SIGNS OF MENSTRUATION. 



855 



external genitals. This is known as the process of menstruation (or menses, cata- 

 menia, or periods). Most women menstruate during the first quarter of the moon, 

 and only a few at new and full moon (Strohl). In mammals, the analogous condition 

 is spoken of as the period of heat [or the " rut " in deer]. There is a slightly bloody 

 discharge from the external genitals in carnivora, the mare, and cow (Aristotle), 

 while apes in their wild condition have a well-marked menstrual discharge (Neubert). 

 [Observations on cases where abdominal section has been performed have shown 

 that the Graafian follicles mature and burst at any time (Lawson Tait, Leopold).] 



The onset of menstruation is usuall}' heralded by constitutional and local phenomena 

 there is an increased feeling of congestion in the internal generative organs, pain in the back 

 and loins, tension in the region of the uterus and ovaries, which are sensitive to pressure 

 fatigue in the limbs, alternate feeling of heat and cold, and even a slight increase of the tem- 

 perature of the skin (Kersch). There may be retardation of the process of digestion and varia- 

 tions in the evacuation of the feces and urine, and in the secretion of sweat. The discharge is 

 slimy at first, and then becomes bloody, lasting three to four days ; the blood is venous, and 

 shows little tendency to coagulate, provided it is 

 mixed with much alkaline mucus from the genital 

 passages ; but, if the haemorrhage be free, the 

 blood may be clotted. The quantity of blood is 

 100 to 200 grms. [The blood contains many 

 white blood-corpuscles and epithelial cells.] After 

 cessation of the discharge of blood there is a 

 moderate amount of mucus given off. 



The characteristic internal phenomena 

 which accompany menstruation are : (1) 

 The changes in the uterine mucous mem- 

 brane ; and (2) the rupture of the Graafian 

 follicle. 



1. Changes in the uterine mucous mem- 

 brane. The uterine mucous membrane is 

 the chief source of the blood. The ciliated 

 epithelium of the congested, swollen, and 

 folded, soft, thick (3 to 6 mm.) mucous 

 membrane is shed. The orifices of the 

 numerous mucous glands of the mucous 

 membrane are distinct, the glands enlarge, 

 and the cells undergo fatty degeneration, 

 and so do the tissue and the blood-vessels 

 lying between the glands. The tissue con- 

 tains more leucocytes than normal. This 

 fatty degeneration and the excretion of the 

 degenerated tissue occur, however, only in 

 the superficial layers of the mucosa, whose 

 blood-vessels, when torn across, yield the blood. The deeper layers remain intact, 

 and from them, after menstruation is over, the new mucous membrane is developed 

 (Kundrat and G. J. Engelmann). [Leopold denies the existence of this fatty 

 degeneration. According to Williams, the entire mucous membrane is removed 

 at each menstrual period, and it is regenerated from the muscular coat (fig. 649). 

 The mucous membrane of the cervix remains free from these changes.] 



2. Ovulation. The second important internal phenomenon is ovulation, in 

 which process the ovary becomes more vascular the ripe follicle is turgid with 

 fluid, and in part projects above the surface of the ovary. The follicle ultimately 

 bursts, its membranes . and the epithelium covering of the ovary are torn or give 

 way under the pressure, the bursting being accompanied by the discharge of a 

 small amount of blood. At the same time, the congested, turgid, and erected 

 fimbriated extremity of the Fallopian tube is applied to the ovary, so that the 



Fig. 648. Fig. 649. 



Fig. 648. Diagram of the uterus just before 

 menstruation. The shaded portion repre- 

 sents the mucous membrane. Fig. 649. 

 Uterus when menstruation has just ceased, 

 showing the cavity of the body deprived 

 of mucous membrane {J. Williams). 



