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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assured."

It follows that this woman, who thus had her left tube and
left ovary removed in May 1898, had only the right ovary
remaining to produce ova. That this right ovary was
functionally active is evident from the sequel, for Dr. Routh
writes me that she afterwards " became pregnant and gave
birth to a boy in April 1899."

1 " Trans. Obstet. Soc.," 1898, p. 222.



78 THE CAUSATION OF SEX

Dr. Macnaughton- Jones 1 describes a case of pregnancy
after removal of the left ovary and tube.

" In February 1903, at the operation, the sac of the left ovary
was found about the size of an orange and full of blood; the cyst
of the left ovary with the left tube was removed entire. Towards
the end of 1895 menstruation ceased, and I found she was pregnant.
She was delivered of a male child on May 3ist, 1896."

Thus this woman with only the right ovary in her abdomen
gave birth to a boy.

Dr. L. B. had the left ovary removed from a patient,
and three years later she was delivered by him of a boy.

Mrs. B. G. had had disease of her left Fallopian tube, etc.,
for years, during which time she had given birth to two
boys. The disease continued, till finally a pyosalpinx or
abscess in the tube formed. The diseased left tube and
ovary were therefore removed. Two years afterwards she
gave birth to another boy, the ovum having necessarily
come from the right ovary.

Dr. P.'s case. Mrs. M. F. married in April 1902; she
became pregnant during September 1902 in her left Fallopian
tube.

She was admitted to hospital, and her pregnant left tube
and left ovary were removed.

Less than two years afterwards, in August 1904, she was
delivered of a living male child.

The right ovary, the only one remaining in her abdomen,
had given rise to a boy.

Similarly if the right ovary be entirely removed, any ovum
subsequently fertilised must come from the left ovary, and
a girl will be born, and thus will support my theory.

Dr. McKerron 2 has a paper on " Obstruction of Labour
by Ovarian Tumours in the Pelvis." Right ovariotomy,
subsequent pregnancy, and birth of female child. The
tumour was removed. It was a right ovarian dermoid.
She subsequently became pregnant once more, having, of
course, then only the left ovary in her body. She was de-
livered on January 15, 1897, of a living female child.

1 " Diseases of Women," 1900, p. 667.

2 " Trans. Obstet. Soc.," 1897, pp. 337 and 339.



CHILDBEARING AFTER OVARIOTOMY 79

After the right ovariotomy the left ovary must of necessity
have supplied the ovum which was fertilised, hence a girl
was born.

Mr. Alban Doran 1 describes a case of right tubal preg-
nancy. The right tube and right ovary were removed.
" The left tube and left ovary were perfectly normal," and
therefore were not removed. Mr. Doran has since in-
formed me that he " removed the whole of the right ovary
on December 2, 1899.

" The uterus was not pregnant at the time of the operation; the
patient was confined of a girl in December 1900."

Thus having only the left ovary, the ovum fertilised
therefrom produced a female child.

Mrs. D. C. had her right ovary and tube removed by
Dr. J. Oliver. She has since been pregnant on two occasions,
a female child being born each time.

I delivered her of her second girl in April 1903, having
assured her it would be a girl directly she became pregnant.

Mrs. B. P. had three boys born. When the youngest was
nearly ten years old an abdominal tumour developed. At
the operation her right ovary was removed for a tumour in
it. Subsequently a girl was born, just three years after the
operation.

Her right ovary having been removed, she had only
one ovary remaining in the abdomen, namely the left, and
a female child was derived therefrom.

H. B. Mylvaganam, 2 in a case of advanced pregnancy
and ovarian cyst, performed abdominal section, and tapped
and removed a large cyst of the right ovary. He then
performed Caesarean section, and " a viable female foetus
about eight months old was removed."

In this case it was evident that the girl had come from the
healthy left ovary, the right ovary being diseased and
occupied by a " large thin- walled cyst containing smaller
cysts," which had existed "for the past few years," and
for which she had been tapped four times and fluid had been
drawn out." The left ovarian origin of the ovum is evident.

