358 HEKRY D. JUMP 



feminine characteristics, with female type of body and pubic hair. In this 

 particular do they differ from cases of virilismus in which male charac- 

 teristics develop and the female qualities lessen. The male characteristics 

 are manifested by enlarged clitoris, male type of pubic hair, coarse voices, 

 increased muscular power and hairiness of the face. 



Hirsutismus must be distinguished from hypertrichosis, which is a 

 congenital condition and in some cases apparently hereditary. The bearded 

 woman seen in museums probably belongs to this class, L. A. Duhring 

 has given a complete and scholarly description of such a one. This woman 

 had a heavy beard and mustache, patches of hair on the back, chest and 

 extremities. At birth there was a fine downy growth where. hair occurred 

 later. This disappeared in the first month of life and a few months later 

 was replaced by coarser dark hair. At ten she had a mustache and at six- 

 teen a beard. Her menstruation was normal and she was of a distinctly 

 feminine type. There are no pathological reports available in such cases 

 and we cannot determine what the cause may be. 



General Considerations of Virilism and Hirsutism 



Virilismus and hirsutismus have many symptoms in common, but so 

 distinct are the differences between them that they must be considered as 

 separate syndromes. As has been noted, the chief characteristic of virilis- 

 mus is the development of maleness and of hirsutismus is the retention 

 of the feminine characteristics. There are some cases of the latter, which 

 are on the borderline: as for instance the woman of mannish behavior, 

 who has developed a moderate growth of hair on the face at the time of 

 menopause, but shows no other male physical characters : or Thummin's 

 case, who had a deep voice but was of a distinctly feminine type : or Wink- 

 ler's who had poorly developed mammae. Apert, Launois, Pinard and Gal- 

 lais and others do not draw this distinction : they discuss a large number of 

 cases from the standpoint of different manifestations occurring in hyper- 

 nephromata of the suprarenal cortex. Tumors of the medulla of the supra- 

 renal capsule alone are not accompanied ~by alterations in the secondary 

 sexual characteristics. 



The chief causative factor in both conditions is hypernephroma of the 

 suprarenal cortex. As Glynn has pointed out, it is not the hypernephroma 

 which causes the changes, for such growths occur elsewhere without caus- 

 ing changes in the secondary sexual characteristics. Sarcoma of the supra- 

 renal cortex is not associated with such changes as these. It is probable 

 that hypernephromata cause an increased activity of the cortex and that 

 sarcomata do not. If this be true it is likely that the milder cases of hir- 

 sutism, who are usually in good health, have simply a hyperplasia of the 

 suprarenal cortex with increased function. 



