INTERSEXUALITY 375 



interstitial tissue large eosinophile cells, resembling exactly 

 the interstitial cells of the testicle, were present.^ 



This case of Blair Bell is of a particular interest. Here, a 

 marked change of sex characters took place, and the developed 

 male sex characters disappeared after removal of the sex 

 glands. Was the intersexual state of the genital gland the 

 real cause of the intersexuality of the characters as observed 

 in this case ? As no signs of any abnormality in the adrenals 

 could be detected, it seems justifiable to give a positive answer 

 to this question. The case seems wholly to correspond to the 

 experimental hermaphrodites of Steinach and Sand, the male 

 sex characters being indeed more marked. The objection 

 might be made that this case was really one of intersexuahty 

 or masculinization caused by an hypernephroma, since absence 

 of any abnormalities in the adrenals does not exclude the 

 possibihty of an hypertrophy of these organs. I do not think, 

 however, that the intersexuality of the sex characters was 

 due to the adrenals; were it so, the patient could not have 

 wholly recovered after castration, as she seems to have done, 

 according to Blair Bell. But even if we adopt the view that 

 in this case masculinization was due to an intensified function 

 of the adrenals, it follows, from what Blair Bell observed after 

 the operation, that the masculinizing effect of the adrenals is 

 possible only when a sex gland is present, and further, that the 

 masculinizing influence of the adrenals on the sex characters 

 w^as due primarily to the masculinizing of the sex gland itself. 



Cases of a gonadal intersexuality in man have been studied 

 chnically or pathologically by Salen and Pick (see Pick, 1916) 

 as well as by other observers, and lately by Sand (1922 b). 



After seeing from the clinical cases related above that inter- 

 sexuality in man may be caused by hormonic disturbances, 

 the question arises as to how far an hormonic basis can be 

 adopted for the great number of cases of intersexuality known 

 to the cHnician or to the pathologist. The question has been 

 carefully examined in recent years by several authorities 

 since the experiments of Steinach and Sand showed that 

 intersexuality in mammals can be caused experimentally by 

 combining ovarian and testicular implantation in the same 

 individual. We shall now discuss some of the cases described 



^ As to the ovarian tumours of a seminiferous type the papers of Peyron 

 (1922) may be referred to. 



