CHAPTER III.

PHYSIOLOGY OF THE UTERUS AND OVARIES.

Menstruation is a periodical flow of blood having its source in the walls of the uterus. But menstruation is excited by and dependent upon ovulation, and the effective cooperation of both the uterus and ovaries is necessary to both menstruation and conception. We shall consider these functions separately.

MENSTRUATION.

In healthy women at the period of puberty, a certain amount of sanguineous fluid is secreted by the lining membrane of the uterus, and is excreted through the vagina every month; this is termed the catamenia, or menses, and the function itself menstruation. A female in whom the discharge recurs at the usual periods, in the usual quantity, and of the usual quality, is said to be regular, The occurrence of menstruation defines the period of puberty at which a girl becomes a woman capable of conception, and its cessation terminates the prolific period of female life.

Dr. Robinson, of Manchester, England, in a paper on the natural history of menstruation, has stated the age at which it occurred in 450 cases.

According to his table, 10 menstruated for the first time at 11 years of age, 19 at 12, 53 at 13, 85 at 14, 97 at 15, 76 at 16, 57 at 17, 26 at 18, 23 at 19, and 4 at 20.

The time at which the first menstruation occurs varies exceedingly from the influence of climate, habits of life and constitution. There have been occasional instances of very precocious menstruation, in which the first appearance of the discharge was attended with all the attributes of puberty. I myself knew one case where a girl of nine years, not only menstruated, but presented the external signs of puberty, such as prominent breasts, wide pelvis, rounded contour of body, &c.

The first appearance of the menses very rarely occurs without being preceded by premonitory symptoms. There is usually a degree of languor and lassitude, fatigue after exertion, inequality of spirits, dark shade under the eyes, headache, sometimes pain in the thyroid gland, pain in the back, a sensation of tension and swelling in the lower part of the abdomen, and occasionally considerably fever. Not unfrequently strange nervous disturbances occur; but all of these symptoms may pass off, the first and second time, without the appearance of the menses, or with a white discharge only. Usually the phenomena may last from one to eight days, then there is an abundant flow of mucus, which after one or two days is mixed with blood, and soon gives place to almost pure blood. When this discharge takes place most of the unpleasant symptoms disappear, and the female only complains of weakness and is somewhat pale. The hemorrhage continues for several days, then the amount of blood mingled with the vaginal mucosities diminishes, soon there is mucus alone, then the discharge ceases.

I should remark now that the propriety of applying the terms, blood or hemorrhage, to the menstrual secretion is properly questioned.

Sometimes the first menstruation takes place without being preceded by any discomfort, but pretty generally there is a change in the girl at the time, both in her body and mind, a change that fits her for the important duties that devolve upon her.

Most young girls have a return of the discharge after a month, the menses afterwards recurring regularly; some do not become regular until after several months. Sometimes the function is imperfectly performed; such cases are accompanied with considerable distress.

In some young girls the precursory symptoms of the first appearance of the menses may not be followed by a flow of blood, and there is an apparent effort of nature recurring monthly for several months before the courses become established.

There are occasional examples of retarded menstruation. I am acquainted with one woman who at the age of twenty-five years has not menstruated. The absence of the menses does not render conception impossible, in every case.

After the menses are established, until the time of their cessation, they generally return every month, unless interrupted by pregnancy or nursing. The average of the catamenial period is about twenty-eight days; in a large number it is thirty days; in some instances they recur every fifteen days.

The duration of the flow varies from one to eight days; three or four days is the most usual duration. The quantity of blood lost is variable; from three to five ounces is said to be the average.

When the ovaries are congenitally absent, or have been removed, or have become disorganized, menstruation is absent, or ceases. The cause of the menses is the successive evolution of the Graafian vesicles; but the regular process may go on in the ovary without the regular sanguineous discharge.

The menses continue in the majority of cases until about the age of 46 years, or perhaps in this country 48 years.

According to Dr. Robertson, of England, the periods at which it closed in 77 individuals was, in 1 at the age of 35 years, 4 at 40, 1 at 42, 1 at 43, 3 at 44, 4 at 45, 3 at 47, 10 at 48, 7 at 49, 26 at 50, 2 at 51, 2 at 52, 2 at 53, 2 at 54, 1 at 57, 2 at 60, and 1 at 70.

The average duration of the menstrual function is about 30 years. The cessation of the ovarian function is generally announced several years in advance by irregularities of the menses. Besides the intermissions and irregularities, there are other symptoms; a general and indefinite feeling of uneasiness, pelvic pains, itching at the genital parts, flashes of heat in the face, alterations of chilliness and perspiration, leucorrhœa, etc. These troubles are usually slight, and disappear promptly. The time of life has been called the CRITICAL PERIOD, because there has been an opinion prevalent that peculiar dangers attend it. However, the mortality is not greater between the ages of 45 and 50 years than at any other period of life. Yet it is true that in some instances diseases that had been latent previously, declare themselves at this period.

THE FUNCTION OF THE OVARIES.

We will now consider the physiological action of the ovaries and its intimate connection with the action of the uterus in menstruation, etc.

Preceding the first menstruation an ovary is considerably enlarged, becomes of a red color, and its vascular apparatus is considerably congested; the Fallopian tube also becomes congested; its fimbriated extremity is of a violet red color, and has a velvety appearance. The Graafian vesicles increase in size; fifteen or twenty of them, more advanced than the others, project from the surface of the ovary; one of these grows so that after a few days it forms a tumor of the size of a cherry; the walls of the vesicle, being distended by an increased secretion of fluid, becomes quite thin, and at last are ruptured. When the thinned walls give way, the ovule is expelled, with a part of the granular contents of the vesicle; these are grasped by the fimbriated extremity of the Fallopian tube which is prepared to receive it and convey it through its canal into the cavity of the uterus.

This evolution of an ovule excites numerous sympathies throughout the organism of the female, and especially the generative organs. The vascular apparatus of the womb becomes developed in an unusual manner; a network of fine blood vessels surround the orifices of the numerous glandular tubes, of which the membrane is almost entirely composed; this gives a violet hue to the internal surface of the womb; the utricular glands increase in size, the muscular structure of the uterus acquires greater extension, becomes redder and more spongy and supple, the volume of the organ is increased, the neck is tumefied and its orifice narrower, the lips of the os tincæ are warmer and their color deeper.

The vascular congestion which the uterus undergoes is accompanied with the exudation of sanguineous fluid, which is at first but a few drops; this communicates to the increased vaginal mucus a reddish hue. After a day or two there is a bloody flow from the vascular network of the mucous membrane. This flow, which constitutes the menses, is diminished after three or four days, and the discharge again contains a large proportion of mucus and serum. It is probable that the rupture of a Graafian vesicle occurs during the last days of the flow, ordinarily, and it is also believed that venereal excitement is capable of exerting so much influence upon it that it may determine the rupture of an enlarged vesicle, which, without sexual intercourse, would have remained whole several days longer.

After the discharge of the ovule consequent on the rupture of the Graafian vesicle, the walls of the vesicle contract on the matter that is effused within it, and form a compact mass, which after a time has an orange yellow color—this is called the _corpus luteum_.

Ordinarily, in the human female in the normal condition, a new Graafian vesicle increases in size every month, becomes excessively developed, and finally bursts and discharges its ovule, to become, through successive transformations, the _corpus luteum_. What is called the “monthly sickness,” “monthlies,” “courses,” etc., never occurs without having been preceded and accompanied by the development of a Graafian vesicle.