quite normal and regular until the month previous to admission. At the time of the onset of the pain the menses were seventeen days

It requires but a short experience in taking gynecologic case histories and in reading such histories as taken by students and resident physicians to demonstrate the difficulty of grasping quickly and remembering accurately the patient's exact menstrual history. Unless a rather wordy description is written and referred to at each visit, the same questions will be put to the patient repeatedly, and, after the history has extended over several months, only moderately accurate replies will be obtained. After a considerable period of dissatisfaction with present conditions I endeavored to formulate a method of graphically recording the patient's menstrual history similar to that universally used for recording variations in pulse, temperature and respiration. The resulting chart, after several months' trial in private and hospital practice, has proved a great improvement over anything previously used. In private practice a chart is given to the patient at her first visit with directions as

The study of symptoms of ectopic pregnancy, augmented in this paper by observation of 81 patients treated surgically in the Ravenswood Hospital, Chicago, reveals results interesting not only to the gynecologist but to the surgeon, who faces the problem of differentiating "surgical" from "gynecologic" diseases of the lower part of the abdomen. Laboratory data which make the diagnosis almost specific, such as the Aschheim-Zondek reaction, are not always available, but once the possibility of an ectopic pregnancy is considered, these tests facilitate a more definite diagnosis. Although, as will be explained later, the blood counts are often bare of any diagnostic significance, there will be occasions when the patient's pallor and other manifestations of shock will make a diagnosis of internal hemorrhage definite. The only difficulty will be in determining the source of the hemorrhage; abnormalities in the menstrual history together with other manifestations, to be mentioned later, should lead

Numerous cases have been reported of mercuric chlorid poisoning by absorption through the vaginal mucous membrane. Most of these have been the result of ignorance, as when a woman has inserted an "antiseptic" tablet into the vagina with a resultant gangrenous inflammation and absorption through the damaged tissue of the part. Other cases of poisoning have been due to douches given to women after childbirth; when absorption is facilitated by the relaxed and abraded tissues. The case I report demonstrates that the normal vaginal mucous membrane also may in certain persons absorb enough corrosive sublimate from comparatively dilute solution to cause toxic symptoms. REPORT OF CASE History. —Mrs. B., aged 22, married six months, has always been healthy with the exception of the usual diseases of childhood. Her menstrual history has been normal; she has not become pregnant. Three weeks prior to examination the patient first noticed a swelling in

The association between Turner's syndrome and hypothyroidism has been described on several occasions. In the reported cases, the X-isochromosome X karyotype has been observed in patients with Hashimoto's thyroiditis whereas the typical XO karyotype of Turner's syndrome has been associated with nongoitrous or primary hypothyroidism.1-5 This report describes a patient with Hashimoto's thyroiditis who was found to be chromatin negative and to have a 45-XO karyotype. She has the typical features of Turner's syndrome with the exception of a normal menstrual history. Patient Summary The patient (00-32-50), a 64-year-old white woman, was seen in the Endocrine Clinic at Ben Taub General Hospital for management of hypothyroidism. She was noted to have many of the clinical features of Turner's syndrome, but gave a history of normal menstrual periods between the ages of 14 and 42 years. Although she was married for the last seven of her theoretically fertile years

In most instances the origin of symmetric gangrene is impossible to explain. I wish to report the following case as the cause seems reasonably clear and the degree of involvement was extensive. REPORT OF CASE D. M., an unmarried woman aged 32, an underwear operator, was first seen by me on June 1, 1936. Her father and mother, three brothers and one sister were all living and well. The menstrual history was normal, and the only previous illness was measles in childhood. The patient drank coffee and wine rarely. The original consultation was to seek relief from articular disturbance associated with generalized weakness, both of which began four years previously when the right wrist began to be painful and later to swell. The weakness and lack of endurance had been slowly progressive, and after a year of debility pain developed in the feet, and the right knee joint became painful

The reason for reporting this case is the unusual location of the polyp. Polyps and papillomas occur in any part of the colon. They may be single or multiple and usually are of inflammatory origin. The case reported here was probably due to repeated attacks of inflammation of the appendix by which the lumen of the appendix became closed off from the cecum. The appendiceal lumen thus enclosed became a source of irritation itself, and the response to this was a reaction of the mucosa on the cecal side of the obliterating membrane in the form of a polyp. A woman, aged 22, married three years, with a negative family history, has one child, aged 2 years, living and well. The menstrual history was negative. At the age of 15 she had an attack of severe abdominal pain while at a girls' camp. This was diagnosed as appendicitis. Since then

The occurrence of a small tumor composed of endometrial tissue on the posterior aspect of the thigh of a Filipino woman seemed sufficiently unusual to warrant reporting. REPORT OF CASE History.—A Filipino woman aged 35, a Philippine army nurse, entered the 247th General Hospital Dec. 26, 1945 complaining of a tumor on the posterior aspect of her left thigh. The family history was noncontributory. The patient began to menstruate at the age of 17. Her periods occurred regularly every twenty-eight days and lasted three days. There was an interval of unexplained amenorrhea lasting one year when she was a student nurse of 19. She gave birth to five normal children between her twenty-first and twenty-seventh years. At the age of 32 after five months of "pregnancy" she passed a hydatidiform mole. Thereafter the menstrual history was not remarkable and the absence of further pregnancies was attributed to the use of

The roentgen rays are being increasingly employed as a therapeutic agent, particularly for tumors. Untoward results are found to happen occasionally, as the dosage is only approximate, and individual patients will react differently to the same quantity of rays. Therefore, roentgen-ray therapy is not without its dangers, although reports of injuries are scarce. The following case is one of hyperthyroidism, treated with the roentgen rays. The hyperthyroid condition was improved, but the patient died from the destructive effects of the roentgen rays. REPORT OF CASE Mrs. G., aged 40, whose menstrual history was normal, had had several healthy children, with normal parturition. The previous history was negative. Seven years previous to consulting me, she had been treated medically for hyperthyroidism and was improved. Five years previous to consulting me she had a recurrence of symptoms, and about three years previous to consulting me she received her first roentgen-ray treatment. She

Dermatitis is relatively common in diabetic patients. It is usually persistent, and sometimes intractable. We therefore believe that the following case report is of interest in view of the quick relief and apparent cure of diabetic dermatitis of five years' standing by means of insulin. REPORT OF CASE A white woman, aged 59, entered The Barnard Free Skin and Cancer Hospital Dispensary on July 30, 1923. The family history for diabetes was negative. The patient had had the usual diseases of childhood. The menstrual history was negative, except for a persistent dysmenorrhea. She had never been pregnant. For the past ten years she has had prolapse of the uterus. During the same period she has suffered from attacks of arthritis, and an arthritis deformans exists at present, but there is no evidence of an eruption about the joints. About five years ago, the patient began to notice an increased thirst

The following clinical recod is presented as an example of a rarely diagnosed disease-form and its cure: History. —Mrs. L. L., aged 35 years, referred by Dr. William Duffield, Los Angeles, is the fifth in a family of nine children. Her parents are alive and healthy. There is no history of headaches or nervous disease in the family. Up to her seventeenth year the patient was in rugged health. Her menstrual history began at the age of 15, and is the dominant feature of the case. Menstruation has been vey irregular. During the last five years it has appeared normally out twice, and not at all in the last thirteen months. Some, of herheadache seem to have been due to cerebral hyperemia caused by suppressed menstruation, inasmuch as at every period when menses should show and failed to do so she suffered with terrific hyperemic headache. She was married five