Ernest Rumley Dawson.

The causation of sex in man; a new theory of sex based on clinical materials together with chapters on forecasting or predicting the sex of the unborn child and on the determination or production of either sex at will online

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are two in number a right and a left; they are curving
muscular canals, arising one from each side of the fundus of
the uterus at its cornu or upper angle. They run outwards
laterally from the uterus to the ovaries, and each ends by a
fringed and funnel-shaped expanded opening, the abdominal
ostium, close to and in immediate proximity to its respective
right or left ovary. Each tube is lined internally by mucous
membrane covered by special epithelium, which has a wave-
like action towards the uterine cavity, due to cilia or fine
hair-like processes which project into the lumen of the tube;
their movement being always in one direction impels on-
wards to the uterus any ovum which may enter them.

A small quantity of thin albuminous fluid is secreted by
the mucous membrane.

The inner or uterine third of each tube is straighter and
thinner than the outer two-thirds, which, increasing gradu-
ally in size, curves sickle-like to encircle its corresponding
ovary for more than half of its circumference.

The tubes are dilatable; the lumen varies in size, being
least where they open into the uterine cavity, and greatest
as they approach their expanded, outer, or abdominal open-
ing, near to the ovary.

The average length of each tube is four inches, but they
are rarely of equal size or length.

Thus Hart 1 says:

" The right Fallopian tube is usually larger than the left,"
while Montgomery 2 says :

" The Fallopian tubes vary in size and length, the right tube
being the longer.""

The tubes have a considerable range of mobility, and are
easily displaced by tumour growth or inflammatory affec-
tions ; the tubes are relatively very much larger, in compari-
son to the size of the human uterus, than are the Fallopian
tubes in most of the mammalia so much so that the
mammalian Fallopian tube is generally overlooked, and the
uterine cornu or branches are thought to be the tubes.

1 Hart, " Atlas of Female Pelvic Anatomy," 1884, p. 12.
- Montgomery, " Practical Gynaecology," 1900, p. 132.


The function of the tubes, as their name oviduct implies,
is to convey the ovum, fertilised or not, into the uterine
cavity. They are practically the excretory ducts of the
ovaries, but, unlike most other excretory ducts, they are
not part of the gland whose product they transmit, but
are portions of the receiving organ.

The contractions of the muscular layers of the tubal
wall help in the propulsion of the ovum, and its easy progress
is assisted by the thin layer of albuminous fluid moistening
the tubal lumen.

THE OVARIES. The ovaries or genital glands are the
essential organs of reproduction; they dominate the entire
reproductive life of the woman.

They are two in number, a right and left, and lie on the
right and left sides respectively of the uterus. Each ovary
is a solid, oval, or almond-shaped organ, and is more or less
encircled by the outer or abdominal end of its corresponding
Fallopian tube.

The ovaries vary in size considerably in different women,
and also at different times in the same woman, according to
the condition of their functional activity. Thus each ovary
enlarges when about to discharge an ovum, so that T. G.
Stevens* says:

" The ripe Graafian follicle may measure an inch in diameter,
and as it projects from the surface its general effect may be to
almost double the size of the ovary " ;

while Garrigues 2 says :

" The ovaries, or at least one of them, swell regularly before each
menstrual period, and decrease after menstruation " ;

an ovary also enlarges markedly when, having discharged
an ovum which becomes fertilised, a true corpus luteum of
pregnancy is formed in the substance of the ovary.


" The right ovary is usually a little larger than the left."

1 Stevens, " Diseases of Women," 1912, p. 25.

2 Garrigues, " Diseases of Women," 1900, p. 596.

3 Henry Morris, " A Treatise on Human Anatomy," 2nded. 1898, p. 1052.


An average ovary measures ij in. long by in., and fin.

Each ovary is attached by its anterior border to the
posterior surface of the broad ligament, and to the uterus



O 2

by a muscular band of varying length, averaging one inch,
the ovarian or utero-ovarian ligament ; also by an enlarged
tubal fringe to the open or abdominal fringed end of the
Fallopian tube.

The relative position of the ovaries in the body is much


disturbed by pregnancy, as also by the growth in them or
near them of any tumour.

At birth the ovaries are much longer than their width,
so that they are described as cucumber-shaped; prior to
puberty and ovulation they resemble smooth olives, while
in the adult who has ovulated and menstruated for years
the ovary becomes scarred and wrinkled, so that it more
closely resembles a peach-stone.

