PSEUDOHERMAPHRODISM 



tient is of the female sex; and this in spite of so many secondary char- 

 acteristics of the opposite, male, sex. 



In the sphere of the internal genitalia the development has followed a 

 normal course ; uterus and ovaries are present, and are normal so far as 

 examined. The external genitalia, however, show many deviations from 

 the normal female type. The urethra opens in its usual position, but the 

 clitoris is much overdeveloped, closely resembling a penis of the hypospadic 

 sort, .and there is no external trace of vagina. It is to be presumed, on 

 morphological grounds, that a rudimentary vagina exists, but attempts 

 to examine the posterior urethra with an endoscope were without con- 

 clusive result because of the small size of the structures, 



The patient, therefore, belongs to the class of female pseudohermaph- 

 rodites of the external type. But though the external genitalia are 

 atypical, it is in the domain of the secondary sex characteristics that the 

 most marked deviations are found. The voice, the hair on the face, the 

 general bodily habitus, and the mental processes are all of the heterologous 

 male type. Indeed, on adding the precocious hair development to the 

 above appearances, this individual seems to possess a degree^ of maleness 

 considerably greater than that usual in normal children at ten years of 

 age. Only the distribution of the pubic hair and the configuration of the 

 thighs remain of the female type. In this respect the case is unusual, for 

 though over two thousand case reports of pseudohermaphrodites are to 

 be found in the literature, those bearing the male gonad are about ten 

 times as common as those bearing the female ; and in these latter only a 

 few reports describe such complete presence of the heterologous secondary 

 manifestations of sex. 



Of late years attempts have been made to produce hermaphrodites arti- 

 ficially in mammals by transplantation of the sex gland. Steiiiach (a) to 

 (/) inclusive, especially, has apparently obtained remarkable results in 

 cases where a sex gland of one sex was transplanted into a young castrated 

 animal of the opposite sex. There followed a masculinization of the fe- 

 male host or a feminization of the male one. Further, he found the gonad 

 of one sex to have definite inhibitory powers on the growth of a transplant 

 of the opposite one. This was supposed to represent a hormone antag- 

 onism. These observations were made on guinea pigs and rats. Recent 

 work by Moore has been successful, however, in proving that castration of 

 the host is not necessary, and that a sex gland can be successfully trans- 

 planted to an animal of the opposite sex which retains one normal gonad. 



Other evidence of possible gonadal hormone antagonism has been 

 brought forth by Lillie(a) (&) in his investigations concerning the occur- 

 rence of the "free-martin" in cattle. He found that in such cases the twin 

 fetal circulations were connected through an anastomosis of the blood 

 vessels of the allantois. Under these circumstances when the twins were 

 male and .female the ovarian development was suppressed in the female 



