392 INANITION AND MALNUTRITION 



R. Koehler ('17, '18), on the basis of 2 necropsies, opposed the theory of 

 Fraenkel ('17) that war amenorrhea is due to small-cystic ovaries produced 

 by sexual abstinence. Koehler concluded that the ovarian changes prevent 

 the ripening of follicles and the formation of corpora lutea. The uterine changes 

 were considered secondary to the ovarian lesions, which in turn are probably 

 caused by inanition, over-exertion and psychic shock. 



H. Koehler ('19) likewise concluded from microscopic examination of the 

 ovaries that war amenorrhea is due to the effect of malnutrition upon the 

 ovaries, in which there is disappearance of the primordial ova and failure to 

 form corpora lutea. In some cases the ovaries become small-cystic, in others 

 they undergo fibrosis. Hoffmann ('20) examined 4 ovaries from cases of war 

 amenorrhea; 2 appeared cystic, the other 2 merely atrophic. That ovarian 

 function sometimes continued in spite of the amenorrhea is indicated by the 

 occasional occurrence of conception during this condition, as was noted by 

 Giesecke ('17), Pok ('17) and others. 



Bauereisen ('19) reviewed fully the literature upon war amenorrhea, includ- 

 ing (in addition to those above mentioned) additional data by Stoeckel ('17), 

 Hamm ('18) and Schaefer ('18). Rubner ('19) reported retarded menstruation 

 and deterioration of the female sex-organs as an effect of the subnormal diet on 

 the German population. In the Russian famine, Ivanovsky ('23) noted that 

 "In women menstruation ceased during the period of fasting. The sexual 

 instinct became very weak and even disappeared entirely. The number of 

 births decreased enormously." The question of malnutritional amenorrhea 

 will be discussed further in connection with the effects upon the uterus. 



In athreptic infants, Mattei ('14) found the ovary somewhat atrophic, 

 weighing 0.30-0.60 g. instead of normally 0.60-1.0 g. On section, the 

 germinal epithelium appeared normal. 



The ovarian cortex contained chiefly primordial follicles; sometimes follicles 

 more advanced in development, atretic, or cystic. These changes were also 

 reviewed by Nobecourt ('16). Marfan ('21) likewise found the ovaries small in 

 athreptic infants, but Nicolaeff ('23) states that they appeared normal in 

 weight in famine-stricken children of vorious ages. Stefko ('23, '24) and 

 Maslowsky ('23), however, find marked follicular atrophy (ova sometimes 

 absent) with increased interstitial tissue. 



The effect of malnutrition in causing retardation or arrest of sexual develop- 

 ment has frequently been observed. Calmette ('19) noted arrested growth in the 

 malnourished children in Lille during the period of occupation. The girls 

 failed to mature sexually at the proper age, those at 18 years appearing only 13, 

 and those of 14 appearing only 10 years of age. 



From Table 3, it appears that in most cases' the weight of the ovaries in 

 atrophic infants (Minnesota cases) is considerably below the normal at birth 

 (0.32 g.), but it is impossible to draw conclusions as to the extent of the atro- 

 phy, on account of the scarcity and irregularity of the data, as well as the lack 

 of an adequate norm of postnatal growth of the ovaries. 



Among the lower animals, data upon the effects of inanition on the ovaries 

 are more numerous. These will be reviewed chronologically, excepting some 



