v GENEEATIVE SYSTEM OF THE FEMALE 177 



which is increased by pressure, tiredness of the legs, general sense 

 of malaise, disturbances of the gastro-intestinal functions, of 

 defaecation and urination, transient sensations of heat accom- 

 panied by sudden reddening and successive pallor of the face. 

 This total of symptoms, which in great part are within the 

 bounds of physiological phenomena, the Ancients called molimina 

 menstrualia. 



With advanced methods of inquiry there have been brought 

 into prominence by Goldmann, Reinl, V. Ott, and by Bossi other 

 objective phenomena connected with the period which precedes, 

 coincides with, and follows menstruation. The frequency of the 

 pulse, the arterial pressure, the muscular strength, the pulmonary 

 capacity, the inspiratory and expiratory power, the reaction- 

 time of the patellar reflexes, increase in the five or six days 

 which precede menstruation and diminish immediately before 

 and during the five or' six days of menstrual flow, finally re- 

 turning gradually to the normal in the successive days. On the 

 other hand, the sensitiveness and excitability of the nervous 

 system in general, the radiation of heat, the formation and 

 elimination of urea in the urine increase somewhat in coin- 

 cidence with the most intense phase of the menstrual period 

 (Schrader) ; but the gaseous respiratory exchange does not show 

 any sensible variation with the similar period (Zuntz). With 

 the increase of the general functional tone of the pre-menstrual 

 period is accentuated in some women the tendency to sexual 

 intercourse which marks the period of rutting in animals. 



The essential phenomena of menstruation consist in the changes 

 which the uterine mucosa undergoes. It begins to become 

 tumefied through hyperaemia of its vessels, and hyperplasia of 

 the epithelium, and thus its thickness increases from 2-3 mm. 

 to 6-7 mm. (Leopold). This stage of the process is usually called 

 pre-menstrual tumefaction, and is most marked in the parenchyma 

 of the ovary and the body .of the uterus; in a less degree 

 participate also the cervix, the mucosa of the Fallopian tubes, 

 the external genitals, and also the mammary glands, in which 

 are noticed, not infrequently, in addition to a subjective sense of 

 tension, a slight swelling and indications of secretion. 



The stage of tumefaction passes to that of escape of red blood 

 corpuscles, either by diapedesis or by rupture of the capillaries 

 in the interstices of the mucous membrane, with a collection of 

 blood, irregularly disseminated in the sub-epithelial lacunary 

 spaces (haematoma of Gebhard). The formation of these haeinato- 

 mata causes the rupture and detachment of the epithelium and 

 the flow of blood into the uterine cavity, from which it trickles 

 slowly through the cervix and the external genitals. The ex- 

 foliation of the superficial epithelium and the uterine glands 

 continues, even increases, after the haemorrhage has ceased; it 

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