212 



THE SEX-COMPLEX 



Ovarian in- 

 sufficiency. 



Primary 

 ovarian in- 

 sufficiency. 



Ovarian Insufficiency. — Before attempting to assign 

 to ovarian insufficiency the causation of mental aberra- 

 tions, we must decide whether the ovarian lesion itself 

 be primary or secondary. Yet some recent writers, as 

 we shall see later, have assumed, because atrophy of 

 the gonads has been found in association with insanity, 

 that the mental condition is the result of the genital 

 lesion. Moreover, it is not always an easy matter to 

 apportion the blame to this organ of internal secretion, 

 or to that ; for, as we have seen, lesions of one hormono- 

 poietic gland are usually associated with changes in 

 the other members of the cryptorrhceic system. How- 

 ever, when secondary lesions are found, and are definitely 

 ascribable to pre-existing primary changes in the ovaries 

 then, of course, we can safely look upon ovarian in- 

 sufficiency as the primary cause in a complicated 

 sequence of events. In this way we narrow our field 

 of inquiry, for in the human subject the only condition 

 which can without doubt be ascribed to ovarian in- 

 sufficiency is the menopause, natural or traumatic. 



Primary ovarian insufficiency, — It is extremely 

 doubtful whether primary ovarian insufficiency is ever 

 congenital. Apparently congenital ovarian insufficiency 

 may be seen, but in such circumstances we have no 

 evidence to show that the lesion is primarily genital ; it 

 is probably an epiphenomenon. 



Apart from the actual menopause — artificial or 

 natural — the evidence that atrophy of the ovaries is the 

 primary cause of insanity is most unsatisfactory, as we 

 shall see later when considering the effect of insanity on 

 the genital organs. 



I believe it may be taken as an axiom that when 

 ovarian insufficiency gives rise to mental disturbances 

 there has previously been normal activity in these 

 organs. Atrophy of previously normal ovaries does not 

 occur as a primary lesion during the reproductive period. 

 This cannot be too forcibly emphasized. In a large 

 experience in gynaecology I have never seen such a 

 thing. There are many conditions to which atrophy 



