392 GYNECOLOGY 



brought to bear on the ovum which can in any way determine sex. 

 The mammalian ovum developing in the uterus seems to enjoy 

 such a sheltered existence that it is impossible to conceive that 

 changes may be induced in its environment comparable to those 

 which have been experimentally introduced in the study of ovums 

 and embryos of low vertebrate and invertebrate forms of life. Indeed, 

 it would seem that the most satisfactory theory of sex-determina- 

 tion in the higher vertebrates is that which supposes the existence 

 of two forms of ovums one destined to maleness and the other to 

 femaleness, though it is impossible to establish any such differentia- 

 tion by microscopic study or chemic analysis. The elaborate work 

 of von Lenhossek, recently published, strongly favors this view 

 that sex is fixed in the ovum before the spermatozoon fertilizes it. 

 If such be the case it is quite futile to expect that any alteration may 

 be brought about by dietetic or other influences made to affect 

 the human female either before or during gestation. 



In this connection it is interesting to refer to the question of the 

 occurrence of true hermaphroditism in the human species. Many 

 hold that this has never been demonstrated. Nagel, for example, 

 states that it probably cannot exist, and holds that the ovary is 

 never found with the testes in cases of so-called hermaphroditism. 

 Recently, however, Sarre has described the case of an individual 

 with the external configuration of a woman, who possessed a well- 

 developed imperf orate penis. On making a rectal examination, two 

 small bodies, each the size of a pigeon's egg, could be felt in the left 

 half of the pelvis, while in the right inguinal canal an ovoid body 

 was found. An exploratory incision was made over the latter and the 

 swelling removed, along wdth a smaller mass attached to it. Micro- 

 scopic examination proved these to be testicular structure and 

 epididymis. Another small mass near the testicle was also examined 

 and found to be ovarian tissue. A Fallopian tube and a structure 

 resembling the vas deferens were also present. Sarre believes that, 

 with the exception of another case described by Ziegler, all other 

 records of true human hermaphroditism are very doubtful, though 

 he thinks it has been clearly demonstrated in some lower mammals, 

 e. g., the pig. 



The Structure of the Ovary. In spite of the immense amount of 

 investigation to which this organ has been subjected, many points 

 in its development, normal and pathologic histology, still require 

 elucidation. It is generally agreed that the ovary is developed from 

 epiblast and mesoblast on the inner surface of the Wolffian body. 

 The epiblast, a specialized portion of the celomic lining, very early 

 forms a mass consisting of several layers of cells, the germinal 

 epithelium. In the deepest portions certain of these cells increase 

 in size, giving rise to the primordial ovums. The latter are all formed 



