original, p. 70, 71, 72, 34 AFTER AN ADJOURNMENT FOR LUNCH PATRICIA ANNE JACOBS (32) EXAMINED:- I am a Bachelor of Science and a Doctor of Science. I am a member of the Clinical Effects of Radiation Research Unit of the Medical Research Council situated at the Western General Hospital, Crewe Road, Edinburgh. I am employed as a permanent member of the scientific staff of the Medical Research Council. I am in charge of the Cytogenetics Laboratory of the Council's Clinical Effects of Radiation Researches. I have held that position for ten years. Q.- Are you one of the scientists who pioneered the development of chromosomal studies in man? A.- Yes. Q.- Have you worked continuously in that particular field for the last ten years? A.- Yes, I have. Q.- Were you present in November, 1966, when Dr. Price and Professor Strong removed from Doctor The Honourable Forbes-Sempill some buccal smears and blood for culture and cytological examination and a skin biopsy? A.- Yes. Q.- Were those things passed to you for examination? A.- Yes. Q.- Did you examine them? A.- I did. Q.- You could perhaps tell us to begin with what tests you conducted on the buccal smears and for what and why ? A.- The first thing I did with the buccal smears was stain them with a suitable dye. I then examined them, I saw sex chromatin bodies there, I did not enumerate those myself, but I handed the smears to Dr. Neil McLean who is more of an authority than I am in this particular aspect and he as it were did the final count and analyses. Q.- Just perhaps at that stage you could just explain what this involves, you say you saw sex chromatin bodies there. Have these to be counted or prepared, or has something got to be done to them? A.- They should be counted, these are small darkly stained bodies which are present in the nuclei of cells from individuals who have more than one X chromosome, and they are never present in cells from an individual who has only one X chromosome. Q.- Did that examination of the buccal smear lead you to a particular conclusion as to the number and type of chromosomes? A.- Yes, it led me to the conclusion that in this particular individual there was more than one chromosome present. Q.- What did that indicate? A.- Since I saw only a single sex chromatin body in any of the nuclei which I saw this would indicate there were two X chromosomes present. original, p. 72, 73, 74 35 Q.- And that indicates what sex, male or female? A.- It does not indicate either, it indicates the presence of two X chromosomes, because it gave us no information at all about Y chromosomes, it merely is an indicate of the number of X chromosomes present. Q.-Then there were the blood and skin samples by you as well as the buccal smear? A.- The blood sample was processed and examined by me, the skin sample was [processed by Dr. Faed who is a colleague of mine and also examined by myself. Q.- You made a Report I think in conjunction with the one Dr. Strong made following his clinical examination of the Second Petitioner. Would you look at No 48 of Process. If you look at the fourth page of that do you see your Report signed by you? A.- Yes, I do. Q.- Does it first of all deal with the sex chromatin aspect of it, do you say, "Sex chromatin was examined on buccal smears and monolayers of skin fibroblasts". What is that? A.- When you take a small sample it is grown in a culture in order to see the chromosomes, you have to get the cells dividing, you cannot see the chromosomes unless the cells are actually dividing, so you grow the skin until it forms a single layer of cells on a glass object, and the cells are actually then in a very favourable condition to also examine the sex chromosomes, it is a single layer, this is a monolayer of cells which has been grown on a piece of glass. Q.- You say, "Both tissues were chromatin-positive and the number and size of the sex chromatin bodies were characteristic of a normal female."? A.- Yes. Q.- Is that the same thing as saying it was double X? A.- Yes, this is the same thing. Q.- Then you go on to say, "Polymorphonuclear leucocytes were examined for the presence of sex specific appendages - `drumsticks'". What does that mean? A.- This is another sex specific way of...another thing which is present in the cells of an individual with two X chromosomes in which the smallest proportion, about 6 percent of the cells of females have these drumstick shaped appendages which stick out from the nucleus, and these are never present in cells from normal males. Q.- Never present in cells from normal males? A.- No. BY THE COURT:- Q.- Before you pass from that part of the Report I notice that in the first paragraph under the heading "Sex chromatin" you say "the number and size of the sex chromatin bodies were characteristic of a normal female". What is the significance of size? A.- Actually you get individual's with abnormal chromosomes, in a female there might be one X of normal size and one which is too small and if this were the situation then the sex chromatin body in such an individual is also smaller than normal, so the size of the sex chromatin body can restrict the actual size of the sex chromosomes. original, p. 74, 75, 76 36 EXAMINATION CONTINUED:- Q.- You then go on in your Report to deal with the examination of chromosomes in cells from short term cultures of peripheral blood? A.- Yes. Q.- And long term cultures of skin? A.- Yes. Q.- And then you say "In both tissues the chromosome number was 46 and the sex chromosome constitution that of a normal female". Could you just expand on that? A.- As I have said a minute ago in order to see chromosomes which are present in all cells you have to catch the cell while it is actually dividing, so the purpose of obtaining these cells from the patient and then culturing them, which you only need to do for a very short time for the peripheral blood cells, and you have to do for much longer time for the cells from the skin, that is purely and simply to get these cells to divide. We then stop them as it were when they are in the middle of division, stain them with a special stain, and we are then in a position to examine the chromosome. This is done by a microscope, the chromosomes from as many cells as you care to can be counted and then you simply numerically count, and that is what the 46 refers to, and they are then analyzed, and by this is meant the chromosomes are paired up as much as we are able to by visual examination, because all the chromosomes occur in pairs with the exception of the sex chromosomes which occur as a pair in normal females - by pair I mean they are identical in morphology, which is size and shape, but they are not identical in normal males, only the sex chromosomes in a normal male are not identical. This is what is meant by analyzing, it is pairing up. Q.- Are the sex chromosomes different in appearance to the autosomes? A.- The X chromosome is not, it is exactly the same in size and shape as the large group, the autosomes, in actual fact there are 15 in the male and 16 in the female, but the Y chromosome is different in size and shape, and it can be differentiated from all the other chromosomes where it is present. Q.- How do you differentiate the sex chromosome from the autosomes where there is no Y chromosome? A.- We cannot do this on morphology alone, we do it by taking into conjunction the sex chromatin findings, because in actual fact the maximum number of sex chromatin bodies in a cell is one less than the number of X chromosomes, so there are none in a normal male who has only got one X, one in a normal female who has got two XX's, and then you have got the abnormal individual's with three X's who have two sex chromatin bodies. While we cannot recognise sex chromosomes on straight morphology you can apply another elaborate test and identify at least one of the two X chromosomes present in the normal female, you can differentiate it from the normal chromosomes because it actually stainalises its genetic material out of phase with the other chromosomes, if you put in some marking or chemical you can identify at least one of the two X chromosomes in a normal female. original, p. 76, 77, 78 37 Q.- What did you do in this case? A.- I did not do this second test, because it is rather long and extremely complicated, and it did not seem necessary, because the chromosome constitution was in complete accord with the sex chromatin findings. Q.- And you quote in your Report "The results of both sex chromatin and chromosome investigation show Dr. Forbes-Sempill to have two X chromosomes and therefore genetically a female". Are you able to tell us what the significance of this approach to sex determination is? A.- Yes, sex is determined actually at the moment of conception, and it depends on the sex chromosome constitution of the sperm, it has got nothing to do with the sex chromosome constitution of the egg, and a sperm can have either an X chromosome or a Y, it does not normally have both. If a sperm carrying an X chromosome fertilises an egg, and the egg always carries one X then the resulting individual has two X chromosomes and normally develops as a female; if the sperm contains a Y chromosome when it fertilises the egg the resulting fertilised egg is one of X and one Y chromosome constitution and normally develops as a male. Q.- If you find as you found here that the chromosomal sex or genetic sex was double X and therefore female can you exclude in such circumstances the possibility that there may be a Y chromosome somewhere in the individual? A.