Anomalies And Curiosities Of Medicine Part 13

CLa.s.s IX.--Of "Lusus naturae" none is more curious than that of duplication of the lower extremities. Pare says that on January 9, 1529, there was living in Germany a male infant having four legs and four arms. In Paris, at the Academie des Sciences, on September 6, 1830, there was presented by Madame Hen, a midwife, a living male child with four legs, the a.n.u.s being nearly below the middle of the third b.u.t.tock; and the s.c.r.o.t.u.m between the two left thighs, the t.e.s.t.i.c.l.es not yet descended. There was a well-formed and single pelvis, and the supernumerary legs were immovable. Aldrovandus mentions several similar instances, and gives the figure of one born in Rome; he also describes several quadruped birds. Bardsley speaks of a male child with one head, four arms, four legs, and double generative organs. He gives a portrait of the child when it was a little over a year old. Heschl published in Vienna in 1878 a description of a girl of seventeen, who instead of having a duplication of the superior body, as in "Millie-Christine, the two-headed nightingale," had double parts below the second lumbar vertebra. Her head and upper body resembled a comely, delicate girl of twelve.

Wells a describes Mrs. B., aged twenty, still alive and healthy. The duplication in this case begins just above the waist, the spinal column dividing at the third lumbar vertebra, below this point everything being double. Micturition and defecation occur at different times, but menstruation occurs simultaneously. She was married at nineteen, and became pregnant a year later on the left side, but abortion was induced at the fourth month on account of persistent nausea and the expectation of impossible delivery. Whaley, in speaking of this case, said Mrs. B.

utilized her outside legs for walking; he also remarks that when he informed her that she was pregnant on the left side she replied, "I think you are mistaken; if it had been on my right side I would come nearer believing it;"--and after further questioning he found, from the patient's observation, that her right genitals were almost invariably used for coitus. Bechlinger of Para, Brazil, describes a woman of twenty-five, a native of Martinique, whose father was French and mother a quadroon, who had a modified duplication of the lower body. There was a third leg attached to a continuation of the processus coceygeus of the sacrum, and in addition to well developed mammae regularly situated, there were two rudimentary ones close together above the p.u.b.es. There were two v.a.g.i.n.ae and two well-developed v.u.l.v.ae, both having equally developed sensations. The s.e.xual appet.i.te was markedly developed, and coitus was practised in both v.a.g.i.n.ae. A somewhat similar case, possibly the same, is that of Blanche Dumas, born in 1860. She had a very broad pelvis, two imperfectly developed legs, and a supernumerary limb attached to the symphysis, without a joint, but with slight pa.s.sive movement. There was a duplication of bowel, bladder, and genitalia. At the junction of the rudimentary limb with the body, in front, were two rudimentary mammary glands, each containing a nipple.

Other instances of supernumerary limbs will be found in Chapter VI.

CLa.s.s X.--The instances of diphallic terata, by their intense interest to the natural bent of the curious mind, have always elicited much discussion. To many of these cases have been attributed exaggerated function, notwithstanding the fact that modern observation almost invariably shows that the virile power diminishes in exact proportion to the extent of duplication. Taylor quotes a description of a monster, exhibited in London, with two distinct p.e.n.i.ses, but with only one distinct t.e.s.t.i.c.l.e on either side. He could exercise the function of either organ.

Schenck, Schurig, Bartholinus, Loder, and Ollsner report instances of diphallic terata; the latter case a was in a soldier of Charles VI, twenty-two years old, who applied to the surgeon for a bubonic affection, and who declared that he pa.s.sed urine from the orifice of the left glans and also said that he was incapable of true coitus.

