IN A HERMAPHROLITHOTOMY: RECOVERY.
CALCULUS,VESICAL, DITE
:
By Surgeon Matthew D. Moriarty, M. B.,
Officiating Civil Surgeon, Mozuffernuggur. During1 the last eighteen months I have seen
three four so-called hermaphrodites,?all were young people. In each case the parents, though knowing there was something wrong, looked on the individual as a female. This indeed was evident from the name and dress of the unoi'
fortunate. One of the parties was brought by the Police on suspicion of having been made an eunuch by some one. -Another formed the subject of legal proceedings, and _
punished for having enticed her (or married woman. Darmee," aged 6 years, was brought to the Charitable Dispensary on the 11th August last. The mother stated that the child had suffered from irritation of the bladder, pain, &c, for the last fifteen months, and had been very bad for the last fortnight. The child evidently Was in great pain. On examination, Darmee was found to be a hermaphrodite. The corpora cavernosa formed a rudimentary penis about an inch or so long; on either side the ununited halves of the scrotum looked like labia : in each, but best marked in the right, could be felt a rudimentary testis. Some three-fourths of an inch below the little penis was the urethral orifice, and below this again was a little cul-de sac. Altogether, I must say the parts looked uncommonly like those of a girl with a small mons veneris and a huge clitoris. The cul-de-sac showed signs of recent injury ; the pother, on being questioned, stated that a few days previously she had called in a "Jarrah" who apparently never doubted that the child was a female, and considered that the symptoms were due to want of a vagina, for he forthwith proceeded to manufacture one with his finger; he didn't do much harm, but he added considerably to the child's discomfort by leaving a raw surface for the urine to trickle over. The child being in considerable pain I gave chloroform, and, passing a female catheter into the bladder, at once struck a stone. Removing the catheter, I introduced an ordinary dressing forceps, and separating the blades dilated the urethra as much as I thought safe. I then seized the stone and tried to extract it, but unsuccessfully. Introducing the finger into the rectum, I got the stone down to the neck of the bladder and with the finger behind it, again tried to extract, but to no avail; part of the stone gave way and came away in the forceps. As it appeared to be pretty soft, I tried to some men were
?) "
away
as a
crush and remove it piecemeal, but in this was only very partially successful, removing rather less than onethird of the stone, as was afterwards seen. I thereupon desisted ; there was much tenesmus all the time and a tendency to prolapsus ani; there was also slight bleeding from the urethra. Some hours after, the child was given a In the evening there warm bath and a dose of opium. was not much fever or pain, but being satisfied that the cystitis, which already existed, would very soon be worse, I determined to cut the child next morning, and accordingly gave a small dose of castor oil,?the child passed a restless night and suffered a good deal. Next morning (12th) having administered chloroform, I proceeded to perform the usual lateral operation, using a No. 8 staff ; the urine was quite turbid ; 1 could not get the bladder to retain any water ; no sooner did I inject The external incision was any than it was expelled. necessarily very limited, for from the posterior margin of the genital fissure to the antenor margin of the anus the perineum measured only two-thirds of an inch (the perineum of a boy a year or two older cut a short time before by the Assistant-Surgeon measured two inches), the incision Wits made with considerable difficulty owing to the constant severe straining The urethra lay much deeper than I expected ; it was moreover very thick and slippery, and my nail being unfortunately very short at the time, I had some difficulty in fixing the point of the knife in the groove of the staff. Having cautiously made the deep incision I introduced my finger and found that the urethra was only divided of it had to a certain extent ; that apparently about been pushed in before the knife, and that behind it a little pouch had been made : there was however no bleeding to signify. Working gently I got my finger into the bladder and dilated the neck ; the stone was then readily removed with a forceps. Sweeping the finger round the bladder, I could find no debris. The bladder, which appeared to be thickened, was then carefully washed out with tepid water: very little blood was lost. After recovering consciousness, the child was in great pain, so after half an hour five minims of Tinct. opii were given which soon sent it off to sleep. As might have been expected, there was pretty sharp cystitis for a few days but this gradually subsided, and on the 21st the urine was quire clear and healthy. The constant straining also brought on a sort of dysenteric attack, but a few small doses of Dover's powder and ipecacuanha soon got this under. The patient was discharged well on the 5th September, and the mother took her child home firmly convinced to the last that it was a girl. The stone was of uric acid, oval in shape, measur?it weighed altogether about 150 X y X ing grains ; from one end the outer layer was gone. This thick and was moderately soft: within layer was about the stone was pretty hard. My attempt at Lithectasy was, I fear, a poor one. With a proper tent, or a three-bladed dilator, or both, the urethra might possibly have been sufficiently dilated to permit the removal of the stone. At any rate, if I meet such another case again, and the stone is of moderate size, I shall be inclined to give this method a fair trial, before proceeding to lithotomy. In attempting to crush the stone as I did, I did mora harm than good. Mozuffemuggur, 29/4 October 1879.
Uterus Bicornis: Double Pregnancy.?A case of this kind has been reported in the Berliner Klinische Wocheii' schrift. On two occasions an abortion took place from one of the horns of the double uterus, and a foetus was borne to the full time in the other.