- No, you cannot exclude this, you can only talk about the cells you have examined, and you can never exclude in any individual normal or abnormal the presence of another cell line with different chromosomes which you are not in a position to examine, so you can only talk about the cells looked at. Q.- If in an individual such as this, the Second Petitioner, there was a Y chromosome somewhere would that mean the person was a mosaic? A.- Yes. Q.- And short of, I suppose, going over every cell in the body, testing it out to see if there is a Y you can just never be sure there was not one? A.- That is absolutely correct. Q.- Have you also seen certain reports I think which have been made on Dr. Forbes-Sempill by a Dr. Stalker about the presence of testicular tissue? A.- Yes, I have. Q.- And have you also seen Professor Strong's Report on his clinical findings? A.- Yes, I have. Q.- Having regard to the part you played in the examination of the samples and the other Reports which you have seen are you able to express any views as to whether the Second Petitioner can be put firmly into one category or another as male and female, or is there some other categorisation which would be applied to the Second Petitioner? A.- Yes, I think my opinion is that clearly the Second Petitioner is neither a normal male nor a normal female, but the most reasonable interpretation that I can think of in the light of all the findings that you mention is an example of original, p. 78, 79, 80 38 probably true hermaphroditism, and this means that both ovarian and testicular tissue are present. As I see it from the Reports there is evidence of testicular tissue being present, but there is no conclusive evidence of ovarian tissue being present, but you cannot exclude this, it is rather like the second cell line in the mosaic, short of taking out both gonads and cutting them up and looking at each constituent part it is very difficult to exclude. Q.- What would you say from such evidence as is before you as to the likelihood of ovarian tissue being present somewhere in this person? A.- I think it is a reasonable supposition. Q.- Would you expect it to be there or not in the circumstances so far as you have been able to see? A.- I would not be surprised if it was there, can I say that. Q.- But it would have to be there if your conclusion is right, namely, that it is an example of...? A.- Of true hermaphroditism, yes. Q.- This genetic sex or chromosome sex is something which is determined in the early foetal stage. Is that right? A.- Yes, actually at the moment of conception. Q.- And never alters? A.- No, it never alters in the general course of events. Supposing somebody could be conceived as a normal male with an X and Y sex chromosome constitution, and at the first division of this fertilised egg by accident one of the sex chromosomes, let us say the Y, could be become lost, the individual would then be a mosaic of some cells perhaps having XY normal male sex chromosome constitution and the other cells having XO chromosome constitution, there is no Y and no second X, so in that individual you could say something had changed since the moment of conception in that the Y chromosome had become lost, and this could happen at any cell division during foetal life or adult life, but if it happens late it won't make any difference to the apparent sex of the individual. Q.- In a sense it looks as if this genetic sex is the sort of nature designed sex, is that right, or naturally intended sex? A.- The sex is determined at the moment of conception and is usually the one which is at were operational for the great majority of individuals for the rest of their lives, this is true. Q.- We have heard the term nuclear sex referred to this morning, did you do anything to determine nuclear sex? A.- This is synonymous with sex chromatin. BY THE COURT:- Q.- Why is it so called? A.- Because the actual sex chromatin body is seen in the nucleus of the cell, so it is the sex as determined by examining the nucleus of any given cell. CROSS-EXAMINED:- Q.- There are not two classifications of sex, are there, into chromatinal sex and chromosomal sex? A.- No. Q.- Chromatinal and chromosomal sex are two facets of one type original, p. 80, 81, 82 39 of genetic sex? A.- Correct. Q.- And I imagine that it must be fairly rare for the chromosomes and the chromatins to vary, that is to say to produce an XX chromosome and a negative chromatin? A.- This never happens at all, you are looking at the same cells. Q.- Never happens at all? A.- No, not on the same cells, a cell which has an XX chromosome constitution will always be a chromatin positive cell. Q.- Can you in the same individual have a situation where you have a negative chromatin and an XX. A.- Yes, you can. Q.- In different cells? A.- Yes. Q.- In the cell in which there is chromatin negative in that individual what is the chromosome? A.- The difficulty here is in order to look at chromosomes we have got to get cells out of the body which are either dividing at the moment you remove them - and this for all practical purposes only means bone marrow, or you have to get some new cells from the body which you can subsequently grow in a bottle in order to stop them in the middle of dividing so that you can look at the chromosomes. Now, sex chromatin is a much less sophisticated thing, you can get all sorts of cells, and one popular place for examining sex chromatin are from cells you can get by scraping the inside of the mouth. Those could be chromatin negative, those cells will not grow in culture, they will not divide and one is not in the position to look at the chromosomes. Q.- I understand, so that what the chromosome constitution would be if you could look at it, whether it would be XX or XY, you cannot say. Is that the position? A.- Correct, but I think you can be reasonably confident if they were chromatin negative they would not be XX. Q.- So if in the same individual you get XX chromosomes from one part of the body and a chromatin negative found from say a buccal smear are the chances that the individual is a mosaic? A.- Yes Q.- Or from some other...? A.- I think one would say on this evidence this was a situation where mosaicism was present. Q.- But I take it you would not consider nuclear sex as being a separate head of sex, it falls within the description of genetic sex. Is that the position? A.- Yes. Q.- Tell me, you said that you pioneered this work on human chromosomes, am I right in thinking that there has been great activity since the second half of the 1950's in this sort of work? A.- Yes. Q.- What is the underlying purpose of all your work? A.- That is a very difficult question to answer, the underlying purpose of my work is to try and understand more about human beings. Q.- What is the most likely practical application of all your original, p. 82, 83, 84 40 knowledge on this matter in relation to any particular human being? A.- I find that very difficult to answer, because - do you mean individual's specifically with sex chromosome abnormalities? Q.- No, I am just asking you the general question what is the predominant application of your knowledge in an ordinary individual? A.- It can be to give advice to parents who have got an abnormal child, give them some kind of probability of having the same sort of abnormal child again, diagnosis of certain kinds of disease, and the ultimate aim we hope of a lot of this work is actually to understand the genesis of cancer, but this is a very long term aim, and I think would not apply to any particular patient. Q.- But would it be fair to say that an important application of your work at present is in determining the sex of the newborn or very young children where this may be doubtful? A.- It is an aspect, but it is a very minor facet of our work. BY THE COURT:- Q.- I suppose there is an element, perhaps a strong one, of pure research in your work? A.- There is a strong element of research. CROSS-EXAMINATION CONTINUED:- Q.- Do you conceive that the finding in an individual of a particular chromosome pattern is the cause of development in that individual in a certain way, or is merely coincidental with that development? A.- In a very large number of instances it is the cause. Q.- Are you in a position to say it is the cause in all cases or not? A.- I don't think I quite understand what you mean. Q.- Perhaps I can put the question in another way, you say in a very large number of cases it is the cause, may I take it there are cases where it is not the cause? A.- You could get a situation whereby a patient presented with some sort of complaint and one could find in such a patient a chromosome abnormality which might be quite coincidental to the complaint or the reason for which you are examining the patient in the first place, this can happen, yes. Q.- You did say that sex was determined, I think, by chromosomes at the date of conception. Is that a fair repetition of your evidence? A.- Yes, it is. Q.- Does that mean - this is genetic sex, of course? A.- Yes. Q.- And you say that is the sex which in most cases is operational for the life of an individual? A.- Yes. Q.- That, of course, does not apply, does it, in the case of patients suffering from testicular feminisation syndrome. A.- No. Q.- Because they presumably are at the moment of conception in the chromosome pattern 46 XY? original, p. 84, 85, 86 41 A.- Yes. Q.- But in all probability are brought up and live as females? A.- Yes. Q.- And they are perfectly happy as females in most cases? A.- In the majority of cases, yes. Q.- And equally, of course, that proposition does not hold good in the cases of males who have 46 XX chromosome pattern? A.- Yes. Q.- They are exceptions again? A.- Yes. Q.