There is, however, one point which of late years has been definitely determined, and which should not be passed without mention: the relation of menstruation to ovulation. It was once supposed that the maturation of an ovule in the ovaries was the necessary accompaniment, and even cause, of menstruation. We now know that ovulation proceeds throughout the whole of life, even before birth, and during gestation,[97] and that removal of the ovaries by no means necessarily involves a cessation of menstruation. It has been shown that regular and even excessive menstruation may take place in the congenital absence of a trace of ovaries or Fallopian tubes.[98] On the other hand, a rudimentary state of the uterus, and a complete absence of menstruation, may exist with well-developed ovaries and normal ovulation.[99] We must regard the uterus as to some extent an independent organ, and menstruation as a process which arose, no doubt, with the object, teleologically speaking, of cooperating more effectively with ovulation, but has become largely independent.[100] It is sometimes stated that menstruation may be entirely absent in perfect health. Few cases of this condition have, however, been recorded with the detail necessary to prove the assertion. One such case was investigated by Dr. H.W. Mitchell, and described in a paper read to the New York County Medical Society, February 22, 1892 (to be found in _Medical Reprints_, June, 1892). The subject was a young, unmarried woman, 24 years of age. She was born in Ireland, and, until her emigration, lived quietly at home with her parents. Being then twenty years of age, she left home and came to New York. Up to that time no signs of menstruation had appeared, and she had never heard that such a function existed. Soon after her arrival in New York, she obtained a situation as a waiting-maid, and it was noticed, after a time, that she was not unwell at each month. Friends filled her ears with wild stories about the dreadful effects likely to follow the absence of menstruation. This worried her greatly, and as a consequence she became pale and anæmic, with loss of flesh, appetite, and sleep, and a long train of imaginary nervous symptoms. She presented herself for treatment, and insisted upon a uterine examination. This revealed no pathological condition of her uterus. She was assured that she would not die, or become insane, nor a chronic invalid. In consequence she soon forgot that she differed in any way from other girls. A course of chalybeate tonics, generous diet, and proper care of her general health, soon restored her to her normal condition. After close observation for several years, she submitted to a thorough examination, although entirely free from any abnormal symptoms. The examination revealed the following physical condition: