632 EMIL NOVAK 



flexion, most Commonly of the cervico-corporeal variety, c. The sub- 

 pubescent type (Fig. 8), in which the hypoplasia is relatively slight. 

 Here, also, there is not infrequently an associated anteflexion. For a 

 fuller discussion of these varieties of uterine hypoplasia and of their 

 clinical significance, I would refer to a previous paper which I have 

 published on the subject. 



Cause of Uterine Hypoplasia. The pertinence of the question of 

 uterine hypoplasia to the present discussion depends on two factors: 

 First, that an extremely frequent symptom of uterine hypoplasia, though 

 not by any means a constant one, is primary or spasmodic dysmenorrhea. 

 Secondly, that the underlying cause of the various grades of uterine 

 hypoplasia is undoubtedly of endocrine nature. In searching for a cause 

 for the hypoplasia, we at once make contact with the endocrine apparatus 

 in the body. Which of the endocrine glands is responsible for the de- 

 fective development of the uterus noted in these cases ?' In the first 

 place, does the ovary exert any important influence on the development 

 of the uterus before the age of puberty, that is, during the fetal, infantile 

 and prepubescent periods of life? Certainly no such influence can be 

 assigned to the corpora lutea, for the latter do not appear before the 

 age of puberty. The possibility suggests itself that some other element 

 of the ovary may possess this function, but the evidence is not convinc- 

 ing. As already stated elsewhere, Mayer believes that the growth of the 

 uterus in very early life follows the general law of body growth and 

 that it is not especially influenced by the ovaries. 



There is much reason to believe that the earlier growth of the uterus 

 is under the influence of other endocrine glands, especially, perhaps, the 

 hypophysis. This seems especially probable in view of the undeniable 

 role played by the pituitary in the production of sexual hypoplasia. For 

 this there is abundant evidence, both experimental and clinical. It is 

 as yet impossible to offer an exact explanation of the mechanism involved 

 in these cases, but there seems to be little doubt that they are associated 

 with hypogenitalism, probably of the secondary type. 



Treatment. For the treatment of primary dysmenorrhea the reader 

 is referred to the various textbooks on gynecology. From the endocrine- 

 logical standpoint, our interest in these cases is based chiefly on the 

 possibility of relieving the dysmenorrhea by bringing about a better 

 development of the uterus. For this purpose pituitary extract, especially 

 in the form of the anterior lobe, would appear to be indicated, although 

 I am frank to say that I have not been impressed with the results of 

 this form of medication in the cases in which I have employed it. The 

 same statement applies to the results of the administration of the various 

 ovarian extracts, either alone or, as is more frequently done, in combi- 

 nation with the pituitary substance. 



