Anomalies And Curiosities Of Medicine Part 14

Worbe speaks of a person who was supposed to be feminine for twenty-two years. At the age of sixteen she loved a farmer's son, but the union was delayed for some reason, and three years later her grace faded and she became masculine in her looks and tastes. It was only after lengthy discussion, in which the court took part, that it was definitely settled that this person was a male.

Adelaide Preville, who was married as a female, and as such lived the last ten years of her life in France, was found on dissection at the Hotel-Dieu to be a man. A man was spoken of in both France and Germany a who pa.s.sed for many years as a female. He had a cleft s.c.r.o.t.u.m and hypospadias, which caused the deception. Sleeping with another servant for three years, he constantly had s.e.xual congress with her during this period, and finally impregnated her. It was supposed in this case that the posterior wall of the v.a.g.i.n.a supplied the deficiency of the lower boundary of the urethra, forming a complete channel for the s.e.m.e.n to proceed through. Long ago in Scotland a servant was condemned to death by burial alive for impregnating his master's daughter while in the guise and habit of a woman. He had always been considered a woman. We have heard of a recent trustworthy account of a pregnancy and delivery in a girl who had been impregnated by a bed-fellow who on examination proved to be a male pseudohermaphrodite.

Fournier speaks of an individual in Lisbon in 1807 who was in the highest degree graceful, the voice feminine, the mammae well developed, The female genitalia were normal except the l.a.b.i.a majora, which were rather diminutive. The thighs and the pelvis. were not so wide as those of a woman. There was some beard on the chin, but it was worn close. the male genitalia were of the size and appearance of a male adult and were covered with the usual hair. This person had been twice pregnant and aborted at the third and fifth month. During coitus the p.e.n.i.s became erect, etc.

Schrell describes a case in which, independent of the true p.e.n.i.s and t.e.s.t.i.c.l.es, which were well formed, there existed a small v.u.l.v.a furnished with l.a.b.i.a and nymphae, communicating with a rudimentary uterus provided with round ligaments and imperfectly developed ovaries.

Schrell remarks that in this case we must notice that the female genitalia were imperfectly developed, and adds that perfect hermaphroditism is a physical impossibility without great alterations of the natural connections of the bones and other parts of the pelvis.

Cooper describes a woman with an enormous development of the c.l.i.toris, an imperforate uterus, and absence of v.a.g.i.n.a; at first sight of the parts they appeared to be those of a man.

In 1859 Hugier succeeded in restoring a v.a.g.i.n.a to a young girl of twenty who had an hypertrophied c.l.i.toris and no signs of a v.a.g.i.n.a. The accompanying ill.u.s.trations show the conformation of the parts before operation with all the appearance of ill-developed male genitalia, and the appearance afterward with rest.i.tution of the v.a.g.i.n.al opening.

Virchow in 1872, Boddaert in 1875, and Marchand in 1883 report cases of duplication of the genitalia, and call their cases true hermaphrodites from an anatomic standpoint. There is a specimen in St. Bartholomew's Hospital in London from a man of forty-four, who died of cerebral hemorrhage. He was well formed and had a beard and a full-sized p.e.n.i.s.

He was married, and it was stated that his wife had two children. The bladder and the internal organs of generation were those of a man in whom neither testis had descended into the s.c.r.o.t.u.m, and in whom the uterus masculinus and v.a.g.i.n.a were developed to an unusual degree. The uterus, nearly as large as in the adult female, lay between the bladder and r.e.c.t.u.m, and was enclosed between two layers of peritoneum, to which, on either side of the uterus, were attached the testes. There was also shown in London the pelvic organs from a case of complex or vertical hermaphroditism occurring in a child of nine months who died from the effects of an operation for the radical cure of a right inguinal hernia. The external organs were those of a male with undescended testes. The bladder was normal and its neck was surrounded by a prostate gland. Projecting backward were a v.a.g.i.n.a, uterus, and broad ligaments, round ligaments, and Fallopian tubes, with the testes in the position of the ovaries. There were no seminal vesicles. The child died eleven days after the operation. The family history states that the mother had had 14 children and eight miscarriages. Seven of the children were dead and showed no abnormalities. The fifth and sixth children were boys and had the same s.e.xual arrangement.

