376 THE DISEASES OF THE SEXUAL GLANDS 



on the organism is, through the maturation of the ovum, increased in a 

 rhythmic manner. It is now urged against the dependence of menstruation 

 on ovulation that not rarely menstruation and ovulation do not occur at 

 the same time, but that under circumstances ovulation can take place after 

 menstruation (Leopold and Mironow, Ravano}. Frankel has therefore upheld 

 the view that the retrogression of the corpus luteum gives rise to menstrua- 

 tion. According to the view of most authors there can, however, be attrib- 

 uted to corpus luteum at most a postponing but not a releasing [auslosende] 

 action (Halban). Halban would principally ascribe to the ovulation, that 

 is to the sexual glands, only a protective but not a formative influence on 

 menstruation or on rut and on the cyclical menstrual phenomena, pointing 

 out the known fact that after even a long time after bilateral ovarectomy 

 the menstrual wave may reappear. Numerous extensive statistics exist as 

 to this question ; I mention only the statement of Pfister that in on an average 

 of 12 per cent, of castrated women menstruation reappeared and that among 

 116 castrations vicarious menstruation from the bowel or the nose occurred 

 for a time in cases. Finally it must be pointed out that in a great per- 

 centage of cases after castration there exist cyclical menstrual molimina 

 (backache, nausea, colics, etc.). Of course these molimina occur when the 

 uterus is removed and the ovaries remain behind in the body. Halban is 

 therefore of the opinion that the menstrual wave is released not from the 

 ovary itself, but by an as yet unknown agent and that much the more the 

 ovary itself reacts to this agent in an especially sensitive way, and this reac- 

 tion of the ovary first brings the menstrual wave to its complete fulfillment. 

 I would not subscribe unreservedly to the view of Halban. The de- 

 pendence of menstruation on ovulation is in any case very considerable. 

 Halban himself has shown that in baboons, which have a menstruation 

 similar to that of human beings, menstruation is retained after transplanta- 

 tion of the ovaries. On the other hand after ovarectomy, rut remains 

 away with almost every case. Lately Adler has shown that subcutaneous 

 injection of watery extract of ovaries calls forth in virginal animals altera- 

 tions in the internal genitalia, especially the uterus, that remind one of the 

 changes that take place during rut. In two amenorrheic women in whom 

 pieces of mucous membrane were obtained from the uterus by curettement 

 before and after injection of this extract, microscopical examinations of these 

 pieces showed that there were menstrual alterations of the mucous mem- 

 brane. As after castration the menstrual wave is recovered after a time in 

 an attenuated form, this does not seem to me quite inexplicable. We can 

 imagine that the menstrual wave that has existed for several years may under 

 circumstances continue for a while after castration, if the sexual life has 

 once been fully developed. The difficult point according to my view would 

 lie in the question whether, in youthful persons in whom menstruation is 

 mostly absent, the development of the wave would be entirely prevented 



