Other instances of supernumerary limbs will be found in Chapter VI.

CLASS X.--The instances of diphallic terata, by their intense interest

to the natural bent of the curious mind, have always elicited much

discussion. To many of these cases have been attributed exaggerated

function, notwithstanding the fact that modern observation almost

invariably shows that the virile power diminishes in exact proportion

to the extent of duplication. Taylor quotes a description of a

monster, exhibited in London, with two distinct penises, but with only

one distinct testicle on either side. He could exercise the function of

either organ.

Schenck, Schurig, Bartholinus, Loder, and Ollsner report instances of

diphallic terata; the latter case a was in a soldier of Charles VI,

twenty-two years old, who applied to the surgeon for a bubonic

affection, and who declared that he passed urine from the orifice of

the left glans and also said that he was incapable of true coitus.

Valentini mentions an instance in a boy of four, in which the two

penises were superimposed. Bucchettoni speaks of a man with two penises

placed side by side. There was an anonymous case described of a man of

ninety-three with a penis which was for more than half its length

divided into two distinct members, the right being somewhat larger than

the left. From the middle of the penis up to the symphysis only the

lower wall of the urethra was split. Jenisch describes a diphallic

infant, the offspring of a woman of twenty-five who had been married

five years. Her first child was a well-formed female, and the second,

the infant in question, cried much during the night, and several times

vomited dark-green matter. In lieu of one penis there were two,

situated near each other, the right one of natural size and the left

larger, but not furnished with a prepuce. Each penis had its own

urethra, from which dribbled urine and some meconium. There was a

duplication of each scrotum, but only one testicle in each, and several

other minor malformations.

Gore, reported by Velpeau, has seen an infant of eight and one-half

months with two penises and three lower extremities. The penises were 4

cm. apart and the scrotum divided, containing one testicle in each

side. Each penis was provided with a urethra, urine being discharged

from both simultaneously. In a similar case, spoken of by

Geoffroy-Saint-Hilaire, the two organs were also separate, but urine

and semen escaped sometimes from one, sometimes from both.

The most celebrated of all the diphallic terata was Jean Baptista dos

Santos, who when but six months old was spoken of by Acton. His father

and mother were healthy and had two well-formed children. He was easily

born after an uneventful pregnancy. He was good-looking, well

proportioned, and had two distinct penises, each as large as that of a

child of six months. Urination proceeded simultaneously from both

penises; he had also two scrotums. Behind and between the legs there

was another limb, or rather two, united throughout their length. It was

connected to the pubis by a short stem 1/2 inch long and as large as

the little finger, consisting of separate bones and cartilages. There

was a patella in the supernumerary limb on the anal aspect, and a joint

freely movable. This compound limb had no power of motion, but was

endowed with sensibility. A journal in London, after quoting Acton's

description, said that the child had been exhibited in Paris, and that

the surgeons advised operation. Fisher, to whom we are indebted for an

exhaustive work in Teratology, received a report from Havana in July,

1865, which detailed a description of Santos at twenty-two years of

age, and said that he was possessed of extraordinary animal passion,

the sight of a female alone being sufficient to excite him. He was said

to use both penises, after finishing with one continuing with the

other; but this account of him does not agree with later descriptions,

in which no excessive sexual ability had been noticed. Hart describes

the adult Santos in full, and accompanies his article with an

illustration. At this time he was said to have developed double

genitals, and possibly a double bladder communicating by an imperfect

septum. At adulthood the anus was three inches anterior to the os

coceygeus. In the sitting or lying posture the supernumerary limb

rested on the front of the inner surface of the lower third of his left

thigh. He was in the habit of wearing this limb in a sling, or bound

firmly to the right thigh, to prevent its unseemly dangling when erect.

The perineum proper was absent, the entire space between the anus and

the posterior edge of the scrotum being occupied by the pedicle.

Santos' mental and physical functions were developed above normal, and

he impressed everybody with his accomplishments.

Geoffroy-Saint-Hilaire records an instance in which the conformation

was similar to that of Santos. There was a third lower extremity

consisting of two limbs fused into one with a single foot containing

ten distinct digits. He calls the case one of arrested twin development.