Valentini mentions an instance in a boy of four, in which the two p.e.n.i.ses were superimposed. Bucchettoni speaks of a man with two p.e.n.i.ses placed side by side. There was an anonymous case described of a man of ninety-three with a p.e.n.i.s which was for more than half its length divided into two distinct members, the right being somewhat larger than the left. From the middle of the p.e.n.i.s up to the symphysis only the lower wall of the urethra was split. Jenisch describes a diphallic infant, the offspring of a woman of twenty-five who had been married five years. Her first child was a well-formed female, and the second, the infant in question, cried much during the night, and several times vomited dark-green matter. In lieu of one p.e.n.i.s there were two, situated near each other, the right one of natural size and the left larger, but not furnished with a prepuce. Each p.e.n.i.s had its own urethra, from which dribbled urine and some meconium. There was a duplication of each s.c.r.o.t.u.m, but only one t.e.s.t.i.c.l.e in each, and several other minor malformations.

Gore, reported by Velpeau, has seen an infant of eight and one-half months with two p.e.n.i.ses and three lower extremities. The p.e.n.i.ses were 4 cm. apart and the s.c.r.o.t.u.m divided, containing one t.e.s.t.i.c.l.e in each side. Each p.e.n.i.s was provided with a urethra, urine being discharged from both simultaneously. In a similar case, spoken of by Geoffroy-Saint-Hilaire, the two organs were also separate, but urine and s.e.m.e.n escaped sometimes from one, sometimes from both.

The most celebrated of all the diphallic terata was Jean Baptista dos Santos, who when but six months old was spoken of by Acton. His father and mother were healthy and had two well-formed children. He was easily born after an uneventful pregnancy. He was good-looking, well proportioned, and had two distinct p.e.n.i.ses, each as large as that of a child of six months. Urination proceeded simultaneously from both p.e.n.i.ses; he had also two s.c.r.o.t.u.ms. Behind and between the legs there was another limb, or rather two, united throughout their length. It was connected to the pubis by a short stem 1/2 inch long and as large as the little finger, consisting of separate bones and cartilages. There was a patella in the supernumerary limb on the a.n.a.l aspect, and a joint freely movable. This compound limb had no power of motion, but was endowed with sensibility. A journal in London, after quoting Acton's description, said that the child had been exhibited in Paris, and that the surgeons advised operation. Fisher, to whom we are indebted for an exhaustive work in Teratology, received a report from Havana in July, 1865, which detailed a description of Santos at twenty-two years of age, and said that he was possessed of extraordinary animal pa.s.sion, the sight of a female alone being sufficient to excite him. He was said to use both p.e.n.i.ses, after finis.h.i.+ng with one continuing with the other; but this account of him does not agree with later descriptions, in which no excessive s.e.xual ability had been noticed. Hart describes the adult Santos in full, and accompanies his article with an ill.u.s.tration. At this time he was said to have developed double genitals, and possibly a double bladder communicating by an imperfect septum. At adulthood the a.n.u.s was three inches anterior to the os coceygeus. In the sitting or lying posture the supernumerary limb rested on the front of the inner surface of the lower third of his left thigh. He was in the habit of wearing this limb in a sling, or bound firmly to the right thigh, to prevent its unseemly dangling when erect.

The perineum proper was absent, the entire s.p.a.ce between the a.n.u.s and the posterior edge of the s.c.r.o.t.u.m being occupied by the pedicle.

Santos' mental and physical functions were developed above normal, and he impressed everybody with his accomplishments.

Geoffroy-Saint-Hilaire records an instance in which the conformation was similar to that of Santos. There was a third lower extremity consisting of two limbs fused into one with a single foot containing ten distinct digits. He calls the case one of arrested twin development.

Van Buren and Keyes describe a case in a man of forty-two, of good, healthy appearance. The two distinct p.e.n.i.ses of normal size were apparently well formed and were placed side by side, each attached at its root to the symphysis. Their covering of skin was common as far as the base of the glans; at this point they seemed distinct and perfect, but the meatus of the left was imperforate. The right meatus was normal, and through it most of the urine pa.s.sed, though some always dribbled through an opening in the perineum at a point where the root of the s.c.r.o.t.u.m should have been. On lifting the double-barreled p.e.n.i.s this opening could be seen and was of sufficient size to admit the finger. On the right side of the aperture was an elongated and rounded prominence similar in outline to a labium majus. This prominence contained a t.e.s.t.i.c.l.e normal in shape and sensibility, but slightly undersized, and surrounded, as was evident from its mobility, by a tunica v.a.g.i.n.alis. The left t.e.s.t.i.c.l.e lay on the tendon of the adductor longus in the left groin; it was not fully developed, but the patient had s.e.xual desires, erections, and emissions. Both p.e.n.i.ses became erect simultaneously, the right more vigorously. The left leg was shorter than the right and congenitally smaller; the mammae were of normal dimensions.

