EFFECTS ON THE FEMALE REPRODUCTIVE TRACT 391 



Among several hundred women stricken by famine, Porter ('89) stated: 

 "Menstruation was not observed in any of these patients, nor was any woman 

 admitted to hospital pregnant. The Sanitary Commissioner, Dr. Cornish, 

 records that only 39 births occurred among some 100,000 famine stricken who 

 passed through the Madras relief camps in 1877. He also shows that the birth 

 rate began to fall off early in the famine, and steadily increased, till some 9 

 months after the height of the famine it reached in the famine districts an annual 

 ratio of 4-5, against an average of 29-30 per mille of population." Cornish 

 concluded that the wasting of the mammary glands and ovaries in the women 

 over 30 was so severe as to make the recovery of normal function impossible, 

 but Porter thought this unlikely. It was apparently assumed, without direct 

 proof, that the amenorrhea and sterility were due to the effects of starvation 

 upon the ovary. 



Frequent observations on famine amenorrhea were also made during the 

 recent world war. Apparently amenorrhea during this war was first noted at 

 Warsaw by v. Jaworski ('16), who called it "Amenorrhea ex inanitione," and 

 ascribed the accompanying marked atrophy of the uterus also to the inhibition 

 of ovarian follicle development. A similar amenorrhea was reported in Ger- 

 many by Dietrich ('17), Ekstein ('17), Giesecke ('17), Graefe ('17), Hannes 

 ('17), Hilferding ('17), Stickel ('17), Schweitzer ('17), Spaeth ('17), Ebeler 

 ('17, '18), Siegel ('17), Vaerting ('18), Abel ('18), Beninde ('19), BauereisenCig), 

 H. Koehler ('19), and Holmberg ('19); in Austria by Pok ('17) and Czerwenka 

 ('17)5 and in Russia by v. Lingen ('21), Abel ('23) and Ivanovsky('23). 



While all found a great increase in the percentage of cases of amenorrhea, 

 the statistics reported vary widely. A few instances may be cited, from gyneco- 

 logical clinics involving thousands of cases. Amenorrhea due to the ordinary 

 causes is excluded. In Kiel, Giesecke ('17) found an increase from 0.19 per 

 cent of all cases in 1914 to 0.31 per cent in 1915, 0.57 per cent in 1916 and 1.29 

 per cent (to May) 191 7. In Vienna, Pok noted an increase from c.037 for 

 1910-14 to 0.65 per cent in 1915 and 1.32 per cent in 1916; and (according to 

 R. Koehler) to 13.5 per cent in 1917. In Leipzig, Schweitzer described an 

 increase from 0.85 per cent in 1911-12 to 4 per cent in 1916-17. In Berlin, 

 Stickel reported an increase from about 1 per cent in prewar times to 1.4 per 

 cent in 1914-15 and 7 per cent in 191 7. In Konigsberg, Hilferding found an 

 increase from 0.55 per cent in 191 2 to 14 per cent in 191 7. The differences 

 were doubtless due partly to actual differences in the amount of inanition at 

 different times and in different localities, but also in part to difference in the 

 diagnosis and classification of cases. Thus cases showing an atrophy of the 

 uterus were included by some authors, but excluded by others. There were also 

 many borderline cases, such as oligomenorrhea, which were difficult to classify. 



The amenorrhea was ascribed chiefly to insufficient nutrition, together with 

 overwork in many cases, resulting in depression of the endocrine function of 

 the ovary. Psychic depression was often considered a contributing factor, 

 and Siegel ('17) even held it to be the primary cause of the amenorrhea. With 

 the return to better food conditions in 1918 and 1919, the number of cases 

 rapidly decreased, according to Holmberg ('19). 