Van Buren and Keyes describe a case in a man of forty-two, of good,

healthy appearance. The two distinct penises of normal size were

apparently well formed and were placed side by side, each attached at

its root to the symphysis. Their covering of skin was common as far as

the base of the glans; at this point they seemed distinct and perfect,

but the meatus of the left was imperforate. The right meatus was

normal, and through it most of the urine passed, though some always

dribbled through an opening in the perineum at a point where the root

of the scrotum should have been. On lifting the double-barreled penis

this opening could be seen and was of sufficient size to admit the

finger. On the right side of the aperture was an elongated and rounded

prominence similar in outline to a labium majus. This prominence

contained a testicle normal in shape and sensibility, but slightly

undersized, and surrounded, as was evident from its mobility, by a

tunica vaginalis. The left testicle lay on the tendon of the adductor

longus in the left groin; it was not fully developed, but the patient

had sexual desires, erections, and emissions. Both penises became

erect simultaneously, the right more vigorously. The left leg was

shorter than the right and congenitally smaller; the mammae were of

normal dimensions.

Sangalli speaks of a man of thirty-five who had a supernumerary penis,

furnished with a prepuce and capable of erection. At the apex of the

glans opened a canal about 12 cm. long, through which escaped monthly a

serous fluid. Smith mentions a man who had two penises and two

bladders, on one of which lithotomy was performed. According to

Ballantyne, Taruffi, the scholarly observer of terata, mentions a child

of forty-two months and height of 80 cm. who had two penises, each

furnished with a urethra and well-formed scrotal sacs which were

inserted in a fold of the groin. There were two testicles felt in the

right scrotum and one in the left. Fecal evacuations escaped through

two anal orifices. There is also another case mentioned similar to the

foregoing in a man of forty; but here there was an osseous projection

in the middle line behind the bladder. This patient said that erection

was simultaneous in both penises, and that he had not married because

of his chagrin over his deformity. Cole speaks of a child with two

well-developed male organs, one to the left and the other to the right

of the median line, and about 1/4 or 1/2 inch apart at birth. The

urethra bifurcated in the perineal region and sent a branch to each

penis, and urine passed from each meatus. The scrotum was divided into

three compartments by two raphes, and each compartment contained a

testicle. The anus at birth was imperforate, but the child was

successfully operated on, and at its sixtieth day weighed 17 pounds.

Lange says that an infant was brought to Karg for relief of anal

atresia when fourteen days old. It was found to possess duplicate

penises, which communicated each to its distinct half of the bladder as

defined by a median fold. The scrotum was divided into three portions

by two raphes, and each lateral compartment contained a fully formed

testicle. This child died because of its anal malformation, which we

notice is a frequent associate of malformations or duplicity of the

penis. There is an example in an infant described in which there were

two penises, each about 1/2 inch long, and a divided scrotal sac 21

inches long. Englisch speaks of a German of forty who possessed a

double penis of the bifid type.

Ballantyne and his associates define diphallic terata as individuals

provided with two more or less well-formed and more or less separate

penises, who may show also other malformations of the adjoining parts

and organs (e.g., septate bladder), but who are not possessed of more

than two lower limbs. This definition excludes, therefore, the cases in

which in addition to a double penis there is a supernumerary lower

extremity--such a case, for example, as that of Jean Baptista dos

Santos, so frequently described by teratologists. It also excludes the

more evident double terata, and, of course, the cases of duplication of

the female genital organs (double clitoris, vulva, vagina, and uterus).

Although Schurig, Meckel, Himly, Taruffi, and others give bibliographic

lists of diphallic terata, even in them erroneous references are

common, and there is evidence to show that many cases have been

duplicated under different names. Ballantyne and Skirving have

consulted all the older original references available and eliminated

duplications of reports and, adhering to their original definition,

have collected and described individually 20 cases; they offer the

following conclusions:--

1. Diphallus, or duplication of the penis in an otherwise apparently

single individual, is a very rare anomaly, records of only 20 cases

having been found in a fairly exhaustive search through teratologic

literature. As a distinct and well-authenticated type it has only quite

recently been recognized by teratologists.

2. It does not of itself interfere with intrauterine or extrauterine

life; but the associated anomalies (e.g., atresia ani) may be sources

of danger. If not noticed at birth, it is not usually discovered till

adult life, and even then the discovery is commonly accidental.

3. With regard to the functions of the pelvic viscera, urine may be

passed by both penises, by one only, or by neither. In the last

instance it finds exit by an aperture in the perineum. There is reason

to believe that semen may be passed in the same way; but in most of the

recorded cases there has been sterility, if not inability to perform

the sexual act.

