OVARIAN INSUFFICIENCY 175 



the causes underlying this physical change. My own Metabolic 

 observations make it obvious that there is an increased dl8turbances - 

 carbohydrate tolerance in these circumstances, associated 

 with deficient oxidation. By this I mean : first, the 

 homonopoietic organs, such as the pituitary, which are 

 concerned with the carbohydrate metabolism, are dis- 

 turbed and fail properly to carry out their functions in 

 this respect ; and second, there is a diminution in oxida- 

 tion, partly due to the insufficiency of ovarian secretion 

 as demonstrated by Loewy and Richter 1 , and partly 

 to the sedentary life that the woman often leads. 



As already stated, the metabolism, once the meno- 

 pause is fully established and the disturbing symptoms 

 have disappeared, usually settles down, and becomes 

 uniform and less elastic than previously. Calcium, 

 for instance, no longer needed for reproduction and 

 lactation becomes deposited in the tissues ; and this is 

 primarily brought about by the absence of ovarian 

 secretion which in the reproductive period,, when the 

 woman is not pregnant, leads to the elimination of 

 lime salts in the faeces and urine, and also in the 

 menstrual discharge. 



These metabolic derangements play an important Metabolic 

 part in the psychical disturbances and alterations which ^Sfaffect 

 so frequently occur at the menopause. psychology. 



Gross changes in the cryptorrhoeic organs. — As already Gross change; 

 demonstrated by experimental evidence, alterations occur in cr yP to - 

 in the hormonopoeitic organs on the withdrawal of the organs. 

 ovarian secretion. As a rule, these changes are not exten- 

 sive, and are only temporary. Sometimes, however, very 

 marked disturbances are seen. It is not uncommon, 

 on the one hand, to see enlargement of the thyroid, and 

 even exophthalmic goitre, supervene after removal of the 

 ovaries during the reproductive period. On the other 

 hand, somewhat paradoxically perhaps, myxcedema is 

 a disease which most frequently occurs in women after 

 the menopause. The other organs of internal secretion 



1 Loewy, A., and P. F. Richter, CentraM.f. Physiol, 1902, vol. xvi, 

 p. 449. 