- Therefore it seems, does it not, that in at least those two cases genetic sex as determined by the chromosomes has little or no bearing upon the general sex of the individual? A.- Chromosomal sex has no bearing as far as testicular feminisation goes, because the genetic sex has enormous power, because the reason this mistake as it were happens is known to be due to a genetic event, it is actually due to genes, so you cannot say genetic sex, you can say chromosomal sex. Q.- I am sorry. Is the gene responsible for the formation of testicles in the condition of testicular feminisation syndrome? A.- The probability of the abnormal gene and the gene mutation you don't need to postulate that is responsible for the development of testicles, because there is a Y chromosome there, and that is responsible for the development of testicles, the gene is perhaps responsible for the lack of formation of some particular chemical which means those testicles do not function properly, but I don't think you need to postulate the gene as being responsible for the presence of a testis. Q.- In your experience what is the normal chromosomal sex of a true hermaphrodite? A.- There are a large number of cases of true hermaphrodites in the literature with about as large a variety of chromosomal variations as there are cases. The great majority fall into two categories, one is that they appear to have normal female sex chromosomes, 46 XX, and the other category are a group of mosaics who have two lines of cells, one normal female 46 XX, and the other normal male 46 XY, and there are a lot of other permutations and combinations of different things which have been quite well authenticated in the literature as well. Q.- Let us assume you have a true hermaphrodite, you understand, do you consider that the chromosomal sex has any relevance at all so far as deciding into which, so to speak, box you put the hermaphrodite, a blue box for a box or a pink box for a girl? A.- I don't think that with the true hermaphrodite you can put them either in a blue box or a pink box, you cannot. Q.- And therefore does that mean in the case of a true hermaphrodite once you have established tissue of both kinds that the question of sex chromosomes is not a matter of importance? A.- To the patient? Q.- In determining into which box the patient should be put? A.- I don't think you can put the patient into one or the other box. BY THE COURT:- original, p. 87, 88, 89 42 Q.- You are really saying a true hermaphrodite is neither a boy or a girl in fact? A.- In fact I am. CROSS-EXAMINATION CONTINUED:- Q.- Assuming that at an early stage the true hermaphrodite is ascertained and has to be brought up in one sex or another? A.- Yes. Q.- Do you consider that the chromosomal determination is relevant in deciding into which class the individual is to be put. A.- I think it is of some relevance. Q.- Supposing to take an extreme case, you had two true hermaphrodites in each of whom the gonadal sex, the apparent sex was the same, one of whom had an XX chromosome and another an XY, would you consider that those two should be into different categories merely because their chromosome content was different? A.- No, I do not. Q.- So that really chromosome determination is so far as determination of sex is concerned more important at the stage when you have a young child or a newborn babe when you really do not know what the precise situation is? A.- You mean an individual where there is some ambiguity? Q.- In an individual where there is some ambiguity? A.- Yes, probably. Q.- Are you aware of a paper by Mr Dewhurst on "An XX Hermaphrodite with Male Social Sex"? A.- I am sure I have read it. Q.- Look at No 19 of Process. Have you seen this before? A.- Yes, I have. Q.- Without going into it in great detail it would appear here that this was a man of about 40, if you see the case record, and he had a simple XX arrangement of chromosomes. Is that correct? I think if you look at Page 5 on the Summary you see that? A.- Yes. Q.- And it appears from this at Page 5 that he was fairly well adjusted to the male sex although he may have suffered acutely, and this man is married? A.- Yes. Q.- So that this would suggest that it is not unknown for a hermaphrodite with a XX chromosome to be satisfactorily assigned to the male sex. A.- Yes. Q.- Are you aware of other comparable situations to that set out by Mr Dewhurst? A.- The one that you mentioned earlier on, males with an XXX chromosome situation, are chromosomally comparable, yes. Q.- Are you aware of any reason for the development of testicular tissue in an individual other than the existence at some time of a Y chromosome? A.- This is one of the areas of the big controversy in human genetics, can a testis develop in the absence of a Y chromosome, and as far as I am aware we have no information one way or the other on this particular topic. original, p. 89, 90, 91 43 Q.- Perhaps we could just explore this a little further, let us assume it could not develop without the existence at some time of a Y chromosome, the critical period for the existence of a Y chromosome is presumably during the foetal period, because that is when the testis develops? A.- Yes. Q.- Is there a theory to the effect that a Y chromosome or part of it can become translocated in some way? A.- There is a hypothesis to this effect, yes. Q.- Is that different from the theory? A.- There is a subtle difference in my mind, but probably not really. Q.- Perhaps we could just look for a moment at a paper by Dr. Ferguson-Smith, No 24 of Process. You have no doubt seen this before? A.- Yes, I have. Q.- I think it calls itself "hypothesis", I am sorry, and not theory. This seems to suggest some sort of X-Y interchange, I don't know whether you can translate the hypothesis shortly in simple language for us, but does it mean something to the effect that at some stage the Y or part of the Y is interchanged in some way with the X, so that it is now no longer determinable by the normal examination for chromosomes? A.- If I understand Dr. Ferguson-Smith's hypothesis correctly it is that the part of the Y, and this is reasonable, not the whole Y, if a part is necessary at all for the development of testes it is not the whole Y, it may be a small part which is necessary, and this small relevant part may become joined in some way to the X chromosome where it would presumably be quite undetectable by the techniques we have for visual examination. Q.- But it may very well be that if this hypothesis is correct and if your development proceeds further that there may be means of detecting this in the future. Is that correct? A.- Yes. Q.- And if that were so that would mean, would it not, that a person in whom translocation had taken place would have XX chromosomes somewhat different to a normal female? A.- That is correct. Q.- The alternative explanation if a Y or part of a Y is necessary is I think mosaicism in a case where you only find on normal examination 46 XX chromosomes. Is that right? A.- That is an alternative, I don't think it is the only alternative. Q.- That is an alternative. Is that right? A.- Yes. Q.- And I think you said in your evidence-in-chief that you could not exclude that in this case? A.- Yes. Q.- Are there other alternatives if there has originally got to be a Y why you do not find one now? A.- Not if you postulate there originally had to be a Y. Q.- I still postulate the Y? A.- Not if you postulate there has to be a Y, it is either that a little bit of the Y is translocated on to some other chromosome and you cannot see it, or mosaicism is present and original, p. 91, 92, 93 44 we cannot detect it, or thirdly that the Y was present during the necessary part of the foetal development and subsequently became lost altogether. Q.- So there are three? A.- There are three that I can think of. Q.- And accordingly the critical stage for analysis would in theory be the formative period of the foetus, would it not? A.- Again you are up against a problem that is not ever possible to examine all the cells of an individual, even of a foetus unless you are prepared to destroy the foetus so that you would still only have a limited answer. Q.- So that necessarily whatever be the relevance of chromosome constitution as to genetic sex it cannot I think be treated as conclusive in the present state of knowledge in all cases? A.- No, it cannot be considered as conclusive in all cases. Q.- And in fact it is just in the difficult sort of case we are concerned with today that this lack of complete conclusiveness occurs. Is that not right? A.- Yes, that is true. Q.- If on the other hand one postulates that the Y chromosome is not necessary for the formation of testicular tissue that would mean, would it not, that the existence of an XX chromosome or an XY chromosome in an individual was coincidental and not determined. Is that not right? A.- No, we know in the vast majority of individuals a Y chromosome is necessary for the development of testes and an XY chromosome constitution is necessary for the development of a normal male, and conversely the XX chromosome constitution is necessary for the development of a functional ovary in a female, this we know. Q.- Do I understand that the hypothesis that a Y chromosome is not necessary for the formation of testicular tissue is not a general hypothesis but is a hypothesis limited to certain particular individual situations? A.- That is correct. Q.- That means then that the existence or absence of a Y chromosome then ceases to be a genetic determinate in those particular limited cases. Is that not correct? A.- That is correct. BY THE COURT:- Q.- This is another hypothesis is it, I did not gather you regarded it as something that was established? A.