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Malformations of the hymen may require incision or partial ex-
cision.

Pseudo-hermaphrodism may perhaps give rise to surgical indica-
tions. In one. case which I saw, the erection of the j^enis was much
interfered with by the frsenum, and the patient requested me to de-
stroy it. A simple section seemed insufficient, and I decided upon
excision of the bridle and autoplastic repair; but when I proposed
to perform the operation, the jDatient refused to allow it.

BIBLIOGRAPHY AND NOTES.

1. Rathke : Abhandl. zur Entwiekel., 1832, vol. i., p. 57. The formation of the
perineum entirely by the median fold was first described after the plan of develop-
ment of the rabbit. The existence of a rhaph^ which is prolonged to the scrotum
and the sheath of the penis is in favor of Rathke's ideas. KOlliker (Embryologie,
French transL, 1882, p. 1,040) and Mihalkovics (Journ. Intern. Mens. d'Anat. et
d'Histol., vol. ii., p. 310) admit the mixed formation at the expense of both median
fold and lateral portions. Tourneux (Journ. de I'Anat. et de la Phys., Sept., Oct.,
1888, and Bull. Soc. de Biolog., Feb. 8th. 1890, p. 75) adopts the theory of the verti-
cal perineal fold exclusively. His researches were made on the embryo of the
sheep. He distinguishes two stages in the descent of the perineal fold : 1st, the
depi-ession of the median fold within the cloacal cavity ; 2d, the gliding of the
cloacal loop along the cloacal plug (Tourneux thus designates the large epithelial
mass which is formed by the union of the ectoderm with the entoderm, limiting
the cavity of the cloaca anteriorly). The cloacal cavity becomes obliterated finally



458 CLINICAL AXD OPERATIVE GYNAECOLOGY.

by the fusion of this cloacal plug with the anterior surface of tlie perineal projec-
tion. E. Ritterer (Bull, Soc. Biolog., Jan. 4th, lf<bO, p. 8; Journ. Anat. et Physiol.,
1890) has reached different results from the study of pig and rabbit embryos, em-
ploying celloidin as in M. Duval's method, to preserve the natural position of the
parts. The cloacal fold descends, as many observers have asserted, but this results
from tlie median fusion of the two lateral folds from the cloaca. The single fold
owes its existence solely to the union of the lateral folds and forms the urethro-
rectal septum — a process like that of the closure of the medullary furrow by the ap-
position and fusion of the medullary folds. Thus the cloacal closure and the forma-
tion of the perineum may be as described by Rathke, but instead of the five folds
admitted by this author, the Avhole process is reduced to the two lateral folds.

2. The corpora cavernosa develop in intimate connection with the bones of
the pelvis and are at first absolutely double. The prepuce appears toward the
sixth month. According to Bokai, the glans and the prepuce are at first adherent,
which accords Avith congenital agglutination of the labia minora in the female as
sometimes occurs. The prostate appears at the third month and by the end of
the fourth has become very prominent. It represents at first only a thickening
where the urethra and the genital cord meet at the commencement of the uro-geni-
tal sinus ; the glands are formed during the fourtli month.

3. S. Pozzi : Annal. de Gyn., April, 1884. Cong. Internat. des Scien. MM. de
Copenhague, Conip. Rend., 1884, vol. i., p. 67. See on the same subject Guinard:
Paris Thesis, 1880. Picqu(5 : Encycl. Internat. de Chir., French edition, vol. vii.
Issauriat : Le Sinus Uro-genital. Paris Thesis, 1888, ]S^o. 310.

4. Deutsch : ZS'eue Zeit. f. Geb.. Bd. xxx. Heppner : Petersb. med. Zeit., 1870,
Bd. i., p. 204. Rizzoli : Dell' Ano Vulvara. Mem. delF Acad. d. Sci., Bologna, vol.
v., 1875. Massari : Wien. med. Woch., 1879, IS^o. 33. Rovillain : Contrib. a I'Etude
Vices Conform, de TAnus, etc., Amiens, 1872. Winternitz : Prag. med. Wochens.,
1883, Bd. vii. Aveling : Lancet, 1884, vol. ii. Jacubowitz : Arch. f. Kiuderk., 1886
Bd. viii. Hadra: Berlin, klin. Woch., Bd. xx.