L "Trans. Obstet. Soc.," 1900, p. 135.

2 H. B. Mylvaganam, F.R.C.S., in " Lancet," July 29, 1911, p. 297.



8o THE CAUSATION OF SEX

The Effects of Bilateral Ovariotomy. It seems difficult to
realise that any other result than absolute sterility can
possibly follow the removal by operation of both ovaries.

THERE ARE, HOWEVER, ON RECORD A DOZEN CASES OF
PREGNANCY FOLLOWING THE SO-CALLED REMOVAL OF BOTH

OVARIES.

It will of course be at once evident that the supposed
removal was not complete, a portion of one or other ovary
being allowed to remain in the abdomen. There is, as far
as I can gather, no case on record of a portion of both ovaries
being inadvertently allowed to remain and different-sexed
twin-pregnancy following.

In one extreme case quoted by Parvin 1

" Olshausen performed, as he thought, ovariotomy; but the result
being fatal, he found at the autopsy that neither ovary had been
removed."

Complete removal, then, of all ovarian tissue from both
sides absolutely stops ovulation, and therefore leads to per-
manent sterility; menstruation, too, is permanently arrested.

I do not propose here to go further into the question of
the results of incomplete operations, which I have con-
sidered in Chapter XXI., beyond pointing out the fact
that, as a small portion of an ovary can carry on its functions,
the operation known as resection of an ovary has been
introduced.

The Effects of Resection of an Ovary. Resection of an
ovary is an operation by which, in a partially diseased
ovary, the diseased part only is removed, the healthy part
being allowed to remain. This conservative operation is
due to the appreciation of the fact that a very small piece
even of an ovary is sufficient to ensure the production of
fertilisable ova, so that pregnancy may follow the entire
removal of one ovary and the partial removal or resection
of its fellow. Hence it follows that resection of one ovary
and entire removal of the other resembles incomplete
bilateral ovariotomy in its results.

The actual effect as regards the sex of children born after
resection of one ovary depends necessarily on whether the
opposite ovary has been entirely removed or not.

1 Parvin, " Science and Art of Obstetrics," 1895, 3rd ed. p. 107.



CHILDBEARING AFTER OVARIOTOMY 81

If not removed, the woman can have either sexed children,
or " pigeon-paired " twins, because there is one complete
ovary and part of the opposite one.

If the opposite ovary have been entirely removed, she
can have but one sex of children, which will correspond to
the ovary resected.

The following is a case in point, which very characteristic-
ally supports my theory :

Mrs. Stanley Boyd 1 operated on a patient and entirely
removed the right ovary. She resected the left ovary, as a
portion of it showed early cystic disease. The cystic portion
was removed, and the healthy part of the left ovary was
allowed to remain in the abdomen.

The patient subsequently became pregnant, and was
duly delivered of a girl.

Necessarily the healthy remainder of the left ovary must
have provided the ovum, and consequently the child born
was a female.

Besides strikingly supporting my theory, this case also
exemplifies very plainly a fact which many critics either
cannot or will not realise viz. that the complete removal
of an ovarian tumour is not synonymous with the complete
removal of all the ovarian tissue on the same side as the
tumour.

One cannot but regret that writers so often fail to record
of which ovary it is that a portion is healthy, and so allowed
to remain in the abdomen; and also fail to record the sex
of the child subsequently born.

From an interesting paper by Mrs. S. Boyd 2 it appears
that probably 20 per cent, of women become pregnant after
such operations.

1 " British Medical Journal," " Conservative Surgery of Tubes and
Ovaries," Sept. 15, 1900.