Sangalli speaks of a man of thirty-five who had a supernumerary p.e.n.i.s, furnished with a prepuce and capable of erection. At the apex of the glans opened a ca.n.a.l about 12 cm. long, through which escaped monthly a serous fluid. Smith mentions a man who had two p.e.n.i.ses and two bladders, on one of which lithotomy was performed. According to Ballantyne, Taruffi, the scholarly observer of terata, mentions a child of forty-two months and height of 80 cm. who had two p.e.n.i.ses, each furnished with a urethra and well-formed scrotal sacs which were inserted in a fold of the groin. There were two t.e.s.t.i.c.l.es felt in the right s.c.r.o.t.u.m and one in the left. Fecal evacuations escaped through two a.n.a.l orifices. There is also another case mentioned similar to the foregoing in a man of forty; but here there was an osseous projection in the middle line behind the bladder. This patient said that erection was simultaneous in both p.e.n.i.ses, and that he had not married because of his chagrin over his deformity. Cole speaks of a child with two well-developed male organs, one to the left and the other to the right of the median line, and about 1/4 or 1/2 inch apart at birth. The urethra bifurcated in the perineal region and sent a branch to each p.e.n.i.s, and urine pa.s.sed from each meatus. The s.c.r.o.t.u.m was divided into three compartments by two raphes, and each compartment contained a t.e.s.t.i.c.l.e. The a.n.u.s at birth was imperforate, but the child was successfully operated on, and at its sixtieth day weighed 17 pounds.

Lange says that an infant was brought to Karg for relief of a.n.a.l atresia when fourteen days old. It was found to possess duplicate p.e.n.i.ses, which communicated each to its distinct half of the bladder as defined by a median fold. The s.c.r.o.t.u.m was divided into three portions by two raphes, and each lateral compartment contained a fully formed t.e.s.t.i.c.l.e. This child died because of its a.n.a.l malformation, which we notice is a frequent a.s.sociate of malformations or duplicity of the p.e.n.i.s. There is an example in an infant described in which there were two p.e.n.i.ses, each about 1/2 inch long, and a divided scrotal sac 21 inches long. Englisch speaks of a German of forty who possessed a double p.e.n.i.s of the bifid type.

Ballantyne and his a.s.sociates define diphallic terata as individuals provided with two more or less well-formed and more or less separate p.e.n.i.ses, who may show also other malformations of the adjoining parts and organs (e.g., septate bladder), but who are not possessed of more than two lower limbs. This definition excludes, therefore, the cases in which in addition to a double p.e.n.i.s there is a supernumerary lower extremity--such a case, for example, as that of Jean Baptista dos Santos, so frequently described by teratologists. It also excludes the more evident double terata, and, of course, the cases of duplication of the female genital organs (double c.l.i.toris, v.u.l.v.a, v.a.g.i.n.a, and uterus).

Although Schurig, Meckel, Himly, Taruffi, and others give bibliographic lists of diphallic terata, even in them erroneous references are common, and there is evidence to show that many cases have been duplicated under different names. Ballantyne and Skirving have consulted all the older original references available and eliminated duplications of reports and, adhering to their original definition, have collected and described individually 20 cases; they offer the following conclusions:--

1. Diphallus, or duplication of the p.e.n.i.s in an otherwise apparently single individual, is a very rare anomaly, records of only 20 cases having been found in a fairly exhaustive search through teratologic literature. As a distinct and well-authenticated type it has only quite recently been recognized by teratologists.

