BOOK II. QUESTIONS ARISING OUT OF THE DIFFERENCE OF SEX CHAPTER I. DOUBTFUL SEX. 146. Definition of hermaphroditism. 152. True tubular. 153. True glandular. 153a. In animals. 154. Embryological objections. 155. Absence of sexual organs. 156. General comments. 146. Definition of hermaphroditism. The word "hermaphroditism," which at one time was used to describe the union of the organs of both sexes in one individual, is now generally applied to all those cases in which doubts exist concerning the real sex, in consequence of some aberration from the normal type of the genital organs. The word can no longer be used in its original acceptation, for most certainly there is no authentic case of self-impregnation recorded, nor even of the association of the generative functions of both sexes in one person.1 The cause of these deviations from the usual form may be found in the earlier stages of embryonic development; but an exposi plished more or less completely in these cases of hermaphroditism. Such cases are referred to in the sections on pseudohermaphroditism. See § 148, infra. 'While the generative functions of sexual perversions, but are accomthe two sexes are always distinct, there are many cases known where the one person may take either the active or the passive part in the connection. Such instances are not merely limited to the tion of the present state of medical knowledge relative to the processes of faulty evolution would here be out of place. 147. Pseudo-hermaphrodites, in general. The practical question which we have to determine is, How far is it possible to discriminate the true sex of a living person? The solution of it is attended with no little difficulty, and in some cases is indeed impossible. The physician will be chiefly embarrassed in the case of children, since the important indications derivable from the general as well as local sexual development will be wanting. It should not be forgotten that even after death a positive opinion is, in some cases of hermaphroditism, hardly warranted by the most careful anatomical inspection. The male and female sexual organs, imperfect in development although distinctive in character, may be so evenly distributed that it will not be possible to know which predominate. Or, on the other hand, the traces of sexual organs may be so indistinct that we can give them no appropriate sexual name. Hence the reader will perceive how much more excusable is reserve in pronouncing an opinion upon the sex of a living person, the essential generative organs being concealed from our observation. We can only hope to approximate to the truth, by observing whether there is not some regularity in the freaks of nature, and thus discover, if possible, some uniform correspondence between the visible deviations and those which are hidden from our view. With this object, the cases of hermaphroditism may be divided into the apparent and real, besides which there is a certain number in which literally no sexual organs exist. In the cases of apparent or false hermaphroditism, either male or female character predominates in the external organs of generation, but the former much more frequently. 148. Male pseudo-hermaphrodites.-In male hermaphrodites the only anomaly is external, the internal organs having their natural conformation and development. The penis exists, more or less developed, with an urethra either normal or opening at variable distances between the glans and the pubes,-a condition which is called "hypospadias." The scrotum is divided or cleft, and thus presents a resemblance to the vulva, but neither nymphæ nor vagina are found, although not unfrequently there is a shallow depression or cul-de-sac between these false labia, which is lined with a delicate skin, and bears no very distant resemblance to the vaginal entrance. The testes are found on each side of the divided scrotum. The history of a supposed female named Marie Rosine Göttliche is related, who had been in the practice of cohabiting with the male sex. His genital organs were formed in the manner here described.2 Nägele gives a case of twins who were considered as female until their seventeenth year. At this time it was discovered that they were male, the penis being imperforate, and the divided scrotum resembling a vulva, but containing a testis on each side. The case of Adelaide Préville, who lived in the married state for a long time and on good terms with her husband, is related in full by St. Hilaire, with a number of other cases which will also fall under the above general description. Persons with these malformations are not necessarily, though frequently, impotent. Sometimes the only deficiency observable in this class is the absence of the testes from their usual location. But, in this case, the testes are not really absent, but have remained in the abdomen, instead of descending, as is usual, in the ninth month of fetal existence. In the case of persons in this condition, the power of procreation is unaffected, provided the testes are healthy. This anatomical defect is very rare. Siebold states that of 37,000 recruits in Würtemberg, only twenty-four were found in whom the testes had not descended." 5 149. Female pseudo-hermaphrodites. By far the greater number of these owe the doubts concerning their sex to an unusual size of the clitoris. Commonly associated with this circumstance are an unfeminine appearance, more or less beard, and a rough and masculine voice and manner; although the sexual desires of these persons are violent, they are usually barren. The usual length of the clitoris in the adult female is about half an inch, but Remer mentions having seen a clitoris an inch long in a girl seven years of age, and Home,7 one of two inches long and as thick as the thumb, in a negress twenty years old. In addition to this hypertrophied condition of the clitoris, an imperfect urethra with one or more openings is often found, and, at the same time, a constriction of the vagina to such a degree that it becomes almost imperforate. Such was the anatomical condition in Marie Lefort; she had menstruated regularly from the age of eight years until her death at thirty; the existence of a uterus was clearly established. Her voice was masculine, and she had a thick and strong beard. Sir Astley Cooper examined the body of a charwoman, aged eighty-six years, who presented these deviations. He says she differed from other women in the magnitude and length of the clitoris, in the absence of the external orifice of the vagina, which began in the Casper's Wochenschrift, 1833, No. 3. potency. Siebold's Handbuch, p. 82. 