- Oh no, this is an area of great doubt at the moment in this area of biology and neither hypotheses have been established. CROSS-EXAMINATION CONTINUED:- Q.- But may I take it that one or other of those hypotheses must be correct? A.- Yes, you either must need a Y or you don't need a Y. Q.- One or the other must be correct? A.- Yes. Q.- But it may be many years before it is found out which? A.- Correct. original, p. 93 45 RE-EXAMINED:- Q.- This I gather from you a field in which there is still a considerable amount of work being done? A.- Yes. Q.- And in which the answer to all the problems which arise has not yet been found. Is that correct? A.- Yes. Q.- And in particular on this matter which was raised last by Mr. Jauncey as to whether you do need a Y chromosome or not for the development of a normal male? A.- Yes. Q.- Am I right in thinking - I think this does arise out of what you said, that the proportion of people who in fact are in a dubious area where sex is indeterminate is very small in relation to the number of people in this country? A.- It depends what you mean by small, if you mean in those whose apparent sex is in some doubt, yes, I agree with you, it is very small. Q.- And this person with whom we are dealing, the Second Petitioner is one of a small band? A.- Yes. Q.- And if as I understand you to say the Second Petitioner has got to be designated as a true hermaphrodite you would not put the Second Petitioner into either a blue box or a pink box? A.- Not scientifically. original, p. 94, 95, 46 DR WILLIAM HENRY PRICE (35) EXAMINED:- I am a Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery, a Member of the Royal College of Physicians in Edinburgh. I qualified at the University of Wales. I then studied at London and Edinburgh and then at the Royal Victoria Infirmary at Newcastle. When I was studying in those places I was studying general medicine. Q.- Is there any particular sphere in which you now operate, any particular field of medicine in which you operate? A.- For the last two years I have been concerned with clinical cytogenics, which is a study of the way in which chromosome abnormalities affect human beings. Q.- Did you along with Dr Jacobs and Professor Strong carry out certain tests as a result of certain samples, if I may so call them, which had been procured from the Second Petitioner, did you do some work on those? A.- I did not do any work on the samples which were taken. Q.- What part did you play? A.- I took the samples of blood and skin, and I was present while Professor Strong obtained Dr. Forbes-Sempill's history and carried out his examination, and I corroborated certain points which Professor Strong established. Q.- But so far as carrying out any chromosomal examination I understand you did not take any part? A.- I took no part in the examination of chromosomes. Q.- You did I understand have the opportunity of being present while Professor Strong examined the Second Petitioner clinically. Is that so? A.- Yes. Q.- And you were able to observe the appearance of the Second Petitioner? A.- I was. Q.- With regard to genital organs? A.- Yes. Q.- And you were able to ascertain what the history of the Second Petitioner was as given by the Second Petitioner? A.- Yes, I was. Q.- You have seen I think the Report put in by Patricia Jac-obs, Dr. Jacobs? A.- I have. Q.- With regard to the sex chromatin and the chromosomal findings? A.- Yes. Q.- From that Report and from the evidence which you have before you were able to form any opinion as to the sex of the Second Petitioner as to whether it was male or female or neither or what it was from the examination you saw Professor Strong conduct and the history you got and the Report on the specimens taken? A.- On the data available up to that point? Q.- Up to that point? A.- I was able to establish that the patient was what we call a pseudo hermaphrodite, and that this was a female pseudo hermaphrodite, in other words that the subject was a female original, p. 95, 96, 97 47 chromosomally, but had other features of both sexes. Q.- Why do you say pseudo hermaphrodite? A.- A situation where there are features of both sexes present is known as a hermaphrodite. A true hermaphrodite state exists only when it is possible to demonstrate both testicular and ovarian tissue. When ovarian tissue alone is present then this is called female pseudo hermaphroditism, when there is only testicular material present this is known as male pseudo hermaphroditism? Q.- Why did you say this was a person who was a female pseudo hermaphrodite on the information available to you at the time the examination was carried out? A.- This at the time seemed the most probable diagnosis, this was because of the form of genitalia, they were those of a female, the development of breast tissue was compatible with the female sex and the chromosomal sex was compatible with a normal female, the chromosomal pattern. Q.- I think it is right, is it not, that the genitalia were not wholly those of a normal female. Is that not so? A.- No, they showed evidence of virilisation. Q.- What about the clitoris? A.- The clitoris was enlarged. Q.- Were you able to form any view as to whether what you were told, namely that intercourse took place was possible? A.- I think that normal intercourse would have been very difficult. Q.- Would it have been possible at all for penetration and the emission of seminal fluid to take place? A.- I cannot say it would be impossible. Q.- But am I right in saying we have been told there was no urethral tube in the clitoris? A.- That is right. Q.- So that any emission of any fluid would have to come from some orifice. Is that so? A.- An orifice other than one in the clitoris, yes. Q.- Was there such an orifice? A.- There was no orifice in the clitoris, no orifice there definitely, we presumed it was present in the anterior wall of what we took to be the entry of the vagina. Q.- But there was no orifice in the clitoris-that was established? A.- That was definitely established. Q.- And I think it was established according to the history that it was impossible for the Second Petitioner to urinate in the standing position, possible but difficult? A.- That is so. Q.- Where in fact would the urine have come from, were you able to identify the place where it would have come from? A.- We did not observe. Q.- You did not observe? A.- No, one presumes it would have come from the vaginal introitus. Q.- Which was present? A.-Yes. Q.- And which would be female characteristics? A.- Yes, the vaginal introitus is a female characteristic. original, p. 97, 98, 99 48 Q.- You did I think have an opportunity later subsequent to the examination at which you were present of seeing some further Reports which are indicative of there being testicular tissue present? A.- Yes. Q.- Assuming that there was testicular tissue present would that alter the view you formed as to the category into which you would put the Second Petitioner? A.- Yes, quite definitely. Q.- In what way? A.- This would make the diagnosis almost certainly that of true hermaphroditism. Q.- As a matter of probability although only testicular tissue was found would you expect there to be ovarian tissue there too? A.- I would expect that. Q.- Why? A.- Because of the female form of the genitalia principally and the female chromosomal pattern. Q.- Did you read Professor Strong's Report? A.- Yes. Q.- Just have a look at No. 48 of Process, do you see in the Opinion given at the end of Page 3 that the Opinion is in effect that in anatomical terms the examination indicates that Dr. Forbes-Sempill is a female. Do you agree with that? A.- I don' think I could wholly agree with that statement. Q.- How would you put it? A.- In anatomical terms the indication indicates that Dr. Forbes-Sempill shows evidence of both feminisation and virilisation. Q.- But I think Professor Strong does indicate in the Report he recognised there is some evidence of virilisation? A.- Yes. Q.- Which you saw, I think hair on the chest and muscular body and so on? A.- Yes, that is right. CROSS-EXAMINATION:- Q.- I take it that the views which you formed at the time of your original examination were altered considerably by the information that there was testicular tissue available. Is that correct? A.- That is correct. Q.- And am I right in thinking that you attributed the masculinization of the Second Petitioner to the existence of this testicular tissue? A.- Yes. (NO RE-EXAMINATION) original, p. 99, 100, 101 49 DR.NEIL McCLEAN (55) EXAMINED:- I am a Bachelor of Medicine and Surgery, a Fellow of the Royal College of Physicians and a member of the College of Pathology. I work in the Pathology Department of the Western General Hospital in Edinburgh. I have had an opportunity of examining certain specimens which were given to me, said to be associated with Dr. Forbes-Sempill and which had been examined I understand in Aberdeen. I examined two specimens, one examined by Dr. Stalker and another which I understand was examined by Dr. Klopper also from Aberdeen. Q.- With regard to the first one, the one examined by Dr. Stalker, what was the specimen, what did it consist of? A.- It appeared to me to consist of an immature testis. Q.- When you say immature testis what do you mean? A.- I mean that the tubules of which it was composed showed no signs of spermatogenesis in the adult testis one normally expects to see a whole range of cellular activity to the production of mature sperms, in the normal adult testis. Q.- Would the tissue which you examined have been capable of producing mature sperms or not? A.- No, not the material I examined. Q.- Was it one portion of tissue you examined or two portions in Specimen 1? A.