anomalies and curiosities of medicine-第50部分

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well…shaped　labia　as　shown　by　the　accompanying　illustration。　She　menstruated　slightly　and　had　an　opening　at　the　root　of　the　clitoris。　The　parotid　region　showed　signs　of　a　beard　and　she　had　hair　on　her　upper　lip。　On　August　20；　1864；　a　person　came　into　the　Hotel…Dieu；　asking　treatment　for　chronic　pleurisy。　He　said　his　age　was　sixty…five；　and　he　pursued　the　calling　of　a　mountebank；　but　remarked　that　in　early　life　he　had　been　taken　for　a　woman。　He　had　menstruated　at　eight　and　had　been　examined　by　doctors　at　sixteen。　The　menstruation　continued　until　1848；　and　at　its　cessation　he　experienced　the　feelings　of　a　male。　At　this　time　he　presented　the　venerable　appearance　of　a　long…bearded　old　man。　At　the　autopsy；　about　two　months　later；　all　the　essentials　of　a　female　were　delineated。　A　Fallopian　tube；　ovaries；　uterus；　and　round　ligaments　were　found；　and　a　drawing　in　cross…section　of　the　parts　was　made。　There　is　no　doubt　but　that　this　individual　was　Marie…Madeline　Lefort　in　age。


Worbe　speaks　of　a　person　who　was　supposed　to　be　feminine　for　twenty…two　years。　At　the　age　of　sixteen　she　loved　a　farmer's　son；　but　the　union　was　delayed　for　some　reason；　and　three　years　later　her　grace　faded　and　she　became　masculine　in　her　looks　and　tastes。　It　was　only　after　lengthy　discussion；　in　which　the　court　took　part；　that　it　was　definitely　settled　that　this　person　was　a　male。

Adelaide　Preville；　who　was　married　as　a　female；　and　as　such　lived　the　last　ten　years　of　her　life　in　France；　was　found　on　dissection　at　the　Hotel…Dieu　to　be　a　man。　A　man　was　spoken　of　in　both　France　and　Germany　a　who　passed　for　many　years　as　a　female。　He　had　a　cleft　scrotum　and　hypospadias；　which　caused　the　deception。　Sleeping　with　another　servant　for　three　years；　he　constantly　had　sexual　congress　with　her　during　this　period；　and　finally　impregnated　her。　It　was　supposed　in　this　case　that　the　posterior　wall　of　the　vagina　supplied　the　deficiency　of　the　lower　boundary　of　the　urethra；　forming　a　complete　channel　for　the　semen　to　proceed　through。　Long　ago　in　Scotland　a　servant　was　condemned　to　death　by　burial　alive　for　impregnating　his　master's　daughter　while　in　the　guise　and　habit　of　a　woman。　He　had　always　been　considered　a　woman。　We　have　heard　of　a　recent　trustworthy　account　of　a　pregnancy　and　delivery　in　a　girl　who　had　been　impregnated　by　a　bed…fellow　who　on　examination　proved　to　be　a　male　pseudohermaphrodite。

Fournier　speaks　of　an　individual　in　Lisbon　in　1807　who　was　in　the　highest　degree　graceful；　the　voice　feminine；　the　mammae　well　developed；　The　female　genitalia　were　normal　except　the　labia　majora；　which　were　rather　diminutive。　The　thighs　and　the　pelvis。　were　not　so　wide　as　those　of　a　woman。　There　was　some　beard　on　the　chin；　but　it　was　worn　close。　the　male　genitalia　were　of　the　size　and　appearance　of　a　male　adult　and　were　covered　with　the　usual　hair。　This　person　had　been　twice　pregnant　and　aborted　at　the　third　and　fifth　month。　During　coitus　the　penis　became　erect；　etc。

Schrell　describes　a　case　in　which；　independent　of　the　true　penis　and　testicles；　which　were　well　formed；　there　existed　a　small　vulva　furnished　with　labia　and　nymphae；　communicating　with　a　rudimentary　uterus　provided　with　round　ligaments　and　imperfectly　developed　ovaries。　Schrell　remarks　that　in　this　case　we　must　notice　that　the　female　genitalia　were　imperfectly　developed；　and　adds　that　perfect　hermaphroditism　is　a　physical　impossibility　without　great　alterations　of　the　natural　connections　of　the　bones　and　other　parts　of　the　pelvis。　Cooper　describes　a　woman　with　an　enormous　development　of　the　clitoris；　an　imperforate　uterus；　and　absence　of　vagina；　at　first　sight　of　the　parts　they　appeared　to　be　those　of　a　man。

