Part 7
As time goes on experience teaches that the condition of the blood when a girl is carried has different characteristics from those in a male pregnancy. The quantity of fat and albumen is rather increased in the former and the proportion of fibrin and hæmatoglobulin possibly greater in the later. Certain deductions, as to these points of difference, have been gathered by the presence of fatty tissue all over the body affecting even the finger tips during pregnancy of a female child, whilst the contrary condition exists in the state of male pregnancy.
“Flooding” is more frequent after the birth of a girl than that of a boy, and the wearisome symptoms of over-profuse menstruation, appearing for months or even years after childbirth, are infinitely more persistent when a girl-baby has produced the weakness. Again, the displacement of the womb, and its inability to return to its normal size after confinement, is a distressing trouble due to the greater inherent weakness of the left side.
It is important to bear in mind that many unhealthy and delicate mothers would miscarry with a male fœtus whilst a girl-pregnancy might go full time.
As regards the actual labour, the first pangs, with a female child, are more apparent in the back and left groin, and the advent of the discharge soon makes the mother willing to lie up. With a boy, however, the pains are more apt to be felt in the stomach and down the right thigh, and it is easier to keep up and about until the last moments. A curious anomaly is that “after pains,” generally supposed to be unknown at a first birth, are frequently present in first _girl_ confinements. I have not heard of a single instance where “after pains” accompanied the birth of a first child who was a boy. In a tedious labour, it is the first stages that are lingering and difficult with a girl, with a boy the latter stages are the worst.
One cannot sufficiently reiterate to all young women the criminal idiocy of attempted abortion. As a result of my clinical experience I have come to the most definite conclusion that the right ovary, lying as it does lower down in the pelvis, is the most easily damaged. Any adverse conditions affecting the womb may interfere seriously with its functions; such an occurrence as _bleeding_, as the result of an abortion, may so react on the right ovary and the Fallopian tube as to paralyse them and prevent all subsequent activity.
Where this occurs the left ovary straightaway takes upon itself the functions of both and with redoubled activity, discharges its ova, “capturing the trade” of its rival, so to speak. As we have seen, this ovary produces only female ova; so, henceforth, as a natural consequence, only female offspring will be produced by the damaged womb.
After a first fatal abortion, whether accidental or voluntary, too often a trail of girls will ensue, and I could tell of countless such instances. A lady, pregnant of her first child, slipped downstairs; as a result she gave birth to a still-born boy; the next six children were all girls. I know of another case where eleven daughters followed the premature advent of a male child. In yet another case sheer folly brought about the miscarriage at first pregnancy of a male fœtus; only after many years was the woman in question able to give birth to three children—all girls. In each of the above instances the birth of an heir was of the utmost importance in view of title or estates.
A lady who had given birth to seven daughters had subsequently five mishaps, each at four months, and every time she proved to have been pregnant of a male. Another lady consulted me, because after eight girls, she longed for a son; she became pregnant but miscarried at four months of a boy. I learnt that she had had two similar mishaps before her daughters were born.
It is safe to say that 80 per cent. of all miscarriages are the result of male pregnancies. I am able to give such a figure and to be positive as to its accuracy in my own wide experience, because of the possibility of diagnosing the sex of a fœtus at a very early stage. A striking demonstration of what can be done in this direction was given by Nagel, who distinguished a testicle in the youngest embryo ever successfully analysed with reference to sex; it was exactly five weeks old. And any abortion younger than that does not need to be considered in relation to sex determination.
All women then should be warned early in married life against any risk of miscarriage, that they may be on their guard against such deplorable results, the bane of motherhood. “Fore-warned is fore-armed,” and a huge percentage of the waste of life and energy which now prevails could be prevented if only a more sensible and normal view could be taken on the question of initiating young girls and women into the wonderful, yet simple, laws of maternity, on which all human welfare depends.
XV
SIDE-THEORY
“Conception may take place even though there coexisted an immense amount of disease in the ovaries, provided one of them retained as much of one ovary sound as belongs to one mature vesicle.”—MORGANI.
There are and always have been so many dissentient opinions on the vital question of sex-predetermination, that it would be well to survey the multiple causes of the scepticism hitherto expressed by some biologists at the mere mention of the “Side-Theory,” since this theory forms an integral part of my principle.
The root of my argument lies in the statement that the right side contains male ova only, and the left side female. I have examined the “Side-Theory” from all points of view and studied the history of its origin from every source at my command. To satisfy the judicial and unbiassed mind, one must hear each argument and then methodically endeavour to answer one by one with irrefutable proof and evidence; only so can the truth of the theory be established, and the weakness or irrelevance of the criticisms advanced against it demonstrated. It is not an uncommon thing for a woman, for one cause or another, to have one or both of her ovaries removed.
