Hermaphroditism.

  • Simpson, James Young, 1811-1870.
Date:
1839
Catalogue details

Licence: Public Domain Mark

Credit: Hermaphroditism. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    these bodies. Further, the effects which this supposed morbid influence exercises directly upon the embryonic ovaries and testicles, and indirectly through them, upon the rest of the genital apparatus, and consequently the modi- fications of sexual structure which it produces, may possibly be much varied according to its extent, duration, and nature, and according to the particular period of development at which it comes into action. It is evident that this ex- planation of hermaphroditism can only refer to the varieties of the malformation which consist of an imperfection or deficiency in the development, and cannot apply to those in- stances in which there is a superaddition of sexual organs. If, however, we can once satisfy ourselves that any set of cases whatever are traceable to a morbid action affecting the testicles or ovaries of the early embryo, our investigations into the causes of these cases will necessarily be much simplified, for our inquiries would be reduced from a vague and indefinite search after the production of a num- ber of anomalies of structure affecting several different organs at the same time, to an attempt to trace out the nature of those morbid condi- tions to which the embryonic testicles and ovaries were subject, and which were capable of so far changing the structure and action of these organs as to give rise to the effects in question. Of the diseased states, however, to which the reproductive and other organs of the system are liable during the progress of their early development, we at present know little or nothing, although in the investigation of this subject a key, we believe, may possibly be yet found to the explanation of many of those malformations to which different parts of the body are subject. Osiander* and Dugesf have suggested that the variety of spurious hermaphroditism which consists of a division of the peri- naeum in the male, may be produced me- chanically in the embryo by the preterna- tural accumulation of fluid in the urinary canal, on account, of an imperforate state of the urethra, and the consequent distension and ultimate rupture of the urethra, &c. From cases published by Sandifort, Howship, Bil- lard, and many others, we are now fully aware of the fact that all the urinary canals of the foetus in utero are occasionally found morbidly distended with a fluid, which, according to the interesting observations of Dr. Robert Lee, J would appear to possess the more character- istic qualities of urine. We have dissected one case in which the dilated foetal bladder was as large as an orange, and have seen in the Anatomical Museum of Dr. William Hunter at Glasgow the preparation of another instance in which the bladder of a full-grown foetus was dilated to the size of that of the adult subject. In one case mentioned by Dr. Mer- riman, the distended organ contained half a * Neue Denkw. fur Aertzte und Geburtsh, Bd. i. t. 264, 267. t Ephem. Med. de Montpellier, t. v. p. 17, 45, and 52. I London Med.-Chirurg. Trans, vol. xix. pint of urine,* and in another detailed by Mr. ream it was capable of containing as much as two quarts of fluid.f It is not impossible that the causes in ques- tion,—namely, the obliteration of the urethra and the consequent distention of all the urinary passages, and probably also of the sexual canals communicating with these passages,— may occasionally produce in the male embryo a re-opening of theperinaeal fissure, giving thus to the external parts the appearance of a female vulva, and perhaps at the same time may lead to the retention and imperfect development of the testicles by the distention of their ducts, and the unusual compression to which these organs may be subjected. Indeed we have satisfactory evidence, in a few instances, that such a cause may have been in operation, by our detecting the other acknowledged effects of the urinary accumulation in question,—such as preternaturally dilated ureters, and a cystic form of the infundibula of the kidneys, as in a case of hermaphroditism given by Mayer, in a human foetus,! in the kid described by Haller,§ and in the child whose case we have already quoted from Steghlener. (See trans- verse hermaphroditism.) At the same time the total absence of these collateral proofs in most other cases of hypo- spadias, our knowledge of the fact that the perinaeal aperture is in some cases never shut, and the difficulty of conceiving the possibility of its being re-opened when once it is firmly closed, are perhaps sufficient to shew that the cause or causes alluded to produce in but few if any instances the effect here attributed to them. We deem it not uninteresting to point out in this place, under the question of the origin of hermaphroditic malformations, a circumstance which has struck us in considering one or two of the cases in which the sexual apparatus of one side of the body was more imperfectly developed than that of other, viz. that the opposite side of the encephalon was at the same time defectively formed. Thus in the case of Charles Durge, on the right side of whose body there was a well-formed testi- cle, and on the left an imperfect ovary, the right hemispheres of the cerebrum and cere- bellum, but particularly of the latter, were found by Professor Mayer to be smaller and less developed than the left, and the left side of the occiput was externally more prominent than the right. The same author, in the ac- count of his case of hermaphroditism in a erson of eighteen years of age, which we ave previously quoted,|| and where there was an imperfect testicle, &c. on the right side, but no trace of testicle or ovary in the left, inci- dentally mentions that the right side of the cranium was somewhat prominent,—“ dextra pars cranii paullulo prominet,” in correspon- * London Med. and Phys. Journ. vol. xxv. p. 279. f Lancet for 1834-35, p. 178. j See p. 8, of leones, &c. S Comment. Soc. Reg. Sc. Gotting. tom, i. p. 2. || leones, p. 12.