156 



THE SEX-COMPLEX 



Ovarian 

 tumours a 

 cause of 

 sexual 

 precocity 

 in girls. 



Atypical 

 sexual 

 precocity 

 in girls. 



cause precocious development. Indeed, as I have 

 pointed out elsewhere 1 , and have emphasized here, the 

 whole hormonopoietic system is concerned in the develop- 

 ment of the genital organs and their functions, and the 

 determination of sex -characteristics ; so unless there are 

 associated changes in the other organs of internal 

 secretion as well as in the ovaries, sexual precocity will 

 probably not occur. And in this connexion it may be 

 suggested that insufficiency of the suprarenal internal 

 secretion, which normally is antagonistic to the ovarian, 

 may lead to hyperplasia in the genital glands, and so to 

 precocious puberty. 



Apart, however, from those cases of precocious 

 puberty which are produced by definite lesions in the 

 ovaries, and which include almost all the examples of 

 this condition, and apart from those cases which are not 

 really instances of feminine precocity, but rather of 

 precocious masculinity in the female with absence of 

 menstruation and ill-development of breasts quite 

 apart from these abnormalities are certain anomalous 

 cases of incomplete feminine precocity of doubtful origin. 

 I have seen a case of this kind which was under the care 

 of the late Dr. Percy Marsh, to whose courtesy in inviting 

 me to examine the patient I was indebted, in which all 

 the external secondary feminine characteristics were well 

 developed in a child, eight years of age, whose mentality 

 was much below that of a child of her own age, while 

 her physical development resembled that of an adult (figs. 

 49 and 50). Menstruation, however, had never appeared. 

 In this case no enlargement of the ovaries could be made 

 out, and the uterus was found to be infantile on examina- 

 tion with the child under anaesthesia. The pituitary 

 fossa on skiagraph examination was found to be of 

 normal size, and the thyroid was well developed. The 

 diagnosis of the lesion responsible for the precocious 

 development in this case is extremely difficult in the 



1 Bell, W. Blair, Proc. Roy. Soc. Med. (Obstet. and Gyncecol Sect.), 

 1913, vol. vii, p. 47 ; Arris and Gale Lectures, Lancet, 1913, vol. i, pp. 

 809, 937. 



