Patient.
—Mrs. H., aged 55, German.
History.
—She has always been well and has borne five children. Menstruation commenced at age of 13. and has always been regular, though with some pelvic pain and distress two or three days prior to flow. She entered the climacteric at age of 49. There were no unusual pelvic symptoms. However, as the regular monthly uterine menstruation diminished there was "nasal menstruation," lasting from two to four days, preceded by more or less severe headache. This condition lasted about two years when normal menstruation ceased and "nasal menstruation" became permanently established.
Examination.
—I first saw the patient in December, 1907, almost two years after the last normal menstrual epoch. She consulted me on account of an enlargement in the angle of the right jaw in the region of the parotid gland. She stated that on the cessation of the menses the gland would become