MINOR TERATA. 10 page

enormous mammae. Goschler, quoted by Jacobson, speaks of a

well-developed man of twenty-two, with abundant hair on his chin and

suprapubic region and the scrotum apparently perfect, with median

rapine; a careful search failed to show any trace of a penis; on the

anterior wall of the rectum four lines above the anus was an orifice

which gave vent to urine; the right testicle and cord were normal, but

there was an acute orchitis in the left. Starting from just in front of

the anal orifice was a fold of skin 1 1/2 inches long and 3/4 inch high

continuous with the rapine, which seemed to be formed of erectile

tissue and which swelled under excitement, the enlargement lasting

several minutes with usually an emission from the rectum. It was

possible to pass a sound through the opening in the rectum to the

bladder through a urethra 1 1/2 inches wide; the patient had control of

the bladder and urinated from every three to five hours.

Many instances of rudimentary development of the penis have been

recorded, most of them complicated with cryptorchism or other

abnormality of the sexual organs. In other instances the organ is

present, but the infantile type is present all through life; sometimes

the subjects are weak in intellect and in a condition similar to

cretinism. Kaufmann quotes a case in a weakly boy of twelve whose penis

was but 3/4 inch long, about as thick as a goose-quill, and feeling as

limp as a mere tube of skin; the corpora cavernosa were not entirely

absent, but ran only from the ischium to the junction of the fixed

portion of the penis, suddenly terminating at this point. Nothing

indicative of a prostate could be found. The testicles were at the

entrance of the inguinal canal and the glans was only slightly

developed.

Binet speaks of a man of fifty-three whose external genitalia were of

the size of those of a boy of nine. The penis was of about the size of

the little finger, and contained on each side testicles not larger than

a pea. There was no hair on the pubes or the face, giving the man the

aspect of an old woman. The prostate was almost exterminated and the

seminal vesicles were very primitive in conformation. Wilson was

consulted by a gentleman of twenty-six as to his ability to perform the

marital function. In size his penis and testicles hardly exceeded those

of a boy of eight. He had never felt desire for sexual intercourse

until he became acquainted with his intended wife, since when he had

erections and nocturnal emissions. The patient married and became the

father of a family; those parts which at twenty-six were so much

smaller than usual had increased at twenty-eight to normal adult size.

There are three cases on record in the older literature of penises

extremely primitive in development. They are quoted by the Ephemerides,

Plater, Schenck, and Zacchias. The result in these cases was impotency.

In the Army and Medical Museum at Washington are two injected specimens

of the male organ divested of skin. From the meatus to the pubis they

measure 6 1/2 and 5 1/2 inches; from the extremity to the termination

of either crus 9 3/4 and 8 3/4 inches, and the circumferences are 4 3/4

and 4 1/4 inches. Between these two we can strike an average of the

size of the normal penis.

In some instances the penis is so large as to forbid coitus and even

inconvenience its possessor, measuring as much as ten or even more

inches in length. Extraordinary cases of large penis are reported by

Albinus (who mentions it as a cause for sterility), Bartholinus,

Fabricius Hildanus, Paullini, Peyer, Plater, Schurig, Sinibaldus, and

Zacchias. Several cases of enormous penises in the new-born have been

observed by Wolff and others.

The penis palme, or suture de la verge of the French, is the name given

to those examples of single cutaneous envelope for both the testicles

and penis; the penis is adherent to the scrotum by its inferior face;

the glans only is free and erection is impossible. Chretien cites an

instance in a man of twenty-five, and Schrumpf of Wesserling describes

an example of this rare anomaly. The penis and testes were inclosed in

a common sac, a slight projection not over 1/4 inch long being seen

from the upper part of this curious scrotum. When the child was a year

old a plastic operation was performed on this anomalous member with a

very satisfactory result. Petit describes an instance in which the

penis was slightly fused with the scrotum.

