618 EMIL NOVAK 



Changed in the voice after castration have been described by Peasler 

 (quoted by Tandler and Grosz) and Moure. In the two cases reported 

 by the latter the voice became stronger and deeper. Bottermund also 

 believes that, whereas in castrated males the voice tends to become boyish 

 in character, the reverse is the rule in castrated women, in whom the voice 

 tends to assume a masculine character. 



The appearance of hirsutism after castration has been described by 

 Atler (Tandler and Grosz), and also by Von Herff, in whose cases the 

 appearance of a beard, and of hairy growth in the mammary and sternal 

 regions, was noted. 



The Menopause 



The Menopause (Climacterium, climacteric, "change of life"). The 

 normal menopause, with the train of annoying symptoms so often attend- 

 ant upon it, is due to the physiological anoophorism (anovarism, agenital- 

 ism, agonadism) which occurs in, women at a certain age, as a result of the 

 withdrawal of the internal secretory activity of the ovary. 



The recent exhaustive statistical study of Sanes (6), based on the liter- 

 ature from thirty-two nations, places the average age of the menopause in 

 all the cases at 47.1 years. In a general way, Webster is probably correct 

 when he says that "in temperate countries it takes place in about fifty per 

 cent, of women between forty-five and fifty ; in twenty-five per cent., bei- 

 tween forty and forty-five ; in twelve and one-half per cent., between thirty- 

 five and forty; and in twelve and one-half per cent., fifty and fifty-five." 



Early Menopause. Cases are not infrequently encountered in which 

 the menopause occurs at an unusually early age. Kisch, for instance, 

 mentions the case of a Jewess who began to menstruate at 9, married at 

 15, bore no children, and ceased to menstruate at 17. It is interesting 

 to note that this patient was described as having been fat from childbirth. 

 This, indeed, is a very common observation, as I have had occasion to 

 note in the cases of early menopause I have myself encountered. 



Whether these cases are to be looked upon as instances of primary 

 hypogenitalism, or whether they are to be considered as secondary to 

 disorders of other endocrine glands, especially the pituitary, it is difficult 

 to say. From the fact that they exhibit all the characteristics of the usual 

 hypopituitary type of amenorrhea, it is probable that they should be 

 classified under this head, and that the amenorrhea and other symptoms 

 referable to the sexual organs are the result of a secondary hypogonadism. 

 Certainly this would seem to be true as regards the patients who exhibit a 

 marked degree of obesity, and these patients constitute the overwhelming 

 majority. In the less frequent cases, in which there is no increase of 

 weight, it is possible that the primary disturbance is to be sought else- 

 where than in the pituitary. 