- In Specimen 1 two small portions of tissue. Q.- Did both consist of immature testis? A.- That is correct. Q.- And in Specimen 2, what did that consist of? A.- There seems to be a certain confusion about this, what I understand was the real specimen was a portion of ductus deferens, but attached to one of the slides there was a portion, probably a third of a mature testis, I understand this had been attached merely as a control for a stain reaction. Q.- It had no connection with the person concerned? A.- I understand so. Q.- Anyway you examined the other material, did you? A.- Yes, I did. Q.- Were those three sections in a wooden slide container you examined? A.- That is correct. Q.- Bearing a paper label No. 313239? A.- That is correct. Q.- And the label of the Department of Midwifery? A.- Yes. Q.- Was that in Aberdeen? A.- Yes. Q.- Was there any identifying number on the glass? A.- Not on the glass. Q.- It was a ductus deferens which you understood belonged to the person we are concerned with? A.- I understood in the second specimen the ductus deferens only and not the mature testis. Q.- Did you examine this specimen and did you draw any original, p. 101, 102, 103 50 conclusions from it? A.- Yes, I examined the ductus deferens and came to the conclusion it had the same morphology as an adult deferens from a male. Q.- How were you able to identify it as a ductus deferens? A.- From the structure, various structures which it contained, it has a loose membrane of columnar cells, it has a thick muscular coat and an external layer of fibrous tissues, and those are the characteristic features of the male ductus deferens. Q.- Did they contain any spermatoza? A.- No. Q.- You understand I think that Dr. Stalker examined Specimen 1 and Dr. Klopper Specimen 2? A.- Yes, Dr. Stalker examined the testicular tissue and Dr. Klopper the ductus deferens. Q.- What is the ductus deferens? A.- It is the tube leading from the testes to the urethra ultimately. Q.- Are you able to say what sort of a person this type of testicular tissue which you found, having regard to the fact that the person would have a double X chromosome, what sort of person would you expect them to be? A.- From merely examining the testicular tissue I could not tell that, it is consistent with the possibility that it may have derived from a person with two X chromosomes, I could not establish that merely from examination of the tissue. Q.- Assuming it was could you go further and say whether that person was more likely to be male or female or something else? A.- If this testicular tissue comes from a person with two X chromosomes the only reasonable explanation is that person is a hermaphrodite. Q.- Would you expect such a person - I don't know whether you are able to answer this question or not - would you expect such a person to have ovarian as well as testicular tissue? A.- One would expect so, yes. Q.- And to be a true hermaphrodite? A.- Yes. Q.- I think you did have an opportunity last Friday of examining some further unstained sections of the tissue which you had previously examined which Professor Strong gave you? A.- That is correct. Q.- Were you able to draw any conclusions from these? A.- Unfortunately nothing was really satisfactory in the testicular substances. The point of the examination was to try and demonstrate sex chromatin. If I could demonstrate that there would be a reasonable inference that those tissues contained two X chromosomes in the testicular substance. I was unable to demonstrate any sex chromatin material in the ductus deferens. I thought they were present, but I am not certain of this. BY THE COURT:- Q.- What was the nature of that last examination in which you thought they were present? A.- It was attempt to demonstrate the sex chromatin in the original, p. 103, 102, 104 51 tissues. Q.- By what means? A.- I had a section stained in the laboratory by a different stain. They had originally used a stain called Cresolphtha- lein, and this is a useful stain for demonstrating sex chromatin, although in good sections can be seen other forms of stain also. I regarded the original sections as unsatisfactory for the demonstration of sex chromatins and tried to demonstrate them by this method, and was not really successful. Q.- The examination being microscopic? A.- Yes. EXAMINATION CONTINUED:- Q.- Did you also examine some buccal smears taken from Dr. Forbes-Sempill? A.- Yes. Q.- Did you do that along with Dr. Jacobs or by yourself? A.- I did this myself. Q.- What conclusion did you draw from that examination? A.- The buccal smears were chromatin positive, from which I inferred the patient had two X chromosomes, but beyond that I could not go. In that type of examination there may be two X chromosomes and a Y chromosome, that is as far as one could go. CROSS-EXAMINED:- Q.- When did you first carry out the tests on the samples of testicular tissues? A.- I think this was last Monday or last Tuesday. Q.- Were these samples set up in glass slides? A.- Yes. Q.- Is the tissue placed between two pieces of glass? A.- A thicker portion of glass slide about 3 inches long, the other is a very thin glass covering. Q.- How did you get these samples? A.- They were delivered to me by Professor Strong's secretary> Q.- How many slides did you have? A.- Two slides of the first specimen and three slides of the second. Q.- I understand when you refer to the first specimen what you are referring to is Dr. Stalker's examination. Is that correct? A.- Yes. Q.- You said that the samples appeared to you to be portions of an immature testis? A.- Yes. Q.- By that do you mean a testis which is not properly descended? A.- That is one interpretation of it, yes. Q.- Were these portions which you examined consistent with a testis which had not properly descended? A.- Yes. Q.- Do I understand that in the second set of samples there was no testicular tissue as such present, but there was only tissue from the ductus deferens? original, p. 105, 106, 107 52 A.- Yes, that is correct, with the proviso that portions of mature testis had been attached as a control. Q.- When you say the ductus deferens do you include in that the epididymis or is it purely the ductus? A.-Merely the ductus. Q.- Is that a part of the excretory mechanism of the testes which is further removed from the testes than the epididymis? A.- The ductus deferens is quite a long structure, part of it is at the same level as the epididymis, it is several centimetres distant. Q.- Did you come to the view that the tissues from the ductus deferens was wholly consistent with a mal-descended testis? A.- No, I don't think one could infer that, it could have been a mal-descended testis, it could have been a normal testis, there was no spermatoza, presumably it was not a normally functioning testis. Q.- Would it have been possible to say that the state of the tissues of the ductus deferens which you found was consistent with a mal-descended testis? A.- No, it would not be possible, I don't think there was any way of differentiating from the normal ductus deferens. Q.- So far as you were concerned it could have come from any ductus deferens, but I understand you are quite satisfied that the first example was consistent with a mal-descended testis? A.- No, I did not say that, I said it was consistent. Q.- Yes, consistent, that is what I asked you? A.- Yes. Q.- These examinations which you carried out to determine the sex chromatin last Friday, were those on the same samples which you had been working on, on the Monday, or were they different samples? A.- They were different samples, that is to say from the same sample of tissue you can cut very many different sections, only one 200th to 100th of a millimetre thick, so one can make up many samples and have a different staining method to quite different sections. Q.- When you say they were cut from the same of tissue on Friday do you mean that they were removed from the sample which had been in the slides earlier in the week or did you mean that the Friday samples were different from the Monday samples but that both had come from the same original piece of tissue cut from the body? A.- They were different samples from the Monday one, but they had been cut from the same piece of tissue. Could I elaborate on this? Q.- Please? A.- When tissues are taken for histological examination they are put through various processes, and they are eventually taken and embedded in paraffin. By this means it is possible to cut very thin sections, and when employing different stains one cuts a separate section from each stain, so when I wanted to have them stained with Cresol-Violet, it was necessary to ask the pathologist in Aberdeen for further unstained sections of the same tissue. Q.- Can you tell me, when you carried out tests on Friday did the tissue demonstrate any part of the testicle and its original, p. 107, 108, 109 53 apparatus which had not been demonstrated in the earlier samples at the beginning of the week? A.- No, they were virtually identical. Q.- From the ductus deferens? A.- Yes. Q.- Did you have any reason to believe that the samples which you saw did not come from one and the same body? A.- One and the same person? Q.- Yes? A.- No, I had no reason to believe that. RE-EXAMINED:- Q.- Have you got the slides? A.- No, I am sorry I have not. Q.- Could you get them? A.- I have not the original slides at all, because they were passed back to Professor Strong, I have the ones which were brought to me on the Friday, and those are available in the Department. (Taken on Wednesday, 17th May) DR. N. McCLEAN recalled FURTHER EXAMINED:- I am a Bachelor of Medicine and a Bachelor of Surgery and a Fellow of the Royal College of Physicians of Edinburgh and a Member of the College of Pathologists. I am Consultant Pathologist to Edinburgh Northern Group of Hospitals. Q.