INFLUENCE OF OVAKY ON GENEKATIVE TKACT 637 



indicating, as has already been emphasized, that the endocrine disorder 

 is not always of the same character. 



In the more frequent cases of functional climacteric hemorrhage I 

 have rarely seen any benefit from thyroid medication, and not infre- 

 quently the bleeding has seemed to be exaggerated. Somewhat better 

 results have followed the administration of ovarian extracts, especially 

 of the corpus luteum preparations. This is in keeping with recent his- 

 tological investigations, which indicate that corpora, lutea are commonly 

 absent in cases of hyperplasia of the endometrium associated with uterine 

 bleeding. In other words, even though we are perhaps dealing in these 

 cases with a form of ovarian hypersecretion, it is not the corpus luteuni 

 which is overactive. Some other element in the ovary is concerned with 

 the hyperfunction, the corpus luteum being deficient. My most encourag- 

 ing results have been obtained from the exhibition of corpus luteum 

 extracts, either alone or in combination with small doses of thyroid. 

 The corpus luteum is usually given in doses representing five or ten 

 grains of the dried extract three times a day. Or it may be administered 

 subcutaneously in the form of the soluble extract, which is now pre- 

 pared commercially in convenient ampule form (1 c.c.). One ampule 

 is injected usually every second or third day, depending on the severity 

 of the hemorrhages. By such measures the condition may in some cases 

 be improved, so that the patient can be tided over the period of endocrine 

 instability which predisposes to the development of this symptom. 



As to the use of pituitary extracts, little of a definite nature can be 

 stated. The use of posterior lobe extracts has been lauded by some. 

 As I have stated above, however, any good results obtainable from these 

 are probably due to the well-known effects of these preparations in stimu- 

 lating contraction of the uterine musculature. The other effects of these 

 substances are of such potency, however, as to contraindicate their con- 

 tinued administration for a prolonged period. So far as I know, anterior 

 lobe extracts have achieved no important place in the treatment of these 

 troublesome cases, and, indeed, there would seem to be no especial ra- 

 tionale for their employment. 



It is unfortunate that we cannot be more explicit in suggestions as to 

 the organotherapy of this important type of hemorrhage, and that our 

 efforts to attack it along what seem to be rational lines have not met with 

 a greater measure of success, but I believe that what has been said repre- 

 sents the worth-while in our present knowledge of the subject. 