5. Cases where the rectum and anus are normal and yet communicate with the
vagina are very rare. Joseph : Beitr. z. Geb. und Gyn., Band iii. Caradec : Gaz.
des Hopit., 1863, Xo. 7. In the latter case the fistula is described as opening below
the vulva, but this is probably an error in interpretation; it was more likely a
second vagina, rudimentary and communicating with the rectum, as Ii. Mayer
remarks (Beitr. z. Geb. und Gyn., Bd. iii.). See also P. Reichel : Die Entwickel.
des Dammes und ihre Bedeutung. etc. Zeit. f. Geb. und Gyn., Bd. xiv.. Heft 1,
1887. A. V. Rosthorn : Unvollkom. Kloakenb. Wiener klin. AVoeh., No. 10.

6. Mosengeil : Archiv f. klin. Chirurg., 1870, Bd. xii., Heft 2. Lebedeflf: Ueber
Hypospad. beim Weibe. Arch. f. Gyn., Bd. xvi., p. 290, 1880.

7. Gosselin : Gaz. des Hop., No. 37, March, 1851. A. Herrgott : De TEstrophie
V^sicale, Paris, 1874. Kleinwiichter : Monat. f. Geb., Bd. xxxiv., p. 81. Testelin :
Gaz. Med. de Paris, 1861, No. 46. Nunez : Paris Thesis, 1882. Guinard : Paris
Thesis, 1886. Emmet : La Pratique des Malad. des Femmes. t'rench trans., Paris,
1887. Richelot : Union Med., March, 1887. Dohrn : Zeit. f. Geb. und Gyn., 1886,
Bd. xii.. Heft 1. MOricke: Zeit. f. Geb. und Gyn., Bd. v., p. 324, 1880. R. Frommel:
Ibid., Bd. vii., p. 430.

8. Klebs : Handbu(*li d. Path. Anat.. Bd. i., Abth. i. Ahlfeld : Die Missbild.
der Menseh., Abth. 2, p. 222. Schroder : Zeit. f. Geb. und Gyn., Bd. v.

9. Henle : Zeitschr. f. rat. Med., Bd. vi., p. 343. Albrecht : Sur la Signification
Morphol. du Penichisis, etc., in 15th Congress of German Surgeons, Berlin, 1886.
This author jiresented considerations full of originality and of great importance
from the standpoint of philosophical anatomy, as regards the interpretation of
malformations, noticing the analogies of atavism with the normal disposition of



MALFORMATIOXS OF THE VULVA, AXD HER:MAPHKODISiI. 459

the parts in the lower vertebrates, e. gr., the two half penes in the selachians : and
proved also that the terms ventral and dorsal as applied to the penis should be
reversed.

10. Secheyron : Abouche. Anorm. de I'Uret., etc. Arch, de Toeol., April, May,
1889. The ureter may also ox^en into The rectum ; see Jeannel : Rev. de Chirurg.,
April, 1887.

11. Debierre : Sur les Canaux de Gartner. Compt. Rendus Soc. Biolog., May
22d, 1885.

13. The ureter may in this ease remain imperforate (Secheyron) when it is
probable that the kidney will be atrophic or cystic.

13. FovUle : Bull. Soc. Anat., February, 1856.

14. De Yilliers : Arch, de Tocol., May, 1890, p. 373. A case of total absence of
the nymi^hfe, the clitoris covered with a fibrous adhesion from the labia majora,
which were very atrophic. See also Auvard: Travaux d'Obst., 1889, ii.. p. 533.