Barnes, Chalmers, Sippel, and Litten describe cases of spurious hermaphroditism due to elongation of the c.l.i.toris. In Litten's case a the c.l.i.toris was 3 1/2 inches long, and there was hydrocele of the processus v.a.g.i.n.alis on both sides, making tumors in the labium on one side and the inguinal ca.n.a.l on the other, which had been diagnosed as t.e.s.t.i.c.l.es and again as ovaries. There was a.s.sociate cystic ovarian disease. Plate 4 is taken from a case of false external bilateral hermaphroditism. Phillips mentions four cases of spurious hermaphroditism in one family, and recently Pozzi tells of a family of nine individuals in whom this anomaly was observed. The first was alive and had four children; the second was christened a female but was probably a male; the third, fourth, and fifth were normal but died young; the sixth daughter was ch.o.r.eic and feeble-minded, aged twenty-nine, and had one illegitimate child; the seventh, a boy, was healthy and married; the eighth was christened a female, but when seventeen was declared by the Faculty to be a male; the ninth was christened a female, but at eighteen the genitals were found to be those of a male, though the mammae were well developed.

O'Neill speaks of a case in which the c.l.i.toris was five inches long and one inch thick, having a groove in its inferior surface reaching down to an oblique opening in the perineum. The s.c.r.o.t.u.m contained two hard bodies thought to be t.e.s.t.i.c.l.es, and the general appearance was that of hypospadias. Postmortem a complete set of female genitalia was found, although the ovaries were very small. The right round ligament was exceedingly thick and reached down to the bottom of the false s.c.r.o.t.u.m, where it was firmly attached. The hard bodies proved to be on one side an irreducible omental hernia, probably congenital, and on the other a hardened ma.s.s having no glandular structure. The patient was an adult.

As we have seen, there seems to be a law of evolution in hermaphroditism which prevents perfection. If one set of genitalia are extraordinarily developed, the other set are correspondingly atrophied.

In the case of extreme development of the c.l.i.toris and approximation to the male type we must expect to find imperfectly developed uterus or ovaries. This would answer for one of the causes of sterility in these cases.

There is a type of hermaphroditism in which the s.e.x cannot be definitely declared, and sometimes dissection does not definitely indicate the predominating s.e.x. Such cases are cla.s.sed under the head of neuter hermaphrodites, possibly an a.n.a.logy of the "genus epicoenum"

of Quintilian. Marie Dorothee, of the age of twenty-three, was examined and declared a girl by Hufeland and Mursina, while Stark, Raschig, and Martens maintained that she was a boy. This formidable array of talent on both sides provoked much discussion in contemporary publications, and the case attracted much notice. Marc saw her in 1803, at which time she carried contradicting certificates as to her s.e.x. He found an imperforate p.e.n.i.s, and on the inferior face near the root an opening for the pa.s.sage of urine. No traces of nymphae, v.a.g.i.n.a, t.e.s.t.i.c.l.es, nor beard were seen. The stature was small, the form debilitated, and the voice effeminate. Marc came to the conclusion that it was impossible for any man to determine either one s.e.x or the other. Everard Home dissected a dog with apparent external organs of the female, but discovered that neither s.e.x was sufficiently p.r.o.nounced to admit of cla.s.sification. Home also saw at the Royal Marine Hospital at Plymouth, in 1779, a marine who some days after admission was reported to be a girl. On examination Home found him to possess a weak voice, soft skin, voluminous b.r.e.a.s.t.s, little beard, and the thighs and legs of a woman.

There was fat on the pubis, the p.e.n.i.s was short and small and incapable of erection, the t.e.s.t.i.c.l.es of fetal size; he had no venereal desires whatever, and as regards s.e.x was virtually neuter.

The legal aspect of hermaphroditism has always been much discussed.

Many interesting questions arise, and extraordinary complications naturally occur. In Rome a hermaphrodite could be a witness to a testament, the exclusive privilege of a man, and the s.e.x was settled by the predominance. If the male aspect and traits together with the generative organs of man were most p.r.o.nounced, then the individual could call himself a man. "Hermaphroditus an ad testamentum adhiberi possit qualitas sesus incalescentis ostendit."

There is a peculiar case on record in which the question of legal male inheritance was not settled until the individual had lived as a female for fifty-one years. This person was married when twenty-one, but finding coitus impossible, separated after ten years, and though dressing as a female had coitus with other women. She finally lived with her brother, with whom she eventually came to blows. She prosecuted him for a.s.sault, and the brother in return charged her with seducing his wife. Examination ensued, and at this ripe age she was declared to be a male.

