636 EMIL NOVAK 



There is abundant evidence, however, that this characteristic change in 

 the endometrium does not represent a primary lesion, but that it is 

 purely secondary to a disturbed function of the ovary. Under normal 

 conditions the endometrium is certainly subordinate to the influence of 

 the ovary. The ever-changing histological appearance of the uterine mu- 

 cosa at different phases of the menstrual cycle is undoubtedly called 

 forth by corresponding cyclical changes occurring in the ovary, and espe- 

 cially in the corpus luteum. So that there is nothing revolutionary in 

 the idea that the characteristic picture of hyperplasia may be associated 

 with some definite endocrine disturbance of the ovary. The reasons for 

 considering hyperplasia of the endometrium, with its accompanying 

 "functional uterine bleeding," as manifestations of ovarian hypersecre- 

 tion, are set forth in a recent paper by the author. I shall not review 

 this evidence here, but it is so impressive that no intelligent gynecologist 

 can afford to overlook the importance of the pathological physiology of 

 the ovary in the consideration of possible causes of uterine bleeding. 



Treatment of Functional Uterine Hemorrhage. Among the most in- 

 teresting, and also the most perplexing, problems encountered in gyne- 

 cological practice is the treatment of these cases of so-called functional 

 uterine bleeding. This type, as already explained, includes the numerous 

 cases of functional climacteric bleeding and the less frequent cases of 

 menorrhagia of puberty. In the majority of such cases, especially if 

 severe, curettage is indicated, chiefly for diagnostic purposes. In the 

 case of menopausal hemorrhage, the indication for curettage is urgent, on 

 account of the importance of excluding cancer. Drugs are of little or 

 no avail in checking this form of uterine hemorrhage. 



From the standpoint of organotherapy, the principal difficulty is pre-- 

 sented by the fact that we as yet know little of the endocrinopathy re- 

 sponsible for this form of menstrual disorder. As a matter of fact, it 

 seems quite probable that the nature of the internal secretory disturbance 

 varies in different cases. It is not surprising, therefore, that the results 

 of organotherapeutic measures, semi-empiric as they must be, have been 

 far from satisfactory. The organ extracts which deserve consideration 

 in this connection are those of the thyroid, ovary and pituitary. 



In the case of the functional hemorrhage of puberty, thyroid extract 

 has, in my own hands, yielded the most encouraging results. To illus- 

 trate, in a recent case of persistent and profuse bleeding in a girl of 

 fourteen, curettage seemed indicated, especially for diagnostic purposes. 

 Microscopic examination of the curettings showed typical hyperplasia of 

 the endometrium. The bleeding, however, did not cease. The patient 

 was then given doses of thyroid extract of two grains a day, with almost 

 immediate cessation of the bleeding. It is only fair to add, however, 

 that similar medication in other cases has appeared to be of no benefit, 



