158 DISEASES OF THE UTERUS. 



removing all parts which seem affected by knife or scissors, and by 

 scooping away the less accessible portions by means of Simon's 

 sharp spoon, and then by cauterizing the wound with the hot iron, 

 or by means of the alcoholic solution of bromine first recommended 

 by Routh, and approved by Schroeder and Henneberg. Otherwise 

 the escape of cancerous offshoots which often exist in parts seem- 

 ingly healthy, or of remnants of the ulcer which often extend up to 

 the inner os, may render the operation abortive. The relief of pain 

 is the most important duty in treatment of the symptoms. Hypo- 

 dermic injections of morphine and opiate enemata are often quite 

 indispensable. When the flow is profuse, copious astringent vagi- 

 nal injections are demanded ; and for the foul odor we must employ 

 disinfectants, such as carbolic acid, permanganate of potash, and 

 chloride of lime. The haemorrhage is to be combated by the use 

 of ice, or of cold or very hot injections, or of dilute liquor ferri ses- 

 quichloridi ; or else we must tampon with sponges, or plugs of cot- 

 ton charged with strong liquor ferri chloridi. For the insomnia 

 which is so common, chloral furnishes an invaluable remedy.] 



CHAPTER IX. 



ANOMALIES OP MENSTRUATION. 



[!T has generally been assumed that the menstrual flux is inti- 

 mately connected with the ripening and bursting of a Graafian ves- 

 icle, and with the escape therefrom of one or more eggs ; but this 

 view of the subject has latterly been contested, and the complete 

 independence of ovulatiou and menstruation has been asserted (Bei- 

 get). According to our present information upon the subject of 

 ovulation, the uterine mucous membrane at puberty undergoes cer- 

 tain periodical metamorphoses, the nature of which has been ascer- 

 tained by the researches of Kundrat and Engelmann. They find 

 that at the menstrual period the uterine mucous lining swells up and 

 develops ; its glands elongate and dilate, and a proliferation of the 

 round cells of its basement-tissues takes place. This process is fol- 

 lowed by a retrogressive one, based upon a fatty degeneration of 

 the upper layers of the mucous membrane, so that the bleeding is 

 caused, not, as is generally supposed, by a menstrual fluxion and hy- 

 persemia, but by destruction of the mucous membrane through fatty 

 degeneration. The purpose of the increased development of the 

 mucous membrane is that the egg may be received into it, and only 

 at this time of so-called nidation is the growth of a fructifying egg 