The literature on hermaphroditism is so extensive that it is impossible to select a proper representation of the interesting cases in this limited s.p.a.ce, and the reader is referred to the modern French works on this subject, in which the material is exhaustive and the discussion thoroughly scientific.

CHAPTER VI.

MINOR TERATA.

Ancient Ideas Relative to Minor Terata.--The ancients viewed with great interest the minor structural anomalies of man, and held them to be divine signs or warnings in much the same manner as they considered more p.r.o.nounced monstrosities. In a most interesting and instructive article, Ballantyne quotes Ragozin in saying that the Chaldeo-Babylonians, in addition to their other numerous subdivisions of divination, drew presages and omens for good or evil from the appearance of the liver, bowels, and viscera of animals offered for sacrifice and opened for inspection, and from the natural defects or monstrosities of babies or the young of animals. Ballantyne names this latter subdivision of divination fetomancy or teratoscopy, and thus renders a special chapter as to omens derived from monstrous births, given by Lenormant:--

"The prognostics which the Chaldeans claimed to draw from monstrous births in man and the animals are worthy of forming a cla.s.s by themselves, insomuch the more as it is the part of their divinatory science with which, up to the present time, we are best acquainted. The development that their astrology had given to 'genethliaque,' or the art of horoscopes of births, had led them early to attribute great importance to all the teratologic facts which were there produced. They claimed that an experience of 470,000 years of observations, all concordant, fully justified their system, and that in nothing was the influence of the stars marked in a more indubitable manner than in the fatal law which determined the destiny of each individual according to the state of the sky at the moment when he came into the world. Cicero, by the very terms which he uses to refute the Chaldeans, shows that the result of these ideas was to consider all infirmities and monstrosities that new-born infants exhibited as the inevitable and irremediable consequence of the action of these astral positions. This being granted, the observation of similar monstrosities gave, as it were, a reflection of the state of the sky; on which depended all terrestrial things; consequently, one might read in them the future with as much certainty as in the stars themselves. For this reason the greatest possible importance was attached to the teratologic auguries which occupy so much s.p.a.ce in the fragments of the great treatise on terrestrial presages which have up to the present time been published."

The rendering into English of the account of 62 teratologic cases in the human subject with the prophetic meanings attached to them by Chaldean diviners, after the translation of Opport, is given as follows by Ballantyne, some of the words being untranslatable:--

"When a woman gives birth to an infant--

(1) that has the ears of a lion, there will be a powerful king in the country;

(2) that wants the right ear, the days of the master (king) will be prolonged (reach old age);

(3) that wants both ears, there will be mourning in the country, and the country will be lessened (diminished);

(4) whose right ear is small, the house of the man (in whose house the birth took place) will be destroyed;

(5) whose ears are both small, the house of the man will be built of bricks;

(6) whose right ear is mudissu tehaat (monstrous), there will be an androgyne in the house of the new-born

(7) whose ears are both mudissu (deformed), the country will perish and the enemy rejoice;

(8) whose right ear is round, there will be an androgyne in the house of the new-born;

(9) whose right ear has a wound below, and tur re ut of the man, the house will be estroyed;

(10) that has two ears on the right side and none on the left, the G.o.ds will bring about a stable reign, the country will flourish, and it will be a land of repose;

(11) whose ears are both closed, sa a au;

(12) that has a bird's beak, the country will be peaceful;

(13) that has no mouth, the mistress of the house will die;

(14) that has no right nostril, the people of the world will be injured;

(15) whose nostrils are absent, the country will be in affliction, and the house of the man will be ruined;

(16) whose jaws are absent, the days of the master (king) will be prolonged, but the house (where the infant is born) will be ruined.

When a woman gives birth to an infant--

(17) that has no lower jaw, mut ta at mat, the name will not be effaced;

(20) that has no nose, affliction will seize upon the country, and the master of the house will die;

(21) that has neither nose nor virile member (p.e.n.i.s), the army of the king will be strong, peace will be in the land, the men of the king will be sheltered from evil influences, and Lilit (a female demon) shall not have power over them;

(22) whose upper lip overrides the lower, the people of the world will rejoice (or good augury for the troops);

(23) that has no lips, affliction will seize upon the land, and the house of the man will be destroyed;

(24) whose tongue is kuri aat, the man will be spared (?);

(25) that has no right hand, the country will be convulsed by an earthquake;

(26) that has no fingers, the town will have no births, the bar shall be lost;

(27) that has no fingers on the right side, the master (king) will not pardon his adversary (or shall be humiliated by his enemies);