THE SYMPATHETIC SYSTEM 229 



V. ACQUIRED OVARIAN INSUFFICIENCY. 



Insufficiency of the ovary resulting from an alteration 

 of the ovaries following a genito urinary disease or a 

 general disease can manifest itself in several ways. 



1. DYSMENORRHCEA. Ovarian dysmenorrhoea, inde- 

 pendent of any appreciable lesion of the uterus or genital 

 organs, manifests itself by painful and difficult menstrua- 

 tion. There are severe abdominal pains, associated with 

 waves of heat, painful sensations in the breasts and general 

 malaise occurring anywhere from 3 to 7 days before 

 menstruation. A few hours before the flow begins, the 

 pains become more severe and radiate towards the anus 

 and rectum taking on very often the character of a pelvic 

 neuralgia. Many of these women are sterile or only be- 

 come pregnant very late. 7 



2. NERVOUS DISTURBANCES. (a) Each menstrual 

 period causes severe headaches or migraine, accompanied 

 by vomiting, and renal or hepatic congestion and various 

 myalgias and neuralgias. These symptoms become much 

 less severe as soon as the periods are over and re-appear 

 just before the next. 



In some women, there is a frontal or periocular head- 

 ache, very painful and very persistent and which continues 

 between the periods and becomes more intense at the time 

 of the flow. At this time, the patients have a thumping 

 sensation in their head, vertigo, visual disturbances, which 

 oblige them to stay in bed. Dalche suggests that this 

 headache may be due to a functional disturbance of the 

 pituitary due to a disequilibrium of the ovary. 8 



7 As a rule when dysmenorrhcea is not due to inflammation or mechanical obstruc- 

 tion, it is a manifestation of hyper pituitary stimulation. The secretion acting during 

 menstruation as it does in labor causes exaggerated uterine contractions which are painful. 



8 1 believe this observation to be correct. Medication designed to overcome 

 excessive pituitary action during menstruation will often relieve the headaches. 