CALCULUS,VESICAL, DITE
:
By Surgeon Matthew D. Moriarty, M. B.,
Officiating Civil Surgeon, Mozuffernuggur. During1 the last eighteen months I have seen
three four so-called hermaphrodites,?all were young people. In each case the parents, though knowing there was something wrong, looked on the individual as a female. This indeed was evident from the name and dress of the unoi'
fortunate. One of the parties was brought by the Police on suspicion of having been made an eunuch by some one. -Another formed the subject of legal proceedings, and _
punished for having enticed her (or married woman. Darmee," aged 6 years, was brought to the Charitable Dispensary on the 11th August last. The mother stated that the child had suffered from irritation of the bladder, pain, &c, for the last fifteen months, and had been very bad for the last fortnight. The child evidently Was in great pain. On examination, Darmee was found to be a hermaphrodite. The corpora cavernosa formed a rudimentary penis about an inch or so long; on either side the ununited halves of the scrotum looked like labia : in each, but best marked in the right, could be felt a rudimentary testis. Some three-fourths of an inch below the little penis was the urethral orifice, and below this again was a little cul-de sac. Altogether, I must say the parts looked uncommonly like those of a girl with a small mons veneris and a huge clitoris. The cul-de-sac showed signs of recent injury ; the pother, on being questioned, stated that a few days previously she had called in a "Jarrah" who apparently never doubted that the child was a female, and considered that the symptoms were due to want of a vagina, for he forthwith proceeded to manufacture one with his finger; he didn't do much harm, but he added considerably to the child's discomfort by leaving a raw surface for the urine to trickle over. The child being in considerable pain I gave chloroform, and, passing a female catheter into the bladder, at once struck a stone. Removing the catheter, I introduced an ordinary dressing forceps, and separating the blades dilated the urethra as much as I thought safe. I then seized the stone and tried to extract it, but unsuccessfully. Introducing the finger into the rectum, I got the stone down to the neck of the bladder and with the finger behind it, again tried to extract, but to no avail; part of the stone gave way and came away in the forceps. As it appeared to be pretty soft, I tried to some men were
?) "
away
as a
crush and remove it piecemeal, but in this was only very partially successful, removing rather less than onethird of the stone, as was afterwards seen. I thereupon desisted ; there was much tenesmus all the time and a tendency to prolapsus ani; there was also slight bleeding from the urethra. Some hours after, the child was given a In the evening there warm bath and a dose of opium. was not much fever or pain, but being satisfied that the cystitis, which already existed, would very soon be worse, I determined to cut the child next morning, and accordingly gave a small dose of castor oil,?the child passed a restless night and suffered a good deal. Next morning (12th) having administered chloroform, I proceeded to perform the usual lateral operation, using a No. 8 staff ; the urine was quite turbid ; 1 could not get the bladder to retain any water ; no sooner did I inject The external incision was any than it was expelled. necessarily very limited, for from the posterior margin of the genital fissure to the antenor margin of the anus the perineum measured only two-thirds of an inch (the perineum of a boy a year or two older cut a short time before by the Assistant-Surgeon measured two inches), the incision Wits made with considerable difficulty owing to the constant severe straining The urethra lay much deeper than I expected ; it was moreover very thick and slippery, and my nail being unfortunately very short at the time, I had some difficulty in fixing the point of the knife in the groove of the staff. Having cautiously made the deep incision I introduced my finger and found that the urethra was only divided of it had to a certain extent ; that apparently about been pushed in before the knife, and that behind it a little pouch had been made : there was however no bleeding to signify. Working gently I got my finger into the bladder and dilated the neck ; the stone was then readily removed with a forceps. Sweeping the finger round the bladder, I could find no debris. The bladder, which appeared to be thickened, was then carefully washed out with tepid water: very little blood was lost. After recovering consciousness, the child was in great pain, so after half an hour five minims of Tinct. opii were given which soon sent it off to sleep. As might have been expected, there was pretty sharp cystitis for a few days but this gradually subsided, and on the 21st the urine was quire clear and healthy. The constant straining also brought on a sort of dysenteric attack, but a few small doses of Dover's powder and ipecacuanha soon got this under. The patient was discharged well on the 5th September, and the mother took her child home firmly convinced to the last that it was a girl. The stone was of uric acid, oval in shape, measur?it weighed altogether about 150 X y X ing grains ; from one end the outer layer was gone. This thick and was moderately soft: within layer was about the stone was pretty hard. My attempt at Lithectasy was, I fear, a poor one. With a proper tent, or a three-bladed dilator, or both, the urethra might possibly have been sufficiently dilated to permit the removal of the stone. At any rate, if I meet such another case again, and the stone is of moderate size, I shall be inclined to give this method a fair trial, before proceeding to lithotomy. In attempting to crush the stone as I did, I did mora harm than good. Mozuffemuggur, 29/4 October 1879.
Uterus Bicornis: Double Pregnancy.?A case of this kind has been reported in the Berliner Klinische Wocheii' schrift. On two occasions an abortion took place from one of the horns of the double uterus, and a foetus was borne to the full time in the other.