The substance of each ovary consists of a groundwork or
stroma of fibrous and muscular tissue, in which run numerous
blood-vessels and nerves. It is seen to be occupied by a very
large number of small vesicles or cysts, called ovisacs or
Graafian follicles, after their discoverer Regnems de Graaf.

Each Graafian follicle or ovisac contains an ovum or egg,
floating in a little clear albuminous fluid, the Liquor Folliculi.

Authorities differ in their estimates of the number of
Graafian follicles contained in the two ovaries at the child's
birth. Thus W. Williams 1 says:

" Each ovary at birth contains at least one hundred thousand
primordial ova,"

while Piersol 2 puts them much lower. He says:

" The entire number contained within the two ovaries of the
child being estimated at over seventy thousand."

All such figures, however, as Dr. T. G. Stevens' 3 definitely

" must be viewed with some scepticism, because the enumeration
of the Graafian follicles in an ovary cannot be a matter of any
certainty, and there must be a large margin for errors of observation."

What, however, is certain is, that by far the larger pro-
portion of the Graafian follicles atrophy and disappear, but
do not burst, so that by the time of puberty the number of
Graafian follicles remaining in the two ovaries, and thus
capable of development, is only about one-third of those
present at birth.

1 Whitridge Williams, " Obstetrics," 1903, p. 61.

2 Piersol, in Norris and Dickinson's " Text-book of Obstetrics," p. 61.

3 Stevens, " Trans. Obstet. Soc.," vol. xlv., 1903, p. 465. " The Fate
of the Ovum and Graafian Follicle in Pre-menstrual Life."


The Graafian follicles are scattered throughout the super-
ficial or greater part of the substance of both ovaries. The

(Modified from Leopold.)

deeper part of the ovary contains loose connective tissue
and muscle fibres, and transmits the blood-vessels and






RUPTURE. (Much magnified.)

S.E. Surface Epithelium of Ovary, showing at B thinning where the follicle is about to rupture
and discharge the Ovum, OV. G.F. The Graafian Follicle, filled with the liquor folliculi,
in which is OV., the Ovum, filled by the granular-looking vitellus or yolk; in this lies
N., the Ovum Nucleus or germinal vesicle; this contains a nucleolus or germinal spot.
S.O. The substance or Stroma of the Ovary. T.F. Condensed ovarian stroma, forming the
external wall or Tunica Fibrosa of the follicle. T.P. The Tunica Propria or true wall of the
follicle, lined internally by layers of cells, M.G., the Membrana Granulosa, which are heaped
around the Ovum to form D.P., the discus proligerus. Z.P. The Zona Pellucida, the outer
wall of the Ovum. OV. The Ovum; should be more circular than it is drawn.


Every follicle contains an ovum, now often called an
oocyte, each ovum contains a germinal vesicle or nucleus,
and this germinal nucleus contains a germinal spot or

Occasionally the Graafian follicle contains two ova
instead of the more usual one (see K, Fig. 8). Heisler* says:

" As a rule each Graafian follicle or ovisac contains but one ovum,
though sometimes two, and more rarely three are present."

Or the single ovum may contain a double nucleus i.e., two
germinal vesicles instead of the more frequent single one
(see H, Fig. 8).

1 Heisler, " Text-book of Embryology," 2nd ed. 1902, p. 27


OVULATION. The chief function of the ovaries is ovulation
or the discharge of ripe ova, or oocytes.

This is brought about by the development and maturing
of a Graafian follicle, its rupture, and the discharge of the
by-now-perfected ovum which it contained. Normally
this occurs quite unconsciously and without pain.

The enlarging follicle having gradually approached the
ovarian surface, its walls becoming .congested, thinned
and weakened, and at one part exposed, it then bursts.
The liquor folliculi is poured out, and the ripened ovum is
set free. This is ovulation or the dehiscence of an ovum.

Heisler 1 says:

" Ova are extruded from the ovary, one or more at a time, at
regular, generally monthly, intervals, from puberty to the climacteric,
usually during the menstrual period."

Halliburton 2 says :

" The ripening of an ovum occurs about once every four weeks."

In a young girl, before the ovaries have begun to ovulate,
i.e., to fulfil their physiological function of providing ova,
the surfaces of the ovaries are smooth. Garrigues 3 says
they are

" even, smooth, velvety, of pearl- grey colour. Later, each ovula-
tion leaving a little puckered cicatrix, the surface shows irregular

Dr. T. B. Grimsdale 4 reports a case of a

" well-developed girl aged 22 who had never menstruated." " Both
ovaries presented smooth surfaces like that of an olive. The
patient was a virgin."

