666 



UTERUS AND ITS APPENDAGES. 



down, and subsequently discharged, along with 

 the menstrual fluid. According to the observa- 

 tions of Pouchet*, such an exfoliation of ute- 

 rine epithelium takes place monthly in women 

 and the mammalia generally. Pouchet, indeed, 

 maintains that not only is there a monthly 

 desquamation from the uterus, but that this 

 extends to the separation and expulsion of a 

 deciduous membrane on each occasion, and 

 that this expulsion, which takes place in the 

 form of the broken down elements of the 

 deciduous lining of the uterus, constitutes the 

 process described by him under the title of 

 intermenstruation. Such an exfoliation, if 

 it extended only to the epithelial cells sur- 

 rounding the uterine capillaries, would simply 

 leave them bare, but if proceeding to the ex- 

 tent of removing the whole deciduous uterine 

 lining, would of necessity carry off with it the 

 whole capillary network of vessels, (see fig. 

 539.) lying upon the face of this membrane, 

 and consequently would leave a surface of 

 torn capillaries, from which the haemorrhage 

 might occur f , and this in fact takes place in 

 cases when dysmenorrhceal membranes are 

 discharged (fig. 443.). 



(rf.) The blood is supposed to escape by 

 permanent vascular orifices. 



In the present state of our knowledge, the 

 evidence in support of this view is not more 

 conclusive than that upon which the preceding 

 hypothesis is built : yet many circumstances 

 lend colour to it. The question of a termina- 

 tion of the uterine vessels by open orifices has 

 been occasionally, though obscurely, touched 

 upon by different authors. Thus, Madame 

 BoivinJ, a most careful observer, after speak- 

 ing of the " perspiratory orifices of extreme 

 minuteness," visible upon the inner uterine 

 surface, evidently meaning the orifices of the 

 now well-known uterine glands, describes the 

 manner in which the blood may be made, by 

 pressure, to appear in droplets upon the inner 

 surface of the uterus when death has occurred 

 during menstruation ; and,without giving a per- 

 sonal opinion, she elsewhere quotes the then 

 prevailing views, that the blood is furnished 

 by the exhalent extremities of arteries termi- 

 nating upon the inner surface of the uterus. 

 Dr. Sharpey endeavoured, by various ex- 

 pedients, to determine what is the precise re- 

 lation of the blood-vessels to these orifices 



* The'orie Positive, Huitieme Loi. 



f Pouchet, who does not enter upon the question 

 of the effect which such a monthly denudation of 

 the inner surface of the uterus would have upon its 

 capillary vessels, nor, indeed, at all upon the con- 

 sideration of the precise mode in which the menstrual 

 fluid escapes, makes this supposed exfoliation and 

 expulsion of the menstrual decidua occur at the 

 periods intermediate between those of the menstrual 

 flux. Thus the idea of a separative process, which 

 might have been made comparable with that occur- 

 ring in labour, when the entire ovum is thrown off 

 and a bleeding surface is left, from which the lochi- 

 al discharge takes place, loses its significance from 

 the circumstance that this phenomenon is said to 

 happen at periods when there is no bleeding. 



J Me'm. de 1'Art des Accouch., quarto ed. p. 61. 



Miiller's Physiology by Baly, p. 1579. 



in the decidua a little more advanced*, as, for 

 example, in early pregnancy ; but after express- 

 ing his conviction upon the subject, the pre- 

 cise anatomical connection between the two is 

 left undetermined. Ordinarily, in injecting the 

 uterus with fine coloured fluids, I have ob- 

 served the cavity to become filled, the injec- 

 tion apparently escaping by the glandular ori- 

 fices, which also themselves may be seen filled 

 with injection. In some specimens a capillary 

 branch may be observed passing to and stop- 

 ping short at one of these canals or orifices, 

 and having much the appearance of an open 

 vessel. Without personally expressing an 

 opinion upon this point until I have carried 

 further some experiments now in progress, 

 I may observe, that the idea of a permanently 

 open termination of vessels here need not be 

 set aside upon the objection that such an ar- 

 rangement would produce a constant bleeding, 

 because the vessels supplying the blood must 

 first pass through a dense muscular tissue, 

 amply sufficient to control or arrest bleeding, 

 as indeed it does effectually after labour, when 

 much larger mouths are laid open, and also 

 occasionally when menstruation is suddenly 

 arrested by powerful mental impressions, acting 

 apparently upon the muscular fibre of the 

 uterus ; while many positive facts might be 

 adduced in support of such a view, such as the 

 frequent bleedings of uterine polypi, which are 

 always invested by mucous membrane, the 

 ready passage of fluids through the surface of 

 the latter when their main vessels are injected, 

 and the like. 



What is the purpose of menstruation ? To 

 this question no reply will be satisfactory 

 which does not include the consideration of 

 many other circumstances besides the mere 

 escape of blood. Menstruation has evidently 

 a much deeper signification than is declared 

 simply by the flux, which is probably not the 

 most important part of the function, although 

 it constitutes the external sign or evidence 

 of it. 



Amid all the crude hypotheses of former 

 times, such as that menstruation is due to fer- 

 mentation, lunar influence, and the like, some 

 of the older writers appear nevertheless to have 

 had a dim perception of the truth when, under 

 the form of an elegant type, they shadowed 

 forth that which appears to be the real pur- 

 pose of the menstrual act. The French term, 

 " fleurs," and the English, " flowers," are now 

 fallen into disuse ; but they were employed in 

 earlier times as designations of menstruation, 

 for the purpose of suggesting that, after the 

 example of trees, which do not bear unless 

 the fruit is preceded by the blossom, so a 

 woman does not become pregnant until she 

 also has had her flowers.f 



Menstruation is not established until the 

 ovaries have reached a certain stage of de- 

 velopment, and the maturation and discharge 



* It must be observed that throughout this 

 article the terms " decidua " and " mucous or lining 

 membrane of the uterus" are employed as strictly 

 synonymous. 



f Mauriceau, Malad. des Femmes grosses. 1681. 