- I wonder if you would be a good enough to look at Nos. 56 and 57 of Process. Are those the slides which you had before you when conducting a pathological examination in connection with this case? A.- Yes, I have had those amongst other slides before me. Q.- Those were made available yesterday as being slides which had been made up in Aberdeen and subsequently passed to you through Dr Shivas. Is it in fact the case that those slides were made up in Aberdeen or were they made up by you? A.- The slides were cut in Aberdeen and sent to me unstained, I had them stained in our Pathology Department and those are duplicates of the original slides I examined. Q.- 56 and 57 are not the original slides but they are duplicates made by you. Is that the position? A.- Yes. Q.- Do you have with you the original slides? A.- I do. Q.- Which you obtained from Dr. Shivas? A.- Yes, I obtained those from Dr. Shivas and handed them to Professor Strong who handed them to the Secretary who handed them to me. Q.- Would you be good enough to tell me whether the duplicates and the originals are similar? A.- They are virtually identical. Q.- Do you now produce the originals which were handed to you? A.- Those are the two original slides in the containers in which they came (numbered 60 and 61 of Process). original, p. 109, 110 54 Q.- And just to complete the story do I understand that when you were asked yesterday or the day before to make available the original slides the duplicates were made available by mistake of a clerical error in the Department? A.- No, that is not quite right, I think there was some misunderstanding, the Messenger of the Court went to the place where they were supposed to be left, the Receptionist was not there at the time, someone directed him to me, I handed him those slides, the duplicates of the originals and said that I had not the originals in my possession. Q.- And by the time they arrived here they had been changed into originals? A.- Yes. BY THE COURT:- Q.- Perhaps just to be absolutely clear will you look at No. 60 and will you tell me very briefly so that I can identify them with your previous evidence what those are in your opinion? A.- Those are the slides which I believe have been previously examined by Dr Stalker and both consist of immature testes. Q.- And No. 61? A.- Consists of three slides, two of them bearing ductus deferens only and another bearing both ductus deferens and a part of a mature testis which was added to the slides as a control for the staining. original, p. 110, 111 55 JOHN ALEXANDER CUMNOCK FORBES-SEMPILL (39) EXAMINED:- I live at 3 Mallard Street, London S.W.3. I am the First Petitioner in this petition. Q.- Was your father the youngest child, and indeed the youngest son of William, who was the 17th Baron Sempill and the 8th Baronet? A.- He was. Q.- And are you the only son of your father? A.- I am. Q.- Having one sister? A.- One half-sister, yes. Q.- And the Second Petitioner is I think your cousin? A.- That is correct. Q.- Who is the youngest child of John, who was the 18th Baron and the 9th Baronet? A.- That is correct. Q.- Who had three children, Gwendoline Janet who died unmarried in 1910, Margaret who was born in 1905, who was killed recently I think in a motor accident? A.- Yes. Q.- And the third child who was the Second Petitioner? A.- Yes. Q.- And also a son William who was the 19th Baron and the 10th Baronet? A.- Yes. BY THE COURT:- Q.- That is four children altogether? A.- Yes. EXAMINATION CONTINUED:- Q.- So that the Barony is out of this question but the Baronetcy of Craigievar would only come to you if you were the heir male of the 8th Baronet? A.- That is correct, yes Q.- I am sorry, it is the 10th Baronet, William Francis? A.- That is right. Q.- Your father having died on the 9th May, 1962, an you being his only son? A.- That is correct. CROSS-EXAMINED:- Q.- So that on the death of the Second-Named Petitioner you will become the Baronet in any event? A.- That is correct, yes. Q.- But you seek to become the Baronet during your second cousin's life? A.- That is right. Q.- And you raised an Action to that effect last year? A.- I did. Q.- So there will be no doubt about it, there is no question of any inheritance or any money dependant upon the result of this Action? A.- No. original, p. 110, 111 56 Q.- It is solely whether or not you can be the Baronet? A.- That is correct, or who is the Baronet. Q.- Are you aware that the Second Petitioner has withdrawn the claim before the Registrar of Baronetcies? A.- That is correct. Q.- So the only question is whether you are or are not the Baronet? A.- That is correct. Adjourned until tomorrow morning at 10 a.m. original, p. 112, 113 57 TUESDAY, 16TH MAY, 1967 SECOND DAY PROOF FOR THE SECOND PETITIONER DR. ALEXANDER LOGIE STALKER (47) EXAMINED:- I hold the Territorial Decoration. I am Deputy Lieutenant of the City of Aberdeen. I am a Doctor of Medicine. I am a Reader in Pathology at the University of Aberdeen. Q.- During the week of the 4th March did you receive in your department certain samples from a Dr. Manson at Alford? A.- Samples were received in the Department, I personally did not receive them, but they were received in the Department. Q.- Did certain samples bearing to come from a doctor in Alford ultimately find their way to you? A.- Yes. Q.- That is this year? A.- Yes, 1967. Q.- I take it there is a certain procedure in the Department whereby samples are received and ultimately passed on to the pathologist. Is that right? A.- Yes, there is a definite set procedure. Q.- Perhaps you would tell us shortly what that procedure is? A.- When specimens have been sent in from the outside they are received at the desk, they are unwrapped, the Senior Technician or his deputy then puts it in a definite specific place where a Junior Pathologist examines it and starts the processing of the tissue so that ultimately we can prepare a paraffin section. Q.- When the Senior Technician receives it does he register it or label it in any way? A.- He allots it a number in sequence according to the Day Book which we keep. Q.- You have a book containing entries of all samples received in the Department? A.- Of every sample. Q.- When samples come in from outside do they normally come in with any particular type of label or writing on them? A.- They may come in with a hospital requisition form which the outside doctor has obtained, more commonly they come in with a sheet of paper giving the description of the specimen. Q.- Are they then given any particular hospital form? A.- If there is no hospital form already he makes out one according to the statement on the sheet of paper coming in. Q.- You told us that a Junior Pathologist prepares the samples for further work by a Senior Pathologist? A.- That is correct. Q.- So I take it that when the samples you have been talking about reach your desk or bench it has been already prepared by a Junior Pathologist? A.- By a Junior Pathologist. original, p. 113, 114, 115 58 BY THE COURT:- Q.- Is this properly called a sample or a specimen? A.- I think in this particular case a specimen. EXAMINATION CONTINUED:- Q.- When you received the specimen concerned what kinds of identification were there attached to it? A.- Attached to it were two identification forms which I can produce, one the paper which had been received with the specimen and two the hospital form made out by the technician. I can produce them if you wish. Q.- Perhaps you would be good enough to look at the underneath sheet which has got 54 on it. Is that the sheet of paper which accompanied the specimen from its original sender? A.- That I cannot swear to. This is the sheet of paper which accompanied the specimen given to me. Q.- That is the sheet of paper that you received? A.- With the section. Q.- Look at 55, is that a hospital form which bears to be completed after the specimen had arrived in the Pathology Department? A.- That is correct. Q.- Did you at any time look at the Day Book? A.- Yes, I looked at the Day Book for the 4th of March. Q.- What did you find therein? A.- One of the entries contained a number 689 and the name Ewan Forbes, Dr. Manson of Alford, Biopsy of Inguinal Region. Q.- Can you tell me if either 54 or 55 has a corresponding number 689? A.- On No. 55 there is 689. Q.- Did you thereafter carry out an examination of the specimen to which those numbers of process relate? A.- Yes, I examined this tissue histologically, that is microscopically. BY THE COURT:- Q.- Are they synonyms? A.- Not strictly, I examined the tissue microscopically. Q.- Perhaps you could tell me, because the word crops up here and there what is meant by histologically? A.- The structure of tissues, particularly very fine structure and usually very microscopic structure. EXAMINATION CONTINUED:- Q.- And what conclusion did you come to having examined this specimen? A.- The specimen contained testicular tubular tissue, this was abnormal in that there was very little spermatogenesis, most of the tubules of the testis were lined by what we call supporting cells, there was a certain amount of interstitial tissues, the appearances were those of cryptorchid or undescended testis. Q.- Look at No. 12 of Process. Does that bear to be a form with a signature at the bottom. Is that your signature? A.- That is my signature. Q.- Is that the Report which you prepared following upon your original, p. 115, 116, 117 59 pathological examination? A.- It is. Q.