4. All the degrees of duplication have been met with, from a fissure of

the glans penis to the presence of two distinct penises inserted at

some distance from each other in the inguinal regions.

5. The two penises are usually somewhat defective as regards prepuce,

urethra, etc.; they may lie side by side, or more rarely may be

situated anteroposteriorly; they may be equal in size, or less commonly

one is distinctly larger than the other; and one or both may be

perforate or imperforate.

6. The scrotum may be normal or split; the testicles, commonly two in

number, may be normal or atrophic, descended or undescended; the

prostate may be normal or imperfectly developed, as may also the vasa

deferentia and vesiculae seminales.

7. The commonly associated defects are: More or less completely septate

bladder, atresia ani, or more rarely double anus, double urethra,

increased breadth of the bony pelvis with defect of the symphysis

pubis, and possibly duplication of the lower end of the spine, and

hernia of some of the abdominal contents into a perineal pouch. Much

more rarely, duplication of the heart, lungs, stomach, and kidneys has

been noted, and the lower limbs may be shorter than normal.

CLASS XI.--Cases of fetus in fetu, those strange instances in which one

might almost say that a man may be pregnant with his brother or sister,

or in which an infant may carry its twin without the fact being

apparent, will next be discussed. The older cases were cited as being

only a repetition of the process by which Eve was born of Adam. Figure

63 represents an old engraving showing the birth of Eve. Bartholinus,

the Ephemerides, Otto, Paullini, Schurig, and Plot speak of instances

of fetus in fetu. Ruysch describes a tumor contained in the abdomen of

a man which was composed of hair, molar teeth, and other evidences of a

fetus. Huxham reported to the Royal Society in 1748 the history of a

child which was born with a tumor near the anus larger than the whole

body of the child; this tumor contained rudiments of an embryo. Young

speaks of a fetus which lay encysted between the laminae of the

transverse mesocolon, and Highmore published a report of a fetus in a

cyst communicating with the duodenum. Dupuytren gives an example in a

boy of thirteen, in whom was found a fetus. Gaetano-Nocito, cited by

Philipeaux, has the history of a taken with a great pain in the right

hypochondrium, and from which issued subsequently fetal bones and a

mass of macerated embryo. His mother had had several double

pregnancies, and from the length of the respective tibiae one of the

fetuses seemed to be of two months' and the other of three months'

intrauterine life. The man died five years after the abscess had burst

spontaneously.

Brodie speaks of a case in which fetal remains were taken from the

abdomen of a girl of two and one-half years. Gaither describes a child

of two years and nine months, supposed to be affected with ascites, who

died three hours after the physician's arrival. In its abdomen was

found a fetus weighing almost two pounds and connected to the child by

a cord resembling an umbilical cord. This child was healthy for about

nine months, and had a precocious longing for ardent spirits, and drank

freely an hour before its death.

Blundell says that he knew "a boy who was literally and without evasion

with child, for the fetus was contained in a sac communicating with the

abdomen and was connected to the side of the cyst by a short umbilical

cord; nor did the fetus make its appearance until the boy was eight or

ten years old, when after much enlargement of pregnancy and subsequent

flooding the boy died." The fetus, removed after death, on the whole

not very imperfectly formed, was of the size of about six or seven

months' gestation. Bury cites an account of a child that had a second

imperfectly developed fetus in its face and scalp. There was a boy by

the name of Bissieu who from the earliest age had a pain in one of his

left ribs; this rib was larger than the rest and seemed to have a tumor

under it. He died of phthisis at fourteen, and after death there was

found in a pocket lying against the transverse colon and communicating

with it all the evidences of a fetus.

At the Hopital de la Charite in Paris, Velpeau startled an audience of

500 students and many physicians by saying that he expected to find a

rudimentary fetus in a scrotal tumor placed in his hands for operation.

His diagnosis proved correct, and brought him resounding praise, and

all wondered as to his reasons for expecting a fetal tumor. It appears

that he had read with care a report by Fatti of an operation on the

scrotum of a child which had increased in size as the child grew, and

was found to contain the ribs, the vertebral column, the lower

extremities as far as the knees, and the two orbits of a fetus; and

also an account of a similar operation performed by Wendt of Breslau on

a Silesian boy of seven. The left testicle in this case was so swollen

that it hung almost to the knee, and the fetal remains removed weighed

seven ounces.

Sulikowski relates an instance of congenital fetation in the umbilicus

of a girl of fourteen, who recovered after the removal of the anomaly.

