ANOMALIES OF MENSTRUATION. 159 



possible ; while in the remaining period, that of so-called denida- 

 tion, during the menstrual flow and during the exfoliation of the 

 mucous membrane, any egg which may reach the uterus will perish. 



Hence it would at first seem as though conception could only 

 take place after a coitus immediately preceding menstruation, and 

 never from coitus following it ; but we should bear in mind that 

 the ripened egg which leaves the ovary at the menstrual epoch re- 

 quires a certain period of time, not precisely known, for its passage 

 through the tube, at the end of which period the state of denidation 

 may have passed over. According to the newest views, those of 

 John Williams, based upon examination of twelve wombs, the re- 

 generation of the fatty mucous lining begins immediately after ces- 

 sation of the bleeding, and progresses steadily until the next retro- 

 gressive period commences. Thus the womb would seem never to 

 be at rest, but to be either in a state of evolution lasting about three 

 weeks, or of involution lasting about one week. Only at the period 

 of involution would implantation and fixing of the ovum (as far as 

 the womb is concerned) seem to be impossible, while impregnation 

 might take place at any part of the period of evolution. Bischoff, 

 however, doubts if an egg be capable of fructification during the 

 latter part of the period of evolution. More probably the egg must 

 receive an impulse toward further development from the seminal 

 fluid while still in the tubes, and only in the improbable event of an 

 egg's requiring three weeks to traverse the tube would there be no 

 period of intermenstrual unfruitfulness.] 



Anomalies of menstruation are not independent diseases, but are 

 symptoms of affections of the sexual organs, or of other diseases 

 impairing the general health. Hence the discussion of amenor- 

 rhoea, dysmenorrhoea, menorrhagia, etc., does not properly belong 

 to a text-book of special pathology and therapeutics, but to a work 

 on semeiology and diagnosis. Following the example of most au- 

 thors, for practical reasons, we will give a short account of the most 

 important menstrual disturbances. 



Too early menstruation menstruatio prcecox is not frequent, 

 if by this term we mean only those cases of haemorrhage from the 

 female genitals before puberty that are accompanied by the expul- 

 sion of a ripe ovum. As we have no certain means of finding out 

 whether this complication exists or not, we must note whether the 

 haemorrhage recurs at regular intervals ; whether it is accompanied 

 by disturbance of the general health, by pains in the back, and 

 other symptoms which almost always accompany menstruation 

 proper. Haemorrhage occurring once, or at irregular intervals in 

 the course of acute diseases, particularly of acute infectious dis- 



