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Gordon Macdonald, M.D., Dunedin.April 1916 In The New Zealand Medical Journal of December, 1904, and again in the same journal of 1911, I recorded the steps taken to render some relief to a case coming under the above heading. In January last I completed what I trust is its final surgical interference. As the journals in which the two preceding reports appeared may not be within the reach of all the readers of today, it may be well to recapitulate the principal points of procedure. The child had a normal prepuce and glans, but no urethra through it and no scrotum. The labii were normal, but no vagina. It had been registered as a male, so I converted the labii into a urinary channel and penis. Afterwards, I made a urethra through the glans, and finally joined the glans to the body of the new penis. This semi-artificial penis has remained sound and well, and is quite a satisfactory male urinary organ. In 1911, military service induced him to have two well-developed mammae removed. Some time before then, menstruation had been established, and it passed through the penis. This caused him no inconvenience, further than more frequent micturition during the period. At that time I remarked that his face, frame, voice, and manner participated more of the female than the male, but that all his feelings and desires were those of the male. The war has excited his military ardour, and he decided to have an operation performed to check menstruation. This operation I performed in January last, and no sooner had he recovered than he enlisted for military service. On opening the abdomen I found a small and apparently normal uterus, but minus any trace of the ovaries. The tubes were normal, and from the side of the left tube extended a thin cord down into the inguinal canal. Here, outside the peritoneum, was a small round body, evidently an undescended testicle or a misplaced ovary. The right ovary or testicle could be easily felt from without, lying in the right inguinal canal. Now, with my hand and eyes in the peritoneal cavity I could find no connection between this organ and the uterus or the abdomen. Both tubes and both glands were far apart from each other, but possibly some means of connection existed which escaped my observation. The vagina was represented by a small, tough, cordlike body, which was found to be open, though undeveloped. I removed the uterus and found it to be normal in its inner chamber, and an opening passed down from it through the cord-like vagina. I did not interfere with the ovaries or testacles in the inguinal canals, and left them in situ. It is possible that the right ovary or testicle may continue to be sensitive to the touch, and if so its removal may be demanded, but it is equally possible that it may atrophy or lose its sensitiveness. The left one, owing to its position, will give no trouble. He made a speedy recovery, and I sincerely trust that this will end his disabilities so far as surgery can do so. Remarks He has grown to be a strong, healthy young man, and takes a keen interest in all that concerns men. The practised eye, however, can at once detect the female, but to the ordinary observer he is a genuine male. The struggle betwixt the two sexes is peculiar, and one wonders if this is an attempt of Nature to revert to the alleged monogony of all life in its early stages. One set of thinkers say that we from all time have been amphigenetic, whilst others, with equal authority, assert that in our early stages we were monogenetic, and merely became amphigenetic by process of evolution. The case is one that lends itself to endless speculation. I do not see how the theory of the fimbriated extremity of the tubes embracing the ovaries during ovulation could possibly occur in this case, owing to their distance apart, and both glands being outside the peritoneal cavity and fixed in the inguinal canals. Yet it is likely indeed fairly conclusive that ovules or spermatazoa from one or other gland found their way into the uterus and were discharged per the cord-like vagina and artificial penis. A normal uterus minus its natural appendages is functionless, so the uterus in this case must have been stimulated to its duty by the presence of the glands, though not connected with it. Again, whether the glands produced ovules or spermatazoa, or a mixture of both, is uncertain. This case has led me to think that the serious character and health changes that frequently follow in the wake of ovarotony in young women or, indeed, women of any age might be arrested by transplanting a piece of ovary into some part of the body. It will be exceedingly interesting to watch in this case how the mind, character and general health of the individual will be influenced. Total extirpation of the sexual glands in either sex undoubtedly has an injurious effect upon the life of every individual who is compelled to submit to it. I expect that from environment, training, and operative procedure the male characteristics will develop more and more, and the female ones become less marked. No hair has as yet appeared upon the face, but it is probable that now or in the near future some hair will appear. As things have transpired, it is exceedingly fortunate that he had been registered as a male, and especially gratifying it is that the glands have been left in situ. The battle of life is much easier for a defective male than a detective female. Fortunately he is engaged in rural pursuits, and is already on the road to moderate independence. He finds the life of a Territorial much to his liking, but whether he succeeds in satisfying the demands of the medical military staff for service abroad remains to be seen. In any case, he deserves success, for his courage and determination to fill the role of a useful and patriotic citizen has been phenomenal.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

