THE KHYTHM OF GONADAL FUNCTION 597 



pathic mammary hypertrophy often has cessation of the menses as a con- 

 comitant symptom. 



Ovarian therapy in amenorrhea (which, as we have indicated, has a 

 rationale which cannot be ascribed to liter ine treatment for this symptom) 

 is nevertheless embarrassed by our inability to affect the ovary except by 

 general methods. hygienic regimen, local stimulus (hyperemia by means 

 of the applications of heat, drugs such as yohimbin, etc.). It is possible 

 that mild dosage with ultra violet rays could prove stimulating instead of 

 toxic in its effect and more than likely that an improved organotherapy 

 with ovarian substance itself, with placenta (Aschner), or with other 

 endocrin hormones will represent therapeutic conquests of the future. 



2. Disturbances Producing Uterine Hemorrhages. In no other respect 

 is the concept which has been developed above of the primary relation 

 of the ovary to the uterus more important than in our understanding 

 of the etiology of certain profuse or irregular uterine bleedings. Since 

 many of these occur at or near the time of menopause, sterilization is a 

 justifiable procedure and it is of significant scientific import that a sov- 

 ereign method of control of many such hemorrhages exists in Rontgen 

 dosage of the ovaries. This has been so well recognized that this treat- 

 ment has been indulged in and will probably unfortunately continue to be 

 resorted to without the previous investigation of all aspects of the par- 

 ticular disorder, e. g., hemorrhage from malignant disease will be so 

 treated. Common among the metrorrhagias, however, occurs a disease to 

 which Schroeder has particularly called our attention and for which he 

 has adopted Pankow's term metropathia hemorrhagica and which is desig- 

 nated by some (e. g., Novak) "functional uterine bleeding." This affec- 

 tion, which causes a large proportion of otherwise unexplainable irregular 

 bleedings at the time of the menopause and to a lesser extent at puberty, is 

 associated with a definite anatomical and functional condition of the 

 ovaries, a condition which stands in etiological relationship to the uterine 

 disorder. The three cardinal symptoms of metropathia hemorrhagica 

 are: (1) chronic bleeding without reference to the cycle and frequently 

 occurring after a period of amenorrhea; 26 (2) the existence of a large 

 velvety or hyperplastic endometrium as seen in curettage samples, an 

 endometrium which in spite of its thickness does not show the functional 

 changes characteristic for instance of the pregravid structure; (3) the 

 absence of recent ovulation in the ovary and hence of all recent corpora 

 lutea but the persistence of large and apparently ripe follicles possessing 

 healthy eggs and granulosa. 



The idea that we may have an ovarian etiology for pathological con- 

 ditions of the endometrium is not new. The endometrium in this disease 

 has previously undoubtedly often gone under Olshausen's name, endo- 



28 Novak, however, describes the hemorrhages as usually menorrhagias although 

 he recognizes that the cycle may be disturbed. 



