1923. 



Xo. ~. A CASE OF "VIRII.ISME SLRRKNAl/ 



affections have been defined, of which the cause must be assumed to be an 

 increased activity of the suprarenal gland. Their obsenations were of a girl of 

 II, who had been healthy until the age of 10, when she began to develope 

 phvsically in a very peculiar manner, both as regards stature and appear- 

 ance. She grew exceedingly fat, her mammæ became large and pendulous, 

 a thick growth of hair appeared, not only on the mons, but also in the 

 axillae and on the face, and menstruation commenced. When she died she 

 had the appearance of a full-grown woman. At the post-mortem examination 

 a large tumour was found upon the suprarenal gland; and as the writers 

 considered that this must be connected with the clinical phenomena, they 

 went through the previous literature on the subject, where they found 

 several cases resembling theirs, and were enabled to establish the fact that 

 in every instance there had been a suprarenal tumour issuing from the 

 cortex, sarcomata in the suprarenal gland never having caused such phe- 

 nomena. In English medical literature important contributions to our 

 knowledge of these matters have since been made by Guthrie and Emery ^ 

 and Glynx. 



In France, in the "Soc. de Pédiatrie de Paris", Dr. Apert reviewed, 

 in 19 10, a number of cases, collected from the literature, in which the 

 phenomena could similarh- only be explained by an increased suprarenal 

 function — hvperepinephry. His view was in agreement wixh a demon- 

 stration that GuiNOx and Bijox had given in that society in 1906. They 

 had shown a girl of 11, who had been well up to the age of 9, when 

 she also developed excessive obesity and growth of hair both on the 

 gentialia and on the face, while, in addition, the clitoris increased in size 

 until it so greatly resembled a penis that it seemed doubtful whether this 

 were not an error of sex. There is no account of an autops\- in this 

 instance-, but Dr. Apert has collected a large number of cases from the 

 literature, in which a post-mortem examination was made, and where either 

 the suprarenal glands had been found to be enlarged, or there was a 

 suprarenal tumour. Apert's work has been continued b\' his countryman, 

 Gallais, whose great work, "Le Syndrome Génitosurrénal", appeared in 

 19 1 4. The work contains three cases of personal obser\ation (one v\-ith 

 post-mortem examination, the other two without), with which is associated 

 a complete collection of publications from the world-hterature ^. While 

 collecting all the cases in which abnormalities of the suprarenal gland and 



Guthrie and Emery's work contains accounts of a number of obser\-ations of clinical pheno- 

 mena classed under the heads of precocious obesity, gigantic stature, hirsutism, etc., 

 and stating whether these phenomena were found in persons with a suprarenal tumour, 

 or where there was no such tumour. • 



On p. 238 Gallais states that the patient died, but no mention is made of autopsy. 

 Glynn has criticised Gallais' cases Xos. XXVII and XXVIII in his paper in the "Jour- 

 nal of Obstetrics and Gynæcologj- of the British Empire", 1921, declaring that they 

 are one and the same case. 



