616 EMIL NOVAK 



talism conveys no definite significance in the present state of our 

 knowledge. 



Primary and Secondary Hypogenitalism. There are certain clinical 

 syndromes which are known to be due to primary disturbance of the gonads. 

 This group may be designated as primary hypogenitalism or primary 

 hypergenitalism, as the case may be. In other cases, however, the aberra- 

 tion in the function of the sexual organs may be well marked, and yet it 

 may be possible to demonstrate that the primary disease is in the pituitary, 

 thyroid, suprarenal, or some other ductless gland. This secondary type of 

 functional disorder is perhaps best illustrated in the case of the sexual 

 hypoplastic change (hypogenitalism) associated with pituitary disease, 

 in the case of the well-known adiposogenital dystrophy. Whether we are 

 dealing, in such cases, with an actual secondary hypogenitalism, or 

 whether the pituitary exerts its effect in some direct fashion on the 

 generative tract, is problematic, but tentatively, at least, it seems best to 

 designate cases of this type as secondary hypogenitalism. 



Primary Hypogenitalism (Hypogenitalismus, hypogonadism, hypo- 

 ovarism, hypo-oophorism). Several different clinical syndromes, arising 

 in several different ways, may be associated with hypogenitalism, or de- 

 ficiency of the genital, i. e., the ovarian, secretion. Complete removal of 

 ovarian tissue is obviously productive of a condition of agenitalism. 

 analogous to the condition brought about in the male by removal of the 

 testes, and designated as eunuchism. The symptoms of female eunuchism, 

 like those of the male form, depend a great deal upon the age at which 

 the castration is performed. 



Agenitalism Due to Congenital Absence of Both Ovaries. The few 

 reported cases of this anomaly are all found in the older literature, and 

 the correctness of some of the reports is open to serious question. Nagel 

 and Gebhard believe tha.t this condition cannot occur except with absence 

 of all the other genital organs and in association with other anomalies 

 incompatible with life. Olshausen, on the other hand, believed that a 

 rudimentary uterus or vagina can be found in such cases. 



Agenitalism Due to Castration in Early Life. Surprisingly little is 

 available in the literature concerning the effects of complete removal of 

 the ovaries in early life, that is, before puberty. Early castration in 

 the male is an operation far more frequently done, and attended 

 with definite local and general effects on the boy. The only reference 

 in the literature to the effects of early castration in the human 

 female appears to be the much quoted one of Roberts, a missionary, whose 

 observations were carried out many years ago in India. According to 

 these, the effects of such an operation are to cause a marked inhibition 

 of the generative apparatus, as well as of the mammary glands. The 

 secondary sex characteristics are said not to appear. As Biedl points out, 

 however^ these observations are probably of no scientific value, inasmuch 



