TESTICLE AS GLAND OF INTERNAL SECRETION 513 



sequently they develop markedly. The bodily shape is not mark- 

 edly feminine but remains more or less masculine. The scrotum is 

 shrunken and the testicles are very small and not particularly sensitive 

 to pressure. The Mujerados are employed in the occupations usually fol- 

 lowed by women. 



In mild degree, we meet clinically many of this type of individual. 

 They fall into two groups. First the individual who has a congenitally 

 deficient sexual system and whose sexual organs are used moderately or 

 only slightly in excess. Second, we have the perfectly normal individual 

 who uses or has used his sexual organs markedly in excess. In the first 

 type the general picture is that of a very mild eunuchoid. He usually 

 has little hair on the body; just a few scattered hairs in the median line 

 above the pubic hair line ; a slight beard, with a tendency to absence of 

 hair on the cheeks, and the hair to be grouped on the chin and the upper 

 and lower lips. The bodily configuration will show a tendency toward 

 the feminine type with a feminine type of panniculus adiposis. 



The testicles are usually small, ranging in typic instances two centi- 

 meters in diameter. Good rather marked examples of this condition are 

 Figure 24 and Figure 25. In one of my patients of this type he had an 

 almost feminine distribution of hair with very slight hair in the abdominal 

 midline, and the hair extended down on either side of the scrotum so that 

 when his perineum was inspected his distribution of hair was similar to 

 the distribution of the vulvar hair. 



In the second type of case, the secondary sex characteristics are usu- 

 ally very well marked. The individual is distinctly masculine; very 

 hairy; large testicles and penis; deep voiced; heavy beard; thick neck. 

 In other words, he is an exceptionally masculine individual in appearance. 

 Examination is negative in every way except for the complaint of impo- 

 tency and the testicles are smaller and softer than normal or congenitally 

 small testicle is quite hard. The treatment of this type of patient is purely 

 hygienic, fortified by the administration of endocrin glands. The glands 

 to use are the testicle, the adrenal cortex, and the anterior lobe of the 

 pituitary. In exceptional instances a testicle transplant may be performed 

 upon this type of case. 



Etiology 



Eunuchs are all due either to accident or design. A congenital process 

 that destroys both testicles is extremely rare. As against this, the classic 

 eunuchoids are practically all congenital, due either to developmental diffi- 

 culties or to pathological processes which have run their course previous 

 to birth. In the case of acquired eunuchoids, the process is one of break- 

 down of a normally developed testicle due to excessive function or it is 

 a breakdown from moderate function on a structurally inferior organ. 