Aretaeos described to the members of the medical fraternity in Athens

the case of a woman of twenty-two, who bore two children after a seven

months' pregnancy. One was very rudimentary and only 21 inches long,

and the other had an enormous head resembling a case of hydrocephalus.

On opening the head of the second fetus, another, three inches long,

was found in the medulla oblongata, and in the cranial cavity with it

were two additional fetuses, neither of which was perfectly formed.

Broca speaks of a fetal cyst being passed in the urine of a man of

sixty-one; the cyst contained remnants of hair, bone, and cartilage.

Atlee submits quite a remarkable case of congenital ventral gestation,

the subject being a girl of six, who recovered after the discharge of

the fetal mass from the abdomen. McIntyre speaks of a child of eleven,

playing about and feeling well, but whose abdomen progressively

increased in size 1 1/2 inches each day. After ten days there was a

large fluctuating mass on the right side; the abdomen was opened and

the mass enucleated; it was found to contain a fetal mass weighing

nearly five pounds, and in addition ten pounds of fluid were removed.

The child made an early recovery. Rogers mentions a fetus that was

found in a man's bladder. Bouchacourt reports the successful

extirpation of the remains of a fetus from the rectum of a child of

six. Miner describes a successful excision of a congenital gestation.

Modern literature is full of examples, and nearly every one of the

foregoing instances could be paralleled from other sources. Rodriguez

is quoted as reporting that in July, 1891, several newspapers in the

city of Mexico published, under the head of "A Man-mother," a wonderful

story, accompanied by wood-cuts, of a young man from whose body a great

surgeon had extracted a "perfectly developed fetus." One of these

wood-cuts represented a tumor at the back of a man opened and

containing a crying baby. In commenting upon this, after reviewing

several similar cases of endocymian monsters that came under his

observation in Mexico, Rodriguez tells what the case which had been so

grossly exaggerated by the lay journals really was: An Indian boy, aged

twenty-two, presented a tumor in the sacrococcygeal region measuring 53

cm. in circumference at the base, having a vertical diameter of 17 cm.

and a transverse diameter of 13 cm. It had no pedicle and was fixed,

showing unequal consistency. At birth this tumor was about the size of

a pigeon's egg. A diagnosis of dermoid cyst was made and two operations

were performed on the boy, death following the second. The skeleton

showed interesting conditions; the rectum and pelvic organs were

natural, and the contents of the cyst verified the diagnosis.

Quite similar to the cases of fetus in fetu are the instances of

dermoid cysts. For many years they have been a mystery to

physiologists, and their origin now is little more than hypothetic. At

one time the fact of finding such a formation in the ovary of an

unmarried woman was presumptive evidence that she was unchaste; but

this idea was dissipated as soon as examples were reported in children,

and to-day we have a well-defined difference between congenital and

extrauterine pregnancy. Dermoid cysts of the ovary may consist only of

a wall of connective tissue lined with epidermis and containing

distinctly epidermic scales which, however, may be rolled up in firm

masses of a more or less soapy consistency; this variety is called by

Orth epidermoid cyst; or, according to Warren, a form of cyst made up

of skin containing small and ill-defined papillae, but rich in hair

follicles and sebaceous glands. Even the erector pili muscle and the

sudoriparous gland are often found. The hair is partly free and rolled

up into thick balls or is still attached to the walls. A large mass of

sebaceous material is also found in these cysts. Thomson reports a case

of dermoid cyst of the bladder containing hair, which cyst he removed.

It was a pedunculated growth, and it was undoubtedly vesical and not

expelled from some ovarian source through the urinary passage, as

sometimes occurs.

The simpler forms of the ordinary dermoid cysts contain bone and teeth.

The complicated teratoma of this class may contain, in addition to the

previously mentioned structures, cartilage and glands, mucous and

serous membrane, muscle, nerves, and cerebral substance, portions of

eyes, fingers with nails, mammae, etc. Figure 64 represents a cyst

containing long red hair that was removed from a blonde woman aged

forty-four years who had given birth to six children. Cullingworth

reports the history of a woman in whom both ovaries were apparently

involved by dermoids, who had given birth to 12 children and had three

miscarriages--the last, three months before the removal of the growths.