2. It does not of itself interfere with intrauterine or extrauterine life; but the a.s.sociated anomalies (e.g., atresia ani) may be sources of danger. If not noticed at birth, it is not usually discovered till adult life, and even then the discovery is commonly accidental.

3. With regard to the functions of the pelvic viscera, urine may be pa.s.sed by both p.e.n.i.ses, by one only, or by neither. In the last instance it finds exit by an aperture in the perineum. There is reason to believe that s.e.m.e.n may be pa.s.sed in the same way; but in most of the recorded cases there has been sterility, if not inability to perform the s.e.xual act.

4. All the degrees of duplication have been met with, from a fissure of the glans p.e.n.i.s to the presence of two distinct p.e.n.i.ses inserted at some distance from each other in the inguinal regions.

5. The two p.e.n.i.ses are usually somewhat defective as regards prepuce, urethra, etc.; they may lie side by side, or more rarely may be situated anteroposteriorly; they may be equal in size, or less commonly one is distinctly larger than the other; and one or both may be perforate or imperforate.

6. The s.c.r.o.t.u.m may be normal or split; the t.e.s.t.i.c.l.es, commonly two in number, may be normal or atrophic, descended or undescended; the prostate may be normal or imperfectly developed, as may also the vasa deferentia and vesiculae seminales.

7. The commonly a.s.sociated defects are: More or less completely septate bladder, atresia ani, or more rarely double a.n.u.s, double urethra, increased breadth of the bony pelvis with defect of the symphysis pubis, and possibly duplication of the lower end of the spine, and hernia of some of the abdominal contents into a perineal pouch. Much more rarely, duplication of the heart, lungs, stomach, and kidneys has been noted, and the lower limbs may be shorter than normal.

CLa.s.s XI.--Cases of fetus in fetu, those strange instances in which one might almost say that a man may be pregnant with his brother or sister, or in which an infant may carry its twin without the fact being apparent, will next be discussed. The older cases were cited as being only a repet.i.tion of the process by which Eve was born of Adam. Figure 63 represents an old engraving showing the birth of Eve. Bartholinus, the Ephemerides, Otto, Paullini, Schurig, and Plot speak of instances of fetus in fetu. Ruysch describes a tumor contained in the abdomen of a man which was composed of hair, molar teeth, and other evidences of a fetus. Huxham reported to the Royal Society in 1748 the history of a child which was born with a tumor near the a.n.u.s larger than the whole body of the child; this tumor contained rudiments of an embryo. Young speaks of a fetus which lay encysted between the laminae of the transverse mesocolon, and Highmore published a report of a fetus in a cyst communicating with the duodenum. Dupuytren gives an example in a boy of thirteen, in whom was found a fetus. Gaetano-Nocito, cited by Philipeaux, has the history of a taken with a great pain in the right hypochondrium, and from which issued subsequently fetal bones and a ma.s.s of macerated embryo. His mother had had several double pregnancies, and from the length of the respective tibiae one of the fetuses seemed to be of two months' and the other of three months'

intrauterine life. The man died five years after the abscess had burst spontaneously.

Brodie speaks of a case in which fetal remains were taken from the abdomen of a girl of two and one-half years. Gaither describes a child of two years and nine months, supposed to be affected with ascites, who died three hours after the physician's arrival. In its abdomen was found a fetus weighing almost two pounds and connected to the child by a cord resembling an umbilical cord. This child was healthy for about nine months, and had a precocious longing for ardent spirits, and drank freely an hour before its death.

Blundell says that he knew "a boy who was literally and without evasion with child, for the fetus was contained in a sac communicating with the abdomen and was connected to the side of the cyst by a short umbilical cord; nor did the fetus make its appearance until the boy was eight or ten years old, when after much enlargement of pregnancy and subsequent flooding the boy died." The fetus, removed after death, on the whole not very imperfectly formed, was of the size of about six or seven months' gestation. Bury cites an account of a child that had a second imperfectly developed fetus in its face and scalp. There was a boy by the name of Bissieu who from the earliest age had a pain in one of his left ribs; this rib was larger than the rest and seemed to have a tumor under it. He died of phthisis at fourteen, and after death there was found in a pocket lying against the transverse colon and communicating with it all the evidences of a fetus.