2 Mrs. S. Boyd, " Journal of Obstetrics and Gynaecology," vol. iii.,
March 1903, p. 241.



CHAPTER XI

CASES OF PREGNANCY IN ABNORMAL UTERI
WHICH PROVE THE THEORY

IT has been pointed out in the chapter on Anatomy that
the uterus in the human female is a single-cavity-containing
organ formed by the fusion of the two ducts of Miiller.

If these two tube-like ducts, from which the uterus is
developed, do not properly coalesce, the uterus in the human
female becomes double, and is known as a bi-cornuate uterus.

The diverging branches of the uterus are known as cornua
or horns, a right and a left, and their cavities being more
or less separated, the whole cavity comes to be somewhat
Y-shaped, and thus it resembles the uterus of many of the
mammalia. Cf. Fig. 4, p. 10.

Though the uterus be thus doubled, the number of
ovaries and Fallopian tubes remain the normal, only one
ovary and one tube being associated with each half of the
uterus.

Pregnancy occurs in these as in normal uteri, and the child
derived from the right ovary usually develops in the right
cornu, and that from the left ovary in the left cornu; thus
these cases confirm and prove the theory.

Dr. A. E. Giles, 1 in describing a case of complete double
uterus, states that the right half of the woman's uterus had
never been pregnant, the mouth of this right half of the
womb being small, round, and virginal. The left half or
cornu of the uterus had been pregnant. It was the larger
of the two, and its mouth was opened and elongated trans-
versely, showing a child had passed through it. She had
given birth to one child only, a girl, which was alive. That
is, the left side of a double uterus had brought forth a
female child.

1 Giles, " Trans. Obstet. Soc.," vol. xxxvii. 1895, p. 305.
82



CASES OF PREGNANCY IN ABNORMAL UTERI 83

Jurinka 1 describes a case, of which an abstract is given
in the above journal, of double uterus. The left half was
not pregnant.

" The cavity of the gravid right half contained an embryo of the
male sex."

There is no mention of a corpus luteum, unfortunately,
but the right side of a double uterus had brought forth a
male child.

Thus these two cases strikingly confirm the theory.

Lusk 2 mentions that Professor Fordyce Barker had a
case of " double uterus." " A mature living male child
was born on July 10, and on September 22 following the
mother gave birth to a full-term living girl." So that each
half of a double uterus produced a full-time child of different
sex, but which side contained which is, most unfortunately,
not given.

Dr. M. Handfield- Jones, 3 in a case of double uterus,
found the left side pregnant, and the corpus luteum in the
left ovary, but no sex of the child was given.

Dr. Walls 4 described an unusual case where, from a double
uterus, a male child was delivered. The placenta was
attached in the right half of the uterus, and the greater
part of the child was in the left half, its " head being in
a cavity between the two cornua."

Possibly before labour set in it was entirely in the left
horn; but the fact is evident that the male child first de-
veloped in the right half, as shown by the location of the
placenta.

Hence this case is confirmatory also.

Ollivier 5 reported a case where a woman had been preg-
nant on six occasions, all in the left half of a double uterus.
The " right half of the uterus was virginal, the left half
larger and more developed."

Unfortunately, the sex of the children is not given.

1 Jurinka, " Journal of Obstetrics and Gynaecology," vol. v., Feb. 1904,
p. 173; and " Brit. Medical Journal," Epitome, Dec. 1903.

2 " Science and Art of Midwifery," 1892, p. 231.
" Trans. Obstet. Soc.," vol. xxix. 1887, p. 146.

4 Dr. Walls, " Practitioner," Jan. 1903, p. 82.

5 " Gazette Medicale de Paris," 1872, p. 163.



84 THE CAUSATION OF SEX

In some cases of double uterus, the two halves of the
uterus are not equally developed.

In a case where the right half of the uterus had thus
only partially developed, Mr. J. H. Targett 1 removed it
and its contained child, which was a boy. That is, the
right half of the uterus had brought forth a male child.
The left half of the uterus was empty.

