Hermaphrodism is a common attribute in the vegetable kingdom, where fixed habitation or position makes such a condition necessary; it is also common to many of our lower forms of animal life, and even in the human fœtus the presence of the Wolfian bodies and the canal of Müller in the same individual attest a primitive case or condition of hermaphrodism. In other words, humanity begins its existence in a state of hermaphrodism. This condition is found up to the end of the second month of fœtal life in the human being, in common with all mammals, as well as all the vertebrates, where, however, it is subject to variations as to time of development and limit of existence in the normal condition. In the chick, it is only after the fourth day that the genital gland begins to determine whether it will turn into an ovary or a testicle; in the rabbit it is on the fifteenth day, and in the human embryo on the thirtieth day. Hermaphrodism does not occur, however, from this at first uncertain state of affairs, but rather from subsequent developments of the external organs that by their abnormality of formation simulate one or the other sex, while the internal organs may belong without any equivocation of structure to its definite sex; as it has often happened that some of these cases, having been the subject of differences of opinion among experts during life, were, after death, unanimously assigned to one sex by all of the same experts, the organs readily defining the sex being completely of the one sex. As observed by Debierre, where the subject is really a female, even where the vagina or uterus is unperceived, the presence of the menstrual function or some physical disturbance at its stated periods are sufficient evidences, as a rule, by which to determine the sex. The case of Marzo Joseph, or Josephine, reported by Crecchio in 1865, had rudiments of an hypospadic penis ten centimetres in length and a prostate of the male sex, with a vagina 6 centimetres in length and 4 in circumference, ovaries, oviducts, and uterus of the female; it was not until her death, at the age of fifty-six, that her sex was fully determined. The case reported by Sippel in 1880, supposed to be a male from external evidences, was at death found to be a female. Guttmann reported a like case in 1882. The celebrated case of Michel-Ann Dronart is remarkable; this case was declared a male by Morand Pere and a female by Burghart, as well as by Ferrein; declared asexual or neutral by the Danish surgeon, Kruger; of doubtful sex by Mertrud. The case of Marie-Madeleine Lefort, to which Debierre devotes four figures, is full of interest. One of the figures is her portrait at the age of sixteen, and another is from her photograph at the age of sixty-five. She has a man’s head in every particular of physiognomy and expression, having in the latter figure a full beard and the peculiar intellectual development of a male sage; she has the hairy breast of the man, with the mammary development of the female, and an abnormally-enlarged clitoris, which was often mistaken for the male organ. The vagina at its lower end was narrow, and the urethral aperture opened into it some distance from its outer opening; otherwise she was sexually a perfect woman, and menstruated regularly. Debierre quotes the case which Duval gives in his work on hermaphrodites, wherein a man asked for a dissolution of marriage, claiming that his wife had a male organ, which, although she was a woman in every other sense, prevented by its interference the consummation of the marriage act. The court had the case examined, when it was found that the erection of the clitoris, which was large, was enough to interfere as the husband had stated. It decreed that the young woman should have the objectionable and interfering member amputated, and on the refusal to have this done the marriage should be dissolved. She refused, and the divorce was consequently granted to the man.
From the history of Marie Lefort, it can well be conceived how the popular mind, in ignorant times, could easily be imposed upon. Montaigne relates the history of a Hungarian soldier who was confined of a well-developed infant while in camp, and of a monk brought to a successful accouchement in the cell of a convent; while Duval reports the case of a priest in Paris who was found to be pregnant with child, who was in consequence imprisoned in the prison of the ecclesiastical court. These cases were strongly females in every sense, but with some male characteristic sufficiently developed, like in the case of Marie Lefort, to allow them to believe themselves men and to pass for such.
On the other hand, males have had some female characteristics so well pronounced that they have passed for females. Debierre mentions a number of cases, to wit: Ambroise Paré reported such a case in his time; Ladowsky, of Reims, reports the case of Marie Goulich, who, up to the age of thirty-three, was believed to be a female, at which time the descent of the testicles removed all doubts as to sex. Sheghelner and Cheselden have reported analogous cases, and Girand’s case—who was happily married to a man with whom he lived until the death of the husband, in which the only female attribute was a blind vagina, which, in his case, seems to have answered all purposes—was a most remarkable case. As a rule, the cases of males who have been mistaken for hermaphrodites have been cases of hypospadic urethræ in a greater or lesser sense of deformity.
