HERMAPHRODITISM.
In times past, under the term hermaphrodite, were designated individuals who were supposed to possess the organs of generation of both the male and the female, and to be able to perform the functions of the two sexes. It is very questionable if from this standpoint there has ever existed in the human race an individual so constituted anatomically and physiologi cally.
It is to Saint-Hilaire that we are indebted for a fairly complete study of this subject, defective only because at the time he wrote embryology was as yet in its infancy.
From a developmental point of view we may distinguish in the genital organs three segments. The first includes the external organs, and primitively these are neutral. As growth proceeds, the genital tubercle and folds are differentiated either into clitoris and labia or else into penis and scrotum; the second segment includes the vagina, uterus and tubes in the female, and the epididymis, the vasa deferentia, the seminal vesicles and the ejaculatory ducts in man. The devqlopment of this seg ment differs from that of the preceding in that it does not result 'from the transformation of a single blastema into male or female organs. Sexal differentiation occurs by the continuous evolution of either Mfiller's ducts or Wolff's ducts. If the former develop and the latter atrophy a female is formed, and vice versd. At the outset, then, the embryo is bisexal. The third segment is formed by the ovaries in woman, the testicles in man. These organs are formed at the expense of the sexal eminence. The tissue from which the latter is formed contains at the outset both male and female elements. The atrophy of one or another element results in sexal differentiation.
A prime law of development is that the formation of one of two sym metrical organs necessitates that of the other. When a male gland ap pears the rest of the excretory apparatus must be male, and vice versd.
There may, however, hero as elsewhere in the body, result anomalies, and when two glands of opposite sexes are formed, we have herma phroditism. Thus, in the third segment, a testicle may exist on one side
and an ovary on the other, or an ovary and a testicle exist on the same side; in the second segment there may be present on the one side organs formed by Milller's ducts, and on the other organs formed by Wolff's bodies, or on the same side both the ducts and the bodies may have simul taneously developed; in the first segment, similarly, there may exist clitoris and scrotum, or penis and labia. There result, therefore, many varieties of hermaphroditism.
We must distinguish, in the first place, apparent hermaphroditism from the above different varieties. For instance, the testicles may not have descended into the scrotum, and the two halves of the scrotum have remained separate, and we have the external appearance of the female,, and yet the individual is a male. If again, the clitoris is hypertrophied, the labia majora fused, the ovaries in the inguinal canal, the individual may be mistaken for a male. These are false hermaphrodites, for they do not possess both male and female organs.
We will consider, in turn, hermaphroditism of the glands and herma phroditism of the excretory canals and of the external organs of genera tion.
Hermaphroditism of the Glands.—This variety exists whenever one or more of the glands belonging to different sexes have simultaneously developed. There are three sub-varieties.
1. Hermaphroditism through bilateral excess where two ovaries and two testicles exist. Schrell has recorded an instance; between the normal testicles and vasa doferentia there were two ovaries with tubes, one uterus and vagina. The male organs were developed, the female atrophied.
2. Hermaphroditism by unilateral excess where there are two ovaries, two tubes, and a rudimentary uterus, a testicle, with vas deferens con taining spermatozoa—as in the individual named Hoffmann, who men struated regularly, and has been described by Rokitansky.