- Do you see the last sentence - look back at No. 54 of Process which you have in front of you which is the manuscript sheet attached to the specimen. What does the manuscript sheet state after the patient's name? A.- "Biopsy from Inguinal Region. Please identify tissues and state if any malignancy present". Q.- Your reference to malignancy in your Report was in answer to the request in the original manuscript sheet? A.- Yes. Q.- Did you have any doubt about coming to the conclusion which you set out in No. 12 of Process? A.- No, none. Q.- Have you since considered further whether this testicular tissue could have come from anything other than a human being? A.- I have considered the possibility. Q.- Have you come to any view on that? A.- Yes, I have come to an opinion on that, that it was extremely unlikely it could come from anything other than a human being. Q.- Can you give us your reasons for having that opinion? A.- I also examined tissue which had been given to me of Dr. Klopper's section, this tissue consisted of epididymis or the first part of the ductus deferens, the appearance there showed that there was little or no sperm content in the epididymis, and it would seem that, that section was consistent with what I found in this section which I examined first. Q.- Do I understand then that the finding of little or no sperm in the second specimen which you examined was something unusual for a normally functioning testis? A.- A normally functioning testis would produce sperm which in the epididymis would be seen. BY THE COURT:- Q.- Can you tell me since the expressions have been used at this stage of your evidence first of all what is meant by and what is the significance of spermatogenic cells which I understand you found in he first of these specimens? A.- Yes, the tubules in the testes are lined by two forms of cell, one supporting cell and one a spermatogenic cell which is elementary to produce he sperms. Q.- I notice that in your Report you say these were in an early maturation stage. What precisely is meant by that? A.- The spermatogenic cell goes through a very complicated process of about three or four divisions before it finally becomes mature, and these spermatogenic cells were in an early stage of this process. Q.- I did ask a question about this earlier in the evidence, but I would like to understand what is exactly meant by this. I take it this was a culture you examined eventually? A.- This was a tissue section. Q.- What process had it gone through before you examined it? A.- There are two processes, one is the process that I say our technical staff put the specimen through so that I could examine it microscopically. The process that is referred to original, p. 117, 118, 119, 120 60 here is the process of maturation of a sperm or a primitive sperm cell, and there is histological and microscopic evidence that spermatoblast, is the official name, are present in these testes. They divide three or four times, and there is evidence that they were dividing for about the first stage of this maturation process. Q.- I want to understand, because I do not want to be misled by this evidence - you must take it that I am not particularly well up in the cellular structure of the human body, you are really speaking to the uninitiated. What I want to understand is what is exactly meant by early maturation stage? A.- From the earliest cell lining the testicular tube eventually all sperm come, this was an early cell which divides which divides by what is called reduction, and this divides again and yet again, and ultimately the small sperms come from this, and when I say this was an early stage I mean that the most primitive cells are present and there is evidence that they have been dividing, but the later stages of division I did not see in my preparation. Q.- At what stage did these cells cease to mature, you say they were in an early maturation stage, so presumably development had ceased at some stage, is that a correct way of putting it or an incorrect way? A.- It just happens that when this tissue was fixed this was the stage which these cells had reached. Q.- What I want to understand is what is meant by, "when this tissue was fixed"? A.- At some stage the tissue had been put into a tissue fixative which stops all further processes. Q.- That is after it came into the hands of your junior? A.- Yes. Q.- Does that have any significance as to the condition of the testis or its development? A.- Yes, I think if one could describe the normal testis, one could point to the first stage, the second, third and fourth stages of maturation, and in the centre of the tubule there would be a lining of sperms, here only one or two of the early stages were present. This is what made me say this is an undescended testis, because it is a typical appearance in an undescended testis. Q.- In practical terms what does this suggest in your opinion in relation to the person from whom the specimen was taken, in practical terms? A.- Practical terms that an undescended testis was present. I think that is as far as one could go. EXAMINATION CONTINUED:- Q.- And whether that testis came from an adult or a child I take it you could not tell from purely pathological examination? A.- No, I could not tell. Q.- But I understand that you were satisfied from your examination that this first specimen which you examined presented the peculiarities you have just described to his Lordship? A.- Yes. Q.- When you examined the second specimen do I understand original, p. 120, 121, 122 61 again there were certain peculiarities in it? A.- Yes, the peculiarity was simply that the centre of the tubule comprising the epididymis was singularly devoid of sperm. BY THE COURT:- Q.- And by that you mean what? A.- The normal epididymis draining the normal testes contains many sperms, here I saw none, or at most one or two structures which might have been sperms. Q.- By sperms what do you mean? A.- Spermatozoa. EXAMINATION CONTINUED:- Q.- Are you in a position to say then whether the first specimen which you examined was likely or unlikely to have come from the same organ from which the second specimen which you examined came? A.- It was likely to have come from the same organ. Q.- Would you please explain why? A.- Because both are showing evidence of poor sperm production. Q.- I should have asked you when was it you carried out the examination of the second specimen which you received from Dr. Klopper's Assistant Technician? A.- The exact date I cannot recollect without reference notes. Q.- Have you notes in front of you - were those notes made at the time you carried out the examination? A.- They are not notes of this examination, they are in terms of correspondence which would establish to me the date at which this was done. I cannot recall the exact date. Q.- Can you recall the approximate date? A.- May I look at my diary - I think I looked at this specimen the week beginning May 1st. Q.- This year? A.- Yes. Q.- I am not sure if I understand this correctly. Have you since your initial pathological examination carried out any further tests to eliminate the possibilities that these specimens came from something other than a human being? A.- Yes, I have carried out further tests, unfortunately the specimens having been fixed in a tissue fixing fixative could not be examined by the Precipitin technique which is the standard procedure. However, some organs do retain their powers even after fixation, but this requires an elaborate technique called the fluorescent antibody technique. I carried this out in co-operation with a colleague and I found that the results showed that the specimen is consistent with human origin. CROSS-EXAMINED:- Q.- Do I understand you to tell us that certainly so far as the first specimen was concerned on which your Report No. 12 of Process comments is described by you as I think you said abnormal testicular tissue? A.- Yes. original, p. 122, 123, 62 Q.- And also the second specimen which I think was epididymis tissue was also abnormal? A.- Yes. Q.- And the abnormality in particular terms was the lack of sperm content and the state of development? A.- That is so. Q.- As regards the state of development or maturation of the first specimen which you examined, can you tell us whether the development had stopped at an early age or had continued for some years or what? A.- I think the development - this is an opinion, not fact - the development had stopped at an early age. Q.- These organs I understand are present from a very early time, the testicles in the embryo? A.- Yes. Q.- And they proceed to develop and descend I suppose normally by puberty? A.- Yes. Q.- Would this testis which you say is undescended and undeveloped, would development have ceased can you say prior to the age of puberty? A.- Testes descend before puberty. Q.- Yes, I am sorry? A.- It is really impossible to say when this happened, the testis had not descended, there has been a failure of development, or full development of the testis at some stage. I think beyond that one cannot go. Q.- Can you as a matter of probability say it was likely to have occurred before, say, the age of 14 or after the age of 14? A.- I don't think one could tie it down. Q.- I was just wondering whether you could give it as a matter of probability or even possibility? A.- I am afraid not. BY THE COURT:- Q.- There is one thing I want to ask you at this stage, can you tell me what is the range of your experience of the descent of the testicle in the human being? A.- By range you mean? Q.- Well, what is the sort of normal earliest dates and the latest sort of normal date for descent of the testicles? A.- The testes is normally in the scrotum at birth. Q.