THE RHYTHM OF GONADAL FUNCTION 595 



mature. This view of the matter might actually assign the disease to an 

 effort at hyper- rather than hypofunctioii of the gland, and Frankel's 

 opinion that it is referable to sexual stimulation through nervous influences 

 would coincide with this. 



3. Corpus Luteum Persistens (Halban and Kohler). The three 

 cardinal symptoms of the condition which has received this name, namely, 

 (1) amenorrhea, (2) the presence of a hyper trophic and true secreting 

 or pregravid endometrium, and (3) the presence of a functional corpus 

 luteum resembling that of pregnancy, has led to its designation as occult 

 or apparent pregnancy. Several cases of this interesting condition have 

 been reported. If a curettage is done during the late amenorrheic stage 

 the endometrium presents the characteristics of an early decidua, but if 

 this procedure is not carried out an intensified menstruation may ulti- 

 mately close the amenorrheic pause. The picture corresponds in its en- 

 tirety to that of an early pregnancy, but the place of implantation of the 

 ovum has escaped all observers, even the most painstaking ones. Roki- 

 tansky first saw such a condition, and his careful scrutiny did not discern 

 the implanted ovum either intra- or extragenitally. Huge I has described 

 such a case, and R. Meyer sectioned serially two cases of tubes and 

 uterus without locating the ovum. Halban's cases, in which the corpus 

 was cystic, apparently belong here, but there would not seem to be any 

 special significance in the cystic condition of the corpus, for this is fairly 

 frequent in the case of the human corpus luteum without the symptom 

 complex which we have just described. 



B. Secondary Ovarian Impairment. Though in many serious gen- 

 ital affections (e. g., malignant tumors, chronic pelvic inflammatory dis- 

 ease) the ovarian function may not be seriously disturbed, yet the gonads 

 are particularly sensitive to some disturbances in the general health and 

 have a particular dependence on other glands of internal secretion. Both 

 the general and particular relations of the ovaries are only beginning to 

 be understood. 



1. Endocrin Upsets. The ovaries appear to maintain definite rela- 

 tions with the pineal, thymus and adrenal glands, as well as with the 

 thyroid and hypophysis. We do not propose to discuss this field. 25 

 Ovarian hypof unction or complete amenorrhea occurs in acquired or con- 

 genital hypothyroidism and in that hypophyseal upset which gives Froh- 

 lich's syndrome 1 distrophia adiposogenitalis. Well known is both a cas- 

 tration and pregnancy hypertrophy of the hypophysis while the thyroid is 

 enlarged both at the menses and in gestation. May the future enlighten us ! 



2. Trophic disturbances of the ovaries produced by general bodily 

 or constitutional upsets are well known. 



Hygienic changes have long been known as operative here. Here may 



25 Which in spite of the strictures of Fehling has received a valuable and sug- 

 gestive formulation in the Aschner monograph. 