15. R. Blanchard : Etude sur la Steaopygie, etc. Bull. Soc. Zool. de France,
1883, pp. 15-75.

16. Bokai : TJeber Atresia der Schamspalte bei Kind. Jahrbuch f. Kinderk.,
N. F., Bd. v., pp. 26 and 163. 1873.

17. S. Pozzi: De la Bride Masc, etc. Bull, et Mem. Soc. Biolog., January
26th and February 16th, 1884. Gaz. Med. de Paris, February 23d, 1884. Annal. de
Gyn.. April, 1884. Sur une Partic. Meconnue des Organ. Gen., etc.: Cong. Intern,
des Sci. Med., Copenhagen, 1884 ; ComjDtes Rendus, vol. i., p. 67. I insist on these
dates on account of the singular omission that they are not cited in the analysis of
a memoir published after many of mine by O. Kiistner of Jena: Das Analogon des
Corp. cavern, ureth. beim Weibe, read May 23d at the Soc. of Med. and Xat. Hist,
of Jena. Centr. f. Gyn., January 10th, 1884.

18. Ledru : De la Memb. Appelee Hymen. Paris Thesis, 1855. P. Roze : De
I'Hymen. Strasburg Thesis, 1865. Henle : Handb. der Anat.; Eingeweidelehre.
Budin : Recherches sur THymen, etc. Bull. Soc. Biol, and Prog. Med., 1879.

19. One proof of the independence of vagina and hymen is the fact, many times
observed, of the existei^ce of this membrane in total absence of the vagina. How
shall the part exist if the whole be suppressed? It is, therefore, unjust to chal-
lenge, as Dohrn did (Die Bildungsfehler des Hymens, in Zeitsch. f. Geb. und Gyn.,
Bd. xi.. Heft 1, 1884), the case of Hofmann's (Gericht. Med., p. 115) relative to a
hymen provided with three openings found in a case of total absence of the vagina;
as also in my own experience, where there Avas a perfectly developed circular
hymen and no vagina (Bull. Soc. Biolog., Feb. 16th, 1884). Since then numerous
cases have been published. See Grohe's Institut (Greifswald) cited by Winekel :
Lehrb. der Frauenkr., 1856, p. 80. Bruns : Centr. f. Gyn.. 1888, p. 366. Zweifel :
Obstet. and Gyn. Soc, Leipsic. January 21st, 1889. Centr. f. Gyn., 1889, ]S"o. 25,
Las Casas de Santos : Zeitschr. f. Geb. und Gyn., Bd. xiv.. Heft 1, pp. 151 and 153.
The latter author observed three cases of absence of the vagina with a well-formed
hymen, in Schroder's service. These later cases should no more be neglected than
the two early ones which Dohrn challenged. As I will show farther on, the hymen
has been found in the hypospadias of the male and its connection with the sub-
penile bridle, the result of the aplasia of the eori^us spongiosum, rendered its true
affinities evident.

20. A. Doran : Handbook of Gyn. Operations, 1887, p. 4.

21. Turnipseed : Amer. Journ. of Obstet., 1877, vol. x. According to Bischoff
(Abhand. der K. bayer. Akad., 1879), the hymen is lacking in the anthropomor-
phic apes, and the vestibule is very deep.

22. Krimer : Hufeland's Journ., Sept., 1834.

23. Breisky : Deutsch. Chir., Lief. 60, 1886.



460 cLixiCAL AiN^D ()pp:kative gynaecology.

24. Sanger (Arch. f. Gyn., Bd. xxxvi., Heft 3) has observed obliteration of the
vagina at its lower third, by a membrane situated 4 em. above the hymen, in -which
a very small opening was discovered with difficulty ; the woman was seven months
pregnant. The membrane was excised and the pregnancy continued.

25. Fristo : Gaz. des Hopit., 1861, No. 96.

26. The corpus spongiosum of the urethra is formed by the erectilization of the
deep layer of the urethral mucous membrane. Now with what has been said of
the homology of the organs in the two sexes, and of the method of displaying the
same by splitting and elevating the penis, it is evident that the mucous membrane
of the pendulous portion of the penis should extend in the female from the meatus
to the clitoris, which is precisely the situation of the fra;num of the vestibule
which has been considered as the exact homologue of the superior part of the
penile portion of the urethra in the niale; of the same fibro-elastic structure also.
I have employed the term "organ of the corpus spongiosum " in order to have a
conniion name for the organ from which are formed the erectile tissue of the corpus
spongiosum in the male and the bulb in the female, which are similar organs in
the two sexes. It would be interesting also to find the mode of erectilization of
the bulb of the vagina in the female embryo and its connection with the hymen.