I have gathered many instances of this, and it may be said definitely that no woman who has ever had her right ovary and tube completely removed, has ever given birth to a boy subsequently; and similarly after removal of the left ovary and tube the birth of a girl is not possible.
A few critics have written to me from various parts of the world intimating a knowledge of cases where the right ovary had been removed, and yet a boy had been born, and vice versa, drawing the conclusion that such evidence entirely disposes of my theory.
My reply to them is that I can go further, as I know not only of instances such as they draw my attention to, but others in which both ovaries have been removed, and yet children of _both_ sexes have since been born. The explanation is perfectly simple. It sometimes happens that if the operation is not absolutely complete, a vestige of pedicle stump remains sufficient to harbour one mature vesicle, and that being so, pregnancy undoubtedly becomes possible.
Some time ago a rising young surgeon expressed the wish that he might come across one single case of a woman bearing a child, after both ovaries had been removed. Then only, he said, would he be prepared to “accept the theory of sides in its entirety.” Shortly afterwards he was able to realise his ambition. A medical friend of his delivered of twins of differing sex a woman who had actually been operated upon by that same surgeon a year or two previously, when both ovaries had been removed. From medical authorities I have been able to gather a few more such cases, to add to my own list. And it is only recently that a lady wrote to me: “I had both ovaries removed and tubes, but since then have given birth to a boy and a girl.”
Experiments on animals, after the removal of both ovaries, go to prove that they may still produce young, just as cases are recorded of certain male animals being able to fertilise a single time after being castrated, and the explanation is simple. In ovariotomy it is sometimes difficult to ascertain that all ovarian tissue has been completely removed. Some of the tissue may yet remain in the pedicle stump, and if this pedicle stump be long, one cannot say how far up the ovarian tissue may extend.
Montgomery gives a case of boy and girl twins born in such circumstances. In the postmortem on the mother only one corpus luteum was discovered, the left ovary having been removed. The pedicle stump, had, however, harboured the female Graafian follicle; hence the girl. On the right ovary, the single corpus luteum could not possibly have contained the _two_ Graafian follicles necessary for the embryo of each sex. A lady I knew of, who had her right ovary removed, became pregnant two years later; about the third or fourth month she was taken very ill with pains in her right side and intense hemorrhage. The doctor advised an immediate operation for tubal pregnancy; this, however, was not eventually found necessary, as the trouble subsided, with the discharge of a blighted fœtus. Later, the patient was assured that this side would be of no further use to her, as the tube “had evidently burst”; thus precluding any hope of future offspring; this diagnosis proved wrong, because she has since then given birth to two sons.
Twins may arise from the same follicle, but they will be of the same sex.
Menstruation may continue after both ovaries have been removed, and invariably does so where only one has been removed. But the fact of so many women being able to conceive after bi-lateral ovariotomy, and to conceive twins of either sex, when only one corpus luteum has been found in either pedicle stump, proves to the hilt the truth of the “side-theory.”
Another striking testimony to the law of sides is afforded by tubal or uterine pregnancy. This unfortunate condition is caused by the ovum being arrested in its passage from the ovary into the uterus, and so being fertilised while yet in the tube. A morbid state of the tube, which has possibly formed adhesion with the ovary or other parts, may be due to congestion or contraction of its natural diameter. This practically never occurs except where previous children have been born and is most common where there has been abnormal distension, such as an unusually big child or twins might cause. Death may ensue from the bursting of the tube, and the results of many post-mortems on such cases have added their testimony to the correctness of my theory.
Male tubal-pregnancies are the most usual, since the right tube is the largest. Dr. Seligsen of Moscow collected fourteen cases of males in the right tube; of females developing in the left I have collected five. In one case, where a female fœtus was found in the left tube, which was removed, the mother recovered and had a boy four years later. Of the right tube I have collected six cases. In two the mother recovered without the tube having to be removed, the fœtus coming away at four months after acute pain in the right side. If, however, the pregnancy lasts for over sixteen weeks the tube invariably bursts, unless otherwise relieved.
In another case the right tube, without bursting, ejected the cigar-shaped male fœtus at four months, after severe hemorrhage. The patient recovered, but two months later a second male fœtus was ejected from the uterus, and severe ovaritis ensued. This was cured and the woman became pregnant again of another male fœtus which aborted at two and a half months. The ovaritis reappeared, whereupon an operation was performed, and the appendix was found to be adhering to and pressing against the ovary. After the removal of the appendix, the ovary promptly recovered its normal health. The original cause of this trouble had been the abnormal size of twin-boys, born some two years previously.
