Vagotomy and peptic ulcer.

SIR,-A man aged 40 was admitted in July 1967 with a reducible right inguinal hernia and an undescended left testis. The right testis, normal in size and consistency, was present in the scrotum. Exploration of the right inguinal canal revealed a completely patent processus vaginalis with the testis inside the sac. On applying traction to the testis, an oval mass, apparently intra-abdominal, was felt in continuity. At laparotomy the oval mass proved to be a fairly well-formed uterus, with gonads on either side. The right gonad was the testis situated in the scrotum, with epididymis and vas deferens attached to it. The left gonad was entirely intra-abdominal and relatively smaller; a fallopian tube attached to the uterus was present in close proximity, but there was no spermatic cord. The left gonad was removed to avoid future complications and examined histologically. No ovarian or testicular tissue could be made out; there was marked interstitial cell hyperplasia. Biopsy specimen from the right gonad showed atrophic seminiferous tubules with large islands of interstitial cells. The nuclear sex was male. The chromosomal pattern could not be ascertained. The patient described here was male in all respects except for the persistence of Miillerian duct on the left side, which had developed into uterus and tube. Sex differentiation in utero, particularly development of the genital ducts, is controlled by the organizing power of the gonads, especially the testis. In the male the MUillerian duct is suppressed by the inhibitory influence of the fetal testis. Also, when aberrations in the genital duct development accompany unilateral cryptorchism, they usually occur on the affected side.' In this case, on the left side, weak androgenic influence of the undescended gonad (if not absence of a testis) was probably responsible for the persistence of Mililerian duct, while on the right side the presence of a descended testis influenced the suppression of Miillerian duct and development of Wolffian duct.-We are, etc.,