Women at the menopause frequently are observed who have become neurasthenic from the irritation of waste material intoxication which is not neutralized because the ovaries are ceasing to function. Ovariotomy in younger women produces this menopause artificially and suddenly; and women from whom both ovaries have been removed, as a rule, become neurotic invalids with a tendency to insanity if they are unstable in character or have a bad inheritance. If the whole thyroid gland is removed, death results from intoxication. Extreme obesity is an effect of undersecretion by the glands and a consequent lack of oxidation. Fat children have deficient glands, as a rule, and eunuchs grow fat as capons do. Removal of the ovaries before puberty arrests or prevents the development of the uterus; removal after puberty stops menstruation, the breasts atrophy, and there is an arrest of general physical growth. Gordon[183] reported on 112 cases of oöphorectomy. Of these thirty-four had had before operation various symptoms of neurasthenia, hysteria, or psychasthenia, and vague abdominal disturbances. Surgeons in each of these thirty-four cases blamed the ovaries for the symptoms; and although these organs were not diseased in any degree, the surgeons removed them. In twenty-five of these cases there was no improvement whatever; in the remaining nine there was improvement for a few weeks, but complete relapse later, and finally their symptoms grew worse. The obsessions became permanent and expanded. Those women in the group who had hysterical paroxysms began to have stronger and more frequent attacks. Several psychasthenics had to be confined in asylums for the insane. Three of the women who had complained merely of vague nervous symptoms, as pain in the abdomen, head, or back, or of constipation or diarrhea, after oöphorectomy grew irritable, highly nervous, quarrelsome, fickle, restless, showed a tendency to travel about, to complain of others; finally there was insomnia, and loss of appetite or voracity. In the remaining seventy-five cases one or both the ovaries were diseased, but both ovaries were completely removed. All these women developed symptoms like those described above, but several grew much worse in their mental condition than the psychasthenics among the first thirty-four women. The generally observed symptoms are: restlessness with a tendency to move from place to place; loss of self-control; dissatisfaction with all persons and things; want of interest in work; indolence; pessimism. Sometimes there are outbursts of anger, with a tendency to attack. The mental conditions do not, as a rule, become clearly developed melancholias or manias, although a few do grow definitely insane. The morbid symptoms, however, persist obstinately. After ten years' observation Gordon found no improvement in some of these psychasthenics. [183] _Jour. Amer. Med. Assoc._, October 17, 1914.