It is In these cases of double uterus that migration of
the ovum most frequently takes place, for we find a foetus
in one cornu and the corpus luteum in the ovary of the
other side. External migration of the ovum must neces-
sarily occur in those cases where the two cornual cavities
do not coalesce above a common cervix, but each ends in a
separate cervix. There is no evidence to warrant a belief
that a fertilised ovum can pass out of the cornu and
cervix of one side into the single vagina, and thence pass
through the other cervix into the cornu of the opposite
side ; certainly it cannot do so if the vagina is also doubled
and distinct.

Dr. Lewers 2 showed a specimen consisting of pregnancy in

" the rudimentary left uterine cornu, with the left Fallopian tube
and ovary attached to it. The ovary does not contain the corpus
luteum, so that the case must have been an example of the external
migration of the ovum from the opposite ovary " (the right).

The child was a boy.

Here is a case of a male child developing in the left
rudimentary half of a uterus, and the left ovary proved not
to have provided the ovum: a most convincing case. The
right ovary was, of course, not examined, but remains in
the abdomen.

A somewhat similar case is recorded by Sir T. Rudolph
Smith 3 and Dr. H. Williamson. The specimen was " a
dilated rudimentary left uterine cornu bearing a foetus."
The left ovary was small and normal. No mention of corpus
luteum in it, as it was evidently not in it, because, owing to
the fact that " the pedicle attaching the sac to the uterus
was imperf orate," the means by which the oosperm reached

1 Targett, " Trans. Obstet. Soc.," vol. xlii. 1900, p. 276.

2 " Trans. Obstet. Soc.," vol. xlvii. 1905, p. 113.

3 " Journal of Obstetrics and Gynaecology," vol. iii. 1903, pp. 27-30.



CASES OF PREGNANCY IN ABNORMAL UTERI 85

this rudimentary cornual cavity must have been by external
migration of the ovum.

The normal right tube and ovary remain in the abdomen,
and the latter undoubtedly contains the corpus luteum.

Note that the left ovary is described as small, therefore
not enlarged by the growth of a corpus luteum in it. In a
private letter Sir Rudolph Smith tells me the child was
a boy.

The ovum, I maintain, must have come from the right
ovary, and the child was a male; it is a similar case to one
published by Howard Kelly.



CHAPTER XII

THE CORPUS LUTEUM AS A SIGN OF
PREGNANCY

PREGNANCY manifestly cannot occur without the provision
of an ovum, so that ovulation precedes pregnancy.

The ovum is extruded by the bursting of a Graafian
follicle. The ruptured follicle filled with blood is the first
stage in the formation of a corpus luteum, hence ovulation
is always followed by the formation of a corpus luteum.

The difference between the corpus luteum of menstrua-
tion and that of impregnation, or the " false " and the
" true " corpus luteum, has already been pointed out to be
one of size only ; the larger s r ze of the truecorpus luteum being
due to the increased congestion or blood supply incident to
pregnancy.

* Hence it follows that pregnancy is practically invariably
shown by the presence of a true corpus luteum, and I have
throughout looked upon the presence of a true corpus
luteum as not only indicative of pregnancy, but as indicative
of the ovary which provided the fertilised ovum.

As Hirst 1 says :

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

But a large corpus luteum has been found in some in-
stances where no pregnancy has existed.

In the great majority of such cases, where the uterus has
not contained a foetus, it has contained a growing myoma
or fibroid tumour.

Two such cases are mentioned by Sir J. Bland-Sutton, 2 a
myoma being present in each; while in a third instance

1 Hirst, " Obstetrics," p. 63.

2 Bland-Sutton, " Surgical Diseases of Ovaries," 1896, p. 18.

86



CORPUS LUTEUM AS A SIGN OF PREGNANCY 87

related by Sir J. Bland-Sutton, 1 not only was the ovary which
contained the well-marked corpus luteum itself occupied by
a large dermoid tumour, but the " uterus contained a large
myoma which blocked up the pelvic cavity.'*

He therein also states he has seen several other instances
in association with myomata; and other cases have been
described by Dr. Herman 2 and Dr. Popow, 3 a fibroid being
present in every case.

