8o THE PHYSIOLOGY OF REPRODUCTION 



Very contradictory statements have been made regarding the 

 extent to which denudation takes place during menstruation. 

 Williams (Sir J.), von Kahlden. 1 and others among the older writers, 

 expressed the belief that a large part, if not the whole, of the 

 uterine mucous membrane was destroyed. This view, as will be 

 seen later, has been partially confirmed for monkeys by Heape. It 

 has been pointed out, however, by Whitridge Williams, 2 that the 

 okler writers made their observations upon uteri which had under- 

 gone post-mortem changes. The preponderance of recent opinion 

 appears to be that destruction of the mucous membrane is, as a rule, 

 confined to the epithelium, and that this is only partially removed. 

 Among those who have accumulated evidence in support of this 

 conclusion are Gebhard, Strassmann, 3 Westphalen, Findley, Whitridge 

 Williams, and Lipes. De Sinety, 4 Moricke, and Oliver appear to 

 uphold the opinion that even the superficial epithelium remains 

 practically intact. Mahdl, 6 Maerdervort, 6 and also Champneys 7 have 

 made the exceedingly likely suggestion that the extent to which the 

 mucosa is destroyed varies within wide limits in different individuals 

 or even in the same individuals at different periods of life. 

 " Exfoliation dysmenorrhoea " (see p. 61) is probably a condition caused 

 by a more extensive denudation of the superficial layers of the 

 mucosa than occurs usually during menstruation. 8 Oliver, who 

 maintains that menstruation is essentially a secretory process, states 

 that in cases of chronic inversion of the uterus there is no denudation 

 of epithelium during menstruation. 9 



Minot 10 and Martin, 11 agree in supposing that the superficial 

 layers of the mucosa degenerate after the blood has passed out, so 

 that the bleeding is in no sense the consequence of the destruction. 

 According to Martin, fatty degeneration plays a distinct part in 

 causing the destruction. 



Lipes has shown that the amount of destruction is related to the 



1 Von Kahlden, "Ueber das Verhalten der Uterusschleimhaut wahrend 

 und nach der Menstruation," Hegar's Festschrift, Stuttgart, 1889. 



2 Whitridge Williams, Obstetrics, London and New York, 1904. 



3 Strassmann, "Beitrage zur Lehre von der Ovulation, Menstruation, und 

 Conception," Arch. f. (lynak., vol. lii., 1896. 



4 De Sinety, " Recherches sur la muqueuse uterine pendant la menstruation," 

 Annales de (jynwc., 1881. 



5 Mandl, "Beitrag zur Frage des Verhaltens der Uterusmucosa wahrend 

 der Menstruation," Arch. f. Qynftk., vol. Hi., 1896. 



6 Maerdervort, " Die uormale und rnenstruirende Gebarmutterschleimhaut," 

 Inorg. Dissert., Freiburg, 1895. 



7 Champneys, "On Painful Menstruation," Harvcian Lectures, 1890. 



8 Blair Bell, The Principles of Gynaecology, London, 1910. 



!) Oliver, New York Ned. Jour., August 1906, June 1907, and November 1920. 



10 Minot, loc. cit. 



11 Martin, "The Physiology of Ovulation, Menstruation, and Fertilisation," 

 Hirst's Obstetrics, vol. i., 1888. 



