INFLUENCE OF OVAKY ON GENERATIVE TEACT 625 



it is also in intra-uterine gestation. This fact was elaborated upon in 

 a recent paper by the writer. 



Lactation Amenorrhea. Amenorrhea is the rule during lactation, 

 or, at any rate, during its earlier part. Ehrenfest (&) has well emphasized 

 that in a very large proportion of cases 81.3 per cent menstruation re- 

 asserts itself sooner or later, even though nursing of the child be con- 

 tinued. The amenorrhea of lactation is undoubtedly due to the inhibiting 

 or antagonistic influence of the lactating-breast hormone upon the func- 

 tion of the corpus luteum. Ovulation occurs and corpora lutea are 

 undoubtedly formed throughout lactation, even though menstruation be 

 absent. The best proof of this is the frequent occurrence of pregnancy 

 in nursing women. This group presents perhaps the best illustration we 

 have of what we have called hypo-luteinism. 



Amenorrhea Due to Disturbances of Other Ductless Glands. Thy- 

 roid. Amenorrhea may be observed with either hyperthyroidism or hypo- 

 thyroidism. There has been considerable discussion as to this point, but 

 the weight of evidence seems to support the view of Hertoghe that 

 hyperthyroidism is far more likely to be associated with scantiness or 

 absence of the menstrual function than is hypothyroidism. 



Pituitary. A frequent and exceedingly important cause of amenor- 

 rhea is hypopituitarism. Every gynecologist and every practitioner of 

 medicine encounters numerous cases in which amenorrhea is associated 

 with obesity. The older textbooks were wont to explain the amenorrhea 

 as due to the adiposity, or vice versa. As a result of the researches of 

 Frohlich, Paulesco, Gushing and others, we now know that this is not 

 the case, but that both the obesity and the amenorrhea are due to the 

 same underlying cause a deficient function of the hypophysis. While 

 in Frohlich's first case of adiposogenital dystrophy the autopsy showed a 

 pituitary tumor to be present, it is important to remember that amenor- 

 rhea is frequently due to hypopituitarism, even though no tumor is 

 present. In these cases the pituitary disturbance does not seem to inhibit 

 ovulation, but rather to counteract the endocrine function of the corpus 

 luteum. The author has observed several cases in which pregnancy has 

 occurred in the course of hypopituitary amenorrhea, in one case of three 

 years' duration. 



Suprarenals. The functional differentiation of the cortex and medulla 

 of the suprarenal bodies has been fully discussed elsewhere. It is suffi- 

 cient here to repeat again that the interrenal system, of which the 

 suprarenal cortex forms part, is closely related, from a functional stand- 

 point, to the gonads. The syndrome of hypersecretion of the cortex, 

 usually associated with suprarenal tumors, and combined with evidences 

 of premature and excessive sexual development, is better known than the 

 opposite condition. 



There are cases reported, however, in which suprarenal atrophy or 



