Case recorded by Diamant: A girl aged 6 years, weight 75 pounds, thighs, buttocks, and breasts developed like those of a sexually mature woman, axillæ and mons Veneris covered with hair. Menstruation began at the age of 2 and recurred regularly, the flow lasting 4 days.

Case recorded by Plyette: A girl with precocious physical development began to menstruate in the fourth year of life; menstruation continued regularly with the exception of two monthly periods, when vicarious epistaxis occurred.

From the collection made by Gebhard of the records of fifty-four cases of precocious menstruation, giving the first appearance and the type of menstruation, the development of the breasts, the other signs of premature sexual development, and any complications that may have been observed, we extract the age at which the first menstruation occurred. This was:

In a new-borninfant in1 case.
At the age of2 weeks in1 case.
At the age of2 months in1 case.
At the age of3 months in1 case.
At the age of4 months in1 case.
At the age of5 months in1 case.
At the age of7 months in1 case.
At the age of9 months in4 cases.
At the age of10 months in2 cases.
At the age of12 months in5 cases.
At the age of15 months in1 case.
At the age of16 months in1 case.
At the age of18 months in2 cases.
At the age of19 months in1 case.
At the age of22 months in1 case.
At the age of2 years in4 cases.
At the age of2½ years in1 case.
At the age of2 years and 9 months in1 case.
At the age of3 years in6 cases.
At the age of3½ years in1 case.
At the age of4 years in4 cases.
At the age of4 years and 3 months in1 case.
At the age of5 years in1 case.
At the age of5½ years in1 case.
At the age of6 years in1 case.
At the age of6½ years in1 case.
At the age of7 years in3 cases.
At the age of9 years in2 cases.
At the age of11½ years in1 case.

From this collection of Gebhard’s we learn that in one case menstruation already existed at birth, and that in a large number of cases it occurred before the expiration of the first year. In many cases the development of the breasts preceded the appearance of menstruation, and was noticed from the time of birth. The vulva also early exhibited the characteristics seen in the sexually mature woman. Further, a high body-weight, great development of fat, and early dentition, were usually seen in these cases, in which, however, the intellectual development was not in correspondence with that of the body.

In several of these cases of premature puberty, moreover, sexual intercourse and even parturition occurred at a very early age. A girl in whom menstruation began at the age of one year, gave birth to a child when she was ten years old (Montgomery). A girl who began to menstruate at the age of nine years, became pregnant very shortly afterward (d’Outreport). The well-known case recorded by Haller, in which at birth the pubic hair was already grown, and in which menstruation began at the age of two years, was also one of very early pregnancy, the girl giving birth to a child when nine years old. Another girl in whom at birth the pubes were already covered with hair began to menstruate when four years old, copulated regularly from the age of eight, and at nine years became pregnant, and was delivered of a vesicular mole with an embryo (Molitor). A girl began to menstruate at the age of two, had a growth of hair on the pubes and developed mammæ at the age of three, and became pregnant at the age of eight (Carus). With these cases must be classed that observed by Martin in America of a woman who was a grandmother at the age of twenty-six. Lantier, in his Travels in Greece, speaks of a mother of twenty-five with a daughter of thirteen.

Observations made by Kussmaul and by Hofmeier prove that in many cases changes in the ovaries form the probable cause of precocious menstruation and the other phenomena of premature puberty. In one case of Hofmeier’s, for instance, of a girl of five with precocious menstruation, the removal of a rapidly growing ovarian tumor was followed by the cessation of menstruation, and the pubic hair, which had been shaved off, did not grow again.

Abnormally early puberty related to the early practice of sexual intercourse is seen in many prostitutes. This is shown by the following figures relating to 150 prostitutes in Russia. Sexual intercourse began:

In1 prostitute at the age of9 years.
In1 prostitute at the age of10 years.
In4 prostitutes at the age of12 years.
In12 prostitutes at the age of13 years.
In14 prostitutes at the age of14 years.
In33 prostitutes at the age of15 years.
In36 prostitutes at the age of16 years.

Thus, among the 150 prostitutes, 65 were less than 16 years of age.