27. J. Heitzmann : Abnorme Bildung des Hymens. Wien. med. Presse, 1884,
XXV., p. 242. Dohrn: Die Bildungsfehl. des Hymens. Zeit. f. Geb. und Gyn., 1884,
Bd, xi.. Heft 1. Courty (loc. cit. [35], p. 112) reproduces many figures from the
theses of Roze and Ledru.

28. Luschka : Zeit. f. rat. Med., Bd. xxvi.

29. Other observations are still more convincing and demonstrate the indepen-
dence of the Mullerian ducts and the hymen, even where there is a septum.
Breisky has seen traces of a vaginal septum which was altogether separate from
the hymen. Corazza (Schmidt's .Jahrb., cxlviii., p. 148) in a case of double vagina
observed a single hymen placed 1 mm. in front of the septum. Winckel (Lehrb.
der Frauenk., p. 246, 1886) reports an analogous case.

30. O. Schaeffer : Bildungsanomal. weibl. Geschlechtsorg. Arch. f. Gyn., 1890,
Bd. xxxvii.. Heft 2.

31. Corazza : Schmidt's Jahrbuch, cxlviii., p. 148.

32. Duncan: Trans. Obst. Soc, vol. xxiv., 1882.

83. Schr5der : Mai. des Org. G6nit., French trans., 1880, p. 46.

34. Godefroy : Gaz. des H6pit., 1856, p. 142. In the fcetus the vagina is filled
■with epithelial dt^bris.

35. See the figure given in Gallard, of one of Luschka's cases (Leg. Clin, sur les
Malad. des Fem., 1879, p. 113), and of a case of Ledru in Courty (Trait<5 Prat, des
Mai. de VUt^r., 1879, p. 112).

36. Bohmer : Observ. Anat. Rai*., Fase. ii. M. N. Tucker: Die regelwidr. Geb.,
1826, p. 235. C. Robin : In Diet, of Nysten, article Membrane, 1855.

37. S. Pozzi : Soc. Biolog. and Copenhagen Cong., 1884, as cited. O. Schaeffer:
Loc. cit.

38. Cabrol operated in 1555, at Beaucaire, on a young girl who presented this
anomaly. See also Middleton : Amer. Jour. Med. Sci., Jan., 1868, p. 79.

39. Budin : Sem. 5l(5d., March 9th, 1889.

40. Budin : Deux Petit. Fis. de THymen dans une Primip., etc. Prog. MM.,
1887, No. 48.

41. Tolberg, cited by Dohrn : Loc. cit.

42. Winckel: Lehrbuch der Frauenk., 1886, p. 80. L. Aschen : Ein Fall von
hochgrad. Blutung, etc. Prag. med. Woch., 1889, No. 3. The bleeding was very
abundant ; arrested by tampon ; caused by laceration of the hymen slightly in-
volving the left nj-mpha and the navicular fossa.



XALFOR:iIATIOXS OF THE YULYA, AXD HEEMAPHKODISM. 461

43. Tide 26, remarks on the eorjjus spongiosum ; also Guinard : Comp. des
Org. Genit. Ext. dans les deux Sex. Paris Thesis. 18S6.

44. C. Devilliers : Xouv. Recherch. sur la Memb. Hymen, etc. Revue Med.,
1840, Tol. ii.

45. Brouardel : Causes d'Erreur et Regies Expert, dans les Affair, d' Attentat a,
la Pud. Gaz. des Hopit., Sept., 1887, p. 881. Memb. Hymen, son Examen, etc.
Ibid., p. 901.