At the Hopital de la Charite in Paris, Velpeau startled an audience of 500 students and many physicians by saying that he expected to find a rudimentary fetus in a scrotal tumor placed in his hands for operation.

His diagnosis proved correct, and brought him resounding praise, and all wondered as to his reasons for expecting a fetal tumor. It appears that he had read with care a report by Fatti of an operation on the s.c.r.o.t.u.m of a child which had increased in size as the child grew, and was found to contain the ribs, the vertebral column, the lower extremities as far as the knees, and the two orbits of a fetus; and also an account of a similar operation performed by Wendt of Breslau on a Silesian boy of seven. The left t.e.s.t.i.c.l.e in this case was so swollen that it hung almost to the knee, and the fetal remains removed weighed seven ounces.

Sulikowski relates an instance of congenital fetation in the umbilicus of a girl of fourteen, who recovered after the removal of the anomaly.

Aretaeos described to the members of the medical fraternity in Athens the case of a woman of twenty-two, who bore two children after a seven months' pregnancy. One was very rudimentary and only 21 inches long, and the other had an enormous head resembling a case of hydrocephalus.

On opening the head of the second fetus, another, three inches long, was found in the medulla oblongata, and in the cranial cavity with it were two additional fetuses, neither of which was perfectly formed.

Broca speaks of a fetal cyst being pa.s.sed in the urine of a man of sixty-one; the cyst contained remnants of hair, bone, and cartilage.

Atlee submits quite a remarkable case of congenital ventral gestation, the subject being a girl of six, who recovered after the discharge of the fetal ma.s.s from the abdomen. McIntyre speaks of a child of eleven, playing about and feeling well, but whose abdomen progressively increased in size 1 1/2 inches each day. After ten days there was a large fluctuating ma.s.s on the right side; the abdomen was opened and the ma.s.s enucleated; it was found to contain a fetal ma.s.s weighing nearly five pounds, and in addition ten pounds of fluid were removed.

The child made an early recovery. Rogers mentions a fetus that was found in a man's bladder. Bouchacourt reports the successful extirpation of the remains of a fetus from the r.e.c.t.u.m of a child of six. Miner describes a successful excision of a congenital gestation.

Modern literature is full of examples, and nearly every one of the foregoing instances could be paralleled from other sources. Rodriguez is quoted as reporting that in July, 1891, several newspapers in the city of Mexico published, under the head of "A Man-mother," a wonderful story, accompanied by wood-cuts, of a young man from whose body a great surgeon had extracted a "perfectly developed fetus." One of these wood-cuts represented a tumor at the back of a man opened and containing a crying baby. In commenting upon this, after reviewing several similar cases of endocymian monsters that came under his observation in Mexico, Rodriguez tells what the case which had been so grossly exaggerated by the lay journals really was: An Indian boy, aged twenty-two, presented a tumor in the sacrococcygeal region measuring 53 cm. in circ.u.mference at the base, having a vertical diameter of 17 cm.

and a transverse diameter of 13 cm. It had no pedicle and was fixed, showing unequal consistency. At birth this tumor was about the size of a pigeon's egg. A diagnosis of dermoid cyst was made and two operations were performed on the boy, death following the second. The skeleton showed interesting conditions; the r.e.c.t.u.m and pelvic organs were natural, and the contents of the cyst verified the diagnosis.

