336 



WM. C. QULNBY 



show regressive* changes, especially those of keratinization and hyalini- 

 zation. 



The organ is irregularly -divided into lobules by thick bands of fibrous 

 tissue. Surrounding the tubular portion is a thick layer of fibrous tissue 

 upon which is superimposed in places tuberculous granulation tissue. 



Diagnosis : Rudimentary orchid, with atypical spermatogenesis and 

 tuberculous periorchitis. 



It is evident from the histological picture of the gonad that we are 

 here dealing with a case of male pseudohermaphrodism showing secondary 



sexual characteristics of the fe- 

 male together with female ex- 

 ternal genitalia. The possibility 

 that such conditions of hermaph- 

 rodism may have a familial 

 aspect is suggested in the perma- 

 nent amenorrhea of this patient's 

 aunt. A few other instances 

 occur in the literature illustrative 

 of this occasional tendency. 



A second case of the opposite 

 type is well illustrated by the fol- 

 lowing which has already been 

 reported by me in 1916. 



Case 2. Female pseudoher- 

 maphrodite showing male secon- 

 dary sexual characteristics. 



Robert S. was admitted to 

 the Brady Clinic of the Johns 

 Hopkins Hospital on June 8, 

 1915, for hypospadias and unde- 

 scended testicles. He was ten 

 years old in July, 1915. 



The family history relates that one brother died at birth, and one at 

 seven months of age. One younger sister is living and is normal. Both 

 parents are well ; they are first cousins. The father has a slight hypo- 

 spadias with the meatus about half an inch below the apex of the glans. 

 Until two years of age the patient suffered from "marasmus," but 

 otherwise has been entirely well and strong, and has had none of the exan- 

 themata. His mentality is considered good, and he is now in the third 

 grade, although attendance at school began only two years ago. His habits 

 and activities are those of a normal boy: he spurns girlish pursuits, and 

 much prefers such games as football. The pubic and axillary hair has 

 been present for four years. The voice has always been "course" and 

 the hands and feet "stubby." Since birth the urethra has opened at the 



Fig. 11. Ilistological picture of the gonad 

 in Case 1. showing type of testicle character- 

 istically found in crypt-orchids. 



