630 EMIL NOVAK 



striking. Thfe indication would seem to be clear for the administration 

 of ovarian extracts, those derived from the entire ovary being preferable 

 in this condition to those derived from the corpus luteum alone. 



Precocious Puberty 



Definition. Average Age. The average age of puberty in girls in the 

 United States is a little less than 14 years (13.9 years). There is, of 

 course, a wide margin of individual variation. When puberty, as mani- 

 fested by the first menstruation, occurs before the age of 9, it is spoken 

 of as precocious. In the great majority of cases, the precocious menstrua- 

 tion is associated with other manifestations of an awakening of the 

 sexual apparatus a rounding of the figure, the growth of hair on the 

 mons veneris and in the axillae, development of the breasts, etc. These 

 cases are, therefore, properly spoken of as cases of precocious puberty. 



Causes. It seems certain that hypergenitalism is the causative factor 

 in precocious puberty. It may be either primary or secondary. An ex- 

 ample of the primary, or ovarian, etiology is furnished by the case of 

 Brohl, in which premature puberty, with menstruation, was observed in a 

 girl of seven. The removal of a large cystic ovary was followed by the 

 disappearance of the menstrual function. Similar cases have been re- 

 corded by Lucas, Guthrie and Emery, Hofacker and others. More fre- 

 quent are the cases of hypergenitalism secondary to disease elsewhere in 

 the endocrine chain, especially in the suprarenal and pineal bodies. Bui- 

 loch and Sequeira have described a series of cases of suprarenal tumors, 

 chiefly hypernephromata, associated with sexual precocity. Newman, 

 in 1901, reported as many as 22 cases in which tumors of the pineal 

 gland were found with precocious maturity. In many cases of sexual 

 precocity, however, there is no indication of the existence of a tumor. 



Diagnosis. This presents no difficulty as a rule, although the recog- 

 nition of the cause may not be easy. Many cases have been reported as 

 instances of precocious menstruation which are in reality cases of the 

 simple non-menstrual hemorrhage of the new-born. The latter condition 

 is characterized by a single hemorrhage, usually slight, occurring com- 

 monly on the fifth or sixth day after delivery. Genuine precocious men- 

 struation, on the other hand, occurs usually at a later age, and is char- 

 acterized by the regular periodicity of its recurrence. 



Treatment. Although the condition is of endocrine origin, no satis- 

 factory form of organotherapy can be advised, in the present state of our 

 knowledge. It should be emphasized that sexually precocious children 

 are usually subnormal mentally, and hence they should be guarded against 

 the dangers of sexual violation. Many instances of pregnancy have been 

 reported in cases of this type. The youngest patient, so far as I have 