A girl under my observation had to have her left ovary removed, before she grew up, as the result of a severe accident; later on she married, and gave birth to six boys in succession. Another girl who also had lost a left ovary married and gave birth to a boy and then to twin-boys; since then, she has had two male miscarriages at four months; neither of these women ever had female issue.
A girl who strained herself at thirteen playing tennis, complained ever after of pains in the left groin; she married and has given birth to seven boys in fifteen years; evidently her left ovary had been rendered inoperative. Numerous instances of this kind could be given, and every case I have come across has emphatically endorsed the side-theory.
No doubt there are occurrences which seem to tell in the opposite direction. For example a male fœtus may be found growing in and distending the tube leading to the womb from the left ovary. But this can be explained quite naturally by the fact that the male ovum had journeyed from the right ovary, down the right tube into the womb, and then, instead of remaining there, had passed right across the cavity into the left tube; here it had become lodged, and so developed into a male fœtus; this is called “internal migration.” Or again it may by “external migration” have passed across the pelvis cavity, along the peritoneal surface of the intestines, to the external opening of the opposite tube—the left.
This, however, savours of an accident, and in no way disproves my theory that the right ovary produces male offspring, and the left female _only_. Experts have mentioned both these anomalies, but have so far offered no explanation, though Pouchet advanced the doctrine that there might be, in these cases, “aberration in the dispersion of the semen which does not follow its natural course,” of which no proof is even suggested.
Professor Scanzoni cites the case of a woman who after a quarrel with her husband, complained of severe pains in her _left side_ and died that night. On examination a laceration was found on the left side of the uterus, in which were the membranes and placenta of a fœtus, but there was every evidence that the ovum had originated from the right ovary.[26]
A Mrs. C., after the birth of two girls, employed my formula and became pregnant of a boy; at the third month the pregnancy, which proved to be tubal, was terminated by the bursting of the tube which had subsequently to be removed. The mother was saved, and it was found that, though the child was a boy, the offending tube was the left one; and apparently since the birth of the last girl this tube had remained abnormally enlarged, and in an unhealthy condition, thus causing this anomaly. Eighteen months later the lady conceived again; she miscarried of another boy, and the right ovary was left in a state of acute irritation and bound down with adhesions. It is some years since this happened, and she has now succeeded in regaining her normal health and has at last produced a much-needed son and heir.
“Placenta prævia” proves the complete vertical journey of the ovum; in such cases, the ovum, having arrived in the womb, drops vertically downwards to the lower part of that organ, instead of becoming embedded in the upper part. Fertilisation ensues and the fœtus becomes attached to the mouth of the womb, and if the child goes full time it is usually born dead. Ovarian pregnancies are equally dangerous though fortunately rare.
Such abnormalities in no way reflect on the truth of the side theory; on the contrary the abundant evidence I have collected corroborates in every particular that the right side is proper to male issue, the left to female.
XVI
TWINS OF MIXED SEXES
“All nature is but art unknown to thee, All chance, direction which thou canst not see.”—POPE.
Hitherto no theory has been advanced which explained, in any satisfactory or credible manner, the conception of twins of opposite sex. I maintain, however, that, in the light of my investigations, it becomes a simple and natural occurrence, and in this chapter I will briefly outline the circumstances from which it may arise.
Twins may be conceived in two or three different ways:
1. A boy may have started at the beginning of the month, or toward the middle, and a girl may be conceived seven days later or more, just before the next period is due; the fact that the uterus does not always close up entirely, and may even slightly re-open after conception, has been sufficiently proved to make such an event entirely probable. To give an instance, an American biologist mentions the case of a white woman who gave birth to twins on two successive days, of which one was white and the other black. She subsequently admitted intercourse with a coloured man a few days after her husband had left her for a long period. Quite clearly this woman conceived each twin on a different day, by a different father.
The fact that so often, where the twins are of opposite sexes, one seems to be less developed than the other, points to the probability of one of them having been conceived one, two or three weeks later than the other. When the girl is the smaller, which is often the case, we may conclude she was the last conceived. If the boy be the smaller he was conceived perhaps at a later date, and after the attempt at menstruation which often occurs during the first or second month of girl-pregnancy. I believe this manner of twin-conception to be rare, however. Out of twelve cases of mixed twins collected recently, I have found only one where the boy was smaller.
2. A boy may be conceived simultaneously with a girl if the ova from both ovaries happen to be present in the tubes or uterus at the same time. This would occur in the “blank week,” which, as we explained previously, does not exist for certain women, if their period arrives every three weeks. So, at the end of fifteen days, from the first day of period, the left ovary, already active, his discharged an ovum before the male ovum discharged by the right ovary has fully lost its vitality. Where this is the case, both of these ova are equally ready for fertilisation. This manner of conception is probably much rarer than that first considered. It is very unlikely that a woman of irregular habits could produce two ova each capable of forming a healthy embryo.