1 Heisler, op. cit., pp. 33, 37.

2 Halliburton, " Physiology," 1915, p. 869.

3 Garrigues, op. cit., p. 71.

4 " Journal of Obstetrics and Gynaecology," vol. iii., May, 1903. P- 5-

17 2



It must be noted that the greater proportion of the
Graafian follicles and their contained ova are microscopic,
hence an infinitely small piece of an ovary may contain
immature Graafian follicles which are capable of develop-
ment and maturation. It is only as the growing follicles
approach the free surface of the ovary, preparatory to
bursting, that they become visible to the naked eye.




A. Ripe ovum just shed from the ruptured Graafian Follicle, with cells of the D.P. or Discus
Proligerus still clinging to it. G.F. A Graafian Follicle. OV. An Ovum. N. The nucleus
of an ovum. L.F. The Liquor Folliculi or liquid contents of a follicle. S. The fibro-
muscular stroma or groundwork of the Ovary. B.V. Blood-vessels. E. Small Graafian
Follicles near the surface of the Ovary. C. Epithelium covering the free surface of the Ovary.
T. Typical G.F. containing the normal single ovum with one nucleus. H. An ovum which
has two nuclei. K. Two distinct ova in a G.F.; each is surrounded by cells of the D.P.
M.G. Cells lining the walls of the follicles, and known as the Membrana Granulosa.

The Graafian follicle having ruptured and the ovum
escaped, the rent in the substance of the ovary then begins
to heal and the cavity of the old follicle or ovisac fills up,


being partly obliterated by the collapse and contraction
of the sac wall, while the remainder of the cavity is rilled
with blood incidental to the rupture.

THE CORPUS LUTEUM. Subsequent changes in the
filled-up follicle convert it into a yellow-coloured body called
the corpus luteum. The after-history of the corpus luteum
is entirely dependent on whether the ovum which was set
free from the Graafian follicle becomes fertilised or not.

If not fertilised the site of the follicle is gradually obliter-
ated, so that after about two months, only a depressed
cicatrix, or pit, shows on the surface of the ovary from
whence the ovum was discharged; this smaller corpus

GRAAFIAN FOLLICLES. (Modified from Leopold.)

Note their relative sizes, and the folded cell-wall of the corpus luteum.

luteum, which thus follows menstruation only, is known
as a. false corpus luteum or corpus luteum of menstruation.
Play fair 1 says:

" The tissue of the ovary at the site of laceration also shrinks,
and this, aided by the contraction of the follicle, gives rise to one
of those permanent pits or depressions which mark the surface of
the adult ovary."

If the discharged ovum be fertilised we get pregnancy,
and the so-called true corpus luteum or corpus luteum of
pregnancy forms.

This true corpus luteum continues to grow for from three
to four months, so that it comes to be a very much enlarged
edition of the other or menstrual form of corpus luteum. At
the end of pregnancy it is very evident on section of the
ovary, while often it may be seen to be present even without
opening the ovary. Its entire obliteration, and termination

1 Playfair, op. cit., p. 67.


as a depressed scar on the ovarian surface, does not take
place for two months after delivery. The differences
between the corpus luteum after menstruation i.e. when
the ovum was not fertilised and the corpus luteum when
fertilisation has occurred are differences of degree only, as
Pier sol 1 says:

" the stimulus of impregnation leading usually to excessive de-

This is also thus confirmed by Whitridge Williams 2 :

" Both the true and the false corpora lutea present exactly the
same structure, the larger size of the so-called true corpus luteum
being simply due to the increased vascular supply incident to

Without an operation or post-mortem, enabling us to see
which ovary contains the corpus luteum, we are quite
unable to say from which ovary the ovum was derived; so
that, as Hirst 3 says:

" The true corpus luteum is of value as an indication of the ovary
from which the impregnated ovum came."

We consequently see that a corpus luteum signifies a
previous ovulation.

PUBERTY. Puberty is the epoch in a female's life which
marks the change from childhood to womanhood; it is the
beginning of her fruitful period. It is a gradual develop-
ment, and usually takes place from the fourteenth to the
fifteenth year of a girl's age.

Spiegelberg 4 says:

" The ovaries and the ova contained in them are the first to
arrive at maturity." " The arrival at puberty, however, is generally
not coincident with the complete development of all the generative
organs, and especially not of the uterus; the latter continues to
grow considerably up to the twentieth year."

