BackStory

Before Thomas M.’s story became part of the Warren Anatomical Museum, he was a patient at Massachusetts General Hospital seeking operative relief from a greatly swollen right testicle and its resulting pain. When surgeon Jonathan Mason Warren, MD 1832, examined the twenty-one-year-old patient in April 1859, he saw a “young working Irishman” with a “full, strong, and black” beard, whose “ordinary” larynx emitted a masculine voice. The recent testicular enlargement was accompanied by appetite loss, diminished “sexual desire,” and painful swelling in both breasts. Warren saw Thomas as any other male surgery patient. “There was no suspicion of the true condition” until Thomas died.

As he prepared Thomas for surgery, Warren’s concept of his patient’s body changed. Beneath Thomas’ penis was a “fissure” that revealed his urethra and “distinct” but “poorly developed labia.” These observations were seemingly incidental to the surgery, and Warren removed the single testicle, which had been wholly “converted into encephaloid matter.” Thomas succumbed to postoperative complications and infection, in addition to the cancer that was confirmed at autopsy. The autopsy also revealed the full uniqueness of Thomas’ internal anatomy.

Harvard anatomist Richard Manning Hodges, MD 1850, conducted a “more minute dissection and investigation” of the patient’s urogenital organs and described a “rudimentary prostate,” a “well-formed uterus of normal size,” and a “poorly-developed” left ovary. While Hodges believed that Thomas had a woman’s internal anatomy, he and Warren could not account for the “genuine masculine formation of the body.” Rather than providing anatomical certainty, Thomas’ autopsy “very much disturbed” the physicians’ conception of the “effect of sexual organs on the external characteristics.” Spurred by this question, Warren preserved the tissue in the museum founded by his father.

What was Thomas’ body to Thomas? It is difficult to know. He is largely silent in the known record; we know him only through his physicians. He was shy during Warren’s exams and had never had sexual intercourse. The museum record states that Thomas had presented himself as a man when he entered the hospital, worked as a “seaman,” and gave no indication that he questioned or was concerned about his place in society. It is likely that he would have never known the details of his internal anatomy. Yet, Thomas was described as “friendless,” a term suggesting that he had no local support system.

While the greater part of Thomas’ life and experience is unknown, the telling of his story offers enduring lessons. His case is a testimony to human uniqueness and the long historical record of the body’s resistance to the neat categories that science often seems to demand.

Dominic Hall is curator of the Warren Anatomical Museum in the Center for the History of Medicine at the Francis A. Countway Library of Medicine.

Image: Warren Anatomical Museum, Center for the History of Medicine, Francis A. Countway Library of Medicine