A placental polypus has also been known to act like a
fibroid, and cause a subsequent menstrual corpus luteum
to develop like one due to pregnancy.

Undoubtedly the presence in the uterus of a fibroid
tumour and the irritation of its growth acting reflexly on
the ovary similarly to what a foetus does, cause the corpus
luteum of menstruation to grow into a large or true corpus
luteum indistinguishable from one due to pregnancy, or, as
Dr. Galabin 4 expresses it

" A fibroid causes a corpus luteum like that of pregnancy, owing
to undue congestion."

One other cause of a " true " corpus luteum in women
whose uterus contains no foetus has been discovered in
prostitutes, and Dr. Popow 5 has described such a case.

Here the life of drink and venery provides that irritation,
stimulation, and " undue congestion," which would lead
to the growth from the " false " to the " true " corpus
luteum.

Some other cases are doubtless due to the occurrence of
extra-uterine gestation, a tubal mole or abortion being over-
looked, for the lately pregnant tube very quickly returns to
its normal condition and appearance, and the fact that it
had been pregnant is missed. Dr. Cullingworth has
exhibited and described a Fallopian tube which had within
ten hours of its rupture, and extrusion of an early ovum,
entirely resumed its normal size and appearance. Had it

1 Bland-Sutton, " Trans. Obstet. Soc.," vol. xxxiv. 1892, p. 6.

2 Herman, Ibid., vol. xxxiv. 1892, p. 10.

3 Popow, Ibid., vol. xxiv. 1882, p. 100.

4 Galabin, " Manual of Midwifery," 1900, p. 45.

5 Popow, loc. cit.

6 " Trans. Obstet. Soc.," vol. xlii. 1900, p. 129.



88



THE CAUSATION OF SEX



not been for the rent and the microscopic detection of
chorionic villi, it would have been impossible to recognize
it as having recently contained an ovum. See Sir J. Bland-
Sutton's 1 diagram of a normal-looking tube after recent
complete tubal abortion: there is a well-marked corpus




FIG. 14. A RECENTLY PREGNANT FALLOPIAN TUBE, WHICH HAS
ABORTED THE LARGE MOLE SHOWN. (After Bland-Sutton.)

There is a well-marked corpus luteum displayed in the opened ovary.

luteum in the ovary; the uterus would of course contain
no foetus in this case.

A few cases of pregnancy and no corpus luteum have been
stated to have been seen. The rate, however, at which a
corpus luteum disappears occasionally varies; thus W.
Williams 21 says:

" In young women, in whom the circulation is active, the de-
generated lutein cells are rapidly absorbed, so that in a short time
the corpus luteum becomes replaced by a newly formed connective

T Bland-Sutton, " Diseases of Women," 1904, p. 290.
2 Williams, op. cit., p. 68.



CORPUS LUTEUM AS A SIGN OF PREGNANCY 89

tissue, which corresponds closely in appearance to the surrounding
ovarian stroma. But in more advanced life, when the ovarian
circulation has become impaired, absorption goes on less rapidly."

It is probable, therefore, that in these cases the corpus
luteum has become absorbed more rapidly than usual, and
so has not been recognised.

We come then to the conclusion that a true corpus luteum
is always present during pregnancy, and is indicative of it,
or as Parry * puts it

" The presence (of the corpus luteum in pregnancy) is the rule,
its absence is the exception, especially in the early months of ges-
tation."

1 Parry, " Ectopic Pregnancy."



CHAPTER XIII

THE MIGRATION OR TRANSMIGRATION OF
THE OVUM

AMONG the cases which might at first sight have appeared
to disprove my theory, are those where the corpus luteum
is found in one ovary, while the foetus is found in the
opposite Fallopian tube ; or the opposite cornu, if the human
uterus happen to be of the mammalian or bifid form. In
these cases, the sex of the foetus corresponds to the ovary in
which the corpus luteum is found.

