ADRENOGENITAL SYNDROME 351 



matic approach. The average age of their patients was 20 

 years. 



The 7 cases of Kepler, et alii 655 differ considerably from those 

 encountered by Broster and Vines. These authors encoun- 

 tered a unilateral tumor in most of their cases. Removal of this 

 growth by a lumbar, extra-peritoneal approach gave remark- 

 ably good results in some of their patients. In figure 17 is 

 reproduced a photograph of one of the patients of Walters 

 and his co-workers 655 showing the curative effects of removal 

 of the affected adrenal. 



THE ADRENALS AND HERMAPHRODITISM 



Gallais 210 in his monograph collected 11 cases of hermaphro- 

 ditism in which marked anomalies of the adrenals were present. 

 In these cases the secondary sexual characters were masculine, 

 the anomalous development having occurred during embryonic 

 development. The adrenals were hyperplastic and there were 

 supplementary aberrant cortical tissues or tumors of cortical 

 origin. Gallais considered the hermaphroditism to be of 

 adrenal origin. However, there is considerable question as to 

 the role of the adrenals in these cases. Further work is neces- 

 sary to decide if the adrenal hyperplasia (probably of the andro- 

 genic tissue) is the cause of the sexual anomalies or whether 

 the changes in the two organs are part of the same underlying 

 cause and due to a more fundamental anomaly of the germ 

 plasm. 



In embryonic life, the internal genital organs are hermaphro- 

 ditic containing both masculine and feminine generative 

 potentialities. This embryonic bisexuality is manifested in 

 the coexistence of the Miillerian and Wolffian ducts. Later in 

 embryonic development, in the female, the Miillerian ducts 

 persist while the Wolffian are partially resorbed. Their per- 

 sistence results in a partial (tubular) hermaphroditism. The 

 external genital organs are in reality only degrees of the same 

 ascending evolution, each organ of one sex having its counter- 



