UTERUS (FUNCTIONS). 



of ova has commenced.* It continues to be 

 performed as long as the process of ovulation 

 is continued ; but when the latter ceases, and 

 the ovaries have become shrunken, their tissues 

 attenuated and wasted, and Graafian follicles 

 can be no longer distinguished, menstruation 

 ceases to be performed. 



These facts show that menstruation and 

 ovulation proceed pari passu ; but they do not 

 alone prove that the one function is dependent 

 upon the other. 



If, however, both ovaries are congenitally 

 deficient, no attempt at menstruation is ever 

 observed ; while, on the other hand, in cases 

 where the ovaries are present but the uterus 

 is deficient, puberty becomes established in 

 due course, and then a regularly recurring 

 menstrual molimen may be observed, although 

 for the want of the uterus this function can- 

 not be carried out. See note . 



Or if, under ordinary circumstances, after 

 the regular establishment of menstruation, 

 both ovaries become extensively diseased, or 

 both are removed by operationf, menstruation 

 is from that moment permanently suspended. 



Hence it appears that the presence of the 

 ovary in a healthy state is essential to men- 

 struation. 



But something more also is needed ; for the 

 ovaries may be present and healthy, yet if 

 they cease for a time to mature or emit ova, 

 as for example during pregnancy and lactation, 

 when they are passive j, then, so long as those 

 processes endure, menstruation is also com- 

 monly suspended, but returns after the com- 

 pletion of one or both of them. 



A series of facts so consistent appears to 

 admit of but one interpretation : namely, that 

 a menstruating condition of the uterus bears 

 a direct relation to the active operations of 

 the ovaries, and that this function is only per- 

 formed under circumstances which render 

 pregnancy possible so far as the ovaries are 

 concerned ; but if the conditions are such that 

 impregnation cannot take place, then the ute- 

 rus, although it may be healthy, does not 

 menstruate. 



But, in addition to this general relationship 

 between menstruation and ovulation, it is ne- 

 cessary to determine further if any direct cor- 

 respondence exists between each separate act 

 of menstruation and the maturation or dis- 

 charge of one or more ova from the ovary, so 

 that these two acts shall be coincidentally 

 performed. 



The following evidence supports this view. 



The ovaries at the menstrual periods are 

 not unfrequently the seat of pain and tender- 

 ness, indicating some unusual activity of this 

 part. This is most remarkable in the rare 

 case of hernia of the ovary.$ 



* The views of Dr. Ritchie in dissent from this 

 statement have been already noticed, p 572. 



f See Mr. Pott's case, p. 573. 



J Negrier's, loc. cit. 



In a case of this kind recorded by Dr. Oldham 

 (Proceedings of the Roy. Soc. vol. viii. p. 377.), both 

 ovaries had descended through the inguinal canals, 

 and were permanently lodged in the upper part of 

 the external labia. "At intervals of about three 



667 



In women who have died during a men- 

 strual period the ovaries have been frequently 

 observed to present unmistakable signs of the 

 recent rupture of one or more Graafian fol- 

 licles. Some examples of this fact have been 

 already given. In one case the ovum itself 

 was found in the Fallopian tube (p. 567.).* 



Conception is supposed to take place most 

 frequently within a few days after a menstrual 

 period, and therefore during the time which 

 an ovum, if it were emitted from the ovary 

 during menstruation, would occupy in passing 

 down the Fallopian tube and perhaps in ar- 

 riving at the uterus. 



Menstruation corresponds in many particu- 

 lars with the oestrus, or rut, in the mammalia, 

 and in them it is only during the oestrus that 

 ova are emitted from the ovaries, and that con- 

 ception can take place. 



The foregoing facts constitute evidence 

 bearing upon two distinct points. The first 

 series proving that a menstruating condition 

 of the uterus is maintained only so long as 

 the ovaries continue in the active performance 

 of their function of preparing and ripening 

 ova. The second series affording a certain 

 amount of presumptive evidence, that each 

 separate act of menstruation is connected 

 with or is dependent upon a corresponding 

 act of maturation, and perhaps of spontaneous 

 emission of one or more ova from the ovaries. 



The accuracy of the first conclusion will 

 probably not be questioned ; but if the second 

 point is to be regarded, as at present, more 

 than an hypothesis having many facts and 

 probabilities for its support ; if, as M. Pouchet 

 believes, we are justified in considering as 

 established laws of generation that in man 

 ova are emitted from the ovary at fixed epochs 

 and at no other times, and that these occa- 



weeks one or both ovaries were observed to become 

 painful and tumid, the swelling augmented for four 

 days, remained stationary for three days, and then 

 gradually declined ; the whole process occupying 

 generally from ten to twelve days. It happened, 

 unfortunately, that in this case the uterus and va- 

 gina were deficient, so that menstruation could not 

 take place ; but the case in one respect is the more 

 interesting on that account, for notwithstanding the 

 absence of the uterus, all the external signs of pu- 

 berty were present, and the evidence of a periodical 

 activity and excitement of the ovaries, and of a 

 menstrual molimen affecting the organs which were 

 not malformed, were here unmistakable. These 

 circumstances forcibly call to mind the painful 

 condition of the ovaries which, in a similar case, 

 induced Mr. Pott to extirpate those organs. 



* Upon the connection between the discharge of 

 ova from the ovaries, and the phenomena of heat 

 and menstruation, the following should be con- 

 sulted, viz. : E. Home, Lectures on Comparative 

 Anatomy, vol. iv., and Phil. Trans. 1817 and 1819; 

 Power, Essays on the Female Economy, 1821; 

 R. Lee, Cyclopaedia of Practical Medicine, art. 

 Ovary, 1834 ; Gendrin, Traite Philosophique de 

 Medecine Pratique, t. i. 1839; W. Jones, Practical 

 Observations on Diseases of Women, 1839 ; Paterson, 

 Edinb. Med. and Surg. Journ. vol. liii ; Girdwood, 

 Lancet, 1842-43 ; in addition to the works of Bis- 

 clu>jf, Raciborski, Negrier, Coste, and Pouchet, al- 

 ready quoted under the title OVARY, p. 568., where 

 will be found a full account of the process of ovula- 

 tion. 



