178 THE SEX-COMPLEX 



insufficiency by sterility and amenorrhoea — is due to primary ovarian 



secretion 11 or to uterme atrophy ; so when there is no evidence to 



apart from enable us to come to a conclusion from clinical observa- 



pause. tions, we must be guided by the results of experimental 



investigation. Thus we are led to believe that the 



amenorrhoea which occurs with thyroid insufficiency, 



such as occurs in the disease known as myxcedema, 



is probably due to uterine rather than ovarian 



atrophy. 



General Besides these interhormonopoietic disturbances there 



causing are other general diseases in which ovarian insufficiency 



ovarian mav \j e seen, and these all come in the same etiological 



insufficiency. J ° 



category, although the primary causal factors differ 

 widely. 



It must, however, clearly be recognized that in those 

 diseases in which there is a general toxaemia, the result 

 produced depends on the severity of the disease. Thus, 

 with mild forms of tuberculosis, amenorrhoea and 

 sterility are unusual; while with advanced stages of 

 the disease the genital functions may be entirely in 

 abeyance. Probably this state of affairs is produced by 

 the lowering of the metabolic — the vital — processes of 

 the body. It is not difficult to understand that in 

 disease the exhausting, but not vital, reproductive 

 processes are first subject to suppression in order that 

 the individual may recuperate. This is in accordance 

 with natural laws. 



The lime salts are among the most important physio- 

 logical agents in resisting infections and in repairing 

 the local ravages of disease ; so it is no wonder that in 

 the conditions under discussion calcium cannot be 

 spared for excretion or reproduction. 



Sometimes, when the factor arresting the ovarian 

 function has been very powerful — such as may be pro- 

 duced by a toxin — the effect may be permanent. This 

 may occur after mumps, after typhoid fever and as a 

 result of local infections. In these circumstances the 

 effect is more than inhibition : there is probably de- 

 struction of the ovarian secretory cells by local and 



