432 THE DISEASES OF THE SEXUAL GLANDS 



least has the advantage that it is not contradicted by any of the known facts. 

 In chlorosis, as has already been mentioned, the behavior of menstruation 

 shows nothing characteristic. We find that although in the majority of 

 cases there is a weakening of the menstrual process, there may be a normal 

 course or an essential strengthening. This is what is told to us with regard 

 to menstruation, but not in regard to ovulation. We know only that there 

 is no menstruation without ovulation. It is known, however, that under 

 circumstances ovulation proceeds without menstruation, and it does not seem 

 to me that anything stands in the way of the proposition that under circum- 

 stances it may go on in an increased or precipitate manner. The assumption 

 of precipitate ovulation in chlorosis is, however, though it seems fascinating, 

 not at all unconditionally necessary. To me the assumption seems enough 

 that the violent revolutions that go on in the feminine organism at the time 

 of puberty or with the setting in of a strengthened activity of the follicular 

 apparatus lead in nonvigorous individuals to a temporary or longer con- 

 tinued exhaustion of the organism. We have seen in the description of the 

 physiology of the sexual glandular apparatus that ripening of the follicle in 

 the premenstrual period leads to a heightened vitality of the whole organ- 

 ism. Hence there proceed impulses from the follicular apparatus that spur 

 on all the organs and especially the entire ductless glandular system to a 

 heightened activity. Would it not be conceivable that in a predisposed in- 

 dividual, in whom these impulses are perhaps increased by precipitate 

 ovulation, there may appear an exhaustion? 



On the basis of this supposition I shall now proceed to analyze the 

 symptom-complex of chlorosis. Let us first consider the genital disturbances. 

 The assumption of an increased activity of ovulation does not seem to me 

 to stand in contradiction to the diverse behavior of menstruation. On the 

 one hand it explains cases with increased menstrual bleeding, and on the 

 other that after a time a feebler organism no longer reacts to every impulse 

 of the growing follicle, or at any rate not with the corresponding altera- 

 tions of the uterine mucous membrane. It is therefore not at all necessary 

 to consider that the internal secretion of the corpus luteum normally is 

 cast off through menstruation and that with the continued absence of men- 

 struation with progressive ovulation an autointoxication becomes established 

 (Villemin). Otherwise we would have to have a chlorosis in every case of 

 amenorrhea, and the cases of chlorosis with excessive hemorrhage would 

 not be explicable at all. 1 An increased activity of the follicular apparatus 

 would also exercise a certain reinforcing action on the function of the in- 

 terstitial glands, thus explaining unforcedly the symptoms of prematurity 

 that are seen in certain cases. 



Through my assumption, a case of childish gigantism with sexual pre- 



1 The assumption of Villemin depends in addition on the incorrect hypothesis that in chlo- 

 rosis there is an increased blood disintegration. 



