EUNUCHOIDISM AND SEXUAL PRECOCITY 437 



that the teratoma developing in the pineal gland is the factor 

 causing sexual precocity. Both these theories seem to be 

 insufficient. That of Marburg does not conform with the fact 

 that sexual precocity as connected with pineal tumours has 

 been observed only in boys, never in girls. On the other hand, 

 the fact that sexual precocity is absent when normal pineal 

 tissue is present besides the tumour seems to support Marburg's 

 theory. The theory of Askanazy is opposed by the fact that 

 sexual precocity has been observed in boys also where the 

 pineal tumour was a sarcoma. But Askanazy's assumption 

 that the tumour of the pineal is the active factor in sexual 

 precocity contains, I think, some truth. One might suppose 

 that the pineal tumour represents, like the hypernephroma, a 

 masculinizing factor. Two observations came to my notice 

 which might give support to such a suggestion. The first is the 

 case described by Boehm (1919) of a boy of 9 with very pro- 

 nounced signs of sexual precocity (external genitalia, pubic 

 hair, male voice). On account of the latter it was assumed 

 intra vitani to be a case of a pineal tumour. Necroscopia 

 showed that the diagnosis was a right one. It was a teratoma 

 containing as usual different kinds of tissues. Besides, there 

 were also big cells of an epithelioid character with much proto- 

 plasm and a spherical vesicular nucleus. The author insists 

 that these cells had a striking resemblance to the interstitial 

 cells of the testicle. According to him there must be some 

 interrelation between the pineal and the male sex gland. The 

 second observation I should like to mention here is that of 

 Baar (1920), who described a girl of 5 with pubic hair and an 

 enlarged clitoris and of a height of 121 cm. There was no 

 menstruation. The symptoms remind one very much of those 

 generally described in cases of adrenal tumours. But Baar 

 insists on the ataxia of the under extremities, which was 

 recorded in this case. There were also temporarily intensified 

 reflexes and a patellar c/ow^^s. Baar is of the opinion that the 

 described symptoms must have been caused by a pineal 

 tumour. If this really was so, one might suppose that the 

 described symptoms, which are identical with those in girls with 

 adrenal tumours, were caused by a masculinizing factor 

 abnormally present in the pineal. But it must be said that 

 Baar's diagnosis is insufficiently proved. 

 We see that our knowledge of the factors conditioning sexual 



