020 EMIL NOVAK 



3. Psycfiic Symptoms. These may assume various forms, such as 

 irritability or depression. In extreme cases, especially where there is a 

 hereditary taint, actual psychopathic conditions may supervene. In these 

 cases, which are fortunately relatively rare, the influence of the menopause 

 is similar to that of any other crisis affecting- the patient's life. 



4. Nervous Symptoms. One of the most interesting, though rela- 

 tively uncommon, symptoms which may be observed at the menopause is 

 tachycardia. There is much plausibility in the view which has been sug- 

 gested by Kisch (b) and others, that this symptom is the result of a relative 

 hyperthyroidism produced by the withdrawal of the ovarian secretion. 

 Other nervous symptoms, whose endocrine relations are not very clear or 

 direct, are numbness and tingling of the extremities, pruritus (either 

 general or genital), headache and vertigo. 



5. Other Symptoms. Among other symptoms occasionally noted are 

 gastric disturbances (the dyspepsia uterina of Kisch), constipation, and 

 skin eruptions of various sorts, the most frequent form being urticaria. 

 Sexual desire and gratification are said to be diminished or lost in a 

 large proportion of cases (Glaevecke, Pfister and Moll). 



Anatomic Changes of the Menopause. The menopause marks the be- 

 ginning of senility in the woman, and the characteristic anatomic changes 

 seen in the reproductive organs at this epoch are all indicative of retro- 

 gression. The external genitalia show atrophy and a disappearance of the 

 fat of the labia, while the vagina becomes narrower, as a result of the 

 same process of senile atrophy. The internal genitalia likewise become 

 atrophic. The uterus is much diminished in size, while the endometrium 

 becomes thin and fibrous, the glands being sparse and almost obliterated 

 (Fig. 2). Especially striking are the changes exhibited by the ovaries, 

 which become small and of dense, fibrous texture. The follicles disappear 

 and corpora lutea are no longer found. The differentiation between the 

 cortical and medullary zones of the ovary becomes very sharp (Fig. 3). 



In a large proportion of cases women exhibit a tendency to a greater 

 or less increase in body weight at the menopause. Glaevecke found a 

 significant increase in body weight in 57.5 per cent, of castrated women, 

 Alter thum (Tandler and Grosz) in 29.5 per cent. As throwing light on 

 this frequently observed fatty deposit may be mentioned the work of 

 Lowy and Richter (>), who found that castration brings about a decrease 

 in the oxygen interchange in the tissues of as much as 20 per cent. In some 

 cases the increase of body weight is very great, more frequently it is mod- 

 erate. The fat is deposited especially in the anterior abdominal wall and 

 about the hips and buttocks. Often the face also shows a heavy deposit of 

 fat. Occasionally there is a loss of weight at the menopause, but this is 

 exceptional. The breasts often become large, fat and pendulous, as a 

 result of a fatty periglaiidular deposit, although the gland tissue itself 

 exhibits atrophic changes. Rarely a secretion of milk may appear in the 



