THE GENERATIVE GLANDS 371 



the development of the genital glands is influenced by a large 

 number of internal secretory organs, and we have to take into 

 consideration the fact that hypergenitalism, and the pubertic 

 precocity which accompanies it, may be the secondary results only 

 of the primary affection of other organs. This applies to cases 

 in which tumours were present either in the suprarenals or at the 

 base of the brain, and especially where these affected either the 

 pituitary or the pineal glands. Hypophysal affections are 

 frequently associated with perversions of growth in the direction 

 of gigantism, though as a general rule these are accompanied by 

 genital atrophy. The cases of pineal tumour which have so far 

 been described show all the signs of pubertas prascox; namely, 

 abnormal growth in height and premature genital and sexual 

 development, with corresponding mental precocity. The presence 

 of suprarenal tumour in sexual precocity is remarkably frequent. 

 Out of seventeen cases examined post mortem and four surgical 

 cases, suprarenal tumours were found in eleven, nine being girls 

 and two boys (Bulloch and Sequiera, Linser, Adams). All these 

 cases were remarkable for the exceptional development of the 

 body, considerable obesity, and physical precocity, together with 

 the habit of sexually mature persons, more especially extreme 

 hypertrichosis ; the functions of the sexual glands and certain 

 secondary sex characteristics, such as the mammae in girls, were 

 not, however, developed in proportion. In many instances, single 

 heterosexual characters were peculiarly well developed. 



If we exclude these observations, a large number of cases 

 remain which cannot be explained otherwise than by primary 

 hypergenitalism. 



Such is the case of the boy R. K., described by W. 

 Knopf elmacher (1903 and 1906), who, at the age of 6, was 

 132 cm. in height, and weighed 38.8 kg. The testicles were the 

 size of a plum, the secondary sex characters w T ere almost fully 

 developed, the amount of hair at the pubes being especially 

 remarkable, while there was a distinct moustache, and the voice 

 was deep. Skiagrams (Schiiller) showed that the sella turcica was 

 normal in size, while the inner surface of the skull manifested no 

 signs of intercranial pressure. 



The case described by Sacchi is even more instructive. The 

 patient was a boy of 9^, who, until the age of 5^, was both 

 physically and mentally normal. At that age, his entire being 

 underwent a gradual and progressive alteration. His bones grew 

 very rapidly, and his muscles became very much developed ; the 

 voice became deep ; hair appeared at the pubes and upon the face ; 

 and his mental condition changed. At 9^ years of age he was 

 143 cm. in height, and weighed 44 kg.; he had a lone black 

 beard and long hair upon the pubes, chest and legs. The left 

 testicle, owing to tumour formation, was enormously enlarged. 

 After removal of the diseased testicle, which the microscope 