'Philos. Trans. 1799, p. 163. St. Hillire, Hist. des Anomalies, t. II., p. 74, and Debierre, Arch. de l'Anthropologie criminelle et des Sciences Pénales, 1886, I., p. 314. urethra itself, and in the imperfect development of the ovaries. A woman twenty-five years of age, on account of her notorious commerce with both sexes, was placed under strict police supervision. Resorting to masturbation, her health became so much impaired that she died in the course of sixteen months. The external genitals were found to have their natural conformation, with the exception of the clitoris, which was three and a half inches long and three inches in circumference, and imperforate, except at the base. The uterus and one ovary were rudimentary, and the general conformation of the breasts was masculine, although, owing to the occurrence of a trifling periodical discharge, she was considered to be a woman. It was proved that this person had been guilty of the most astonishing and unnatural excesses with young people of both sexes.10 A child described by Mr. E. Smith may be placed in the same class, as all the female organs were complete; the only anomaly being that the urethra opened in two places, and the clitoris bore some resemblance to the penis.11 In a black female subject, dissected by Dr. Jno. Neill, the clitoris was five inches long and one inch in diameter, and resembled a penis, except that it was not traversed by a perfect urethra. The perineal opening was not larger in diameter than a catheter of average size, and the vagina was extremely narrow. On one side of the penis existed what appeared to be a scrotum, but which contained an irreducible omental hernia. This gave the feel of a testicle, but no true glandular structure or excretory tube could be detected. The internal organs were completely female, although not completely developed. The general habitus was feminine.12 A very similar case is reported by Dr. F. L. Parker.18 The subject of it was of the negro race, was regarded as a man, bred as a cooper, and had been married as a man. The genital organs were exclusively those of a female, except the clitoris, which measured, after death, an inch and threequarters externally, and in its entire length five inches. A perfect analogous example in which the clitoris was from two to three inches in length, is reported by Dr. J. Mason Warren. The subject was of Irish birth, bore a man's name, and had a masculine appearance.14 Dr. Bainbridge has reported the case of a female whose clitoris was five inches in length and of the diameter of the quiescent penis of an adult. This malformation was discovered while the woman was in labor.15 Mr. Wells has described the case of a person in whom the general external organs were those of a hypospadic male; but there were no testes, and a small uterus and one ovary existed.16 The case related by Dr. Mayer, of Bonn, which gave rise to much discussion, and which is usually classed among the cases of mixed sex, may with more reason, we think, be placed under this head. The only male organs were a (so-called) penis, which was only two inches long, imperforate, and partly concealed under the mons veneris. On the other hand, the orifice of the urethra was situated as in the female, there was a large vagina, a uterus with its appendages, and a defective ovarium on one side, and (what is called) a withered testis on the other. We cannot avoid holding some doubts concerning this lastmentioned organ. From the absence of any account of the seminal tubes, deferent vessels, or seminal vesicles, and the evidently rudimentary nature of this body, it might as properly have been termed an ovary. This supposition would, moreover, have been favored by its position. However this may be, it is evident that the female character greatly predominated. When twenty years of age, this person menstruated on three different occasions.17 The case of Badaloni, reported18 in 1895, is associated with considerable medico-legal interest. The husband sought to obtain a divorce from Maura Faustina, who he said was a male, acting as his wife. The husband complained that his wife lay with other women and made him subject of ridicule before his acquaintances. The divorce was granted, and then Maura, in his right as a male, demanded of his brother one half of the property of his deceased father, till then held by his brother. The brother refused, and brought a counter charge of seduction of his wife by the "Lond. Times and Gaz., Jan. 1860, happily with her first two husbands, but P. 45. 16Ibid., Feb. 1860, p. 177. "Neugebauer collected records of sixty-eight marriages between persons of the same sex. In fifty-nine cases the supposed woman was a man. He also notes several instances in which the person of doubtful sex was required to change sex several times. One such was Anne Grandjean, who, until fourteen, was considered as a girl; then she assumed male characteristics and male attire and was married as a man. She had no children and later the marriage was annulled, but she was permitted to live as a woman. Otto reported a very interesting case of Kuluza, who lived the third said that she was a man, and asked to be divorced. The two previous husbands had found nothing the matter with her, and the physician who was called in to make an examination decided that she was a woman. The case was appealed, and finally it was decided that she was a woman. Josephine Marzo was baptized as a girl, at puberty considered a boy, and the sex changed, and as such she lived. The necropsy, at an advanced age, proved however, that she was a female. See Neugebauer, British Gynæcological Journal, Nov. 1903, p. 227. 19 Badaloni, Gazzetta degli ospitali, Milano, July 29, 1895. |