46. The word hermaphroditism would be more correct.

47. Eschricht : Miiller's Arch. f. Anat., 1836, Heft 2. Bouillaud and Manec :
Jour. Univ. Hebd. de Med. et de Chir., etc., Paris, 1833: with an autopsy. Debout,
in Le Fort : Vices de Conform, de la Vulv., etc. Pai'is Thesis, 1863. J. Marzo :
Annal. d'Hyg. et de Med. Leg., 2d series, vol. xxv., 1866; doubtful ease. J. Simp-
son (Collected Works, vol. ii., p. 407) describes a little gui with apparently male
organs observed by Ramsbotham, Med. Gaz., xiii., p. 184: with demonstrative
autopsy; Hart and Barbour : French trans., 1888, p 584. Hofmann has published
(Wien. med. Jahrbuch, 1877, Heft 3, p. 24) a case analogous to that given in fig.
144. The latter is deposited in the Museum of Legal Medicine at Vienna, labelled
"excessive development of the clitoris*'; from a child of rachitic constitution
who died at three weeks of capillary bronchitis ; internal genitals normal ; no
other deformity.

48. Jeannel (Bull. Soc. Chirurg., 1887, p. 505) reports a case where there was a
bicorn uterus and a hypertrophied clitoris. In the autopsy of Bouillaud's case,
made by Manec, the presence of a prostate is spoken of about the end of the
vagina which received and contracted the vagina, which did not open by itself
in the vulva ; this condition is essentially masculine, but the absence of a micro-
scojjic examination leaves us in some doubt as to the nature of the pretended
prostate. The interpretation of the case is defective in another point : it was not
the vagina which opened in the urethra, but the urethra and the vagina together
opened into the vestibular canal, a vestige of the uro-genital sinus (see fig. 139, 4).

49. S. Pozzi : iSote sur deux Xouv. Cas de Pseudo-hermaph. M^m. Soc. Biol.,
1885, pp. 21-29, case No. 1.

50. Transverse hermaphrodism has been described as the term apphcable to
eases where the external organs belong to the one sex (almost always female) and
the internal to the other. They usually are cases of perineo-scrotal hyjjospadias
in the male.

51. On hypospadias in the male see Bouisson : Tribut a la Chir., 1868. vol. ii.,
p. 500. Guyon : Thesis, 1863.

52. S. Pozzi: Bull. Soc. Biolog.. January 26th, 1884. Mem. Soc. Biolog., 1884,
and 1885, pp. 21-29. Bull. Soc. Anthropolog. , December oth, 1889, vol. xii.. 2d ser.,
p. 602.

53. Case of Ernestine G., presented by Magitot (Bull. Soc. Anthropol., 1881)
and of Adele H., which I presented before the same society (ibid., December oth,
1889, p. 602.

54. S. Pozzi : Loc. cit. (52). Sanger presented before the Obstet. and Gyn. Soc.
of Leipsic, January 21st, 1889 (Centr. f. Gyn.. 1889. No. 25), a pretended female who
was remarkably large and. although married, had all the attributes of masculine
hyposioadias, as Zweifel declared : at the vulvar orifice there Avere the remains of a
crescentic hymen.

55. Marchand : Ein neuer Fall von Hermaphrod. Virchow's Archiv, Bd. xcii.,
p. 286. On the uterus masculinus see Ahlfeld : Missbild., ii. Ab., p. 250, and an
important autopsy published by A. Pozzi and P, Grattery (Pseudo-hermaph., in
Prog. Med., 1887). One of the interesting features of the case is the structure of
the frsenum ; under a mucous investment there was erectile tissue.