The accompanying illustration, taken from Baldy, pictures a dermoid

cyst of the complicated variety laid open and exposing the contents in

situ. Mears of Philadelphia reports a case of ovarian cyst removed from

a girl of six and a half by Bradford of Kentucky in 1875. From this age

on to adult life many similar cases are recorded. Nearly every medical

museum has preserved specimens of dermoid cysts, and almost all

physicians are well acquainted with their occurrence. The curious

formations and contents and the bizarre shapes are of great variety.

Graves mentions a dermoid cyst containing the left side of a human

face, an eye, a molar tooth, and various bones. Dermoid cysts are found

also in regions of the body quite remote from the ovary. The so-called

"orbital wens" are true inclusion of the skin of a congenital origin,

as are the nasal dermoids and some of the cysts of the neck.

Weil reported the case of a man of twenty-two years who was born with

what was supposed to be a spina bifida in the lower sacral region.

According to Senn, the swelling never caused any pain or inconvenience

until it inflamed, when it opened spontaneously and suppurated,

discharging a large quantity of offensive pus, hair, and sebaceous

material, thus proving it to have been a dermoid. The cyst was freely

incised, and there were found numerous openings of sweat glands, from

which drops of perspiration escaped when the patient was sweating.

Dermoid cysts of the thorax are rare. Bramann reported a case in which

a dermoid cyst of small size was situated over the sternum at the

junction of the manubrium with the gladiolus, and a similar cyst in the

neck near the left cornu of the hyoid bone. Chitten removed a dermoid

from the sternum of a female of thirty-nine, the cyst containing 11

ounces of atheromatous material. In the Museum of St. Bartholomew's

Hospital in London there is a congenital tumor which was removed from

the anterior mediastinum of a woman of twenty one, and contained

portions of skin, fat, sebaceous material, and two pieces of bone

similar to the superior maxilla, and in which several teeth were found.

Dermoids are found in the palate and pharynx, and open dermoids of the

conjunctiva are classified by Sutton with the moles. According to

Senn, Barker collected sixteen dermoid tumors of the tongue. Bryk

successfully removed a tumor of this nature the size of a fist.

Wellington Gray removed an enormous lingual dermoid from the mouth of a

negro. It contained 40 ounces of atheromatous material. Dermoids of the

rectum are reported. Duyse reports the history of a case of labor

during which a rectal dermoid was expelled. The dermoid contained a

cerebral vesicle, a rudimentary eye, a canine and a molar tooth, and a

piece of bone. There is little doubt that many cases of fetus in fetu

reported were really dermoids of the scrotum.

Ward reports the successful removal of a dermoid cyst weighing 30

pounds from a woman of thirty-two, the mother of two children aged ten

and twelve, respectively. The report is briefly as follows: "The

patient has always been in good health until within the last year,

during which time she has lost flesh and strength quite rapidly, and

when brought to my hospital by her physician, Dr. James of

Williamsburg, Kansas, was quite weak, although able to walk about the

house. A tumor had been growing for a number of years, but its growth

was so gradual that the patient had not considered her condition

critical until quite recently. The tumor was diagnosed to be cystoma of

the left ovary. Upon opening the sac with the trocar we were confronted

by complications entirely unlooked for, and its use had to be abandoned

entirely because the thick contents of the cyst would not flow freely,

and the presence of sebaceous matter blocked the instrument. As much of

the fluid as possible was removed, and the abdominal incision was

enlarged to allow of the removal of the large tumor. An ovarian

hematoma the size of a large orange was removed from the right side. We

washed the intestines quite as one would wash linen, since some of the

contents of the cyst had escaped into the abdominal cavity. The abdomen

was closed without drainage, and the patient placed in bed without

experiencing the least shock. Her recovery was rapid and uneventful.

She returned to her home in four weeks after the operation.

"The unusual feature in this case was the nature of the contents of the

sac. There was a large quantity of long straight hair growing from the

cyst wall and an equal amount of loose hair in short pieces floating

through the tumor-contents, a portion of which formed nuclei for what

were called 'moth-balls,' of which there were about 1 1/2 gallons.

These balls, or marbles, varied from the size of moth-balls, as

manufactured and sold by druggists, to that of small walnuts. They

seemed to be composed of sebaceous matter, and were evidently formed

around the short hairs by the motion of the fluid produced by walking

or riding. There was some tissue resembling true skin attached to the

inner wall of the sac."

