INTERSEXUALITY 373 



individual was caused by an hypernephroma. Matthias 

 paper (1921, 1922) may be referred to here. 



The second case I will mention is that of Blair Bell (1920). 

 The patient was seen the first time at an age of seventeen. 

 Menstruation commenced during the fourteenth year and had 

 stopped eighteen months before examination. The voice had 

 got deeper. Nothing abnormal was felt in the abdomen or 

 per rectum. When the patient presented herself about two 

 years later it was at once noticed that she had become more 

 masculine in appearance ; she had a slight moustache, and the 

 distribution of hair on the trunk and legs was mascuhne. 

 The chtoris was much enlarged (two inches in length) and there 

 was a well marked prepuce; per vaginam the left genital 

 gland could be felt somewhat enlarged; no tumour was dis- 

 covered in the suprarenal region; there was still complete 

 amenorrhoea. Pieces of both genital glands were taken for 

 histological examination, and it was stated that the right 

 genital gland contained a large corpus luteum and an almost 

 mature Graafian folHcle; the left ovary was thought to contain 

 a carcinoma. After this pathological diagnosis both ovaries 

 and the uterus were removed. After the operation the patient 

 underwent very marked changes. When examined eight 

 months subsequently all the hair of the legs and of the upper 

 lip was found to have disappeared. "The voice was shghtly 

 higher in tone, and the figure and skin were greatly altered 

 towards the feminine type. The breasts, however, showed 

 very little development, but this was not to be expected in 

 the absence of ovaries." The patient suffered from sUght 

 menopausal sjmiptoms, but somatically reverted, as seen 

 from the description, entirely to the feminine or neutral type. 

 When Blair Bell examined the sections of the left genital gland 

 himself, he came to the conclusion that the first histological 

 diagnosis of the pathologist was erroneous; the left genital 

 gland was an ovariotestis and not the seat of a carcinoma. The 

 organ (Fig. 129) consisted of a thin capsule of normal ovarian 

 tissue (Graafian folhcles, primordial ova and stroma) surround- 

 ing a central portion which was most Hkely an underdeveloped 

 testis. This portion contained tubules and an interstitial 

 tissue between them. The tubules were mostly fined with 

 several layers of epithelial cells, among which'[cells with big 

 nuclei, possibly spermatogonia, were to be seen. In the 



