OVARIAN INSUFFICIENCY 173 



sufficient to prevent menstruation, in the presence of 

 functional ovaries. 



The chief types of general menopausal phenomena to Menopausai 

 be observed clinically may be classified as follows : - p e 



(1) Psychical. 



(2) Vasomotor. 



(3) General metabolic. 



(4) Gross changes in the cryptorrhoeic organs 



and in the mammary glands. 

 The psychical disturbances I shall deal with later. 

 Vasomotor disturbances. The regulation of the vaso- Vasomotor 



T n ., , ,, , . ., disturbances. 



motor system is very definitely under the control of the 

 internal secretions, although as yet we do not know 

 exactly the different parts played by all the hormono- 

 poietic organs. 



It has, of course, long been known that the chromaffin 

 system, of which the suprarenal medulla is probably the 

 most important element, exerts a controlling influence 

 over the tone of the vessels. We have not only physio- 

 logical evidence of this in the pressor action of the 

 prepared extract, but also morphological, since the 

 secretory cells of the suprarenal medulla are derived 

 from the same anlage as the sympathetic nervous system. 

 Again, Weed, Gushing and Jacobson 1 have demon- 

 strated that stimulation of the superior cervical sympath- 

 etic leads to an increased output of infundibulin, 

 followed by glycosuria. It is true that this is merely a 

 secretory -nervous phenomenon ; but we know that the 

 connexion does not stop there, and that the infundib- 

 ulin has a powerful action on the blood-pressure : not, 

 of course, through the sympathetic -nervous system, but 

 owing to its direct, peripheral effect on the blood-vessels. 

 With regard to the thyroid we know that the extract 

 of this gland, when injected intravenously, lowers the 

 blood-pressure. The modus operandi is somewhat 

 doubtful ; many authorities believe that the action is 

 not specific, but common to many animal extracts ; 



1 Weed, L. H., H. Gushing, and C. Jacobson, Butt. Johns Hopk. 

 Hosp. t 1913, vol. xxiv, p. 40. 