There are several cases of multiple dermoid cysts on record, and they

may occur all over the body. Jamieson reports a case in which there

were 250, and in Maclaren's case there were 132. According to Crocker,

Hebra and Rayer also each had a case. In a case of Sangster, reported

by Politzer, although most of the dermoids, as usual, were like

fibroma-nodules and therefore the color of normal skin, those over the

mastoid processes and clavicle were lemon-yellow, and were generally

thought to be xanthoma until they were excised, and Politzer found they

were typical dermoid cysts with the usual contents of degenerated

epithelium and hair.

Hermaphroditism.--Some writers claim that Adam was the first

hermaphrodite and support this by Scriptural evidence. We find in some

of the ancient poets traces of an Egyptian legend in which the goddess

of the moon was considered to be both male and female. From mythology

we learn that Hermaphroditus was the son of Hermes, or Mercury, and

Venus Aphrodite, and had the powers both of a father and mother. In

speaking of the foregoing Ausonius writes, "Cujus erat facies in qua

paterque materque cognosci possint, nomen traxit ab illis." Ovid and

Virgil both refer to legendary hermaphrodites, and the knowledge of

their existence was prevalent in the olden times. The ancients

considered the birth of hermaphrodites bad omens, and the Athenians

threw them into the sea, the Romans, into the Tiber. Livy speaks of an

hermaphrodite being put to death in Umbria, and another in Etruria.

Cicero, Aristotle, Strabonius, and Pliny all speak concerning this

subject. Martial and Tertullian noticed this anomaly among the Romans.

Aetius and Paulus Aegineta speak of females in Egypt with prolonged

clitorides which made them appear like hermaphrodites. Throughout the

Middle Ages we frequently find accounts, naturally exaggerated, of

double-sexed creatures. Harvey, Bartholinus, Paullini, Schenck, Wolff,

Wrisberg, Zacchias, Marcellus Donatus, Haller, Hufeland, de Graff, and

many others discuss hermaphroditism. Many classifications have been

given, as, e.g., real and apparent; masculine, feminine, or neuter;

horizontal and vertical; unilateral and bilateral, etc. The anomaly in

most cases consists of a malformation of the external genitalia. A

prolonged clitoris, prolapsed ovaries, grossness of figure, and hirsute

appearance have been accountable for many supposed instances of

hermaphrodites. On the other hand, a cleft scrotum, an ill-developed

penis, perhaps hypospadias or epispadias, rotundity of the mammae, and

feminine contour have also provoked accounts of similar instances. Some

cases have been proved by dissection to have been true hermaphrodites,

portions or even entire genitalia of both sexes having been found.

Numerous accounts, many mythical, but always interesting, are given of

these curious persons. They have been accredited with having performed

the functions of both father and mother, notwithstanding the statements

of some of the best authorities that they are always sterile.

Observation has shown that the sexual appetite diminishes in proportion

to the imperfections in the genitalia, and certainly many of these

persons are sexually indifferent.

We give descriptions of a few of the most famous or interesting

instances of hermaphroditism. Pare speaks of a woman who, besides a

vulva, from which she menstruated, had a penis, but without prepuce or

signs of erectility. Haller alludes to several cases in which prolonged

clitorides have been the cause of the anomaly. In commenting on this

form of hermaphroditism Albucasiusus describes a necessary operation

for the removal of the clitoris.

Columbus relates the history of an Ethiopian woman who was evidently a

spurious female hermaphrodite. The poor wretch entreated him to cut off

her penis, an enlarged clitoris, which she said was an intolerable

hindrance to her in coitus. De Graff and Riolan describe similar cases.

There is an old record of a similar creature, supposing herself to be a

male, who took a wife, but previously having had connection with a man,

the outcome of which was pregnancy, was shortly after marriage

delivered of a daughter. There is an account of a person in Germany

who, for the first thirty years of life, was regarded as feminine, and

being of loose morals became a mother. At a certain period she began to

feel a change in her sexual inclinations; she married and became the

father of a family. This is doubtless a distortion of the facts of the

case of Catherine or Charles Hoffman, born in 1824, and who was

considered a female until the age of forty. At puberty she had the

instincts of a woman, and cohabitated with a male lover for twenty

years. Her breasts were well formed and she menstruated at nineteen. At

the age of forty-six her sexual desires changed, and she attempted

coitus as a man, with such evident satisfaction that she married a

woman soon afterward. Fitch speaks of a house-servant with masculine

features and movements, aged twenty-eight, and 5 feet and 9 inches

tall, who was arrested by the police for violating the laws governing

prostitution. On examination, well-developed male and female organs of

generation were found. The labia majora were normal and flattened on

the anterior surface. The labia minora and hymen were absent. The

vagina was spacious and the woman had a profuse leukorrhea. She stated

that several years previously she gave birth to a normal child. In

place of a clitoris she had a penis which, in erection, measured 5 1/4

inches long and 3 5/8 inches in circumference. The glans penis and the

urethra were perfectly formed. The scrotum contained two testicles,

each about an inch long; the mons veneris was sparsely covered with

straight, black hair. She claimed functional ability with both sets of

genitalia, and said she experienced equal sexual gratification with

either. Semen issued from the penis, and every three weeks she had

scanty menstruation, which lasted but two days.

