664 



UTERUS AND ITS APPENDAGES. 



decline, when the discharge loses its deep red 

 colour and assumes the hue of water in which 

 raw flesh has been washed. This is very com- 

 monly the condition of the discharge during 

 the last day or two of each period, especially 

 in those women in whom the flow is of long 

 continuance. 



M. Pouchet* has examined with great care 

 the menstrual discharge at each of these 

 periods. The following are the results of his 

 observations : 1st invasion. A very few blood 

 globules mixed with mucus may be observed, 

 together with mucous-corpuscles and scales of 

 epithelium, mostly entire, floating in an abun- 

 dance of limpid fluid. Almost all the mucous- 

 corpuscles contain smaller globules or granules 

 which form in them a central nucleus. 2. 

 Stasis. Menstruation havingreached its apogee, 

 the blood-globules are much more numerous 

 than at the onset. The plates of epithelium 

 usually remain entire. 3. Decline. The fluid 

 contains the same substances, and presents 

 nearly the same appearances as at the time of 

 commencement of the flow. 



These observations agree generally with my 

 own, and also with those of Donne, who found 

 the menstrual fluid to consist of, 1. Ordinary 

 blood-globules of the proper character, and in 

 great abundance. 2. Mucus from the vagina 

 mixed with epithelial scales. 3. Mucous- 

 corpuscles from the cervix uteri. 



The unmixed menstrual fluid. But in order 

 to determine the nature of the menstrual fluid 

 as it issues from the uterine orifice, unmixed 

 with the secretions of the vagina, it must be 

 collected by a speculum accurately fitting the 

 uterine neck. The fluid so obtained possesses 

 properties very different from those of the 

 flux already described. Its sensible characters, 

 as observed in more than a dozen specimens, 

 are well described by Mr. Whitehead. Thus 

 procured, the fluid is never so dark in colour 

 as ordinary menstrual blood, so called, nor so 

 fluid always as that of the arteries. Its colour 

 varies slightly, but whatever is its tint, this 

 is not subsequently affected by intermixture 

 with the vaginal mucus. It appears usually 

 rather more viscid than systemic blood, pro- 

 bably on account of its slow exudation. When 

 thus collected it invariably coagulates, the 

 separation into clot and serum being complete 

 in three or four minutes. It sometimes passes 

 off" in a continued stream as pure blood, but 

 more often as a thin coloured serum mixed 

 with small flattened clots, the size of orange 

 seeds, which, becoming broken down and, as 

 it were, dissolved in the vaginal mucus, 

 appear at the external orifice in the usual 

 uncoagulable fluid form. It is invariably 

 alkaline. 



In menorrhagia the discharge is as fluid as 

 arterial blood, and not being delayed on ac- 

 count of the greater rapidity of escape, it 

 trickles in drops along the tube. 



On account of the great difficulty which is 

 experienced in obtaining the pure fluid from 

 the uterus in quantities sufficient for chemical 



* Theorie Positive, Atlas, plate xii. 



analysis, the following results by Bouchardat 

 are the more valuable. The woman, a multi- 

 para, was thirty-five years of age. To explain 

 the large proportion of water Bouchardat 

 states that she had subsisted chiefly on a 

 vegetable and milk diet. 



BouchardaPs analysis of pure menstrual blood. 



Water - - 90-08 



Solid matter - - 6'92 



The solids were composed of 



Fibrine, albumen, colouring matter - 75-27 



Extractive matter - - 0-42 



Fatty matter - 2-21 



Salts - - 5-31 



Mucus - -.. 16-79 



100-00 



It will be observed that the proportion of 

 fibrine is here much larger than in the former 

 example. But chemical analysis is not needed 

 to show that this element of the blood con- 

 stitutes a part of the fluid exuded from the 

 uterus. For in women who have died men- 

 struating fibrinous clots have been found in 

 the uterine cavity ; coagula have also just 

 been described as forming at the os uteri and 

 mixing with the fluid collected by the specu- 

 lum, and it cannot have escaped observation 

 that clots sometimes form about the vulva, at 

 times of menstruation, especially when the 

 discharge is freer than usual. 



But the notion that the menstrual discharge 

 differs from ordinary blood " in containing 

 only a very small quantity of fibrine, or none 

 at all,"* which view has gained general cur- 

 rency of late, and in support of which the in- 

 vestigations of Brande or Lavagna are usually 

 quoted, appears to be altogether a modern 

 one. For the older writers considered the 

 menstrual discharge as identical with blood. 

 Hippocrates says in reference to it, " procedit 

 autem sanguis velut a victima, et cito coagu- 

 latur, si sana fuerit mulier." Mauriceau-j- says 

 that menstrual blood does not ordinarily differ 

 in any way from that which remains in the 

 woman's body. So also Haller and Hunter, 

 both of whom regarded menstruation as a 

 natural evacuation of blood. 



The results of these careful investigations 

 therefore warrant the conclusion that the men- 

 strual fluid, at the moment of its effusion, con- 

 sists of pure blood, mixed only with the small 

 quantity of mucus and epithelium which it 

 receives in passing through the body and neck 

 of the uterus, and that at this point it always 

 has an alkaline reaction. But that in the 

 course of its passage through the vagina the 

 original fluid becomes mixed with the mucus 

 of that canal, which there exists in increased 

 quantities, and that in the acid of that mucus 

 the fibrinous portion is so far dissolved as to 

 render the detection, by chemical means, of 

 fibrine, as a constituent of the secretion, diffi- 

 cult or impossible. So much, however, of 

 fibrine as belongs to the blood-corpuscles must 

 always be present, for these bodies exist in 



* Mailer's Physiology by Baly, p. 1481. 

 f Traite des Mai. des Fern. Gross, p. 45. 3rd ed. 

 1681. 



