According to John Williams and IA'opold, the modifications of the mucous membrane are analogous to those which occur during pregnancy and delivery. The phenomena which we have just mentioned, are ac companied by a true degeneration of the mucous membrane, which ex foliates cell by cell. But, according to Leopold, these phenomena are limited to the most superficial layer of the mucous membrane, and its glands, and they do not occur until after the appearance of the dis charge, and hence could not be its cause, as Kundrat and Engelman thought.
The tubes participate in this hyperemia, their vessels are injected, their walls thicken, and they also suffer a sort of erection which brings them toward the ovary. Their canal is sometimes filled with blood, which aug ments the menstrual flow.
As for the broad ligaments, the same phenomena of congestion occur in the uterine and sub-ovarian plexus which they contain. Hence, as Richet said, the possibility of feeling the projections, due to the great development of these plexuses.
The vagina becomes redder, darker, warmer, its circulation more active, the mucous membrane slightly swollen, and its secretion has more or less odor, according to the woman. The women feel torpid, heavy, and com plain of fatigue, and an unusual lassitude.
Even the vulva seems to become tumefied, and is sometimes the seat of slight pruritus; urination becomes more frequent; in a word, the whole genital system participates in this function.
The breasts swell, become harder, more sensitive, sometimes even painful.
Besides the genital organs, the catamenial epoch reacts upon the rest of the economy, and it is not rare to see women experience a little flatulence, accompanied with diarrhoea; taken with neuralgic pains, headache, tonsillar or herpetic angina, swelling of the thyroid gland, transitory congestions and cutaneous eruptions, especially on the face. All this is accompanied by a feeling of sickness, general fatigue, which is shown by a want of calmness and repose, with an excitement and a nervous susceptibility which reacts upon the moral and intellectual condition. In some cases even a slight febrile movement occurs. We have seen that this state is in intimate relation to the evolution of a Graafian vesicle. Women without ovaries do not have the menstrual discharge. But what is the precise moment of the maturation of the
ovum? It is impossible to determine, for this maturation varies with the individual and with circumstances. Rouget's researches show, however, that it is generally in the last days of the menses.
In the last few years, however, some writers oppose this view as too absolute, and even go so far as to deny the correlation between ovulation and menstruation.
It is not very rare to find, in young girls, a great number of Graafian follicles in process of development, and even in an apparent state of maturity. But, in them, the vesicle does not rupture, and these devel oped follicles disappear by simple regression. But some writers go still further. Giraudet de Tours, Beige], Paul Mundt•, and de Sinety, have tried to show, that, on the one hand, spontaneous ovulation may take place without the menstrual discharge, and that, on the other hand, the menstrual flow may take place without ovulation.
Beige!, who among the first was against the old theory, cites the case of Ashwell, who, in three autopsies on women who died during the menses, found on the ovaries no traces of corpora lutea, or of the rupture of the vesicle of de Graaf. To an analogous case of Paget's, we may add Kalliker's ten cases, those of Girwood, Coste, Giraudet, Godard, and Gubler, who, in a great number of acute diseases, observed bloody dis charges analogous to the menses, but independent of ovulation, and which he called uterine epistaxis.
Seigel then calls attention to the more singular cases, in which there had been an extirpation of the two ovaries, and a continuation of menstrua tion; those of Clay, Beigel, Peaslee, Koeberl(- and Storer; we may add. those of Atlee, Spencer Wells, Baker-Brown, Goodeman, Lefort, de Tessier, etc. Ormieres (1880) collected all the cases of menstruation after simple and double ovariotomy and hysterectomy.
From another point of view, in cases of congenital absence of the uterus, if the ovaries are intact, there is ovulation and the production of corpora lutea without menstruation. (Oldham.) Gubler cites cases in which ovulation preceded menstruation by several years.
De Sinety found traces of recent corpora lutea in women whose menses had disappeared for some time on account of disease.