596 HERBERT M. EVANS 



belong the amenorrhea which Europeans writers have cited as exhibited in 

 girls of the servant class when entrance upon duties in a large city entails 

 sudden alteration of previous rural surroundings. The causes, of course, 

 may possibly be nervous. 



The relation of nutrition to ovarian hypofunction has been equally 

 clear, but studies of the particular nutritional components or proportions 

 which are necessary for the gonads remain to be carried out. The Great 

 War would appear to have furnished in the central empires widespread 

 examples of the nutritive impairment of the gonads in the so-called war 

 amenorrheas (see Ebeler). Quantitative under-nutrition expresses itself 

 quickly upon the ovary of the guinea pig (Papanicolaou and Stockard) 

 and upon that of the rat (as I have been able to determine with K. J. 

 Scott), as seen in delayed appearance of the next oestrus, 



3. Systemic diseases, while frequently involving the ovaries, in 

 some cases have appeared to have special relations to them. One may 

 mention here above all the chlorosis of young girls and tuberculosis. In- 

 cipiency in the latter infection may sometimes first be surmised by the 

 amenorrhea. The chlorqtic conditions are in harmony with the effect of 

 other acute or chrome anemias, where amenorrhea is extremely frequent. 

 Other infections, though without this peculiar emphasis, take their toll of 

 the ovaries. Here are to be mentioned scarlet fever and typhoid, chronic 

 nephritis and diabetes. The metabolic disorder known as adiposity is 

 also particularly prone to lead to cessation of ovarian function. 



4. Drugs. The ovary is particularly sensitive to many chronic and 

 some acute poisons. In the former category belong morphin and to a 

 lesser extent alcohol. Olshauson has described an ovarian toxicity of 

 phenacetin, though this is temporary in effect. Radioactive substances 

 have a highly specific toxic effect upon the eggs and follicular apparatus 

 of the ovary and Rontgen or radium therapy has become the sovereign 

 method of ablation of this function in many cases which were previously 

 submitted to the knife. 



5. Causes of ovarian impairment unknown in their exact mode of 

 operation are also well known. One must cite here amenorrhea due to 

 nervous origin, particularly to depression and long continued anxiety. It 

 has long been known that severe and sudden psychic agitation may pre- 

 maturely provoke or postpone an expected menses. But though the 

 nervous connections' of the ovary are being continually investigated (e. g., 

 the recent work of Wallart and Dahl), we are actually unaware of the 

 mechanism of nervous control of this organ. Dahlmanii and Ricker look 

 upon menstruation itself as a vasomotor paralysis, and various but incon- 

 clusive tests of the state of the vegetative nervous system during the men- 

 strual cycle have been made by Franke, Dahlmann and others. Claims are 

 to the effect that both vagotonic and sympathicotonic symptoms are found. 

 Urinary fistula3 predispose to amenorrhea in a way unknown to us; idio- 