462 CLINICAL AND OPERATIVE GYNiECOLOGY.

56. Franqu(^ : Seanzoni's Beitrage, Bd. iv., cited by KoUiker : Embryolog.,
French trans., 1882, p. 1,043.

57. The vas deferens of one side has been seen to open by the meatus at the
side of the pseudo-vulva. Dohrn : Ein verheirat. Zwitter. Archiv f. Gyn., 1883,
p. 325. ,

58. The importance of malformations of the genital organs (micro-orchidia,
cryptorchidia) for the development of mental disease has been described by
Christian : Annal. M6dico-psychol., ser. 1, 40th year, p. 126, and Etude sur la Me-
lanchol., observ. 39, p. 135; and also by L. du Saule : Les Signes Physiq. des Folies
Rais., p. 15. RaiTegeau : Du Role des Anom. des Org. G^n. dans le Devel. de la
Folie, etc. Paris Thesis, 1885. Magnan : Des Anomal. des Aberrat., etc., commu-
nicated, to the Acad. M(3d., January 13th, 1885. Prog. Med., 1885. Trois Gas de
Conform. Vicieuse des Org. Gen. Bull. Soc. Anthrop., February 17th, 1887. Some
of these i^atients have been crazy. Alexina B., who was the subject of a remai-ka-
ble memoir by Tardieu (L'Identit6 dans les Rapports avec les Vices de Conform.,
etc., Paris, 1872), committed suicide. Complete account of the autopsy given by
Goujon: Joui". Anat. et Pln's. de I'Homme et des Anim., 1869, p. 599. It was a case
of male hypospadias.

59. Luigard : Lancet, 1884, vol. i., p. 16. See also the curious genealogy of the
family of Jan. Motet : Mem. Soc. Biol., 1885, p. 24.

60. Laugier : Art. Hermaphrodism in Diet, de M6dic. et de Chir. Pratique of
Jaccoud. A. Guinard : Thesis, 1886.

61. Rokitansky : Ein Fall von Hermaph. vera later. Allg. Wiener med. Zeit.,
No. 27, 1868. The article has been completely, but incorrectly, translated in Union
M6d., 1868, p. 498. On the same case see also Allg. med. Cent. Zeit., Berlin, 1868,
and Virchow's Arch., Bd. xliii. and xlv.

62. Ahlfeld remarks on the tendency which these individuals have to deceive
the physician. Catharina H. had a nose-bleed every month which she (he) used
for the purpose anointing the genitals with blood.

63. Hei^pner, Reichert : Dubois' Arch., 1870, p. 687. Analysis by Denmic in
Gaz. M6d. de Paris, 1872, p. 29. This case has often been incorrectly reported.
The specimen had been for many years in alcohol.

64. H. Meyer, of Zurich : Ein Fall von Hermaph. later. Yirchow's Arch., 1857,
p. 420. Klebs : Handbuch der path. Anat., Berlin, 1876. For a detailed criticism
of this case see J. Gai-rigues : Amer. System of Gyn., edited by Mann, vol. 1.,
p. 273.

65. Berthold (Abhand. kOnigl. Gesellsch. Gottingen, Bd. ii., p. 104, 1845) has
described a new-born child Avith hypospadias, a testicle on one side, a pretended
ovary on the other; this latter was. certainly an atrophied testicle, for it was
impossible to find any follicles in it. Banon : Dublin Medical Journ., vol. xiv.,
p. 75. Same remarks as above. See on this case Ahlfeld; for other cases of old
date see Maret, Yarocler, Rudolphi, Stark, Barkow, Gruber, Klotz. In the Mus6e
Dupuytren there are two specimens relating to the same number of cases of
true hermaphrodism^ No. 264 is a wax model, by Lemmonnier, of the external
organs; No. 265 is a reproduction in wax of the internal organs after autopsy ; the
notice accompanying them is expi'essed thus: "To a complete female genital ap-
paratus there are added two testicles and two deferent canals which take the place
of the round ligaments." It seems to me only a case of double hernia of the ovaries
into the labia majora. Houel, the curator of the museum, whose advice I re-
quested on the specimen, described it as "simple imagination." Specimen No.
267B is thus labelled : " Neuter hermaphrodite, Angelique Courtois (dissection in
alcohol). This hermaphrodite, observed by M. Foliin, is a man as regards the
external organs, a woman by the internal, and both man and woman by the deeper



MALFORMATIONS OF THE YULYA, AlfD HERMAPHEODISM. 463

organs." FoUin : Gaz. des Hopit., December 4th, 1851. The case appears to me
simply a hypospadias with an atrophied testicle.