Bischoff, in 1844, was the first to call attention to the fact
that occasionally, in animals with a bicornuate or bifid
uterus, the corpus luteum may be in one ovary and the
embryo in the opposite cornu or branch of the uterus.

This he ascribed to a migration of the ovum, and alleged
that the fertilised ovum had come from the ovary in which
the corpus luteum was found, and had made its way into
the cornu of the opposite side instead of attaching itself
to the wall of the cornu corresponding to the ovary from
which it was derived. This explanation is certainly the
correct one.

Kussmaul first described its occurrence in woman, especi-
ally in tubal pregnancies, and pointed out that it might
arise either (a) owing to the ovum passing from one ovary
across the pelvic cavity along the peritoneal surfaces of the
intestines, into the external opening of the opposite tube,
which he called the External Migration of the ovum, or
(b) from its passing down one tube, then across the uterine
cavity and so up into the opposite tube, which variety he
called Internal Migration of the ovum.

Hirst 1 says:

"It is possible for the ovum, after its discharge from the ovary,
to be taken up by the fimbriated extremity of the opposite tube
an external transmigration of the ovum.

1 Hirst, " Obstetrics," 1900, p. 62.
90



MIGRATION OR TRANSMIGRATION OF OVUM 91

"It is also possible for the ovum to traverse one tube and the
uterine cavity, and to enter the uterine ostium of the opposite tube,
an internal transmigration of the ovum."

Both forms of migration of the ovum are credited by,
among others, Dr. Herman, ^ who said:

" There was abundant evidence in support of the external migra-
tion of the ovum, and some evidence in favour of internal migration."

W. Williams 2 says external migration " is probably by no
means rare," and further points out that proof of internal
migration is very difficult to bring forward, though " its
theoretical possibility cannot be denied."

It will be necessary to discuss each event, to show that
the occurrence is rather proof of the theory than otherwise.

The external migration of the ovum, or transperitoneal
migration, as Dr. Galabin describes it, means that an ovum
reaches the opposite tube without passing through the uterus.
It was described by Barnes 3 as Extra-Uterine Transmigra-
tion of the ovum.

In the normal condition of the tubes and ovaries, the great
majority of the ova, after leaving the ovary, enter the nearer
or corresponding tube ; but, as Sir J. Bland-Sutton 4 says :

" Probably a certain number of ova fail to enter the Fallopian tube,
and are lost in the peritoneal cavity."

But not all are lost because they miss the nearer tube,
for, falling into the general peritoneal cavity, they are caught
up in the thin capillary layer of serous fluid which bathes
the surfaces of the organs and intestines. This fluid acts
by keeping their surfaces moist, and by thus preventing
them from drying or adhering to each other, it enables one
coil of intestine to readily pass over another.

The peristaltic movements of the intestines, as well as
the natural changes in posture of the woman, must help
to carry small floating bodies like ova along the moist sur-
faces of the pelvic viscera. In this thin layer of fluid a
current exists, due to the wavy motion of the cilia or hair-

1 Herman, " Trans. Obstet. Soc.," vol. xlvi. p. 103.

2 Whitridge Williams, " Obstetrics," pp. 79, 80.

3 Barnes, " Midwifery," 1878, p. 346.

4 Bland-Sutton and Giles, " Diseases of Women," 1900, p. 18.



92 THE CAUSATION OF SEX

like processes lining the fimbriated ends of the Fallopian
tubes, and this current runs towards the large open abdominal
end of the tubes, and so down the tubes into the uterine
cavity.

But in addition to the peritoneal fluid or serum, we also
have the follicle fluid (Liquor Folliculi), together with a
little blood, which is discharged when the ovum escapes by


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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 7 of 18)