STRUCTURAL ANOMALIES OF GENITALIA 133 



ducts such as absence of the vagina, bicornute or incomplete 

 rudimentary uterus arise during foetal life. It is not deve^ment 

 known whether in these circumstances the internal secre- of the ducts - 

 tions alone are responsible for the malformation, or 

 whether local conditions help to bring about or are 

 responsible for the abnormality present. It is probable 

 that local conditions frequently contribute to the result 1 . 

 Whether the local conditions are not themselves de- 

 pendent on an asynchronous development of the 

 frame, the result of some irregularity of sex-determin- 

 ation, is an interesting question and one which it 

 is not possible to settle satisfactorily on the evidence 

 before us. 



When the postnatal development of the uterus is Causes of 

 incomplete I have found that the pituitary frequently postnatal 

 and sometimes the thyroid are at fault. development. 



In one case, in which a girl of eighteen, otherwise 

 well-developed, was found to have an infantile type of 

 uterus, the sella turcica was shown by a skiagram to be 

 about one-half of the normal size (fig. 40). Evidence 

 confirmatory of this diagnosis was found in the sugar 

 tolerance of the patient, which amounted to over 350 

 grammes of dextrose. 



Similarly, with insufficiency of thyroid secretion 

 occurring during the infantile stage there may be 

 incomplete development of the uterus, with retarded 

 activity of the ovaries. 



Moreover, it may be stated that under-development inactivity 

 of the uterus continued after puberty leads before long 

 to permanent inactivity in ovaries previously normal : 



this I have found to be so on several occasions development 

 on which I have had the opportunity of examining 

 histologically ovaries from these cases. Ovarian in- 

 activity is shown by the absence or scarcity of Graafian 

 follicles, or by the presence of atretic follicles instead 

 of corpora lutea (fig. 41). 



1 Bell, W. Blair, Proc. Roy. Soc. Med. (Obstet. and Gyncecol. Sect.), 

 1909, vol. ii, p. 311. 



