324 ALLAN WINTER ROWE 



Of this total of 230 individuals, 145 or nearly two-thirds had a demonstrated 

 incretory malfunction as one significant impedence to fertile union. The 

 diagnosis of an endocrine disorder thus becomes a matter of prime impor- 

 tance in the resolution of the factors potentially causative of an infertile 

 mating. There are two steps involved; first, the proof of an existing endo- 

 crinopathy and, if found, second, the determination of the gland at fault. 

 Though time precludes the documentation of the statement, it may be 

 affirmed that pluriglandular involvement, in the older conventional sense 

 of the term, will not be demonstrated. 



The days when endocrine diagnosis derived from the shape of the eye- 

 brow or a selective distribution of the adipose resulting from a healthy 

 appetite are gradually becoming a thing of the past. Less certainly has 

 been laid aside the interpretation of all lowered basal rates as indices of 

 thyroid failure. With but minor exception it may be safely said that the 

 diagnosis of disturbed endocrine function must rest upon the collection 

 of a large amount of diverse factual evidence with the interpretation of each 

 single factor in terms of all of the other data. For simple illustration, let us 

 revert to the lowered basal rate which in addition to anterior lobe, adrenal 

 and ovarian as well as thyroid failure, may derive from so remote a cause 

 as a partial protein inanition. The urine nitrogen offers a basis of precise 

 interpretation of this factor as does the blood morphology in the case of 

 leukaemia where the basal rate attains the level usually associated with 

 thyrotoxicosis. 



So-called vital function testing, the term used in comprehensive sense, 

 offers a direct objective approach to the partial resolution of the problem. 

 Basic to the thesis, however, is the fact that in function testing only the 

 end result of what is usually a wide variety of causes may be measured. 

 The test thus lacks a clear-cut specificity. On the other hand, this multi- 

 plicity of control factors offers the largest element of value in the form of 

 approach. The application of a series of function tests gives, not a single 

 criterion of a single disturbed function, but a series of inter-related criteria 

 in each of which several functional activities are involved. Thus, while 

 several factors influence both the magnitude and direction of the result of 

 each observation, it is highly improbable that all of a series of widely diver- 

 gent tests should be uniformly affected both in quality and amount by each 

 of the several agents implicated. The accuracy of this assumption has been 

 amply proven in the experience of the past twenty years. 



For this reason, then, in the study of our infertile couples, the carefully 

 compiled medical history and thorough physical examination already dis- 

 cussed by my colleagues are supplemented by a series of objective measure- 