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Gordon Macdonald, M.D., Dunedin.April 1916 In The New Zealand Medical Journal of December, 1904, and again in the same journal of 1911, I recorded the steps taken to render some relief to a case coming under the above heading. In January last I completed what I trust is its final surgical interference. As the journals in which the two preceding reports appeared may not be within the reach of all the readers of today, it may be well to recapitulate the principal points of procedure. The child had a normal prepuce and glans, but no urethra through it and no scrotum. The labii were normal, but no vagina. It had been registered as a male, so I converted the labii into a urinary channel and penis. Afterwards, I made a urethra through the glans, and finally joined the glans to the body of the new penis. This semi-artificial penis has remained sound and well, and is quite a satisfactory male urinary organ. In 1911, military service induced him to have two well-developed mammae removed. Some time before then, menstruation had been established, and it passed through the penis. This caused him no inconvenience, further than more frequent micturition during the period. At that time I remarked that his face, frame, voice, and manner participated more of the female than the male, but that all his feelings and desires were those of the male. The war has excited his military ardour, and he decided to have an operation performed to check menstruation. This operation I performed in January last, and no sooner had he recovered than he enlisted for military service. On opening the abdomen I found a small and apparently normal uterus, but minus any trace of the ovaries. The tubes were normal, and from the side of the left tube extended a thin cord down into the inguinal canal. Here, outside the peritoneum, was a small round body, evidently an undescended testicle or a misplaced ovary. The right ovary or testicle could be easily felt from without, lying in the right inguinal canal. Now, with my hand and eyes in the peritoneal cavity I could find no connection between this organ and the uterus or the abdomen. Both tubes and both glands were far apart from each other, but possibly some means of connection existed which escaped my observation. The vagina was represented by a small, tough, cordlike body, which was found to be open, though undeveloped. I removed the uterus and found it to be normal in its inner chamber, and an opening passed down from it through the cord-like vagina. I did not interfere with the ovaries or testacles in the inguinal canals, and left them in situ. It is possible that the right ovary or testicle may continue to be sensitive to the touch, and if so its removal may be demanded, but it is equally possible that it may atrophy or lose its sensitiveness. The left one, owing to its position, will give no trouble. He made a speedy recovery, and I sincerely trust that this will end his disabilities so far as surgery can do so. Remarks He has grown to be a strong, healthy young man, and takes a keen interest in all that concerns men. The practised eye, however, can at once detect the female, but to the ordinary observer he is a genuine male. The struggle betwixt the two sexes is peculiar, and one wonders if this is an attempt of Nature to revert to the alleged monogony of all life in its early stages. One set of thinkers say that we from all time have been amphigenetic, whilst others, with equal authority, assert that in our early stages we were monogenetic, and merely became amphigenetic by process of evolution. The case is one that lends itself to endless speculation. I do not see how the theory of the fimbriated extremity of the tubes embracing the ovaries during ovulation could possibly occur in this case, owing to their distance apart, and both glands being outside the peritoneal cavity and fixed in the inguinal canals. Yet it is likely indeed fairly conclusive that ovules or spermatazoa from one or other gland found their way into the uterus and were discharged per the cord-like vagina and artificial penis. A normal uterus minus its natural appendages is functionless, so the uterus in this case must have been stimulated to its duty by the presence of the glands, though not connected with it. Again, whether the glands produced ovules or spermatazoa, or a mixture of both, is uncertain. This case has led me to think that the serious character and health changes that frequently follow in the wake of ovarotony in young women or, indeed, women of any age might be arrested by transplanting a piece of ovary into some part of the body. It will be exceedingly interesting to watch in this case how the mind, character and general health of the individual will be influenced. Total extirpation of the sexual glands in either sex undoubtedly has an injurious effect upon the life of every individual who is compelled to submit to it. I expect that from environment, training, and operative procedure the male characteristics will develop more and more, and the female ones become less marked. No hair has as yet appeared upon the face, but it is probable that now or in the near future some hair will appear. As things have transpired, it is exceedingly fortunate that he had been registered as a male, and especially gratifying it is that the glands have been left in situ. The battle of life is much easier for a defective male than a detective female. Fortunately he is engaged in rural pursuits, and is already on the road to moderate independence. He finds the life of a Territorial much to his liking, but whether he succeeds in satisfying the demands of the medical military staff for service abroad remains to be seen. In any case, he deserves success, for his courage and determination to fill the role of a useful and patriotic citizen has been phenomenal.