RITA DUNLEVY, M. D.
Mary H-, for so this child was named, was born in Brooklyn, N. Y., in 1873. When examined, the child was found well developed above and below the pelvis, but peculiarly deformed about the public region. It was evident that nature had intended to create a man, but for some unknown cause had failed to develop the type of either sex.
The navel and the public bones were wanting. For either groin a sac-like mass hung fully two-thirds the length of the thighs. At about one-half their length these two sacs coalesced. Into the upper quadrant of these two sacs a portion of the intestine descended, white the lower segment was filled with testicle tissue.
At the angle formed by the junction above of these hernial, testicle sacs, was a mass of erectile tissue, about one and one-half by two and one-half inches; evidently a rudimentary penis. At times this would erect several inches. Above this erectile mass was a red mucous surface, the inner coat of the bladder; and from four openings in this bladder the urine dribbled constantly. The parts were exquisitely sensitive, so much so that the patient could not bear the slightest touch, not even of the clothing.
In 1881, the case was operated upon by Dr. Wm. Tod Helmuth. He tried by plastic operations to cover the bladder, but only succeeded in closing two of the openings.
Later Dr. Helmuth removed the left testicle mass, and did several other operations with small success.
In May, 1889, the case came before the class of the New York medical College and Hospital for Women, and was examined under either by Dr. Edmund Carleton. The following day, in the presence of several members of the profession interested in the case, the faculty and the students, Dr. Carleton operated.
First he removed the remaining testicle from the right sac be dissection. Then he denuded the edges of tissue at the upper angle of the bladder, and brought the raw surfaces together with several sutures, two of which were have lip, the others simple interrupted sutures.
In ten days, when the stitches were removed, quite an angle of the opening was found closed in. June 16th, same year, again in the pressure of members of the profession, faculty and students Dr. Carleton operated a second time on the patient. He removed the mass of erectile tissue, or rudimentary penis, by means of a strong ecraseur. There was no haemorrhage following its removal.
Then he denuded the surface above the bladder corresponding to the pubes, brought the pendant flap of the hernial sacs up over the bladder and united the two surfaces with twenty-five interrupted silk sutures. An ivory drainage tube devised for the patient by Dr. Wm. Krause was fitted in the lower left quadrant of the hernial sacs, to allow the escape of urine.
The patient was placed in bed in a semi-lateral position to favor the drainage of urine; and the small remaining portion of the sacs was kept constantly supported to prevent the hernia from making traction upon the stitches. To guard against bed sores, and give the patient relief, the position had to be changed from time to time. This rendered it impossible to recent an escape of urine through and over some of the stitches. On removal of sutures, the parts were found nicely united, except several central sutures. Their union was prevented by the action of the urine.
June 29th healthy granulation had taken place on the raw edges that had failed to unite. This Dr. Carleton furthered by skin grafting. Meanwhile the patient was fed on the most nourishing diet. The wound was washed frequently with calendulated water, and in the meantime kept anointed with oil or mutton tallow. For the first three days the temperature rose to 102 degrees F., then fell to normal and there remained.
As a result of the operation, the sc was os reduced in size that the patient could walk, stand and sit with comfort. Sensations of n amorous nature, which had troubled the patient greatly, ceased entirely. The great sensitiveness of the parts was removed and the bladder well concealed.
July 27th the patient was dismissed, greatly improved mentally and physically, and was delighted with the success of the operation and with the surgeon who had given such relief.
