HYPERGENITALISM 425 



I quote the following examples. The case of Bernhardt-Ziehen was that of a three- 

 year-old boy in whom an enormous growth had set in at the eighteenth month. At two 

 years the pubic, axillary, and beard hairs were present. At two and one-half years the legs 

 had hair on them; he was 103 cm. tall, the circumference of the skull was 53 cm., the body 

 weight 49.5 kg. He looked like a seven- or eight-year-old boy. He was again examined at 

 the age of eight years. He was then 138 cm. tall (116 cm. is the height for this age). The 

 circumference of the skull was 56.5 cm. The sexual parts were developed like those of a 

 grown man. He looked as if he were twenty-five to thirty years old. His intelligence was 

 fairly well developed, he was lively, showed inclination for the female sex, but otherwise his 

 demeanor was childish. As another example I cite the case of Hudovernig and Popovicz. 

 In a later investigation of Hudovernig the boy was five and one-half years old; at one and 

 one-half years he sustained a febrile disease (meningitis). The abnormal growth had 

 existed since that time. He was 137 cm. tall and weighed 35.5 kg., this corresponding to 

 the age of fifteen or sixteen years. The penis is 9 cm. long, the testicles very well de- 

 veloped. The psyche is infantile. The intelligence is rather behindhand. Skull and 

 face were rather asymmetrical. The X-ray examination showed that the ossification was 

 as well advanced as that of a fifteen- or sixteen-year-old boy. Also the skull bones were 

 well developed, and the sella turcica seems to have been enlarged, although the observation 

 is not convincing. The boy was first treated with thyroidin tablets or with thyroidin 

 tablets plus potassium iodide. This did not affect the excessive growth. Later ovarian 

 tablets were administered. This time the growth was somewhat less (only 3.1 cm. in nine 

 months as compared with 5 cm. in the six months of the first period and 5 cm. in the ten 

 months of the second period). In the third period the boy seemed to have become psy- 

 chically more quiet. Hudovernig assumes that the ovarian tablets have retarded the 

 excessive growth. I doubt this. If we calculate the growth per month we obtain for the 

 first period 0.95 cm., for the second, 0.5 cm. and for the third, 0.3 cm. There is hence 

 found a gradual decrease of the excessive growth, which surely, as we shall see later, 

 is to be referred to the gradual closing of the epiphyses. Finally I would mention the 

 case of Stone, which is especially interesting from the fact that also the father of the boy 

 showed a premature development. 



These cases all have in common the premature and excessive development 

 of the genitalia and of the secondary sexual characters, premature change of 

 voice, and the excessive body development. Already in the first year 

 there occur erections, ejaculation Pellizzi demonstrated spermatozoa in his 

 cases and eventually premature sexual instinct. The development of the 

 internal genitalia often hurries the development of the whole body. As far 

 as the latter is concerned, the osseous system and the musculature are mostly 

 affected in like manner. There therefore occurs a transitory gigantism; 

 as, however, the epiphysial closure is rather hastened, the body growth finally 

 attained is not abnormal, but mostly rather small. The psychic and intel- 

 lectual development of such individuals do not keep pace with the body 

 development; they for the most part show a childish demeanor, corresponding 

 with their age, which demeanor has a characteristic stamp only through the 

 premature sexual life. The assumption of such cases as primary hyper- 

 genitalism is often uncertain without autopsy findings, although such a pri- 

 mary hypergenitalism may be made secure by operation in certain cases. 

 I mention especially the case of Sacchi. It was that of a nine-year-old boy 



