DELAYED PUBERTY 163 



spared for the reproductive functions ; there may be Physical 

 constipation and chlorosis ; or, again, hard muscular delayed 1 

 exercise or a sedentary life may each prevent the develop- pubeity. 

 ment of the sexual functions — the former by using up 

 the reserve metabolic forces, and the latter by failing to 

 stimulate metabolic energy. With regard to muscular 

 exercise, evidence has been produced to show that in 

 gymnasts puberty may be delayed or incomplete ; but, 

 on the other hand, Angenette Parry 1 , in an enquiry 

 among members of this class of woman, found that they 

 were nearly all normal with respect to their genital 

 functions. The truth probably lies halfway between 

 these extreme statements, as was pointed out in the 

 discussion following the paper just referred to : moderate 

 exercise is beneficial, and excessive harmful. 



In races in which the women always perform muscular 

 work, agricultural and domestic, heredity appears to 

 play an important part ; and by a process of selection 

 women are produced whose functions remain undis- 

 turbed. The same argument may apply to healthy 

 gymnasts, many of whom have a long line of gymnastic 

 ancestresses. But if we were to take a girl of ten years 

 of age from the upper classes and put her to work con- 

 tinuously in a factory or even in fresh air in the fields, 

 or bring her up as a professional gymnast, it is probable 

 that the onset of puberty in her case would be delayed, if 

 not prevented. 



In the lower classes the effect of hard work, a 

 sedentary life, or bad feeding on the onset of puberty 

 is in part mitigated by heredity, by the close association 

 with the opposite sex, and by the free discussion of 

 sexual matters common among girls in this station of 

 life ; but, in spite of all, the fact remains that girls of 

 the upper classes who are well tended commence menstru- 

 ating at an earlier age than their poorer sisters 2 . 



Incompletely delayed Puberty. — By this term I wish incompletely 

 to imply a temporary state of incomplete puberty. In puberty. 



1 Pcarry, Angenette, Amer, Journ. ObsteL, 1912, vol. lxvi, p. 341. 



2 Engelmann, G, J., Amer. Journ. ObsteL, 1900, vol. xlii, p. 753. 