In　1859　Hugier　succeeded　in　restoring　a　vagina　to　a　young　girl　of　twenty　who　had　an　hypertrophied　clitoris　and　no　signs　of　a　vagina。　The　accompanying　illustrations　show　the　conformation　of　the　parts　before　operation　with　all　the　appearance　of　ill…developed　male　genitalia；　and　the　appearance　afterward　with　restitution　of　the　vaginal　opening。

Virchow　in　1872；　Boddaert　in　1875；　and　Marchand　in　1883　report　cases　of　duplication　of　the　genitalia；　and　call　their　cases　true　hermaphrodites　from　an　anatomic　standpoint。　There　is　a　specimen　in　St。　Bartholomew's　Hospital　in　London　from　a　man　of　forty…four；　who　died　of　cerebral　hemorrhage。　He　was　well　formed　and　had　a　beard　and　a　full…sized　penis。　He　was　married；　and　it　was　stated　that　his　wife　had　two　children。　The　bladder　and　the　internal　organs　of　generation　were　those　of　a　man　in　whom　neither　testis　had　descended　into　the　scrotum；　and　in　whom　the　uterus　masculinus　and　vagina　were　developed　to　an　unusual　degree。　The　uterus；　nearly　as　large　as　in　the　adult　female；　lay　between　the　bladder　and　rectum；　and　was　enclosed　between　two　layers　of　peritoneum；　to　which；　on　either　side　of　the　uterus；　were　attached　the　testes。　There　was　also　shown　in　London　the　pelvic　organs　from　a　case　of　complex　or　vertical　hermaphroditism　occurring　in　a　child　of　nine　months　who　died　from　the　effects　of　an　operation　for　the　radical　cure　of　a　right　inguinal　hernia。　The　external　organs　were　those　of　a　male　with　undescended　testes。　The　bladder　was　normal　and　its　neck　was　surrounded　by　a　prostate　gland。　Projecting　backward　were　a　vagina；　uterus；　and　broad　ligaments；　round　ligaments；　and　Fallopian　tubes；　with　the　testes　in　the　position　of　the　ovaries。　There　were　no　seminal　vesicles。　The　child　died　eleven　days　after　the　operation。　The　family　history　states　that　the　mother　had　had　14　children　and　eight　miscarriages。　Seven　of　the　children　were　dead　and　showed　no　abnormalities。　The　fifth　and　sixth　children　were　boys　and　had　the　same　sexual　arrangement。

Barnes；　Chalmers；　Sippel；　and　Litten　describe　cases　of　spurious　hermaphroditism　due　to　elongation　of　the　clitoris。　In　Litten's　case　a　the　clitoris　was　3　1/2　inches　long；　and　there　was　hydrocele　of　the　processus　vaginalis　on　both　sides；　making　tumors　in　the　labium　on　one　side　and　the　inguinal　canal　on　the　other；　which　had　been　diagnosed　as　testicles　and　again　as　ovaries。　There　was　associate　cystic　ovarian　disease。　Plate　4　is　taken　from　a　case　of　false　external　bilateral　hermaphroditism。　Phillips　mentions　four　cases　of　spurious　hermaphroditism　in　one　family；　and　recently　Pozzi　tells　of　a　family　of　nine　individuals　in　whom　this　anomaly　was　observed。　The　first　was　alive　and　had　four　children；　the　second　was　christened　a　female　but　was　probably　a　male；　the　third；　fourth；　and　fifth　were　normal　but　died　young；　the　sixth　daughter　was　choreic　and　feeble…minded；　aged　twenty…nine；　and　had　one　illegitimate　child；　the　seventh；　a　boy；　was　healthy　and　married；　the　eighth　was　christened　a　female；　but　when　seventeen　was　declared　by　the　Faculty　to　be　a　male；　the　ninth　was　christened　a　female；　but　at　eighteen　the　genitals　were　found　to　be　those　of　a　male；　though　the　mammae　were　well　developed。

