836 THE FEMALE GENITAL TRACT. 



The case furnished by Dr. Munde was the fifth. He gave a history of a 

 patient of his, a married lady, who menstruated only at intervals of three 

 months, and who cast off decidual formations at every menstrual period. In 

 microscopical examination of this case, it was seen that most of the medullary 

 corpuscles were large and oval in shape. The fields of myxomatous "basis- 

 substance were abundant, and often holding in their midst coarsely granu- 

 lated nuclei. The formation of a fibrous reticulum around the nucleated 

 myxomatous fields and around the medullary corpuscles was more advanced 

 than in any other case. In all sections obtained from these specimens I met 

 with fields of tissue, consisting either of medullary elements or fibrous con- 

 nective tissue, in which a peculiar change had taken place, into a shining, 

 homogeneous mass, such as has been described as waxy degeneration. Capil- 

 laries and veins were also abundant, the latter being frequently engorged 

 with blood, but no arteries could positively be distinguished. These features 

 are not fully analogous to those of decidua reflexa or vera ; and, from what I 

 have observed, I should conclude, therefore, that the case was one of decidua 

 catamenialis unusually far advanced in development, and almost approaching 

 the features of decidua vera. 



A positive discrimination between decidua menstrualis and decidua vera, 

 in their earliest stages of formation, seems to be a matter of impossibility, as 

 they have features in common. The development of fibrous connective tissue,, 

 as a rule, is farther advanced in decidua vera than in decidua catamenialis. 

 Decidua vera, in its early stages that is, up to the sixth or eighth week 

 is always characterized by the presence of a myxomatous structure uniformly 

 distributed throughout the formation. Its circular or oblong spaces con- 

 tain either large, finely granular plastids, with one or two nuclei, or a pale, 

 indistinctly granular myxomatous basis-substance, in the center of which 

 often an unchanged nucleus is visible. Not infrequently, in decidua vera, 

 we meet with multinuclear bodies, whose significance is shown by Dr. J. W, 

 Frankl. Finally, decidua vera is marked by the presence of villosities, 

 which, running in all directions, are seen in longitudinal, transverse, and 

 oblique sections. 



Literature. According to H. Kundrat and G. J. Engelmann,* the hyper- 

 trophied mucosa of the uterus, during menstruation, overlaps the openings of 

 the glands, with a marked increase of the size Of the latter. The condition of 

 rest of the uterus during the period of reproduction is of but short duration. 

 as the mucosa commences to swell slowly before the menstruation, and slowly 

 returns to rest after it. No new formation of blood-vessels could be observed 

 in the mucosa of the uterus, swelled and hypertrophied in menstruation, but 

 a considerable opacity and fatty degeneration of the cells takes place. The 

 surface epithelium is preserved to the time of the fatty metamorphosis, but 

 when this ensues, the epithelium of the mucosa, as well as that of the glands, 

 is cast off to a considerable extent. In the first weeks of pregnancy, the 

 mucosa especially the inter-glandular tissue of the upper layers develops 

 to decidua, and the glands become elongated and enlarged. 



G. Leopold t draws attention to the difference between membraiiaceous 

 formations from the uterus and those from the vagina. The former are cov- 

 ered by columnar epithelia, and contain the characteristic glands, while the 



" Untersuchungen iiber die Uterus-Sclileimhaut." Wiener Mediz. Jahrbiicher, 1873. 

 t " Dysmenorrhcea Membrauacea." Arcliiv f. Gynakologie, 1876. 



