418 THE DISEASES OF THE SEXUAL GLANDS 



Symptomatology. Late eunuchoidism is found almost exclusively in 

 men. There have been individual cases reported in women but these are 

 not pure cases. As we shall see later they belong to the group of multiple 

 ductless glandular sclerosis. The cause of the disease in man is either violent 

 trauma effecting the testicles or their vicinity, or, as in my case, probably, a 

 damage to both spermatic cords through shrinking of scar tissue; or a bi- 

 lateral high-grade orchitis on a syphilitic or gonorrheal basis, or mumps 

 orchitis; or it may be due to severe infectious disease typhoid for example 

 or to an infectious process of an unknown nature, affecting the entire organ- 

 ism and probably also the testicles. At the close of these deleterious influ- 

 ences, or also in certain cases quite spontaneously, without distinct recog- 

 nizable cause, in individuals who previously had been entirely normally 

 developed, in whom especially the secondary sexual characters were com- 

 pletely developed and in whom the genital function has been entirely nor- 

 mal there develops quite gradually an atrophy of the entire genital appa- 

 ratus and at the same time a retrogression of the secondary sexual characters. 



Finally there seem to be cases in which there exists from youth a certain 

 lessened valuation of the rudiments of the sexual glands and soon an exhaus- 

 tion (case of Josef son and Lundquist) . 



The ages of the affected individuals are very different. In the case de- 

 tailed the beginning of the disease fell between the eighteenth and fifty- 

 third years of life. 



The alterations in the genitals must be regarded as manifestations of 

 retrogression and not, as Claude and Gougerot believe, as mere atrophy. In 

 this view I am entirely in accord with Gandy. The retrogression of the testi- 

 cles may be astounding. The testicles are estimated as at the size of hazel- 

 nuts, cherries, beans, and peas. The diminution of volume is naturally less 

 where connective tissue has formed at the site of an infectious process; and 

 here too there is not such a diminution in consistence; in most cases has been 

 emphasized an especial softness. The scrotum can be as small as that of an 

 eight- to ten-year-old boy; and it loses its tension and its pigments. Also the 

 penis can reduce in size to such an extent that it looks like that of an eight- 

 to ten-year-old boy. The picture is therefore entirely similar to that of early 

 eunuchoidism. Also the prostate takes part in the atrophy. 



We have already described the manifestations that occur after castration 

 in the matured woman. Retrogression of the genitalia occurs, mostly an 

 increased fat-deposit and loss of pigment, but not a falling out of the pubic 

 and axillary hair. We shall consider later under ductless glandular sclerosis 

 those cases in which retrogression in the hairiness occurs simultaneously 

 with spontaneous atrophy of the ovaries. 



In late eunuchoidism the function of the genitals suffers severe damage. 

 In man complete impotence with entire incapability of cohabitation can 

 occur under circumstances. Libido is here entirely lost; but in other cases 



