DELAYED PUBERTY 161 



many cases ; but first of all it will be necessary to define 

 what we mean by ' delayed puberty '. 



Strictly speaking ' delayed puberty ' should refer to Definition 

 the temporary non-appearance of all the phenomena of puberty. 

 puberty in a girl who is past the period of life at which 

 they appear normally (complete delay). But that is not 

 what is always implied by the term : it is often employed 

 to denote the temporary absence of menstruation in a 

 girl who is otherwise fairly well developed, both in 

 regard to the uterus and the secondary characteristics 

 (incomplete delay) ; hence there is considerable con- 

 fusion as to the pathological conditions which may be 

 responsible for the delay. It will, therefore, make 

 the discussion of the subject clearer if we consider the 

 subject under the two headings indicated. 



Completely delayed Puberty. — By ' completely delayed Completely 

 puberty ' is implied that not only menstruation is puberty. 

 delayed, but also the development of the adult secondary 

 characteristics. This condition may be distinguished 

 from general persistent infantilism by the fact that there 

 is merely delay in and not suppression of further 

 development. 



To understand best this retardation in reaching 

 puberty we have only to look at the girls who come under 

 our notice every day, and observe how differently they 

 develop under different conditions. The influences at 

 work may be divided into two classes — psychical and 

 physical. 



With regard to psychical conditions, there is no Psychical 

 doubt that the mental character of the individual is de?ayed° 

 altered at puberty by the physical changes which occur in P^ berfc y- 

 the body at that time : the secretions from the hormono- 

 poietic glands play the chief part in effecting this result. 

 On the other hand, it is certain that the mind itself 

 can hasten or unconsciously delay the onset of sexual 

 activity 1 . In this connexion it must be clearly under- 

 stood that the mind can certainly influence function, 

 and vice versa, however impossible it may be for the 



1 Engelmaim, G. J., Amer. Journ. Obstet., 1900, vol. xlii, p. 753. 



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