OVARIAN INSUFFICIENCY 171 



operative interference. As we have already seen, when Absence and 

 the ovaries are removed experimentally definite changes Tovarian C 

 occur in the general metabolism, in the uterus and in secretion. 

 the structure of the other organs of internal secretion ; 

 and these changes appear to be more marked in the 

 higher than in the lower mammals. 



From observations made on the human subject Oophorect- 

 there is no doubt that a train of events similar to that 

 seen in animals follows complete oophorectomy. In P 

 women, however, there are, in addition to the phenomena 

 already described, frequently to be noted psychical 

 disturbances which are no doubt dependent on the 

 general disturbance of the metabolism. It must not be 

 forgotten, also, that marked individual variations exist 

 in regard to the symptoms produced, just as normally 

 there are considerable variations in the degrees of 

 femininity in different women. 



Many surgeons have stated that complete oophor- Effects of 

 ectomy produces no detrimental symptoms, or, at any ecfomy pro- 



rate, no disturbances worthy of consideration. Such 

 surgeons remove both ovaries without the slightest femininity. 

 hesitation. Nevertheless, those who have asserted 

 that oophorectomy is of small moment to the patient 

 have failed to make good their scientific position hi the 

 matter by any reliable evidence. Of course, as already 

 mentioned, women differ considerably in their reactions 

 to oophorectomy. Knowing this, by the exercise of a 

 discretion that appears obvious in view of what has been 

 said regarding individual variability, we might be able 

 to avoid seriously injuring the patient. If one were to 

 gauge the degrees of femininity and ovarian activity in 

 women before operation and in many cases it would 

 not be difficult it might be possible to assert that in 

 those cases in which these were obviously in abeyance 

 or below the average standard little disturbance of the 

 metabolism would result from oophorectomy ; and, 

 consequently, it might be justifiable in such cases com- 

 pletely to remove the ovaries with a fibromyomatous 

 uterus or with infected tubes. But, unless such a 



