96 THE INTERNAL SECRETIONS—1920 
In the early stages the symptoms may be referred 
either to the ovary or the thyroid; in well-marked cases 
both glands are equally involved; and in late cases 
symptoms of thyroid dysfunction are the more promi- 
nent. The syndrome is for the most part one of hypo- 
function, though some cases show marked evidences 
of hyperfunction of one of the glands—this probably as 
a manifestation of what might be termed a terminal 
compensatory effort. 
BACKACHE A COMMON SYMPTOM 
The sequence of symptom development varies with 
the type of case. Where the ovary initiates the condi- 
tion (twenty-two of forty-one cases), the first com- 
plaint was a pain in the back just above the sacrum. 
This pain could not be explained by any static condi- 
tion, such as flat feet, etc., neither was it relieved by 
treatment directed to the correction of a static condi- 
tion. A characteristic of the backache is that it is re- 
lieved during active menstruation. In a few cases the 
control of a coincident constipation also afforded 
marked relief. The pain often radiates down one or 
both legs, at times to the knee, either along the course 
of the sciatic, or genitocrural nerve. In two cases a 
laparotomy was performed, because of this symptom, 
and what were said to be systic ovaries were removed. 
The backache was not influenced by this procedure. 
Accompanying the backache there may or may not 
be menstrual disturbances, either amenorrhea, or a 
brief period of profuse menstrution, followed by 
amenorrhea. Later, there may or may not appear 
varying degrees of hirsuties. In one case the patient 
was very definite in asserting that the growth of hair 
was most marked one week before menstruation. Physi- 
cal examination shows no characteristic pelvic condi- 
tion other than extremely sensitive ovaries, and even 
this is not constant. The ovarian type is found in those 