For the first twelve years of a girl's life the uterus usually
retains its infantile condition, but at puberty it rapidly

1 Piersol in Norris and Dickinson, " Text-book of Obstetricfi, " 1897, p. 61 .

2 W. Williams, " Obstetrics," 1903, p. 71.

3 Hirst, " Text-book of Obstetrics," 2nd ed. 1900, p. 63.

4 Spiegelberg, op. cit., pp. 59 and 62.


begins to increase in size. There are, too, certain external
signs of the approach of womanhood, for the breasts become
larger and menstruation begins.
As Bland-Sutton 1 says :

" In the female puberty is strikingly declared by the institution
of menstruation," so that " the actual establishment of puberty is
reckoned from the first menstruation."

Further, he says


" With the onset of puberty the ovaries, previously small, en-
large and exhibit the periodic series of changes known as ovulation."

Hence we get the two processes, ovulation and menstrua-
tion, normally starting together at puberty; and being
coincident at their beginning, they usually remain so during
life. It is not, therefore, until the approach of puberty that
the regular full development of the (iraafian follicles and
their contained ova begins to take place; a few partially
develop and then abort, and a very minute proportion may
even burst and discharge an ovum before puberty, proof
being that girls sometimes get pregnant before they first
menstruate; but, as Pier sol' 3 says:

" The advent of puberty marks the establishment of the full and
regular development of the Graafian follicles and their contained
ova, accompanied by the usual attendant phenomena of men-

Herman 4 says :

" Graafian follicles ripen, though they have not yet been proved to
burst, long before menstruation has appeared; and there is reason
to think that they may degenerate without bursting before puberty " ;

and W. Williams, 5 while admitting their growth during
childhood, says:

" They rarely rupture at this time, on account of their position
in the depths of the ovary and the intervention of a thick layer of
cortex between them and the surface."

1 Bland-Sutton, " Diseases of Ovaries," 2nd ed. 1896, p. 5.

2 Bland-Sutton and Giles, " Diseases of Women," 4th ed. 1904, p. 17.

3 Piersol, op. cit., p. 71.

4 Herman, " Diseases of Women," 2nd ed. 1903, p. 518.

5 W. Williams, op. cit., p. 66.


T. G. Stevens 1 says:

" No rupture of the follicles takes place, and nothing in the
least approaching the structure of a corpus luteum is formed in
pre-menstrual life."

So that we see that rupture of the follicles and the forma-
tion of corpora lutea do not normally occur prior to the
onset of menstruation.

MENSTRUATION. Menstruation is the expulsion of the
menses, a periodic discharge of a bloody fluid containing
mucus and debris derived from the superficial cells of the
mucous membrane lining the cavity of the uterus. Normally
it recurs every twenty -eight days throughout the repro-
ductive period of a woman's life.

It begins at puberty and ceases at the " change of life "
or menopause, and on an average it may be taken to extend
from the fourteenth to the forty-fifth year of a woman's
life, so that the average duration of the menstrual function
is about thirty years.

Exceptions to this age-limit at both the beginning and
the cessation are frequent, several cases of precocious
menstruation, some in infants shortly after birth even,
being recorded. These very early cases are open to the
objections that bloody vaginal discharge is not necessarily
menstruation, and that in most cases it does not recur and
so is not periodic, as in the case recorded by Dr. R. Jardine
in the "British Medical Journal," February 1901; and
Dr. ] elicit is doubtless correct when he says, in " Journal
of Obstetrics and Gynaecology," vol. i. 1902, p. 700:

" Menstruation appeared to him to be a misnomer for the red
discharge that occurred in newly born female children. It was
an isolated haemorrhage, not a menstrual flow."

Dr. Macnaught on- Jones? however, quotes a case by
Mengus of regular menstruation in a child 23 months old.

It is commoner to find cases of delayed menopause, some
women continuing to menstruate beyond the age of sixty.
Dr. E. J. Tilt 3 met with two cases at the 6ist year out of

1 Loc. cit., p. 468.

2 Macnaughton-Jones, " Diseases of Women," 1900, p. 30.

3 Tilt, " Diseases of Women," 1853, p. 44.


284 patients ; while W. Williams* quotes a case of a woman
who had her 22nd child at the age of 63 years, " after which
she still continued to menstruate."

