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HEKBEKT M. EVANS 



sweat (Schick). 11 It is indeed surprising that exact anatomical informa- 

 tion about menstruation is so recent and that the conception of insignificant 

 tissue loss formulated by Gebhardt (a) and accepted by Schaeffer, lasted as 

 late as 1908, when the famous paper of Hitschmann and Adler first gave 

 us the truth about the endometrial cycle. 



Due largely to the latter observers and to the subsequent work of 

 Robert Schroeder, we now know that the menstrual processes may be 

 defined as the desquamation of the superficial or "functional" layer 

 of the uterine endometrium, the layer which constitutes from three-fourths 

 to four-fifths of its depth, the remaining portion of the mucosa, the basalis, 

 possessing a thicker-meshed stroma and the ends of the uterine glands, 



Day 21 



Rosalia 



Fig. 1. Scheme of the menstrual cycle (slightly modified from. Schroeder). 



regeneration from which furnishes the epithelial reinvestiture of the 

 naked wound. 



The essential note, however, furnished by these newer studies on the 

 endometrium does not merely concern menstruation itself but the concep- 

 tion of cyclic structural changes undergone by the uterine mucosa. The 

 diagram in Fig. 1, which is slightly altered from Schroeder, will demon- 

 strate these changes, the curve representing the surface of the mucosa and 

 the base line, the outer limits of the endometrium or the position of the 

 muscle layer upon which it rests. By consulting it one sees that a very 

 rapid reinstatement occurs after the menstrual denudation, so that on the 

 ninth day of the cycle the greater part of the endometrium has been re- 

 established, though a slower growth continues to occur. In the latter 

 phases of the cycle the uterine glands, which are also schematically drawn, 



11 The idea of the existence of a menstrual intoxication ought not, of course, to be 

 mentioned so casually. There is a very considerable literature here. Many generally 

 distributed body changes are referred to this. Aschner regards a menstrual enlarge- 

 ment of the liver and spleen as evidence of a periodic toxemia. The menstrual ne- 

 crosis of the endometrium itself has been viewed as a localized auto-intoxication, the 

 school of Gautier viewing this as due to the accumulation of arsenic by the endometrium 

 (cf. Gautier, Ries, Imchanitzky-Ries and Frommer but also Schroeder, Arch. f. Gynak., 

 Bd. 104). 



