1923- -^'''- 7- A CASE OF 'VIRILISMF SL-RRFNAL". I3 



fested itself early is proved by the statement that the tirst phenomena 

 began to appear when the bird was six months old. These observations, 

 moreover, agree very well with the discoveries made in the post-mortem 

 examination, as it must be assumed that the tumour took rather a long 

 time to grow. It was presumably only just before death that metastasis 

 began to develope, as all the metastases are so small. 



Another point of resemblance to many of the cases observed in man 

 is the relation between the tumour and the aplastic ovarv. Those investi- 

 gators who have not been able to subscribe to Marchand's theorv that the 

 suprarenal hyperplasia is formed at the expense of the genital gland, will 

 perhaps find a support for their view in my case; for if it is difficult to 

 accept Marchand's hypothesis as regards man, it is even more difficult as 

 regards the hen, for birds have only one ovary, and that, moreover, is 

 situated on the left side, while the tumour in this case originated in the 

 right suprarenal gland. It should here be remarked, however, that birds 

 originally have 2 genital glands, the females also; but the right one begins 

 to dwindle after a few days, and very soon disappears. The genital glands 

 in birds, during the first few days, are exactly alike in the two sexes, and 

 the differentiation of the sexes is seen first, and best, in the condition of 

 the right genital gland, which, as early as the 5th day of incubation, is 

 outdistanced b}- the left in the hens. If, therefore, a part of the right 

 genital gland in this case has contributed to increase the volume of the 

 suprarenal gland, it must, in all probability, have taken place very early in 

 the period of incubation. On the other hand it seems to me quite im- 

 possible to suppose that the left genital gland has contributed to the 

 development of the tumour in the rigJü suprarenal capsule. 



With regard to the theory that the Danish investigator. Dr. Krabbe 

 has recentU' brought forward concerning cortical suprarenal tumours it 

 should be observed that in the article in which he sets forth his theory 

 he mentions that the testicular parts of the medullary substance of the 

 genital gland which he supposes to be split off, are "absorbed" by the 

 suprarenal capsule, "and developed into a part oi this". I cannot see that 

 either Krabbe or anjone else has brought forward any cytological support 

 for his theory; and it appears to me a priori improbable that cells from 

 the testicular medulla should be so completely "absorbed" and so closely 

 incorporated that they did not also retain a cytologicalh' divergent cha- 

 racter answering to their site of origin. I am fully aware, however, and 

 Dr. Krabbe has also referred to the fact in a letter to me, that the cortical 

 cells of the suprarenal gland present a great similarity to other cells — e. g. 

 the interstitial cells in the testicle — and it may be very difficult to 

 distinguish one from another. The same opinion is strongly emphasised 

 by the Danish physician, Dr. Johannes Ipsen, in his work "Studier over 

 ondartede Nyrtsvidstcr lios J'ok<:ne'\ to which the reader is referred. At 

 the demonstration in the Norske Medicinske Selskab, where I published the 



