MENSTRUATION.
This likewise makes its first appearance at the time of puberty, and returns more or less regularly at intervals of four weeks; is interrupted in healthy women only during the time of gravidity, and usually during the period of lactation, and ceases at about the same time as does ovulation, at the so-called Climacteric period. While it was for merly generally believed that the hemorrhage took place from the intact mucous membrane of the uterine body, whether by rupture of the capil laries or by diapedesis, in recent times tthe view that the hemorrhage is a result of fatty degeneration and throwing off of the upper and middle layers of that membrane, is more believed. The cause then, whether one believes the process results in the one way or the other, lies in a periodi c,a1 congestion of the genitals. In the first way, the hemorrhage would occur at the height of the hypertemia, in the second, the degenerative process is caused by the hyperEemia, but the erfoliation and its consequent hemorrhage follows only after the cessation of the congestion. Recent investigations, however, make it seem probable that such radical changes of the mucous membmne are not intimately connected with menstruation, that the exfoliation extends only to the epithelial covering, or at most only involves the superficial layer; briefly, the separation is confined, as in acute simple catarrh of the mucous membrane, to the superficial ele ments, an injury which is quickly repaired.
These two processes, ovulation and menstruation, were formerly looked upon as cause and effect. The cause of both was supposed to be the slowly developing Graafian follicles, from the time of puberty. By their enlargement, a continual pressure was supposed to be exerted upon those nerves which passed between them in the ovarian str mia. This irritation is conveyed to the central nervous system, and by reflex action, causes, after a certain degree of irritation has, by cumulative action, been reached, an arterial congestion of the genitals, This hyperEemia then leads on the one hand to a more active transudation into the most matured Graafian follicles, and causes, as already explained, a rupture of these with extrusion of the ovum, ovulation; on the other hand, it causes at the same time an excessive hyperaemia of the uterine mucous mem brane, and occasions the periodical hemorrhage, menstruation.
As well grounded as the opinion of a causal and temporal relation of the two processes seemed to be, certain considerations still gave reasons for doubt; these were founded on the fact that anatomical investigations had proved that a rupture of a follicle might occur without menstruation between two catamenial hemorrhages. This discovery did not negative the belief that ovulation and menstruation, two coincidently occurring processes, were related to each other as cause and effect, but only weak ened the belief that they occurred coincidently. But the above-mentioned results of investigation, which moreover leave room for many exceptions, are opposed to many other facts, which serve as substantial supports for the previous belief., The tinselling of the ovary, which points in that direction, and which can be substantiated by a series of authors from ob servations made during the menstrual period on ovaries, while superficially placed (ovarian hem*, is also proved to be true of the normally situated ovaries, by the investigations of v. Ho1st and Joh. Meyer; the prepon derating frequency with which a single completed cohabitation, directly following menstruation, leads to conception, which is not the case in later occurring cohabitations, lends support to the older view. As proof of
this may be cited the investigations of Hasler, and more convincingly, the compilation made by E. Wa,chs, of a series of observations raade by Cederskjeld, Veit, Hecker and Ahlfeld, according to which, in not less than 138 of 194 cases, coition occurred between the flrst and twelfth day after the beginning of menstruation. And although the great fruitfulness of the Israelites, in whom intercourse is supposed to be forbidden for seven days after menstruation, is usually looked upon as a contradiction to this, it is not of much importance, because that religious command really reads differently from what is usually accepted—the period of seven days during which the woman is unclean begins with and not after men struation. If now the menstrual flow lasts ordinarily five or six days, the period of abstinence for the male ends almost at the same time as does the flow. The great fruitfulness of this race, then, does not speak against, but positively for the coincidence of ovulation and menstruation. s Fur ther, the knowledge that among animals, the rut, the analogue of men struation although not identical with it, oe,curs at exactly the same time as ovulation, must not remain unmentioned. Finally, the fact that ac cording to the anatomical investigations above mentioned, the rupture of the Graafian follicles in the majority of cases must have occurred during or near the menstrual period causes the coincidence of the two processes to appear normal; the admittedly large number of exceptions may per haps be explained in the following manner: It is possible that ovulation does not always and in all individuals con form to a monthly type, as is shown perhaps in some women by the not infrequent intermenstrual pain or by a catarrhal secretion or slightly bloody discharge between two menstrual periods which persists for several days. Perhaps also the sexual act, so irregularly performed in the human species, may influence ovulation. While an animal is only im pelled to cohabit during the rut, and the sexual appetite seems to be dor mant outside of this period, the most varied sexual excitements of a psychic,a1 and bodily nature are constantly exerting their influence upon the woman. Shall these intense, repeated irritations of this kind remain without influence on the internal genitals — or, in other words, shall no congestion of these organs and its consequent ripening and rupture of the follicle be the result ? Is it not possible that through this a modification of the type of ovulation may be brought about? In regard to menstru ation there can be no doubt but that by the sudden change from abstinence to sexual intercourse, as we often see it among the newly-married, a change in the menstrual peliods may be effected; is it not possible that this may often be the case with ovulation ? If now, taking all things into consideration, ovulation and menstrua tion have a causal relation to each other, and if the two processes do mostly occur at the same time and seldom separately, it is not said that both processes must under all circumstances always appear at the same time. We know positively that ovulation may occur without menstruation, as is proven by conception in those suffering from amenorrhcea, and we are justified in the supposition that the bloody periodical secretion does not always coincide with a follicular rupture.