Quite similar to the cases of fetus in fetu are the instances of dermoid cysts. For many years they have been a mystery to physiologists, and their origin now is little more than hypothetic. At one time the fact of finding such a formation in the ovary of an unmarried woman was presumptive evidence that she was unchaste; but this idea was dissipated as soon as examples were reported in children, and to-day we have a well-defined difference between congenital and extrauterine pregnancy. Dermoid cysts of the ovary may consist only of a wall of connective tissue lined with epidermis and containing distinctly epidermic scales which, however, may be rolled up in firm ma.s.ses of a more or less soapy consistency; this variety is called by Orth epidermoid cyst; or, according to Warren, a form of cyst made up of skin containing small and ill-defined papillae, but rich in hair follicles and sebaceous glands. Even the erector pili muscle and the sudoriparous gland are often found. The hair is partly free and rolled up into thick b.a.l.l.s or is still attached to the walls. A large ma.s.s of sebaceous material is also found in these cysts. Thomson reports a case of dermoid cyst of the bladder containing hair, which cyst he removed.

It was a pedunculated growth, and it was undoubtedly vesical and not expelled from some ovarian source through the urinary pa.s.sage, as sometimes occurs.

The simpler forms of the ordinary dermoid cysts contain bone and teeth.

The complicated teratoma of this cla.s.s may contain, in addition to the previously mentioned structures, cartilage and glands, mucous and serous membrane, muscle, nerves, and cerebral substance, portions of eyes, fingers with nails, mammae, etc. Figure 64 represents a cyst containing long red hair that was removed from a blonde woman aged forty-four years who had given birth to six children. Cullingworth reports the history of a woman in whom both ovaries were apparently involved by dermoids, who had given birth to 12 children and had three miscarriages--the last, three months before the removal of the growths.

The accompanying ill.u.s.tration, taken from Baldy, pictures a dermoid cyst of the complicated variety laid open and exposing the contents in situ. Mears of Philadelphia reports a case of ovarian cyst removed from a girl of six and a half by Bradford of Kentucky in 1875. From this age on to adult life many similar cases are recorded. Nearly every medical museum has preserved specimens of dermoid cysts, and almost all physicians are well acquainted with their occurrence. The curious formations and contents and the bizarre shapes are of great variety.

Graves mentions a dermoid cyst containing the left side of a human face, an eye, a molar tooth, and various bones. Dermoid cysts are found also in regions of the body quite remote from the ovary. The so-called "orbital wens" are true inclusion of the skin of a congenital origin, as are the nasal dermoids and some of the cysts of the neck.

Weil reported the case of a man of twenty-two years who was born with what was supposed to be a spina bifida in the lower sacral region.

According to Senn, the swelling never caused any pain or inconvenience until it inflamed, when it opened spontaneously and suppurated, discharging a large quant.i.ty of offensive pus, hair, and sebaceous material, thus proving it to have been a dermoid. The cyst was freely incised, and there were found numerous openings of sweat glands, from which drops of perspiration escaped when the patient was sweating.

Dermoid cysts of the thorax are rare. Bramann reported a case in which a dermoid cyst of small size was situated over the sternum at the junction of the manubrium with the gladiolus, and a similar cyst in the neck near the left cornu of the hyoid bone. Chitten removed a dermoid from the sternum of a female of thirty-nine, the cyst containing 11 ounces of atheromatous material. In the Museum of St. Bartholomew's Hospital in London there is a congenital tumor which was removed from the anterior mediastinum of a woman of twenty one, and contained portions of skin, fat, sebaceous material, and two pieces of bone similar to the superior maxilla, and in which several teeth were found.

Dermoids are found in the palate and pharynx, and open dermoids of the conjunctiva are cla.s.sified by Sutton with the moles. According to Senn, Barker collected sixteen dermoid tumors of the tongue. Bryk successfully removed a tumor of this nature the size of a fist.

Wellington Gray removed an enormous lingual dermoid from the mouth of a negro. It contained 40 ounces of atheromatous material. Dermoids of the r.e.c.t.u.m are reported. Duyse reports the history of a case of labor during which a rectal dermoid was expelled. The dermoid contained a cerebral vesicle, a rudimentary eye, a canine and a molar tooth, and a piece of bone. There is little doubt that many cases of fetus in fetu reported were really dermoids of the s.c.r.o.t.u.m.

