598 HEKBEET M. EVANS 



metritis fungSsa, or endometritis cystica, polyposa, and may also have been 

 confused with the normal premenstrual or pregravid endometrium which, 

 as is well known, was also previously looked upon as a hyperplastic endo- 

 metritis. It differs from this, however, in possessing no signs of glandular 

 "function" (i. e., no glycogen or fat storage or mucus secretion) as R. 

 Schroeder and O. Frankl have shown. Olshausen, Swievicki, von Winckel 

 and Brennecke ascribed an ovarian cause for this anomaly of the uterine 

 mucosa without, however, discovering the particular type of ovarian dys- 

 function. Brennecke especially, who described the particular endo- 

 metrium in 1882, emphasized that it was not an endometritis but a pure 

 hyperplasia called forth by uterine hyperemia. Cullen in this country 

 called attention as early as 1900 to these endometrial hyperplasias and has 

 repeatedly referred to the condition in his various publications since then. 

 Brennecke conceived deficiencies in ovulation as explaining the uterine 

 congestion which continued without resolution ; Adler, Aschner, Lauth, 

 Novak and Fraenkel have also recognized the ovarian etiology and noticed 

 the lack of fresh corpora lutea. One of the views expressed has been that 

 the hemorrhage is a menstrual one, but one unchecked, because the corpus 

 was not there to repress it ! We owe to Schroeder the analysis of the 

 ovarian dysfunction. 



The endometrium as seen after curettage may have a distinctive ap- 

 pearance to the naked eye. It is often abundant and fungous or polypous 

 with distinct tiny cysts, which are distentions of hypertrophic glands, 

 and with many places which are reddened by bleeding. Microscopically 

 the great thickness of the structure and complexity of the glands with 

 their high epithelium but lack of secretion may be made out. The stroma 

 resembles that of the basalis though it may be in places close and in others 

 loose meshed. There are small thromboses where leukocytes, necrosis and 

 hemorrhage can be made out. Schroeder has shown that the ovaries show 

 large follicles with a healthy and often thick granulosa (the cells of which 

 may show mitoses), healthy ova and enlarged cells of the theca interna, 

 that is, we have the persistence of large ripe follicles. The only corpora 

 lutea which may be found are at least six to seven weeks old. The follicles 

 have also occasionally been reported as cystically degenerating (as in the 

 type of follicular atresia which overtakes ripe follicles) and, in which 

 cases an hypertrophied theca interna layer can be made out (R. Meyer). 

 It is apparent that in this condition we have a rather precise example of 

 prolonged proliferative endometrial effects of ovarian follicular ripening, 

 i. e., the pathological accentuation of ovarian preovulation effects on the 

 remainder of the reproductive system and a complete absence of the 

 transformations effected normally by the corpus luteum on account of the 

 long delay and indeed failure in ovulation. One must confess that both 

 the non-luteinous granulosa and the theca interna may be concerned here ; 

 the latter is reported as frequently hypertrophied. Scientific interest in the 