There are many varieties of torsion of the penis. The glans itself may

be inclined laterally, the curvature may be total, or there may be a

veritable rotation, bringing the inferior face above and the superior

face below. Gay describes a child with epispadias whose penis had

undergone such torsion on its axis that its inferior surface looked

upward to the left, and the child passed urine toward the left

shoulder. Follin mentions a similar instance in a boy of twelve with

complete epispadias, and Verneuil and Guerlin also record cases, both

complicated with associate maldevelopment. Caddy mentions a youth of

eighteen who had congenital torsion of the penis with out hypospadias

or epispadias. There was a complete half-turn to the left, so that the

slit-like urinary meatus was reversed and the frenum was above. Among

the older writers who describe incurvation or torsion of the penis are

Arantius, the Ephemerides, Haenel, Petit, Schurig, Tulpius, and

Zacchias.

Zacutus Lusitans speaks of torsion of the penis from freezing.

Paullini mentions a case the result of masturbation, and Hunter speaks

of torsion of the penis associated with arthritis.

Ossification of the Penis.--MacClellann speaks of a man of fifty-two

whose penis was curved and distorted in such a manner that urine could

not be passed without pain and coitus was impossible. A bony mass was

discovered in the septum between the corpora cavernosa; this was

dissected out with much hemorrhage and the upward curvature was

removed, but there resulted a slight inclination in the opposite

direction. The formation of bone and cartilage in the penis is quite

rare. Velpeau, Kauffmann, Lenhoseck, and Duploy are quoted by Jacobson

as having seen this anomaly. There is an excellent preparation in

Vienna figured by Demarquay, but no description is given. The

Ephemerides and Paullini describe osseous penises.

The complete absence of the frenum and prepuce has been observed in

animals but is very rare in man. The incomplete or irregular

development is more frequent, but most common is excessive development

of the prepuce, constituting phimosis, when there is abnormal adherence

with the glans. Instances of phimosis, being quite common, will be

passed without special mention. Deficient or absent prepuce has been

observed by Blasius, Marcellus Donatus, and Gilibert. Partial

deficiency is described by Petit Severinus, and others.

There may be imperforation or congenital occlusion of some portion of

the urethra, causing enormous accumulation of urine in the bladder, but

fortunately there is generally in such cases some anomalous opening of

the urethra giving vent to the excretions. Tulpius mentions a case of

deficient urethra. In the Ephemerides there is an account of a man who

had a constant flow of semen from an abnormal opening in the abdomen.

La Peyroma describes a case of impotence due to ejaculation of the

spermatic ducts into the bladder instead of into the urethra, but

remarks that there was a cicatrix of a wound of the neighboring parts.

There are a number of instances in which the urethra has terminated in

the rectum. Congenital dilatation of the urethral canal is very rare,

and generally accompanied by other malformation.

Duplication of the urethra or the existence of two permeable canals is

not accepted by all the authors, some of whom contend that one of the

canals either terminates in a culdesac or is not separate in itself.

Verneuil has published an article clearly exposing a number of cases,

showing that it is possible for the urethra to have two or more canals

which are distinct and have separate functions. Fabricius Hildanus

speaks of a double aperture to the urethra; Marcellus Donatus describes

duplicity of the urethra, one of the apertures being in the testicle;

and there is another case on record in which there was a urethral

aperture in the groin. A case of double urethra in a man of twenty-five

living in Styria who was under treatment for gonorrhea is described,

the supernumerary urethra opening above the natural one and receiving a

sound to the depth of 17 cm. There was purulent gonorrhea in both

urethrae. Vesalius has an account of a double urethral aperture, one of

which was supposed to give spermatic fluid and the other urine.

Borellus, Testa, and Cruveilhier have reported similar instances.

Instances of double penis have been discussed under the head of

diphallic terata, page 194.

