224 THE INTERNAL SECRETIONS 1920 



In combating the numerous disorders which ac- 

 company the menopause, from first to last, ovarian 

 medication is indicated and, of course, any other neces- 

 sary medication compatible with it. There are three 

 ovarian preparations available: total ovarian extract, 

 extract of the corpus luteum, and ovarian residue. The 

 second is indicated chiefly in cases presenting disturb- 

 ances of the menstrual function only. As these are 

 not usual at the menopause, extracts of the whole 

 gland should be used, and the desiccated extracts are 

 to be preferred. Each case, of course, should receive 

 minute study to determine just what endocrine re- 

 quirements exist. 



The majority of cases suffer from hyperadrenia. 

 But adrenal therapy may be given for the rare con- 

 dition asthenia, pigmentation, and hypoadrenia. Mrs. 

 W. illustrates the latter 40 years of age. She com- 

 plained of epigastric pain an hour after eating, some 

 nausea and great weakness; was badly constipated 

 and had some hot flashes, though her periods were 

 still fairly regular. She had had the "flu" five months 

 previously and had lost some weight, but had never 

 been well since the birth of her last baby five years 

 ago. Family, past history and physical examination 

 negative except for a low blood pressure. She had 

 been in the County Hospital where her stomach con- 

 tents had been examined three times. She was given 

 ovarian substance, two grains; thyroid, one grain; 

 adrenal, one grain ; one capsule t.i.d. In a week she re- 

 ported feeling much better, and in two weeks went 

 out and got a job to help support her three children 

 and drunken husband. 



In any of these disorders it must be remembered 

 that ovarian pain is rarely the fault of the ovary. In 

 this connection Chipman 18 recalls the words of La 

 Rochefoucauld, "Pain is the biggest liar in the world." 



