352 CLINICAL CONSIDERATIONS 



part in the other, e.g., the penis and clitoris, or the prostate 

 and para-urethral glands of Skene. 



Hermaphroditism may involve a true co-existence of male 

 and female generative organs in the same individual. A lesser 

 degree of hermaphroditism exists in cases in which the sec- 

 ondary characteristics of one sex are present in individuals with 

 the anatomical generative organs of the opposite sex. These 

 secondary characteristics in man are hypertrichiasis, muscular 

 development, low pitch of the voice, and virility of character; 

 in the female, they are menstruation, soft voice, adiposity, 

 gynecomasty, and a feminine psychological outlook. 



The cases reviewed by Gallais 210 showed for the most part 

 secondary male characteristics with female generative organs. 

 One might consider the male characteristics as results of the 

 accompanying hyperplasia of the androgenic zone of the 

 adrenals. Whether this hyperplasia is primary or merely a 

 compensatory mechanism due to deficiency in the female 

 characters is still open to question. The most logical inter- 

 pretation of the observed facts would be that the adrenals are 

 not in themselves responsible for the development of herma- 

 phroditism. If by some anomalous development hermaphro- 

 ditism of the female type occurs, there is a tendency for the 

 androgenic zone to become overactive and thus accentuate the 

 secondary male characters present in these primary female 

 hermaphrodites. In accord with this view we find that bi- 

 lateral hyperplasia of the adrenal gland is found in about 15 

 per cent of female but in only 0.7 per cent of male pseudo- 

 hermaphrodites. 227 The so-called adrenal cortical rests so 

 commonly found in female pseudo-hermaphrodites 195 are com- 

 posed of androgenic tissue and not true cortical tissue as has 

 previously been believed. They have often been mistaken 

 for a displaced testicle or ovary. 



According to the theory outlined in the preceding paragraph, 

 the adrenal hyperplasia observed in hermaphroditism may be 

 looked upon as a process analogous to the enlargement of the 



