THE patient, a lady of somewhat poor physique, overwrought from mental and physical strain, collapsed from " nervous exhaustion" in June, 1905, when she was aged 32. At this time, too, she had had to lift a heavy weight. Possibly the over-strain, physical and mental, in a person of relaxed fibre, may have been a contributory factor in the trouble which followed four months later. In October, 1905, for the first time, the patient became aware of a protrusion from the vagina, which persisted for a month, and then gradually receded. By April, 1906, it had completely disappeared. It again appeared in August, 1906, and thenceforward reappeared regularly about four or five days before each period, associated with aching pains across the back, at the bottom of the spine. In the latter part of 1907, the protrusion appeared about ten days before each period. The periods had been a little irregular in the summer of 1905, but were regular thereafter. The protrusion was described as appearing in the form of two ldbes; sometimes there was a third, or what seemed to be a third lobe. It was of a bright red colour; occasionally it turned a very dark red, almost black, but this seldom occurred. The size varied, but on two or three occasions it projected for half an inch or more, when it felt as if suspended from something inside. When the patient was walking or standing it was much more distinctly