MENSTKUATIOK 



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 -fa 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- 

 se-arches 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 hemorrhage 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 

 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 membrana granulosa, with a pro- FIQ 

 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 blood 



of two cor- 

 natural size. 



eight days after 

 conception : a, external coat 

 of the ovary ; J, stroma of the 

 ovary; c, convoluted wall of 

 Graafian follicle; d, clot of 

 blood. 



into its interior; but this is not constant, though we usually 2, corpus o }. ute r um na jjt * 

 have a gelatinous exudation, more or less colored with blood. ma of the ovary; c, convo- 



fibrous envelope of the corpus 



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 marked at the deep- 

 est portion of the follicle. At the end of about three weeks, the body which is now 

 called the corpus luteum, on account of its yellowish or reddish-yellow color has arrived 

 at the height of its development and measures about half an inch in depth by about 

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

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



