332 WM. C. QUINBY 



The partiaUpersistence of portions of one system in the presence of 

 the other produces the anomalous conditions usually seen. The varieties 

 of forms of maldevelopment which can occur are best seen in the schematic 

 illustrations of Tuffier and Lapointe. 



From the above considerations it is easily seen that there is opportunity 

 for much variety in the types of pseudohermaphrodism which can occur, 

 for the irregularity may involve the sex gland itself, or the external geni- 

 talia or the internal gentalia, and all may he accompanied by confusing 

 secondary sexual characteristics. Several writers have constructed clas- 

 sifications showing such possible combinations. That of Pick(fr) adapted 

 from Poll is the most comprehensive. This writer considers all attributes 

 of sex to be either (a) essential or germina, or (b) somatic or accidental. 

 The first are inherent in the opposed differences of the embryological cells 

 and are therefore differences due to the gamete. They determine exclu- 

 sively the sex of the individual, whether male or female. The second group 

 of attributes are numerous and are divided into (1) those characteristics 

 subsidiary to the genitalia either internal or external and (2) those not 

 so related, or extragenital. To the first group belong the genital ducts and 

 their accessory glands, together with the penis, scrotum and vulva, while to 

 the second belong the larynx, pelvis, and psychic make-up ; together with 

 the hair distribution, pigmentation of skin and, in fowls, the feathering. 



Considering hermaphrodism in general as a mixture of opposed char- 

 acteristics there are various possibilities in the above scheme. An in- 

 dividual may be mixed in the germinal attributes only or in the somatic 

 only or there may be a mixture of each. If only the somatic attributes 

 are mixed we have the commonest condition found in which an individual 

 of definite sex shows characteristics apparently of the opposite one to a 

 greater or less degree. 



Clinical Cases. From the literature Neugebauer has collected the re- 

 ports of over 2000 cases of pseudohermaphrodism showing every va- 

 riety of type. It will suffice here to report two cases observed by the writer 

 as illustrative of these anomalies. 



Case 1. Male pseudohermaphrodite showing female secondary sexual 

 characteristics. 



Rae Marion It., No. 10432, an unmarried negress seventeen years 

 of age, entered the Peter Bent Brigham Hospital on the seventh of May, 

 1919, complaining of pain in the lower abdomen and a tender mass in 

 the right groin. Both father and mother are living and well, as are also 

 two sisters and one brother. There was no history of tuberculosis or in- 

 sanity in the family. The patient's general health has always been good. 

 She was born in Virginia, but since infancy has lived in Massachusetts. 

 The only disease of childhood of which there is a history is measles. At 

 the age of six the patient was operated on for bilateral hernia. Patient 

 has been through eight grades of grammar school, following which she 



