Excerpt from The Glasgow Medical Journal, Vol. 79: January to June, 1913

I propose, therefore, to submit to your scrutiny some impressions of mine relating to the physiology and pathology of early pregnancy, along with evidence which appears to me to give them some degree of plausibility. The evidence you may reject as being inadequate for its purpose; nevertheless, I beg leave to hold by my impressions. This attitude of mind I would explain and excuse by means of an anecdote. Somewhere on the frontiers of the Empire a man was appointed to a judgeship. He had had no technical training, but he was the only person available for the post. From the official who made the appointment he received this advice Never give reasons for your judgments. Your judgments are likely to be right; your reasons are sure to be wrong. I cannot escape giving reasons for the faith that is in me, but if I could I should not seek to do so merely from the fear of their being wrong.

It is common knowledge among us that for most women child-bearing ceases years before the cessation of menstrua tion. Only very occasionally is it continued up to the establishment of the menopause. It is common knowledge, also, that for some there are long intervals between the births of their children, during which intervals the usual standard of health is maintained, and, so far as we can know, there is nothing to prevent conception.

It appears, then, that notwithstanding normal menstruation, and after absolute sterility has been disproved by pregnancy, there may yet be incapacity for child-bearing. What is the nature of this incapacity; is it pathological or physiological?

We cannot avoid the conclusion that it is pathological if we hold to the view that menstruation is proof of ovulation, and that ovulation means the forthcoming of an ovum which is capable of development, and which can only fail to develop by reason of some impediment to fertilisation. Cases there are in which the cure of some morbid condition results in the cure of a concomitant sterility. In such cases, of course, the sterility is properly denominated pathological. But the question is not whether there are particular instances of pathological sterility; the question is whether the periods of sterility and lessened fertility which occur generally among women are of this character. The fact of their being common and general is against their being so, and points rather to their being of physiological origin. If they are physiological, then we must revise our notions with respect to the relation ship which we have believed to subsist between menstruation and ovulation, and with respect to the function of ovulation itself.

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