Debierre, however, mentions some cases of true hermaphrodism. He quotes a number of cases, the earliest being from the writings of Cœlius Rhodigin, who claimed to have seen in Lombardy a case in which the organs of the two sexes were side by side; Ambroise Paré records that in 1426 a pair of twins were born, joined back to back, wherein both were hermaphrodites. Among the many reporters that he quotes, he mentions Rokitansky, who reported a case in 1869, at Vienna, this being the autopsy of Hohmann, who had two ovaries and oviducts, a rudimentary uterus, and a testicle, with a sperm-duct containing spermatozoa. This individual menstruated regularly, and it is an interesting question as to what the result would have been had some of the spermatic fluid come in contact with some of the ovules that were periodically discharged. Hohmann had an imperforate penis and a bifide scrotum. Ceccherelli, who gives a more minute description of this interesting case, relates that Hohmann, who died at the age of forty, had menstruated regularly to the age of thirty-eight. The penis was imperforate but hypospadic, from whence came the urinary and spermatic discharges, and Hohmann could in turn copulate as either male or female. Odin is also quoted in relation to the case seen at the Hôtel-Dieu-de-Lyon, during the service of M. Bondet. The subject was aged sixty-three, and named Mathieu Perret. The case greatly resembled that of Hohmann, at the autopsy being found to be double sexed. So that, while most of the cases mentioned are fictitious and only apparent, the fact remains that the existence of true hermaphrodites is indisputable.[42]
If the subject of either apparently or true hermaphrodism is one of unhappiness, and oftentimes of discomfort and misery, history relates that this unfortunate class has suffered additionally, from the laws and action of ignorant and barbarian times, as such freaks of nature must of necessity have occurred at all times; only in the then ignorant state of medicine and anatomy they must have been considered as occurring much oftener—every deviation from the normal being considered as hermaphroditic. Opmeyer relates that in excavating in the neighborhood of the capitol in Rome, the laborers discovered the bronze tables on which were inscribed the twenty-two laws of Romulus, termed by many historians “The Double Decalogue of Romulus.” Article XV of this law, as well as Articles IX and X, seem to be directed against the life of these androgynes. In Roman history, however, we have an event which would seem to contradict that there existed any laws in actual force against this unfortunate class. It happened during the existence of the Punic wars, when the people were more or less laboring under fear and excitement, which would readily prepare them to accept any superstitious notion. It was during these times that three of these androgynes were known to exist in Italy. Titus Livius mentions that the existence of one of these was denounced during the consulships of C. Claudius Nero and of Marcus Livius. Etruscan soothsayers and seers were summoned to Rome, that they might consult the signs and the conditions of the constellations that accompanied the nativity of this hermaphrodite, or androgyne. These impostors, after a careful consultation of all attending circumstances, gave it as their opinion that the occurrence was an unfortunate impurity, and that it could only result to the disadvantage of Rome, unless she at once took steps to purify herself of such a monstrosity, with the conclusion that the androgyne should be first exiled from Roman soil, and then drowned in the depths of the sea. The unfortunate being was accordingly inclosed in a chest and put on board a galley, which put immediately to sea; when the vessel was out of sight of land the chest was thrown into the Mediterranean.[43]
A hermaphrodite born in Umbria during the consulship of Messalus and C. Lucinius was condemned to death, as well as was the one born at Luna during the consulship of L. Matellus and Q. Fabius Maximus. Debierre states that in the reign of Nero this barbarous custom was discontinued, as this emperor admired these freaks of nature from their novelty, as it is related that his chariot was drawn by four hermaphroditic horses.[44]
In connection with hermaphrodism it has been shown that the males who have been supposed to be so malformed were really, in most instances, but cases of hypospadias. It may not be uninteresting to observe that, while during nearly four thousand years circumcision has been practiced without the habit or condition ever having become transmissible or hereditary, hypospadias has shown a decided tendency to being transmitted. In Virchow’s Archives, Lesser reports having treated eight subjects during one generation in a family.[45] Fodéré records the case of hypospadias reported by Schweikard, in a person of forty-nine years of age, whose urethral orifice was near the junction of the penis and scrotum, but who, nevertheless, had three fine children. The same author records the remarkable case reported by Hunter to the Royal Society of London, also so deformed, who successfully impregnated his wife by receiving the spermatic fluid in a warm spoon and immediately injecting it into the vagina.