THIS name implies the union of the two sexes in the same individual. So far as the internal organs are concerned such a condition is rendered possible by the fact that in every foetus the embryonic structures for both sexes are present at a certain period of development; the Wolffian ducts go to form the male, and the Miillerian ducts the female organs. It is by the subsequent retrogression of one of these and the preponderance of the other that the sex of the child is determined. Though the proper glands are scarcely represented in the opposite sex, yet the gland ducts or passages are preserved as rudiments. Thus in the female the parovarium represents the epididymis, whilst in the male the hydatid of Morgagni represents the Fallopian tube and the vesicula prostatica the uterus.

A True Tiermaphroditism, in which ovary and testicle are both represented in the same individual, is possible, and cases have been recorded in which on both sides both of these glands have been present, one or other of them, however, generally ill-developed. This would form a true Bilateral hermaphroditism. On the other hand, there may !>»• a testicle on the one side and an ovary on the other, forming a true Lateral hermaphroditism. It is necessary, however, in such cases to be careful, and not to conclude that an organ is testis or ovary from its mere position, but to subject it to microscopic examination.

Pseudo-hermaphroditism is more common. In it the existence of testicles or ovaries determines the sex to be male or female, but other parts are developed so as to resemble those of the opposite sex, and so produce an apparent combination.

In Male pseudo-hermaphroditism the testicles are present, but the other structures, in whole or in part, resemble those of the female. Three combinations are distinguished.

(a) Complete male pseudo-hermaphroditism is the condition in which, while the glands are the testes, all the remaining organs, both internal and external, resemble those of the female. This arises by a persistence of Midler's ducts and an imperfect closure of the urethra. It may here be remarked that as the external generative organs arise from the same foetal structures in both sexes, they cannot really represent both the female and the male sexes in the same person. But as the male organs present as it were a further development, chiefly consisting i \ enlargement of the clitoris and closing in of the urinary passage to form a urethra, we may, by arrest of development, have more or less of an approach to the condition of the female organs.

(b) Internal male pseudo-hermaphroditism comprises cases in which the external organs are those of the male and the testes are present, but from the prostatic urethra a canal arises which represents an elementary vagina with a uterus at its extremity, sometimes with Fallopian tubes. The uterus may be of the regular form but small, or it may be two-horned, or with one horn and a Fallopian tube. We have already seen that the vesicula prostatica is the representative in the male of the vagina and uterus, and the condition we are now considering is an exaggeration of that pouch due to an unusual persistence of the lower part of Muller's ducts. There may be all degrees of this persistence, but the case is not one of pseudo-hermaphroditism unless there is something that can be called a vagina and uterus, even if very rudimentary.

(c) External male pseudo-hermaphroditism is characterized by the external organs presenting the characters of those of the female while the entire internal organs are those of the male. The cases are to be excluded in which there is simply an opening up of the urethra (hypospadias) from arrest of development. There must, in addition, be an approach in the form of the organs to those of the female. At the same time the general form of the body is that of the female. Several such cases have been married as females, and the true sex only discovered afterwards, even as late as the death of the person.

Female pseudo-hermaphroditism is of much more rare occurrence than male, and is susceptible of similar division. In all these forms there are ovaries, and the variations are in the other organs.

(a) Complete female pseudo-hermaphroditism presents the male form of the external organs as well as a portion of the male internal organs, while the ovaries are the glands present. In one case the male organs were complete as far as 'the prostate, but from this sprang vagina, uterus, and Fallopian tubes.

(b) Internal female pseudo-hermaphroditism is that in which, with well-developed female organs both external and internal, there are male organs present from the persistence of the Wolffian ducts, tubes passing from the parovarium to the uterus or vagina. This condition is excessively rare, although in ruminating animals it is a normal condition.

(c) External female pseudo-hermaphroditism is the form in which the external parts have the characters of the male while the internal have those of the female. It will be understood that an elongation of the clitoris will cause the parts to approach to those of the male. Some cases present nothing more than this, while there are others in which there is a distinct penis, and the opening of the vagina is narrow and concealed. The name hermaphrodite can hardly be applied unless there is, as well, a type of body approaching that of the male. A case is recorded in which the real sex was only suspected when the person became pregnant.

Literature

Forster, Missbild. des Menschen, 1861; Gunther, Commentatio de Hermaphroditismo, 1846.