I o o. BERNER. M.-N. Kl. 



the sexual organs occurred, Gallais was struck, as Apert had been, with 

 the frequent coincidence of large suprarenal glands with the malformation 

 called "feminine pseudo-hermaphroditism". This is not intended to imply that 

 Apert and Gallais were the first investigators to have observed this con- 

 currence, for eminent pathological anatomists such as Marchand and Fibiger 

 had minutely described it before, but have either not co-related the facts 

 with each other, or have been perplexed as to the manner in which they 

 were to be explained. It is thus quite characteristic that in 1905 Fibiger 

 should say: "The cause of the enlargement of the suprarenal glands seems 

 at present to be a complete mystery"; for he does not agree with the 

 assumption to which Marchand, and subsequently Apert too, had recourse, 

 namely, that the excessive size ol the suprarenal glands in these pseudo- 

 hermaphrodites is due to an addition received, through a disturbance in 

 the development that has taken place, from the genital gland (or glands), 

 which, at the time when these organs are in their embryonic condition, 

 lie close to the suprarenal glands. Marchand considers that by the trans- 

 ference of some of the tissue to the suprarenal glands the latter become 

 large, while simultaneously the genital gland (or glands) whence the tissue 

 is taken must become smaller. Professor Fibiger does not, however, accept 

 this explanation, because in one of the 3 cases he describes, the generative 

 organs were quite normal, or perhaps one might even be justified in sav- 

 ing that the ovaries in this little child were larger than they should 

 have been. 



Nor can Gallais accept Marchand's theory regarding the unequal 

 division of material between the suprarenal gland and the genital gland in 

 pseudo-hermaphroditism. He holds that if the cause is of a terato! ogical 

 nature, the ovary on the same side should be found to be aplastic while 

 the other was normal, assuming that the case under consideration was one 

 in which the suprarenal abnormality is on one side onlv; but such an 

 assumption is impossible when, as often happens, it is a case of a small 

 ovary on each side and only one suprarenal gland being hyperplastic. 

 Gallais goes on to say that if the suprarenal disturbance were to be re- 

 garded as a compensation caused by the small genital glands, then supra- 

 renal hypertroph}^ should also be found in persons with masculine pseudo- 

 hermaphroditism and in persons with cryptorchism or sclerosis of the testes; 

 but he adds: "I'l n'en est rien cependant, et cette hypertrophie de com- 

 pensation, si tant qu'elle existe, est au contraire, chez ces sujets, très 

 rare". 



It seems, therefore, reasonable to take Professor Fibiger's view when 

 he says: "At present it is impossible to explain how suprarenal hyper- 

 plasia and the pseudo-hermaphroditic malformation are connected"'. 



' Guthrie and Emerj^'s paper gives a very curious account of H. B. Robinson's observa- 

 tion of feminine pseudohermaphroditism in 2 sisters, one aged 2 years, the other 14 

 days. Thev were brought to him to decide whether thev were male or female. He 



