PRECOCIOUS PUBERTY 157 



absence of further evidence. It may be suggested that Atypical 

 there is hyperplasia of the pineal. This condition would precocity 

 best account for the development of the adult secondary m girl8, 

 characteristics with inactivity of the internal genitalia 

 in the female. The absence of menstruation practically 

 excludes ovarian hyperplasia. 



Precocious puberty, however, in quite young girls Treatment of 



4. 11 T 4- A A 4-U 4- 4- 4- ' precocious 



is not usually complicated, and the treatment in a puberty in 

 majority of cases is well defined : when there is an girls * 

 ovarian tumour it should be removed. These neoplasms 

 are usually solid and often malignant; and when the 

 tumour is not benign the prognosis, so far as life is 

 concerned, is extremely grave. If no lesion be found, 

 or on bimanual examination the ovaries appear large 

 (hyperplasia), the treatment will consist in the adminis- 

 tration of some extract, such as that of the suprarenals, 

 which is antagonistic to the ovarian secretion. 



When puberty is slightly precocious — that is, occurs 

 between the ninth and tenth years of age — ovarian 

 hyperplasia or tumours are not often found. Such cases 

 may be due to inherited tendencies, or to early develop- 

 ment of the ovarian function with associated changes 

 in the other hormonopoietic organs. This in some 

 obscure manner may be caused by the climate, feeding, 

 and surroundings of the child ; or by masturbation, 

 which will be considered later. 



Absence of the Onset of Puberty. — In certain Absence of 

 pathological conditions puberty may never supervene. In puberty. 

 such circumstances the patients are the victims of some 

 severe general disorder, usually connected with the 

 cryptorrhceic system. Thus, with cretinism the patient 

 remains in a condition of sexual inactivity, and the 

 secondary sexual characteristics and functions are in 

 abeyance. 



In the case of a female cretin, who died at the un- Absence of 

 usually late age of thirty-three years, I had an oppor- cretins^ m 

 tunity of examining the genital organs, and the distant 

 hormonopoietic glands. The ovaries were large and 



