SYLLABUS OF OBSTETRIC LECTURES. LECTURES TO GRADUATING CLASS. PART I. Menstruation. Definition. A periodic discharge of a sanguineous fluid from the uterus and Fallopian tubes, occurring during the time of a woman's sexual activity, from puberty to the menopause. Time of Occurrence. --In temperate climates, in Teutonic and Anglo-Saxon girls, the first menstruation occurs oftenest in the fifteenth year. It is influenced by (a) Race, (b) Mode of Life, (c) Climate, (d) Heredity, (e) Genital Sense. Once established it should return every four weeks. Time of Cessation.-Usually in the 45th year. Phenomena. 1. Congestion.---Manifested in changes in uterine body, mucous membrane, adnexa, and peritoneum. 2. Molimina. The clinical and subjective manifestations, as nervous irritability, pigmentation, enlargement of thyroid, changes in voice and circulation, etc. 3. Rise of Temperature.-0.5° C. 4. Character of Flow.-- Alkaline and composed of blood, shreds of mucous membrane, vaginal and uterine secretion. Is darker than ordinary blood and should not clot. 5. Duration of Flow.-The average is three days. 6. Quantity.-Four to six ounces. Theories in explanation of its occurrence. 1. Why it occurs : (a) Cleansing. Plethora. The ancients' idea. (b) Pflüger's. The ripening of the ovule within the ovary and the development of the Graafian follicle, producing a nervous irritation culminating at the end of the menstrual month, which leads to congestion and other menstrual phenomena. (c) Result of the death and degeneration of the ovule. If the ovule happens to be impregnated, menstruation is prevented. If conception has not occurred, the congested condition of the mucous membrane, prepared to receive and surround the ovule, results in the menstrual discharge. (d) Comparative anatomy and physiology. Explained by similarity to heat or rut. (e) The most satisfactory theory is that it occurs in obedience to a central nervous influence reflected through the sympathetic nervous system to the ovaries and uterus. 2. How it occurs: (a) Kundrat, Engelmann, Williams: By fatty degeneration of the mucous membrane. (b) Leopold: By diapedesis. This is the most recent explanation. Connection between Ovulation and Menstruation.-From Leopold's investigations upon 29 pairs of ovaries, examined at varying intervals after the menstrual period, it appears that menstruation and ovulation may occur independently—i. e., neither is dependent upon the other, but both have a common cause. Women may conceive without ever having menstruated, and may menstruate, after oöphorectomy for instance, without ovulating. Ovulation. The Ovary.-Weight, 5.5 grms. or 78 grains. Diameters, 38 x 19 x 13 mm. or 1 x & x inches. Constituent parts :-stroma, glandular substance, epithelial covering, blood vessels, lymphatics and nerves. The epithelial covering of the ovary differs from the epithelium lining the rest of the peritoneal surface, in |