SEXUAL PSYCHOSES AND NEUROSES 215 



Careful attention to the state of the bowels ; as Menopausal 

 much fresh air and exercise as possible, with moderate 

 occupation and company are essential. Tonics together 

 with thyroid extract, or thyroid and ovarian extracts 

 combined, with the relief of special symptoms, will assist 

 us in the majority of cases to tide the patient over the 

 period of stress, until such time as a natural readjust- 

 ment of her metabolism shall have occurred. 



Secondary ovarian insufficiency. — There is another Secondary 

 aspect of diminished ovarian secretion in relation to 8U ffi c i enC y. 

 the mentality of the individual that requires brief 

 mention here in order to complete the picture — I refer 

 to the ovarian insufficiency seen in association with 

 masculinity or reduced femininity in women. 



It has already been stated (p. 212) that except in the 

 presence of outspoken insanity, in association with 

 which ovarian atrophy is a secondary lesion, no marked 

 mental change is found as the result of the genital 

 retrogression. But in the circumstances now mentioned 

 the secondary ovarian atrophy is an essential part of 

 the phenomenon — the losing of femininity and the 

 assumption of masculinity. 



When any of the masculinity-producing internal The 



,. -. , ii . • • j_i_ assumption 



secretions become abnormally active m women the o{ maS cuiine 

 ovarian secretions are antagonized or inhibited, partly ?^* cter " 

 or completely, and the metabolism is directed towards 

 the necessities of masculinity. In such circumstances, 

 with the development of the physical changes towards 

 masculinity, the mind becomes less feminine in its 

 outlook. Cases of so-called * true hermaphroditism ' 

 are, as we have seen, rare ; but there is little doubt that 

 women with a larger share of masculinity than is normal 

 are extremely common. These unnatural individuals 

 are easily detected by the coarseness of their skins, by 

 the size of their extremities, by the ill-development of 

 the breasts, and by the assertiveness and aggressiveness 

 of their conversation and schemes. No doubt many of 

 them have hyperplasia of the suprarenal cortices or of the 

 pituitary ; and atrophy of the ovaries, when it exists, is 



