INFLUENCE OF OVAKY ON GENEEATIVE TKACT 615 



others attach much importance to the so-called interstitial cells (Zwischen- 

 zellen), although these cells in the human female are well developed only 

 in the pregnant state. For a full discussion of this question, the reader 

 is referred to the numerous special articles dealing with it. 



Mechanism of Menstruation. To summarize the prevailing views, 

 it may be stated that the corpus luteum, beginning its life history at the 

 time of ovulation, passes through a series of developmental changes which 

 reach their acme just before the onset of the next menstrual period (Fig. 

 1). Hand in hand with this development of the corpus luteum there 

 proceeds a similar hypertrophic change in the endometrium, also reach- 

 ing its high point (premenstrual stage) just before the onset of the next 

 period. The clinical phenomenon of menstruation, with its discharge of 

 blood, is indicative of a catabolic or destructive process in the endome- 

 trium, when conception does not occur. It is a transition of the endo- 

 metrium from the highest to the lowest point of its development. On 

 the other hand, if the ovum has been impregnated, the premenstrual 

 hypertrophy of the endometrium passes on by easy stages into the forma- 

 tion of the early decidua. 



So much seems to be well supported by the evidence at hand. It 

 should perhaps be emphasized that while the corpus luteum is essential 

 for menstruation, it is not, of course, the cause of the actual menstrual 

 hemorrhage. The role of the corpus luteum is to prepare the endo- 

 metrium for the reception of a possible impregnated ovum. The actual 

 menstrual discharge is synchronous with the beginning of retrogression in 

 the corpus luteum, as Labhardt emphasizes in his recent article. The in- 

 fluence responsible for this has not as yet been determined, but there is 

 reason to believe that it is associated in some way with the ovum discharged 

 at the preceding ovulation. Perhaps it is the death of this ovum which 

 determines the beginning of the retrogressive changes in the corpus luteum 

 and in the endometrium. 



Clinical Syndromes Referable to Disturbances of 

 Ovarian Secretion 



Introductory 



Quantitative Disorders. Our knowledge of the clinical syndromes 

 dependent upon functional disturbances in the ovary is still very imperfect. 

 A few facts have, however, crystallized out with a fair degree of clearness, 

 so that we are beginning to recognize certain clinical pictures as indicative 

 of either an excess or a deficiency of the internal secretion of the gonads. 

 It is perhaps best to confine our discussion to these quantitative disorders 

 agenitalism, hypogenitalism and hypergenitalism for the term dysgeni- 