Hypospadias and epispadias are names given to malformations of the

urethra in which the wall of the canal is deficient either above or

below. These anomalies are particularly interesting, as they are nearly

always found in male hermaphrodites, the fissure giving the appearance

of a vulva, as the scrotum is sometimes included, and even the perineum

may be fissured in continuity with the other parts, thus exaggerating

the deception. There seems to be an element of heredity in this

malformation, and this allegation is exemplified by Sedgwick, who

quotes a case from Heuremann in which a family of females had for

generations given birth to males with hypospadias. Belloc mentions a

man whose urethra terminated at the base of the frenum who had four

sons with the same deformity. Picardat mentions a father and son, both

of whom had double urethral orifices, one above the other, from one of

which issued urine and from the other semen--a fact that shows the

possibility of inheritance of this malformation. Patients in whom the

urethra opens at the root of the penis, the meatus being imperforate,

are not necessarily impotent; as, for instance, Fournier knew of a man

whose urethra opened posteriorly who was the father of four children.

Fournier supposed that the semen ejaculated vigorously and followed the

fissure on the back of the penis to the uterus, the membrane of the

vagina supplanting the deficient wall of the urethra. The penis was

short, but about as thick as ordinary.

Gray mentions a curious case in a man afflicted with hypospadias who,

suffering with delusions, was confined in the insane asylum at Utica.

When he determined to get married, fully appreciating his physical

defect, he resolved to imitate nature, and being of a very ingenious

turn of mind, he busied himself with the construction of an artificial

penis. While so engaged he had seized every opportunity to study the

conformation of this organ, and finally prepared a body formed of

cotton, six inches in length, and shaped like a penis, minus a prepuce.

He sheathed it in pig's gut and gave it a slight vermilion hue. To the

touch it felt elastic, and its shape was maintained by a piece of

gutta-percha tubing, around which the cotton was firmly wound. It was

fastened to the waist-band by means of straps, a central and an upper

one being so arranged that the penis could be thrown into an erect

position and so maintained. He had constructed a flesh-colored covering

which completely concealed the straps. With this artificial member he

was enabled to deceive his wife for fifteen months, and was only

discovered when; she undressed him while he was in a state of

intoxication. To further the deception he had told his wife immediately

after their marriage that it was quite indecent for a husband to

undress in the presence of his wife, and therefore she had always

retired first and turned out the light. Partly from fear that his

virile power would be questioned and partly from ignorance, the

duration of actual coitus would approach an hour. When the discovery

was made, his wife hid the instrument with which he had perpetrated a

most successful fraud upon her, and the patient subsequently attempted

coitus by contact with unsuccessful results, although both parties had

incomplete orgasms. Shortly afterward evidences of mental derangement

appeared and the man became the subject of exalted delusions. His wife,

at the time of report, had filed application for divorce. Haslam

reports a case in which loss of the penis was compensated for by the

use of an ivory succedaneum. Parallel instances of this kind have been

recorded by Ammann and Jonston.

Entire absence of the male sexual apparatus is extremely rare, but

Blondin and Velpeau have reported cases.

Complete absence of the testicles, or anorchism, is a comparatively

rare anomaly, and it is very difficult to distinguish between anorchism

and arrest of development, or simple atrophy, which is much more

common. Fisher of Boston describes the case of a man of forty-five, who

died of pneumonia. From the age of puberty to twenty-five, and even to

the day of death, his voice had never changed and his manners were

decidedly effeminate. He always sang soprano in concert with females.

After the age of twenty-five, however, his voice became more grave and

he could not accompany females with such ease. He had no beard, had

never shaved, and had never exhibited amorous propensities or desire

for female society. When about twenty-one he became associated with a

gay company of men and was addicted to the cup, but would never visit

houses of ill-fame. On dissection no trace of testicles could be found;

the scrotum was soft and flabby. The cerebellum was the exact size of

that of a female child.

Individuals with one testicle are called monorchids, and may be divided

into three varieties:--

(1) A solitary testicle divided in the middle by a deep fissure, the

two lobes being each provided with a spermatic cord on the same side as

the lobe.

(2) Testicles of the same origin, but with coalescence more general.