[46] Another interesting case is taken from L’Union Médicale of August 26, 1856. It instances both the heredity connected with hypospadias and the peculiar circumstances under which impregnation at times takes place; it is reported by Dr. Trexel, of Kremsier, and is as follows: “On April 1, 1856, a newborn infant was brought to Dr. Trexel, that he might determine its sex. The father and mother were servants of a peasant. On an examination of the alleged father, he was found to have all the external characters of a male; the urethra, which was rather shorter than ordinary, but of large size, was imperforate; the scrotum was divided into two pouches, each containing a testicle. The apposed surfaces of the scrotal pouches were covered with a red skin, and the division extended through their entire length. At the root of the penis, in the anterior angle of these pouches, was an opening of the size of a lentil; this was the orifice of the urethra. The lower surface of the penis was grooved from the above-mentioned orifice to the end of the glans. There was no prepuce. Almost in a line behind the corona of the glans, and in the groove, were two elliptical openings, which readily admitted a large hog-bristle; there was a third smaller opening two lines from the orifice of the urethra. This man had always passed for a woman. He lay in the same room with the mother of the child; and they acknowledged having had frequent connection. The woman declared that she had had no commerce with any other man for three years, and the man did not deny this assertion. The idea of cohabitation with another man was further negatived by the circumstance that the infant had the same conformation of the genital organs as the father. How did fecundation take place? The three openings in the penis were probably the orifices of the excretory ducts of Cowper’s glands. But might not these have been the openings of the ejaculatory ducts? It is to be regretted that Dr. Trexel did not examine these canals; their length and direction would have thrown light on the subject. The fact of fecundation may also be explained by supposing that during coition the posterior wall of the vagina supplied the place of the absent floor of the urethra, thus forming a complete canal. This is the most probable explanation.”[47]
The above case, as stated, had passed for a woman; these cases are by no means such rarities. The case of Marie Dorothee, mentioned by Debierre in his work, was as peculiar. Hufeland and Marsina had pronounced Marie a woman, while Stark and Martens pronounced her a man, and Metzger could not determine on the sex. The case of Valmont, noticed by Bouillaud and Manee, is on a par with that of Giraud, in which the party was married as belonging to one sex and where it was not until after death ascertained that the person belonged to the other sex. Valmont had a hypospadic urethra and penis; a scrotum without testicles; ovaries with the Fallopian tubes; a uterus opened into a vagina of two inches in length, which, gradually narrowing, ended in the male urethra, to which was attached a prostate gland. Valmont contracted marriage as a man and was not discovered to have been a female until the autopsy revealed her to be a woman. The relation does not state anything in regard to menstruation; so that her condition in that regard is unknown.[48]
There has also been reported a number of cases in the male analogous to the double organed female mentioned by Debierre. Geoffrey St. Hilare reports a case where the penis was double, one being above the other, urine and semen flowing through both urethras. Gorè mentioned a like case to the Academy in 1844. Dr. Vanier (Du Havre) records the case reported by Huguier to the Academy, where the organs in the anatomical preparation which he exhibited were so anomalous that it was impossible to decide the sex. Aside from the medico-legal aspects that these cases present, there is an interesting Jewish theological question connected with them. The law is explicit as to circumcision; the cases presenting, if males, should be circumcised, but how to determine the sex where an autopsy alone will decide the question is not defined. It has been decided, in such cases where the presumption is that the child is of the male sex, that, like in cases of absence of prepuce, a suppositious circumcision should be performed, so that the covenant should be observed; this being in keeping with the sentiment shown by the Jews when persecuted by the Romans, or, later, by the Spaniards, who often were not able to circumcise until after death; but they never fail to comply with the covenant as far as it is possible.
Cases are liable to occur, however, which, without leaving the question as to sex in doubt, if reasoned by exclusion, would not furnish any possible opportunity for circumcision. Such a case is reported in Virchow’s Archives, vol. cxxi, No. 3; also in the British Medical Journal of December 6, 1890, and in the Satellite for January, 1891. It is one of congenital absence of penis. “Dr. Rauber records very briefly the case of a shoe-maker, aged 38, who complained of pain and trouble in the anus. On examining him, Rauber found a well-formed scrotum containing two testicles, each with a vas deferens and spermatic cord, but no trace of a penis. The urethra opened apparently into the anterior wall of the rectum. The man occasionally experienced sexual excitement, followed by an emission into the rectum. The burning pain complained of in the rectum and about the anus was due to the irritation caused by the urine. The man would not allow an ocular inspection of the interior of the rectum. Unfortunately, the details of this very rare condition are incomplete.”