MENSTRUATION. 



877 



Changes in the Uterine Mucous Membrane during Menstruation. -If the mucous mem- 

 brane of the uterus be examined during the menstrual flow, it is found smeared with 

 blood, which sometimes extends into the Fallopian tubes. It is then much thicker and 

 softer than during the intermenstrual period. Instead of measuring about T ^ of an inch 

 in thickness, as it does under ordinary conditions, its thickness is from | to i of an inch. 

 It becomes more loosely attached to the subjacent parts, is somewhat rugous, and the 

 glands are very much enlarged. At the same time, there are developed, in the substance 

 of the membrane, numerous spherical and fusiform cells. According to the recent and 

 very striking researches of Kundrat and Engelmann, this condition probably precedes the 

 discharge of blood by several days, during which time, the membrane is gradually pre- 

 paring for the reception of the ovum. One of the most important points in these re- 

 searches is that there is a fatty degeneration of the different elements entering into the 

 structure of the mucous membrane, including the blood-vessels, this change being most 

 marked at the surface; and it is on account of the weakened condition of the vascular 

 walls that the haemorrhage takes place. A short time after the flow has ceased, the 

 mucous membrane returns to its ordinary condition. 



We have already noted that there is a considerable desquamation of epithelium from, 

 the uterus with the flow of blood, during the menstrual period. Sometimes, in normal 

 menstruation, the epithelium is in the form of patches ; and, in certain cases of dysmen- 

 orrhea, there is a membranous exfoliation, which has led to the idea that the mucous 

 membrane is actually thrown off. In normal menstruation, there is no true exfoliation 

 of the membrane, and, even in what is called membranous dysmenorrhea, the so-called 

 membrane is usually nothing more than a membraniform 

 exudation, secreted by the mucous surface. 



Changes in the Graafian Follicles after their Rupture 

 (Corpus Luteum}. After the discharge of an ovum, its d~ 

 Graafian follicle undergoes certain retrograde changes, in- 

 volving the formation of what is called the corpus luteum. 

 Even when the discharged ovum has not been fecundated, 

 the corpus luteum persists for several weeks, so that, ovu- 

 lation occurring every month, several of these bodies, in 

 various stages of retrogression, may sometimes be seen in the ^ 

 ovaries. 



For a certain time anterior to the discharge of the ovum, 

 there is a cell-growth from the proper coat of the Graafian fol- 

 licle, and probably from the raembrana granulosa, with a pro- 

 jection of looped blood-vessels into the interior of the follicle, 

 which is the first formation of the corpus luteum. At the 

 time of rupture of the follicle, the ovum, with a great part 

 of the membrana granulosa, is discharged. Sometimes, at the 

 time of rupture of the follicle, there is a discharge of blond 

 into its interior ; but this is not constant, though we usually 2 

 have a gelatinous exudation, more or less colored with blood. 

 At the same time, the follicular wall undergoes hypertrophy, 

 and it becomes convoluted, or folded, and highly vascular. 

 This convoluted wall, formed by the proper coat of the fol- 

 licle, is surrounded by the fibrous tunic, and its thickening is most 

 est portion of the follicle. At the end of about three weeks, tin- body- wind 

 called the corpus luteum, on account of its yellowish or reddfch-yellow n,W- ha* o 

 at the height of its development and measures about half an inch ill depth b 

 three-quarters of an inch in length, its form being ovoid. The confuted wall then 

 contains a layer of large, pale, finely granular cells, which are internal and are 



FIG. 9Sl.&rtffm* of tiro cor- 

 pora lutea; natural tiM. 



(Kolliker.) 



1, corpus luteum eiirht days after 

 ciineeptiiin : ''. external coat 

 of the ovary : />. stroinii of the 

 ovarv: <'. convoluted wall of 

 Croatian follicle ; </, clot of 



blood. 





lid..; e. (1 >lori/ed H"t : .t\ 



lil.roll* envelope of tl. 

 luieuin. 



