THE RHYTHM OF GOKADAL FUNCTION 593 



above. In grave impairment of ovarian function so that follicular growth 

 does not even take place, the endometrium as seen by curettage samples 

 may not grow appreciably above a mere healing over of the basalis. 23 The 

 stimulus due to substances supplied by the growing and ripening follicles 

 is apparently absent. It is self-evident that the further effects of func- 

 tional corpora lutea cannot exist. Furthermore, in other cases, it is 

 possible 'to have the stimulus from ripening follicles in an exaggerated 

 form and great endometrial growth, but since follicular rupture does not 

 take place, none of the peculiar endometrial changes due to a corpus 

 luteum can occur. (In metropathia hemorrhagica, for which see below.) 



III. True Disturbances of Gonadal Rhythm Which Are 

 Associated with Menstrual Aberrations 



If the view which we have developed in the above is correct, it will be 

 apparent that any grave impairment of the ovary must lead to disturb- 

 ances and eventually obliteration of the menstrual rhythm. The intact 

 menstrual rhythm, then, may be taken as a true indication of ovarian 

 periodicity. On the other hand various complicating circumstances pre- 

 vent us from immediately assigning menstrual aberration to ovarian 

 deficiency. Even in the presence of ovulating gonads, local trouble with 

 the uterus or lower portion of the generative tract may either gravely 

 disturb the endometrial cycle or irregular hemorrhage may obscure the 

 periodic bleedings so that we are not led to realize that along with the 

 uterine pathology the cyclic mucosal changes are nevertheless going on. 

 These apparent disturbances of menstruation unassociated with ovarian 

 dysfunction fall into two categories (1) the seeming absence of uterine 

 bleedings on account of mechanical obstructions (which may, for example, 

 cause hematokolpos) and (2) the great increase and irregularity of such 

 bleedings, which may result from uterine polyps, and submucous myomata 

 and from corpus, cervix, portio or vaginal carcinomata as well as from 

 severe endometritis. 



Before mentioning the instances of true ovarian disorder which cause 

 disturbances of the menstrual rhythm we may comment briefly upon 

 ovarian hyperf unction. The indications of overact ivity of the ovary are 

 not at present satisfactorily understood. It is easy to understand that ex- 

 cessive activity of the corpus luteum would conceivably increase the amount 

 of the pregravid endometrial changes and hence the amount of menstrual 



which result from the spontaneous postpartum ovulation in the lactating rat, and which 

 have been described by Long and me and designated corpora lutea lactationis. We have 

 also indicated that the same prolongation of the life of corpora takes place after in- 

 fertile coitus which thus delays the next oestrus, and in these instances the unfertilized 

 ova degenerates at the usual time in the proximal portions of the tube. 



23 See for instance the low postmenstrual mucosa reported by Pock, Hofstatter 

 and others in the cases of ovarian hypofunction constituted by war amenorrheas. 



