364 INTERNAL SECRETION 



partly to the indefinite localization of hermaphroditic glands, and 

 partly to the undefined nature of their histological characteristics, 

 such observation is very difficult to carry out. If definite proof 

 of glandular hermaphroditism were forthcoming, it would be easy 

 to account for the presence of heterologous sex characteristics. 

 The assumption would necessarily be that male and female forma- 

 tive influences are mutually exclusive, and that the sex charac- 

 teristics of the body are in accordance with the nature of the 

 genital gland which is best developed and functionally most active. 

 But the important point in this connection would be, not the 

 conditions governing the functions of external secretion (sperma- 

 togenesis, ovulation), but the degree of development and func- 

 tional activity of that tissue of the genital gland by which the 

 internal secretion is elaborated. 



It is only by the assumption of a hermaphroditic primitive 

 genital trace, together with the dependence of the somatic and 

 psychic sex characteristics upon the internal secretory activity of 

 the genital glands, that we can explain those cases in which com- 

 plete alteration of single sex characteristics, or even of the entire 

 sexual character, takes place during the life of the individual. 

 These cases appear to be by no means exceptional, though they 

 have not received the attention which they deserve. 



A case of Friedrich-Grawitz's, recently described by Alberti, 

 is very interesting in this connection. The subject w r as a girl 

 of 20, with clearly defined female habit, well-developed mammary 

 glands, and regular menstruation, who gradually reverted to the 

 masculine type, with cessation of the menses. The adipose tissue 

 diminished and the body became covered with hairs; the breasts, 

 which \vere previously very well developed, became soft ; the 

 hair of the head became short and thin ; the voice deepened ; 

 and thick, dark whiskers and moustache made their appearance. 

 Three years later she was operated upon for ovarian tumour ; and 

 she eventually died of peritonitis, the outcome of twisting of the 

 pedicle by rotation of a multilocular cystoma. 



A large number of analogous cases have been described, in 

 which the female stigmata have, after puberty or even late in 

 life, reverted to the male type, and vice versa (Zambini, Freund, 

 Hegar, Wilson, Parhon and Goldstein, Hammond, Djemil- 

 Pascha). In some instances, there was more or less complete 

 disappearance of certain well-marked stigmata of the one sex, 

 their place being taken by corresponding characteristics of the 

 other. As a general rule, however, the alteration in the sex 

 characters followed pathological processes, of traumatic or idio- 

 pathic origin, in the genital glands. 



Important evidence in favour of the hermaphroditic nature 

 of the primitive genital trace and of the dependence of the 

 characteristics of sex upon the internal secretion of the pre- 

 ponderating specific genital tissue, is provided by those not very 