(3) A single testicle and two cords.

Gruber of St. Petersburg held a postmortem on a man in January, 1867,

in whom the right half of the scrotum, the right testicle, epididymis,

and the scrotal and inguinal parts of the right vas deferens were

absent. Gruber examined the literature for thirty years up to the time

of his report, and found 30 recorded postmortem examinations in which

there was absence of the testicle, and in eight of these both testicles

were missing. As a rule, natural eunuchs have feeble bodies, are

mentally dull, and live only a short time. The penis is ordinarily

defective and there is sometimes another associate malformation. They

are not always disinclined toward the opposite sex.

Polyorchids are persons who have more than two testicles. For a long

time the abnormality was not believed to exist, and some of the

observers denied the proof by postmortem examination of any of the

cases so diagnosed, but there is at present no doubt of the

fact,--three, four, and five testicles having been found at autopsies.

Russell, one of the older writers on the testicle, mentions a monk who

was a triorchid, and was so salacious that his indomitable passion

prevented him from keeping his vows of chastity. The amorous

propensities and generative faculties of polyorchids have always been

supposed greater than ordinary. Russell reports another case of a man

with a similar peculiarity, who was prescribed a concubine as a

reasonable allowance to a man thus endowed.

Morgagni and Meckel say that they never discovered a third testicle in

dissections of reputed triorchids, and though Haller has collected

records of a great number of triorchids, he has never been able to

verify the presence of the third testicle on dissection. Some authors,

including Haller, have demonstrated heredity in examples of

polyorchism. There is an old instance in which two testicles, one above

the other, were found on the right side and one on the left. Macann

describes a recruit of twenty, whose scrotum seemed to be much larger

on the right than on the left side, although it was not pendulous. On

dissection a right and left testicle were found in their normal

positions, but situated on the right side between the groin and the

normal testicle was a supernumerary organ, not in contact, and having a

separate and short cord. Prankard also describes a man with three

testicles. Three cases of triorchidism were found in recruits in the

British Army. Lane reports a supernumerary testis found in the right

half of the scrotum of a boy of fifteen. In a necropsy held on a man

killed in battle, Hohlberg discovered three fully developed testicles,

two on the right side placed one above the other. The London Medical

Record of 1884 quotes Jdanoff of St. Petersburg in mentioning a

soldier of twenty-one who had a supernumerary testicle erroneously

diagnosed as inguinal hernia. Quoted by the same reference, Bulatoff

mentions a soldier who had a third testicle, which diagnosis was

confirmed by several of his confreres. They recommended dismissal of

the man from the service, as the third testicle, usually resting in

some portion of the inguinal canal, caused extra exposure to traumatic

influence.

Venette gives an instance of four testicles, and Scharff, in the

Ephemerides, mentions five; Blasius mentions more than three testicles,

and, without citing proof, Buffon admits the possibility of such

occurrence and adds that such men are generally more vigorous.

Russell mentions four, five, and even six testicles in one individual;

all were not verified on dissection. He cites an instance of six

testicles four of which were of usual size and two smaller than

ordinary.

Baillie, the Ephemerides, and Schurig mention fusion of the testicles,

or synorchidism, somewhat after the manner of the normal disposition of

the batrachians and also the kangaroos, in the former of which the

fusion is abdominal and in the latter scrotal. Kerckring has a

description of an individual in whom the scrotum was absent.

