Developmental Anomalies of the Female Reproductive Organs, With Two Cases of Pseudohermaphroditism

Abstract

I r is my intention to record certain rases of genital malformation which have been seen in my practire, dealing with them from the point of view of the clinical problems which they present, and refraining from the discussion of the errors in embryology which have produced them, Case I : Male Pseudo-Hermaphroditism. A single man, aged twenty-seven years, was admitted into my ward a t the Auckland Hospital on account of a severe attack of lower abdominal pain. He w-as a farm-hand in a remote country district. Twelve hours before admission he had been found lying unconscious and was said not to have recovered until half an hour after he was picked up. He then remembered that while working he had been seized with very acute pain in the lower part of the abdomen and had had to sit down, after which he remembered nothing. The pain was severe for a further two hours and then eased somewhat.When he arrived a t hospital he was very tender and resistant to palpation in the hypogastriurn. It was noted that while the penis was well developed, there was a flat, empty scrotum and a scar in the left inguinal region.The man then produced a document which he said had been given him by his parents with instructions to show it on any occasion of illness. From this it was found that in 1905, when he was one and a half years old, he was admitted to the Auckland Hospital as a male, by name John, for operation for a left inguinal hernia.No spermatic cord was found, but on opening the sac the latter was found to contain what at first appeared to be the testicle with the cord, but on further examination i t was found to be an ovary with Fallopian tube, the fimbriated extremity of which was well marked. O n drawing on the tube the fundus of a n infantile uterus appeared, followed by the other Fallopian tube with its fimbriated extremity, and the other ovary. Externally the reproductive organs a r e those of a male child, the penis is well developed, the scrotum shows a median raphe. (He was a twin child, the other appearing to be a normal male.)After this operation the parents were advised that they should consider the child a female, and i t was renamed "Doreen". This does not appear, however, to have given final satisfaction, for, when the child was three years old:A consultation of the whole honorary staff was held concerning your child "Doreen" on July 8. The case was then referred to the consulting staff, who met in consultation on July 12. As a result of these consultations I have now to advise YOU as follows: "That it would be unwise to come to a final decision about the sex of the child at present; but as the private parts have externally the appearance of a n imperfectly formed male child, the