734 



HERMAPHRODITISM. 



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 praeterna- 

 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 Deukw. fur Aertzte und Geburtsh, Bd. i. 

 t. 264, 267. 



t Ephem. Med. de Montpellier, t. v. p. 17. 45. 

 and 52. 



t London Med.-Chirurg. Trans, vol. xix. 



pint of urine,* and in another detailed by Mr. 

 Fearn 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 witVi these passages, 

 may occasionally produce in the male embryo 

 a re-opening of the perinseal 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 

 person of eighteen years of age, which we 

 have 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. 



$ See p. 8, of Icones, &c. 



Comment. Soc. Reg. Sc. Getting, torn. i. p. 2. 



j| Icones, p. 12. 