66. An ovary and a testicle are often found on tlie same side in the.iish called
serranus, less often in the herring and the cod, etc. True hermaphrodism is the
rule in the toad (Bufo vulgaris) and it is very common in the frog (Ranatemporaria).
In the latter a testicle has been found in the male, surmounted by an adipose
body on each side, with a duct which was both ureter and vas deferens ; seminal
vesicles existed, as well as Muller's canals. The latter, which in the female become
large oviducts, in the male form delicate bands which prolong the seminal vesicles
up to the lungs (Bland Sutton). The seminal vesicles of the frog seem like dilata-
tions of Muller's ducts, but they really are part of the Wolffian duet. In the toad,
between the testicle and the adipose body, there is a small body called the organ
of Bidder, and according to recent writers this organ is a rudimentary ovary and
seems to have an important influence on the high degree of development of the
Mtillerian ducts of the male. In the male frog the Mullerian ducts are hardly visi-
ble, but by anomaly the male frog often presents an organ of Bidder by the side of
the testicle— that is, an ovo-testis, and at the same time the Mullerian duct may be
largely developed ; the latter seems to be in direct relation with the organ of
Bidder. J. B. Sutton : Dis. of the Lower Animals. Trans. Path. Soc. London,
1885, pp. 509, 510. A. F. Kent : A Case of Abnorm. Devel. Reproduct. Org. in the
Frog. Jour. Anat. and Phys., June, 1885, vol. six., part iv.

67. F. Schnopfhagen : Wien. med. Jahrb., 1878, Heft iii., p. 341.

68. Kolliker: Ueber einige Falle von Hermaph., etc. Cong. Period. Internat.
des Sci. Med., 8th session, Copenhagen, 1884, Compt. Rend., vol. 1., p. 47. Two of
these cases were simple hypospadias in the male, with a vagina and a large bicorn
uterus and imperforate tubes. In a third case there was true lateral hermaphrod-
ism (one testicle and one ovary), bicorn uterus, and external organs of the female
type. J. Renter: Inaug. Dissert., Wtirzburg, 1884.

69. For the operation necessary in vaginal atresia of the anus, I refer to trea-
tises on general surgery.

• 70. Roser : Wurtemberg Correspondenzblatt, June 12th, 1861.

71. Richelot : Union M(5d., March, 1887. No. 31.
. 72. Dohrn : Zeit. f. Geb. und Gyn., 1886, Bd. xii., Heft 1.

[73. Krug : Am. Jour, of Obst., Jan.. 1891. The physical characteristics of this
patient were strongly masculine ; the external genitals resembled those .of a male,
being very similar to those shown in Fig. 148. There was a small uterus ; the
apparent ovaries were the seat of sarcomatous degeneration for which a laparat-
omy was done, the patient dying on the second day of pneumonia.]



CHAPTER XXV.
MALFORMATIOXS OF THE VAGINA AXD THE UTERUS.

Muller's ducts form tlie entire genital canal, vagina, uterus, and
tubes ; the vagina and the uterus develop from the inferior segments
of these ducts enclosed between the uro-genital sinus and the inser-
tion of Hunter's ligament in the Wolffian body. These inferior seg-
ments fuse in the median line to form a single canal, called the geni-
tal canal (Leuckart) or the utero-vaginal ; their upper portions, diverg-
ing between the ends of the genital cord and the round ligaments, be-
come the uterine cornua. Xonnally, these horns are little developed in
the human species, being absorbed into the fundus of the organ as
part of its further development. But if the space included between
the insertion of the round ligaments and the end of the genital canal
is obliterated, as is the rule in certain animals and the abnormal ex-
ception in the human female, the uterine fundus is diminished or
suppressed; the organ then develops singly at the expense of the



Online LibraryS. (Samuel Jean) PozziTreatise on gynæcology : medical and surgical (Volume v.2) → online text (page 47 of 59)