Excerpt from The Canada Lancet, Vol. 9: A Monthly Journal of Medical and Surgical Science, Sept; 1st, 1876; Membranous Dysmenorrh?a
On the inner side of this membrane, the surface is smooth, irregularly subdivided by furrows, and presents, even to the unassisted eye, small openings, which my friend Dr. Malloch has kindly examined with the microscope, and informs me are undoubtedly the orifices of the utricular glands' The outer side, where the separation took place, is rough, ragged and flocculent, having much the same appearance as early aborted ova.
Etiology and Pathology. - Now the question arises, what is the anatomical or physiological structure of these membranous formations, and what is the pathological condition of the uterus which causes it to cast off or exfoliate them from month to month? You remember that when we were at the schools, the theory taught in those days, and indeed, by some teachers, even up to the present time, I understand, was, that the cause of membranous dysmenorrh?a was attributable to an inflammatory condition of the inner surface Or the uterus; exudations of lymph, it was thought took place, and casts, similar to those of croup, were formed and ultimately extruded.
To Dr. Oldham belongs the honor of first pointing out that this theory was incorrect, and he distinctly enunciated the proposition that these membranes were formed under the ovarian stimulus, and that they were formed by the uterine glands - that they were, in short, the lining membrane of the uterus itself.
The New Theory. - This theory, or more strictly speaking, the latter part of this theory, - that the membrane exfoliated in these cases is really the uterine mucous membrane, is fully accepted by all the leading authorities of the present day. To be brief on this point, and without doing injustice to any recent author, I think I may safely assume that Dr. Finkler, of Kiew, after examining seven specimens of dysmenorrh?al membrane, obtained from four patients, summarizes about all that has been definitely ascertained concerning the structure of these formations, as follows: - "That the membrane is the mucous membrane of the uterus inclusive of the blind extremities of the glands, but that, in some cases, the deeper layer of the membrane and the termination of the glands remain in the uterus." The membrane, Dr. Finkler thinks, "is the product of disease, a pathological condition, and not of impregnation, nor an increased physiological action which takes place in the generative organs periodically." Dr. Barnes, admitting "the new fact," that the membrane expelled in these cases is the mucous membrane, argues that, "If it be admitted, and observations in point are now so numerous and authentic that it can scarcely be disputed, that the mucous membrane, under simple ovarian menstrual excitation, does undergo a high degree of development not distinguishable from the decidua of early pregnancy, it must also be admitted as possible, that the mucous membrane so developed may be cast off." Graily Hewitt goes further; he says, "The mucous membrane lining the body of the uterus, which is ordinarily one-eighth of an inch thick, is very vascular; during menstruation it becomes much more so, and moreover increases in thickness. The mucous membrane thus thickened appears to be shed at each catamenial period, and in cases I have found it in actual process of disintegration." Recently, some investigators have been endeavoring to prove that the mucous membrane of the uterus is exfoliated at the time of parturition and abortion, as, for I instance, Kolliker maintains that, "during parturition, the mucous membrane of the body of the uterus is entirely removed - completely cast off -in the form of decidua and placenta uterina, and that the muscular fibres become exposed in the uterine cavity."
At the time of abortion, Dr. Engelmann found it in the following condition: - "Ova expelled in the first month, and mostl. Это и многое другое вы найдете в книге The Canada Lancet, Vol. 9 (J. W. Rosebrugh)