Ward reports the successful removal of a dermoid cyst weighing 30 pounds from a woman of thirty-two, the mother of two children aged ten and twelve, respectively. The report is briefly as follows: "The patient has always been in good health until within the last year, during which time she has lost flesh and strength quite rapidly, and when brought to my hospital by her physician, Dr. James of Williamsburg, Kansas, was quite weak, although able to walk about the house. A tumor had been growing for a number of years, but its growth was so gradual that the patient had not considered her condition critical until quite recently. The tumor was diagnosed to be cystoma of the left ovary. Upon opening the sac with the trocar we were confronted by complications entirely unlooked for, and its use had to be abandoned entirely because the thick contents of the cyst would not flow freely, and the presence of sebaceous matter blocked the instrument. As much of the fluid as possible was removed, and the abdominal incision was enlarged to allow of the removal of the large tumor. An ovarian hematoma the size of a large orange was removed from the right side. We washed the intestines quite as one would wash linen, since some of the contents of the cyst had escaped into the abdominal cavity. The abdomen was closed without drainage, and the patient placed in bed without experiencing the least shock. Her recovery was rapid and uneventful.

She returned to her home in four weeks after the operation.

"The unusual feature in this case was the nature of the contents of the sac. There was a large quant.i.ty of long straight hair growing from the cyst wall and an equal amount of loose hair in short pieces floating through the tumor-contents, a portion of which formed nuclei for what were called 'moth-b.a.l.l.s,' of which there were about 1 1/2 gallons.

These b.a.l.l.s, or marbles, varied from the size of moth-b.a.l.l.s, as manufactured and sold by druggists, to that of small walnuts. They seemed to be composed of sebaceous matter, and were evidently formed around the short hairs by the motion of the fluid produced by walking or riding. There was some tissue resembling true skin attached to the inner wall of the sac."

There are several cases of multiple dermoid cysts on record, and they may occur all over the body. Jamieson reports a case in which there were 250, and in Maclaren's case there were 132. According to Crocker, Hebra and Rayer also each had a case. In a case of Sangster, reported by Politzer, although most of the dermoids, as usual, were like fibroma-nodules and therefore the color of normal skin, those over the mastoid processes and clavicle were lemon-yellow, and were generally thought to be xanthoma until they were excised, and Politzer found they were typical dermoid cysts with the usual contents of degenerated epithelium and hair.

Hermaphroditism.--Some writers claim that Adam was the first hermaphrodite and support this by Scriptural evidence. We find in some of the ancient poets traces of an Egyptian legend in which the G.o.ddess of the moon was considered to be both male and female. From mythology we learn that Hermaphroditus was the son of Hermes, or Mercury, and Venus Aphrodite, and had the powers both of a father and mother. In speaking of the foregoing Ausonius writes, "Cujus erat facies in qua paterque materque cognosci possint, nomen traxit ab illis." Ovid and Virgil both refer to legendary hermaphrodites, and the knowledge of their existence was prevalent in the olden times. The ancients considered the birth of hermaphrodites bad omens, and the Athenians threw them into the sea, the Romans, into the Tiber. Livy speaks of an hermaphrodite being put to death in Umbria, and another in Etruria.

Cicero, Aristotle, Strabonius, and Pliny all speak concerning this subject. Martial and Tertullian noticed this anomaly among the Romans.

Aetius and Paulus Aegineta speak of females in Egypt with prolonged c.l.i.torides which made them appear like hermaphrodites. Throughout the Middle Ages we frequently find accounts, naturally exaggerated, of double-s.e.xed creatures. Harvey, Bartholinus, Paullini, Schenck, Wolff, Wrisberg, Zacchias, Marcellus Donatus, Haller, Hufeland, de Graff, and many others discuss hermaphroditism. Many cla.s.sifications have been given, as, e.g., real and apparent; masculine, feminine, or neuter; horizontal and vertical; unilateral and bilateral, etc. The anomaly in most cases consists of a malformation of the external genitalia. A prolonged c.l.i.toris, prolapsed ovaries, grossness of figure, and hirsute appearance have been accountable for many supposed instances of hermaphrodites. On the other hand, a cleft s.c.r.o.t.u.m, an ill-developed p.e.n.i.s, perhaps hypospadias or epispadias, rotundity of the mammae, and feminine contour have also provoked accounts of similar instances. Some cases have been proved by dissection to have been true hermaphrodites, portions or even entire genitalia of both s.e.xes having been found.