It is usually said that menstruation is arrested during
pregnancy and during lactation : this arrest is not absolutely
certain, for menstruation may continue for the first two
or three months of pregnancy. It very rarely, if ever,
does so for longer in a normal uterus; but for men-
struation to take place during lactation is far more

Remfry 2 states that among 900 suckling women, in
57 per cent, only was menstruation entirely absent, and
that 43 per cent, of suckling women menstruate more
or less, 26 per cent, of these menstruating with absolute

Karl Heil, 3 as a result of his own observations of 200
women, found that 125 of them menstruated during lacta-
tion that is, 62-5 per cent. and adding his figures to
those of other authors, concludes that about one-half of
all women menstruate during lactation. Also that as the
number of pregnancies increases, the liability to menstruate
during lactation increases also.

He considers it probable that the women who menstruate
during lactation represent the normal type, rather than
those who have amenorrhoea.

Menstruation is the outward periodic sign that the lining
or mucous membrane the endometrium of the uterine
cavity had been prepared to receive and give anchorage
to a fertilised ovum; hence Geddes and Thomson 4 say that
" menstruation is comparable to an abortion prior to a new
ovulation ' ' ; but as the stimulus imparted by a fertilised
ovum is not forthcoming, its degeneration and discharge
accompanied by some bleeding follow.

Menstruation is therefore, as Dr. John Power in 1821
wrote of it, a " disappointed pregnancy "; or, as Dr. Robert
Cory 5 calls it, " only the abortion of an unimpregnated ovum

1 W. Williams, op. cit., p. 74.

2 Remfry, " Trans. Obstet. Soc.," vol. xxxviii. 1896, p. 26.

3 " Monat. fur Geb. und Gyn."

4 Geddes and Thomson, " The Evolution of Sex," 1901, p. 265.

5 Dr. R. Cory, " Lancet," November 7, 1891.


or egg "; while Dr. Peter Horrocks 1 terms it a " miniature

Dr. A. W. Addinsell 2 says:

" Menstruation may be considered as evidence of a failure of
these anticipations " " for the implantation of an impregnated

The process of building up a fresh nidus of swollen mucous
membrane, to prepare for an oosperm or fertilised ovum,
recurs after each discharge of the preceding unused one;
the degeneration anol discharge of some of the hypertrophied
mucous membrane is the result of disappointment in the
absence of an oosperm. This constitutes menstruation;
and the process is made evident to the woman by a varying
amount of pain and constitutional disturbance, and clinically
by variations in temperature, pulse, blood pressure, etc.

These, then, are the phenomena of menstruation, and have
nothing whatever to do with its causation.

Some few authorities, as Heape and F. H. Marshall, are
disposed to call menstruation a preparation for pregnancy,
not an undoing of the preparations: which is correct is
immaterial to this theory of sex causation, but certainly, if
this is so, pregnancy in a non-menstruating woman, i.e. in
a woman whose uterus was not prepared for pregnancy,
would be very difficult to explain.

Proof that the presence of menstruation is not necessary
in order that impregnation should occur is shown by the
cases of pregnancy beginning during long periods of amenor-
rhcea; thus

Strassmann 3 recorded a remarkable case of absence of
menstrual periods and repeated pregnancies. A woman of
45 began to menstruate at 16 years of age, and continued
regularly up to her i8th year, when she had her first child.
From the i8th to the 39th year she did not menstruate
at all, but had seventeen full-time pregnancies and a three-
months' miscarriage. At the age of 39 menstruation
returned and continued regularly monthly until she was 45.

So that for over twenty years her uterus was not prepared

1 Horrocks, " Trans. Obstet. Soc.," vol. xl. 1898, p. 173.

2 Dr. A. W. Addinsell, " Lancet," March, 1905, p. 791.

3 " Lancet," July, 1905, p. 171.


by menstruating for pregnancy ! yet she became pregnant !
and gave birth to seventeen children.

A somewhat similar case occurred in my own practice :

Mrs. W. A. T. was aged 38 in September 1911. Her
menstrual periods began when she was between 16 and 17
years of age, irregularly at first and always rather scanty.

She had three children in the first three years of her
married life. After that her periods only occurred at very
long intervals, never less than a year apart.

In September 1911, being then pregnant some three
months, she engaged me to attend her in her confinement.
She had then just gone two years and six months since
her last period, and a similar interval had elapsed between
that one and its predecessor, i.e. two periods in five years
she had only seen five periods altogether in the nine years

2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Online LibraryErnest Rumley DawsonThe causation of sex in man; a new theory of sex based on clinical materials together with chapters on forecasting or predicting the sex of the unborn child and on the determination or production of either sex at will → online text (page 2 of 18)