THE SYMPATHETIC SYSTEM 235 



longer and which resist the usuai treatment: hot irriga- 

 tions, tampons, curettage, etc. They are sometimes 

 accompanied by neuralgias and end up by severe anemia. 



The cause of these hemorrhages escapes detection. 

 They are not caused by a general disease, nor by a cardio 

 vascular affection, nor by a blood abnormality. There 

 are no lesions of the genital organs. For this reason 

 they are called essential menorrhagia. 



Their etiology has been very doubtful. Some believe 

 that they were due to a metritis, butRichelot has shown that 

 they were independent of all infections ; others believe that 

 a sclerosis of the uterus is the cause, but this has never been 

 verified by histological examination (Pankow). Finally, 

 they have been blamed on adenomatous transformation of 

 the uterine mucosa, but we know to-day that this transfor- 

 mation is a physiological modification occurring in the 

 interval between the menses. 



At present it is believed that these hemorrhages are due 

 to a disturbance of the internal secretion of the ovary. 

 The conception is based on certain facts : 



1. These hemorrhages are observed at the two 

 extremes of the genital life, when menstruation begins 

 or ends. That is when the ovarian secretion is defec- 

 tively regulated. 



2. They are abolished by the removal of the ovaries 

 (Lawson-Tait-Bouilly). Castration cures the majority 

 of the cases. 



3. Forgue and Massabuau have found in these patients 

 histological lesions of the ovary, which consisted in a 

 marked increase in the number of atresic follicles, very 

 scarce normally. Each atresic follicle is made up of 

 a neo formation of lutein cells, so that this condition 

 is really a hypertrophy of a gland of internal secretion. 