Numerous accounts, many mythical, but always interesting, are given of these curious persons. They have been accredited with having performed the functions of both father and mother, notwithstanding the statements of some of the best authorities that they are always sterile.

Observation has shown that the s.e.xual appet.i.te diminishes in proportion to the imperfections in the genitalia, and certainly many of these persons are s.e.xually indifferent.

We give descriptions of a few of the most famous or interesting instances of hermaphroditism. Pare speaks of a woman who, besides a v.u.l.v.a, from which she menstruated, had a p.e.n.i.s, but without prepuce or signs of erectility. Haller alludes to several cases in which prolonged c.l.i.torides have been the cause of the anomaly. In commenting on this form of hermaphroditism Albucasiusus describes a necessary operation for the removal of the c.l.i.toris.

Columbus relates the history of an Ethiopian woman who was evidently a spurious female hermaphrodite. The poor wretch entreated him to cut off her p.e.n.i.s, an enlarged c.l.i.toris, which she said was an intolerable hindrance to her in coitus. De Graff and Riolan describe similar cases.

There is an old record of a similar creature, supposing herself to be a male, who took a wife, but previously having had connection with a man, the outcome of which was pregnancy, was shortly after marriage delivered of a daughter. There is an account of a person in Germany who, for the first thirty years of life, was regarded as feminine, and being of loose morals became a mother. At a certain period she began to feel a change in her s.e.xual inclinations; she married and became the father of a family. This is doubtless a distortion of the facts of the case of Catherine or Charles Hoffman, born in 1824, and who was considered a female until the age of forty. At p.u.b.erty she had the instincts of a woman, and cohabitated with a male lover for twenty years. Her b.r.e.a.s.t.s were well formed and she menstruated at nineteen. At the age of forty-six her s.e.xual desires changed, and she attempted coitus as a man, with such evident satisfaction that she married a woman soon afterward. Fitch speaks of a house-servant with masculine features and movements, aged twenty-eight, and 5 feet and 9 inches tall, who was arrested by the police for violating the laws governing prost.i.tution. On examination, well-developed male and female organs of generation were found. The l.a.b.i.a majora were normal and flattened on the anterior surface. The l.a.b.i.a minora and hymen were absent. The v.a.g.i.n.a was s.p.a.cious and the woman had a profuse leukorrhea. She stated that several years previously she gave birth to a normal child. In place of a c.l.i.toris she had a p.e.n.i.s which, in erection, measured 5 1/4 inches long and 3 5/8 inches in circ.u.mference. The glans p.e.n.i.s and the urethra were perfectly formed. The s.c.r.o.t.u.m contained two t.e.s.t.i.c.l.es, each about an inch long; the mons veneris was spa.r.s.ely covered with straight, black hair. She claimed functional ability with both sets of genitalia, and said she experienced equal s.e.xual gratification with either. s.e.m.e.n issued from the p.e.n.i.s, and every three weeks she had scanty menstruation, which lasted but two days.

Beclard showed Marie-Madeline Lefort, nineteen years of age, 1 1/2 meters in height. Her mammae were well developed, her nipples erectile and surrounded by a brown areola, from which issued several hairs. Her feet were small, her pelvis large, and her thighs like those of a woman. Projecting from the v.u.l.v.a was a body looking like a p.e.n.i.s 7 cm.

long and slightly erectile at times; it was imperforate and had a mobile prepuce. She had a v.u.l.v.a with two well-shaped l.a.b.i.a as shown by the accompanying ill.u.s.tration. She menstruated slightly and had an opening at the root of the c.l.i.toris. 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.