3. The conception of mixed twins has been explained in the following way:—It is known that healthy spermatozoa may live for weeks in a woman’s Fallopian tube. Thus, the male ovum having been fertilised on the twelfth day or so after the first day of period, the female ovum may be fertilised by the same issue of spermatozoa some ten days later. This would also account for the smaller weight at birth of the girl. Any exception, where the girl was the finer specimen of the two, might be explained either by the arrested development of the male infant, owing to a less healthy male ovary, or by the cornu of the uterus on that side being less elastic and so preventing as full a development as that on the left side.
This last theory of conception, which has the support of many biologists, does not appear to me to be satisfactory. How can the fertilisation of the left ovum by the belated spermatozoa be really effective? And, if it is so, would not the lack of spontaneous vitality account for those arrested pregnancies one so often comes across, and for which, up to now, no cogent reason has been advanced? Faulty fertilisation might as well be the cause of an abortion at any early state of one embryo whilst the other continues its normal course.
I knew of one woman who, having had a mishap at thirteen weeks of a male fœtus, was surprised on getting up again to find that she was still pregnant. Five months later she gave birth to a healthy girl. Dr. Jameson cites the following case. A lady he attended was delivered on February 13 of a healthy male child, whom she nursed. On April 3, however she was taken ill, and shortly after was confined of a blighted fœtus, between eight and nine inches long. This fœtus was attached to a placenta, which appeared to be quite healthy, as large as that belonging to a full-grown one.[27] Great numbers of such cases may be quoted, but till recently the causes have been obscure.
It is commonly believed that when twins are of mixed sex one or the other proves sterile when adult and there seems some ground for this assumption, but it is not of universal application.
Difficult as it was, I have made every effort to get at the facts, with the result that in scores of cases one or other of the twins has been found to have remained celibate, or, after marriage, to have had no children. I know of three sets only of mixed twins where both have married and had families.
The bearing of twins apparently tends to be hereditary in the female line, often recurring from mother to daughter, and this is more frequently the case where the twins are of the same sex. These are the result of a special development of one ovary or the other, accompanied by a propensity to discharge two ripe ova simultaneously.
Triplets, quadruplets, and quintuplets are likewise produced for similar reasons, as above described. In May, 1915, a Mrs. Howarth of Sheffield gave birth to three boys and one girl. They have all survived and done well. “An Italian woman at Palermo has given birth to five children, all of whom are in perfect health,” was an announcement which appeared in the papers not many months ago.
Such occurrences are quite tame compared to the account given by Ploss of an Italian woman, named Dorothea, who in two births produced twenty sons.[28] First, a bevy of nine arrived, and two years later eleven more boys were born at one birth, these happenings being substantiated and vouched for by the doctors Francesco Pico della Mirandola and Ambrose Paré. The engraving, made from an authentic picture of this woman before the birth of her many sons, is most extraordinary to behold: the curious thing is that all were male children, so evidently the woman had a right ovary abnormally developed to the complete extinction of the left. Statistics go to prove, however, that the birth of female twins is more common than that of male.[29] No doubt this is, in a measure, due to the greater difficulty of carrying male twins.
I knew of a woman who, within two years, gave birth to two sets of male twins; she subsequently bore first a single boy, and then a triplet of boys. Her left ovary had previously been removed, as the result of an unfortunate confinement when a girl-child was still-born; but she did not carry the first male twins longer than a bare thirty-three weeks. Had she carried them to their full term, it is doubtful whether she would have made a normal recovery and been able to produce the other six boys.
Those women always recover most easily from boy twins who do not carry them full time, and whose babies, when born, weigh barely from four to five pounds each. Twins weighing together twelve pounds or more at birth tend to overstrain the genital organs of the mother, with bad results. The tube is frequently left in a disastrously distended condition, which may lead to tubal pregnancies and appendix trouble.
Girl twins are seldom carried over eight months and are usually small, entailing infinitely less strain on the mother. They are not only more frequent, but easier to rear than boy twins. Mixed twins are the most usual of any, and they are rarely like each other, whether in looks or character. If they are very large, the result to the mother may subsequently be sterility, but this is not by any means to be taken as a general rule. I have known a woman start a fine family of six sons and six daughters with a good-sized set of mixed twins.
Mr. Rumley Dawson divides twins into four varieties:
_Variety A._ One Boy: One Girl: One from each ovary—a different Graafian follicle: a different ovum: generally one placenta to each.