Beclard showed Marie-Madeline Lefort, nineteen years of age, 1 1/2

meters in height. Her mammae were well developed, her nipples erectile

and surrounded by a brown areola, from which issued several hairs. Her

feet were small, her pelvis large, and her thighs like those of a

woman. Projecting from the vulva was a body looking like a penis 7 cm.

long and slightly erectile at times; it was imperforate and had a

mobile prepuce. She had a vulva with two well-shaped labia as shown by

the accompanying illustration. She menstruated slightly and had an

opening at the root of the clitoris. The parotid region showed signs of

a beard and she had hair on her upper lip. On August 20, 1864, a person

came into the Hotel-Dieu, asking treatment for chronic pleurisy. He

said his age was sixty-five, and he pursued the calling of a

mountebank, but remarked that in early life he had been taken for a

woman. He had menstruated at eight and had been examined by doctors at

sixteen. The menstruation continued until 1848, and at its cessation he

experienced the feelings of a male. At this time he presented the

venerable appearance of a long-bearded old man. At the autopsy, about

two months later, all the essentials of a female were delineated. A

Fallopian tube, ovaries, uterus, and round ligaments were found, and a

drawing in cross-section of the parts was made. There is no doubt but

that this individual was Marie-Madeline Lefort in age.

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 passed for many years as a female. He had a cleft scrotum and

hypospadias, which caused the deception. Sleeping with another servant

for three years, he constantly had sexual congress with her during this

period, and finally impregnated her. It was supposed in this case that

the posterior wall of the vagina supplied the deficiency of the lower

boundary of the urethra, forming a complete channel for the semen 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 labia 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

penis became erect, etc.

Schrell describes a case in which, independent of the true penis and

testicles, which were well formed, there existed a small vulva

furnished with labia 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 clitoris,

an imperforate uterus, and absence of vagina; at first sight of the

parts they appeared to be those of a man.

In 1859 Hugier succeeded in restoring a vagina to a young girl of

twenty who had an hypertrophied clitoris and no signs of a vagina. The

accompanying illustrations show the conformation of the parts before

operation with all the appearance of ill-developed male genitalia, and

the appearance afterward with restitution of the vaginal 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 penis.

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 scrotum, and in whom the

uterus masculinus and vagina were developed to an unusual degree. The

uterus, nearly as large as in the adult female, lay between the bladder

and rectum, 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 vagina, 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 sexual arrangement.

Barnes, Chalmers, Sippel, and Litten describe cases of spurious

hermaphroditism due to elongation of the clitoris. In Litten's case a

the clitoris was 3 1/2 inches long, and there was hydrocele of the

processus vaginalis on both sides, making tumors in the labium on one

side and the inguinal canal on the other, which had been diagnosed as

testicles and again as ovaries. There was associate 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 choreic 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 clitoris 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 scrotum contained two hard

bodies thought to be testicles, 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 scrotum,

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 mass 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 clitoris 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 sex cannot be

definitely declared, and sometimes dissection does not definitely

indicate the predominating sex. Such cases are classed under the head

of neuter hermaphrodites, possibly an analogy 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 sex. He found an

imperforate penis, and on the inferior face near the root an opening

for the passage of urine. No traces of nymphae, vagina, testicles, 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 sex or the other. Everard Home

dissected a dog with apparent external organs of the female, but

discovered that neither sex was sufficiently pronounced to admit of

classification. 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 breasts, little beard, and the thighs and legs of a woman.

There was fat on the pubis, the penis was short and small and incapable

of erection, the testicles of fetal size; he had no venereal desires

whatever, and as regards sex 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 sex was settled by

the predominance. If the male aspect and traits together with the

generative organs of man were most pronounced, 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 assault, 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 space, 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.

Date: 2014-12-29; view: 706