CAUSES OF IMPOTENCE AND STERILITY IN THE MALE 285 commences earlier and ceases later than the power of procreation. The changes which occur in a boy at puberty are the development of the genital organs, the ability to secrete semen, the growth of hair on the pubes, axillae and chin, and the increase in size of the larynx leading to the deepening of the pitch of the voice. When examining an individual for sexual capacity the medical jurist * should depend more on physical development than on age alone. Rarely, sexual development may occur at a very early age. Ram Chandra Row 2 reports the case of precocious development of a boyj aged aboul^months^whose penis and testicles were highly developed simulating those ^f_an^adi4k anl£S5LJg^^ _ He possessed a very shrill voice, and his Erother7 4 years old, was terribly afraid of him on account of his rough behaviour. A case3 is recorded in which a boy, 13 years old, impregnated a girl, 13 years old. Gemmel * reports a case in which ~a~boy,~~aged 14 years, impregnated a girl, 12 years and 11 months old, after a single coitus, and the girl at the age of 13 years and 8 months gave birth to a baby weighing 6J pounds. It has been proved that precocious puberty is caused by interstitial-cell tumours of the testes. A case5 is recorded in which a boy without any important familial or hereditary history developed normally until the end of the fourth year, when Jiisj£Sice began to become deeper sadJais penis. increaseSln siza Tb£l]^ '^ "" ~ pEysiquF°wSTEat of 'a 15-year-old boyT^gweigKej. J2""kg. an?~was Jt40 crn. tall. w"HaIFugr^wth^ areli~lEghs and legs. His face had a velvety appe^^^e due to'Ti^^haff! No axillary^hair ^as present. The penis was!5fl|3uT^^ teeth were normal for his truelige. X-ray films^oOEeTSids sHowecl the bone formation of a 15-year-old boy. The right testicle wasnoomiaL but the left testicle showed hard swelling, the size ^F^asn^lajppIeT^vmch was due to a myeloid neoplasm, arising obviously from the interstitial cells of the testicle. The left testicle was removed. After about nine months of the operation the size of the penis began to diminish. Sexuaj^eveipjmieiit may be delayed .till late in lif e^ Curling6 quotes the case of a man, wnose"sexual°^r^^ at tEe age of tweaty-six wer^Jike those of JL jdnlo^^ organs assumed their -e ^married and^becSie |he father jjf a famTjrT" TEe"""power ofsexual intercourse and procreation diminishes, but no limit can be assigned at which this power ceases, as men of eighty years and over have been known to have begotten children. In October 1924, I referred a case to Dr. Mukarji, where he found spermatozoa^ in a man of about ^^ ninetyvears of age^ Seymour and others report a case ffiTwnicn^nian, ageS^^^^TclcLild BjThis wife, aged 27 years. His seminal fluid contained motile spermatozoa of normal conformation and of average size.7 2. Malformations. The absence or non-development of the penis renders a man impotent, but the man is not sterile if semen can be deposited into the vagina with the partially developed penis. The penis adherent to the scrotum cannot be a plea for divorce if he can be remedied by a surgical operation. The presence of double penis, although a rare occurrence, may cause difficulty in sexual intercourse, but coition is, nevertheless, possible in some cases. 2. Ind. Med. Go*., Feb. 1926, p. 70. 3. Fairfield, Lancet, Vol. II, 1940, p. 61. 4. Brit. Med. Jour., May 7, 1927, p. 862. 5. J. Anagnostou and G. J. Frangopoulos, Brit, Med. Jour., April 18, : 6. On Sterility in Man ; Collis Barry, Leg. Med., Vol. H, p. 45. 7. Jour. Amer. Med, Assoc,, Nov. 2, 1935, p. 1,423.