626 EMIL XOVAK 



hypoplasia have been associated with a secondary hypogonadism, as mani- 

 fested by retarded sexual development. In the case of Wiesel, for 

 example, a girl of eighteen presented an infantile condition of the geni- 

 talia, the mamma3 were practically absent, the nipples very rudimentary, 

 there were no axillary hairs and practically none on the mons veneris. 

 Autopsy demonstrated a striking hypoplasia of the adrenals. Similar 

 cases have been recorded by Karakascheff, Gelford and Zander. 



Amenorrhea Due to Mental and Psychic Factors. Amenorrhea is 

 occasionally the result of such psychic causes as sudden fright. It may 

 also be due to an intense longing for pregnancy (pseudocyesis), or to a 

 dread of its occurrence, as in the case of girls fearing themselves illegiti- 

 mately pregnant. Finally, it is observed in a large proportion of insane 

 women. The exceedingly prevalent form of amenorrhea observed in the 

 continental countries, especially Germany, during the great war (Kriegs- 

 amenorrhoe), was the result of under-nutrition, combined with the pro- 

 found psychic influences secondary to war conditions. It is useless to 

 speculate as to the mechanism of the amenorrhea in these cases, although 

 it would appear difficult to explain it except on endocrinologic lines. 



Amenorrhea Due to Acute and Chronic General Diseases. It is com- 

 mon to observe amenorrhea with the acute infectious diseases, and also 

 with the chronic debilitating affections. Especially striking is its fre- 

 quency as an early symptom of tuberculosis and of anemia. Here also 

 we are undoubtedly dealing with a hypogonadism secondary in some way 

 to the systemic condition. 



Amenorrhea Due to Change of Climate. This is a not infrequent and 

 exceedingly interesting cause of amenorrhea, often of many months' dura- 

 tion. It is difficult to see how a change of climate or environment could 

 produce amenorrhea except through some influence, as yet unknown, on 

 the endocrine apparatus. 



Treatment. Drug medication is rarely of value in the treatment of 

 amenorrhea, except in that type due to chlorosis and the other forms of 

 anemia. In these cases the administration of such hematinics as iron 

 and arsenic brings about an indirect emmenagogue effect, with restora- 

 tion of the function. The value of such general measures as fresh air 

 and proper food is obvious in all cases. 



The organotherapy of functional amenorrhea varies somewhat with 

 the type of the disorder. In some cases it is of course not indicated, as in 

 the amenorrhea associated with such debilitating diseases as tuberculosis, 

 diabetes, etc. The same statement applies to the forms of physiological 

 amenorrhea which were enumerated above. In the primary form of 

 amenorrhea, associated with delayed puberty, ovarian extracts are fre- 

 quently resorted to. Here the entire ovarian substance would seem to be 

 preferable to the corpus luteum extract. It is often combined with extract 

 of the pituitary, either of the entire gland or of the anterior lobe. In a 