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Gordon Macdonald, M.D., Dunedin.April 1916 In The New Zealand Medical Journal of December, 1904, and again in the same journal of 1911, I recorded the steps taken to render some relief to a case coming under the above heading. In January last I completed what I trust is its final surgical interference. As the journals in which the two preceding reports appeared may not be within the reach of all the readers of today, it may be well to recapitulate the principal points of procedure. The child had a normal prepuce and glans, but no urethra through it and no scrotum. The labii were normal, but no vagina. It had been registered as a male, so I converted the labii into a urinary channel and penis. Afterwards, I made a urethra through the glans, and finally joined the glans to the body of the new penis. This semi-artificial penis has remained sound and well, and is quite a satisfactory male urinary organ. In 1911, military service induced him to have two well-developed mammae removed. Some time before then, menstruation had been established, and it passed through the penis. This caused him no inconvenience, further than more frequent micturition during the period. At that time I remarked that his face, frame, voice, and manner participated more of the female than the male, but that all his feelings and desires were those of the male. The war has excited his military ardour, and he decided to have an operation performed to check menstruation. This operation I performed in January last, and no sooner had he recovered than he enlisted for military service. On opening the abdomen I found a small and apparently normal uterus, but minus any trace of the ovaries. The tubes were normal, and from the side of the left tube extended a thin cord down into the inguinal canal. Here, outside the peritoneum, was a small round body, evidently an undescended testicle or a misplaced ovary. The right ovary or testicle could be easily felt from without, lying in the right inguinal canal. Now, with my hand and eyes in the peritoneal cavity I could find no connection between this organ and the uterus or the abdomen. Both tubes and both glands were far apart from each other, but possibly some means of connection existed which escaped my observation. The vagina was represented by a small, tough, cordlike body, which was found to be open, though undeveloped. I removed the uterus and found it to be normal in its inner chamber, and an opening passed down from it through the cord-like vagina. I did not interfere with the ovaries or testacles in the inguinal canals, and left them in situ. It is possible that the right ovary or testicle may continue to be sensitive to the touch, and if so its removal may be demanded, but it is equally possible that it may atrophy or lose its sensitiveness. The left one, owing to its position, will give no trouble. He made a speedy recovery, and I sincerely trust that this will end his disabilities so far as surgery can do so. Remarks He has grown to be a strong, healthy young man, and takes a keen interest in all that concerns men. The practised eye, however, can at once detect the female, but to the ordinary observer he is a genuine male. The struggle betwixt the two sexes is peculiar, and one wonders if this is an attempt of Nature to revert to the alleged monogony of all life in its early stages. One set of thinkers say that we from all time have been amphigenetic, whilst others, with equal authority, assert that in our early stages we were monogenetic, and merely became amphigenetic by process of evolution. The case is one that lends itself to endless speculation. I do not see how the theory of the fimbriated extremity of the tubes embracing the ovaries during ovulation could possibly occur in this case, owing to their distance apart, and both glands being outside the peritoneal cavity and fixed in the inguinal canals. Yet it is likely indeed fairly conclusive that ovules or spermatazoa from one or other gland found their way into the uterus and were discharged per the cord-like vagina and artificial penis. A normal uterus minus its natural appendages is functionless, so the uterus in this case must have been stimulated to its duty by the presence of the glands, though not connected with it. Again, whether the glands produced ovules or spermatazoa, or a mixture of both, is uncertain. This case has led me to think that the serious character and health changes that frequently follow in the wake of ovarotony in young women or, indeed, women of any age might be arrested by transplanting a piece of ovary into some part of the body. It will be exceedingly interesting to watch in this case how the mind, character and general health of the individual will be influenced. Total extirpation of the sexual glands in either sex undoubtedly has an injurious effect upon the life of every individual who is compelled to submit to it. I expect that from environment, training, and operative procedure the male characteristics will develop more and more, and the female ones become less marked. No hair has as yet appeared upon the face, but it is probable that now or in the near future some hair will appear. As things have transpired, it is exceedingly fortunate that he had been registered as a male, and especially gratifying it is that the glands have been left in situ. The battle of life is much easier for a defective male than a detective female. Fortunately he is engaged in rural pursuits, and is already on the road to moderate independence. He finds the life of a Territorial much to his liking, but whether he succeeds in satisfying the demands of the medical military staff for service abroad remains to be seen. In any case, he deserves success, for his courage and determination to fill the role of a useful and patriotic citizen has been phenomenal.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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