O'Neill　speaks　of　a　case　in　which　the　clitoris　was　five　inches　long　and　one　inch　thick；　having　a　groove　in　its　inferior　surface　reaching　down　to　an　oblique　opening　in　the　perineum。　The　scrotum　contained　two　hard　bodies　thought　to　be　testicles；　and　the　general　appearance　was　that　of　hypospadias。　Postmortem　a　complete　set　of　female　genitalia　was　found；　although　the　ovaries　were　very　small。　The　right　round　ligament　was　exceedingly　thick　and　reached　down　to　the　bottom　of　the　false　scrotum；　where　it　was　firmly　attached。　The　hard　bodies　proved　to　be　on　one　side　an　irreducible　omental　hernia；　probably　congenital；　and　on　the　other　a　hardened　mass　having　no　glandular　structure。　The　patient　was　an　adult。　As　we　have　seen；　there　seems　to　be　a　law　of　evolution　in　hermaphroditism　which　prevents　perfection。　If　one　set　of　genitalia　are　extraordinarily　developed；　the　other　set　are　correspondingly　atrophied。　In　the　case　of　extreme　development　of　the　clitoris　and　approximation　to　the　male　type　we　must　expect　to　find　imperfectly　developed　uterus　or　ovaries。　This　would　answer　for　one　of　the　causes　of　sterility　in　these　cases。

There　is　a　type　of　hermaphroditism　in　which　the　sex　cannot　be　definitely　declared；　and　sometimes　dissection　does　not　definitely　indicate　the　predominating　sex。　Such　cases　are　classed　under　the　head　of　neuter　hermaphrodites；　possibly　an　analogy　of　the　〃genus　epicoenum〃　of　Quintilian。　Marie　Dorothee；　of　the　age　of　twenty…three；　was　examined　and　declared　a　girl　by　Hufeland　and　Mursina；　while　Stark；　Raschig；　and　Martens　maintained　that　she　was　a　boy。　This　formidable　array　of　talent　on　both　sides　provoked　much　discussion　in　contemporary　publications；　and　the　case　attracted　much　notice。　Marc　saw　her　in　1803；　at　which　time　she　carried　contradicting　certificates　as　to　her　sex。　He　found　an　imperforate　penis；　and　on　the　inferior　face　near　the　root　an　opening　for　the　passage　of　urine。　No　traces　of　nymphae；　vagina；　testicles；　nor　beard　were　seen。　The　stature　was　small；　the　form　debilitated；　and　the　voice　effeminate。　Marc　came　to　the　conclusion　that　it　was　impossible　for　any　man　to　determine　either　one　sex　or　the　other。　Everard　Home　dissected　a　dog　with　apparent　external　organs　of　the　female；　but　discovered　that　neither　sex　was　sufficiently　pronounced　to　admit　of　classification。　Home　also　saw　at　the　Royal　Marine　Hospital　at　Plymouth；　in　1779；　a　marine　who　some　days　after　admission　was　reported　to　be　a　girl。　On　examination　Home　found　him　to　possess　a　weak　voice；　soft　skin；　voluminous　breasts；　little　beard；　and　the　thighs　and　legs　of　a　woman。　There　was　fat　on　the　pubis；　the　penis　was　short　and　small　and　incapable　of　erection；　the　testicles　of　fetal　size；　he　had　no　venereal　desires　whatever；　and　as　regards　sex　was　virtually　neuter。

The　legal　aspect　of　hermaphroditism　has　always　been　much　discussed。　Many　interesting　questions　arise；　and　extraordinary　complications　naturally　occur。　In　Rome　a　hermaphrodite　could　be　a　witness　to　a　testament；　the　exclusive　privilege　of　a　man；　and　the　sex　was　settled　by　the　predominance。　If　the　male　aspect　and　traits　together　with　the　generative　organs　of　man　were　most　pronounced；　then　the　individual　could　call　himself　a　man。　〃Hermaphroditus　an　ad　testamentum　adhiberi　possit　qualitas　sesus　incalescentis　ostendit。〃

There　is　a　peculiar　case　on　record　in　which　the　question　of　legal　male　inheritance　was　not　settled　until　the　individual　had　lived　as　a　female　for　fifty…on