In those cases in which the testicles are still in the abdominal cavity

the individuals are termed cryptorchids. Johnson has collected the

results of postmortem examinations of 89 supposed cryptorchids. In

eight of this number no testicles were found postmortem, the number

found in the abdomen was uncertain, but in 18 instances both testicles

were found in the inguinal canal, and in eight only one was found in

the inguinal canal, the other not appearing. The number in which the

semen was examined microscopically was 16, and in three spermatozoa

were found in the semen; one case was dubious, spermatozoa being found

two weeks afterward on a boy's shirt. The number having children was

ten. In one case a monorchid generated a cryptorchid child. Some of the

cryptorchids were effeminate, although others were manly with good

evidences of a beard. The morbid, hypochondriac, the voluptuous, and

the imbecile all found a place in Johnson's statistics; and although

there are evidences of the possession of the generative function,

still, we are compelled to say that the chances are against fecundity

of human cryptorchids. In this connection might be quoted the curious

case mentioned by Geoffroy-Saint-Hilaire, of a soldier who was hung for

rape. It was alleged that no traces of testicles were found externally

or internally yet semen containing spermatozoa was found in the seminal

vesicles. Spermatozoa have been found days and weeks after castration,

and the individuals during this period were capable of impregnation,

but in these cases the reservoirs were not empty, although the spring

had ceased to flow. Beigel, in Virchow's Archives, mentions a

cryptorchid of twenty-two who had nocturnal emissions containing

spermatozoa and who indulged in sexual congress. Partridge describes a

man of twenty-four who, notwithstanding his condition, gave evidences

of virile seminal flow.

In some cases there is anomalous position of the testicle. Hough

mentions an instance in which, from the great pain and sudden

appearance, a small tumor lying against the right pubic bone was

supposed to be a strangulated hernia. There were two well-developed

testicles in the scrotum, and the hernia proved to be a third. McElmail

describes a soldier of twenty-nine, who two or three months before

examination felt a pricking and slight burning pain near the internal

aperture of the internal inguinal canal, succeeded by a swelling until

the tumor passed into the scrotum. It was found in the upper part of

the scrotum above the original testicle, but not in contact, and was

about half the size of the normal testicle; its cord and epididymis

could be distinctly felt and caused the same sensation as pressure on

the other testicle did.

Marshall mentions a boy of sixteen in whom the right half of the

scrotum was empty, although the left was of normal size and contained a

testicle. On close examination another testicle was found in the

perineum; the boy said that while running he fell down, four years

before, and on getting up suffered great pain in the groin, and this

pain recurred after exertion. This testicle was removed successfully to

the scrotum. Horsley collected 20 instances of operators who made a

similar attempt, Annandale being the first one; his success was likely

due to antisepsis, as previously the testicles had always sloughed.

There is a record of a dog remarkable for its salacity who had two

testicles in the scrotum and one in the abdomen; some of the older

authors often indulged in playful humor on this subject.

Brown describes a child with a swelling in the perineum both painful

and elastic to the touch. The child cried if pressure was applied to

the tumor and there was every evidence that the tumor was a testicle.

Hutcheson, quoted by Russell, has given a curious case in an English

seaman who, as was the custom at that time, was impressed into service

by H.M.S. Druid in 1807 from a trading ship off the coast of Africa.

The man said he had been examined by dozens of ship-surgeons, but was

invariably rejected on account of rupture in both groins. The scrotum

was found to be an empty bag, and close examination showed that the

testicles occupied the seats of the supposed rupture. As soon as the

discovery was made the man became unnerved and agitated, and on

re-examining the parts the testicles were found in the scrotum. When

he found that there was no chance for escape he acknowledged that he

was an impostor and gave an exhibition in which, with incredible

facility, he pulled both testes up from the bottom of the scrotum to

the external abdominal ring. At the word of command he could pull up

one testicle, then another, and let them drop simultaneously; he

performed other like feats so rapidly that the movements could not be

distinguished.

In this connection Russell speaks of a man whose testicle was elevated

every time the east wind blew, which caused him a sense of languor and

relaxation; the same author describes a man whose testicles ascended

into the inguinal canal every time he was in the company of women.

Inversion of the testicle is of several varieties and quite rare, it

has been recognized by Sir Astley Cooper, Boyer, Maisonneuve, Royet,

and other writers.

The anomalies of the vas deferens and seminal vesicles are of little

interest and will be passed with mention of the case of Weber, who

found the seminal vesicles double; a similar conformation has been seen

in hermaphrodites.

CHAPTER VII.

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