- Is it known at what stage it descends before birth, or does that vary to a considerable extent? A.- It is variable. In most cases, not a all, the testes are in the scrotum by birth. Sometimes they come in the first month, in the latter months of intr-uterine life they are in the process of descent. Q.- Can you say between what month and birth normally? A.- In the seventh or eighth month the testes first come down towards the scrotum, it is in the groin. In the normal nine month birth it is in the scrotum. Q.- Are you able to say from your examination whether this testis had ceased to develop before birth - the question is not a very good one? original, p. 123, 124, 125 63 A.- This testis is still to some degree producing sperms so there is not a total failure of development. This is what makes the question about when development ceased very difficult to answer. Q.- Because they make an assumption which you cannot accept? A.- Which I cannot accept. CROSS-EXAMINATION CONTINUED:- Q.- On that point you say that the testis was still producing sperms, could it be described as fertile or infertile testis? A.- This is a matter of probability, it is almost certainly an infertile testis. Q.- You got no information as to which side the tissue had been taken from, left or right? A.- No, I got no information. Q.- And you had no information as to who had made the biopsy? A.- No. Q.- Were you able from either of the specimens which were before you to form any opinion as to the possible size of organ from which the specimens had been taken? A.- No, lacking information as to how much of the organ was given I cannot hazard a guess. Q.- I understand you to say that so far as the comparison of the two specimens is concerned they bear certain similarities which were not inconsistent with them having come from the same organ? A.- Yes. Q.- On the other hand they might have just come from two organs which had those similarities but which were not associated with the same person? A.- That is so, bearing in mind that the condition is not a common condition. Q.- Is a common condition? A.- Is not a common condition. Q.- Did you qualify at Aberdeen University? A.- I did. Did you qualify at the same time as the Second Petitioner, Dr. Forbes-Sempill? A.- I was one or two years ahead of Dr. Forbes-Sempill. Q.- Did you know the Doctor at that time? A.- Yes, by sight. Q.- And when qualifying the Doctor qualified as a she, I understand? A.- Yes. Q.- And was accepted as such? A.- Yes RE-EXAMINED:- Q.- Was Dr. Forbes-Sempill qualifying as a feminine or a masculine she? A.- As a masculine she in my opinion. Q.- If in fact those two specimens came from two different persons the coincidence would be remarkable, would it not, in that this uncommon condition you have referred to should be present in both persons? A.- Yes, it would be. original, p. 125, 126 127 64 Q.- And from what you said in cross-examination, Am I correct in thinking that a failure of testis to descend does not necessarily mean a failure of that testis to continue producing sperm? A.- That is so, but sperm production is usually greatly reduced. Q.- So that while there may be a total failure to descend it does not follow that there is total failure of sperm production? A.- There is often a total failure of sperm production, but there need not necessarily be so. Q.- And do I understand in this case from your first examination it appears there was not a total failure of sperm production? A.- Not a total failure. Q.- You said that during the seventh and eighth month the testis starts coming down towards the scrotum? A.- That is so. Q.- The last passage before it reaches the scrotum is down the inguinal canal? A.- Through the inguinal canal. Q.- Do you know how long it takes in a normal foetus for the testis to pass through the inguinal canal into the scrotum? A.- I am afraid I do not. Q.- But if this specimen which you found came from the inguinal canal that would suggest, would it not, that the testis proceeded quite a long way on its final journey to the scrotum? A.- Quite a long way on its path, yes. DR. A. L. STALKER recalled FURTHER EXAMINED:- Q.- Would you be good enough to look please at the slides in front of you. Are you in a position to say whether those or any of them were the slides which you have at any time examined? A.- Yes, they are in two sets, those two are the slides from the specimen that I received and those three slides which I received at the hands of Dr. Klopper's Technician. Q.- Did you hand those slides to Dr. Shivas? A.- I handed those slides to Dr. Shivas. Q.- On what date? A.- On the 6th May, Saturday the 6th May. Q.- And are those all the slides which you had from the samples sent to you or is there one missing? A.- There are other slides which I have not brought with me which were used for other purposes. Q.- Were those the only slides which you handed to Dr. Shivas, those five? A.- Yes, those are the only slides which I handed to Dr. Shivas. BY THE COURT:- Q.- There are really two articles to be numbered, one with two and one with three? original, p. 127, 128 65 A.- Yes. Two slides numbered 56, and three slides numbered 57. FURTHER EXAMINATION CONTINUED:- Q.- Do I understand that 56 of Process is a container containing two slides examined by you on the first occasion? A.- That is correct. Q.- And No. 57 is three slides which were examined by you after the slides had been handed to you by Dr. Klopper's assistants? A.- That is correct. Q.- Look at No. 56, the first one. Are those slides of the specimen which you received at the beginning of March, 1967, and which relate to your Report No. 12 of Process? A.- That is correct. Q.- And is No. 57 the collection of slides which relate to your examination of a part of a testicle which you considered to be part of the ductus deferens? A.- That is correct. (no cross-examination) original, p. 128, 129, 130 66 DR. ANDREW ARMITAGE SHIVAS (45) EXAMINED:- I am a Doctor of Medicine and hold the Diploma of Public Health. I am a member of the College of Pathologists. I am Senior Lecturer in Pathology at the University of Edinburgh. Q.- Do you specialize in your work in the examination of tumours? A.- I do. Q.- Do you have a considerable experience of examining mal-descended testes? A.- I have the experience which is common to those in practice in surgical diagnostic histology, that is to say the examination of material removed from hospital patients in the course of operative surgery. Q.- is there any connection between undescended testes and malignant tumours? A.- There is a connection to this extent, that it is accepted generally that the risk of supervention of tumours in undescended or mal-descended testes is substantially greater than that in normal testes. The extent of this increased risk is difficult to define precisely since various authorities would define it at different levels, but it is certainly substantially greater. Q.- Did you during the month of May, 1967, carry out examination of certain slides? A.- This is the slides presented to me by Dr. Stalker? Q.- Did you receive any slides from Dr Stalker? A.- I did. Q.- When did you receive them? A.- In the Department of Pathology in the University of Aberdeen. Q.- Did you bring those back from Aberdeen? A.- I did. Q.- Did you carry out certain examinations on them? A.- In fact I did the examinations in Aberdeen. Q.- How many slides did you examine? A.- I examined I think in all some six slides, but those in fact represented two specimens, various different staining procedures had been applied. Q.- Can you tell me first of all what conclusion you formed in relation to your examination of the first set of slides relating to the first specimen? A.- The first specimen presented the typical appearance of a mal-descended or undescended testis, that is to say it consisted of the functional elements of a testis with the difference that the tubules which are in the sperm producing agent in the testis were lined to a much greater degree than one would find in the normal testis by the supporting or Sertoli cells and the actual sperm producing elements were presented in reduced numbers. This is typically found in undescended testes, and in that respect it was well within the normal spectrum of appearances seen in mal-descended testes. Q.- Did you examine then a second set of slides for the second specimen? original, p. 130, 131, 132 67 A.- I did. Q.- And what conclusions did you come to as a result of that examination? A.- This was a much smaller biopsy and it presented the appearance normally seen in the ductus epididymis or possibly the proximal part of the ductus deferens of the testes, that is to say the conducting tubes leading spermatozoa to the exterior. Q.- Is the fact that you found the external tubes at all significance from your point of view so far as the stage of growth of the testis was concerned? A.- Well, I should say that it indicated a well formed testicular appearance in respect that not only were seminiferous tubules present but also the conducting mechanism to the exterior was so far as I could judge on the evidence well found also. Q.- Did you apply your mind to the question of whether or not the first specimen which you examined might have come from the same origin as the second specimen came from? A.- I was to some extent given the information by Dr. Stalker who identified the sections to me, but taking the matter at morphological level the two specimens equated well in respect that in the passages of the conducting tubules in the second biopsy there were few identifiable spermatozoa which equated very well with the expectation in view of the appearance in the first specimen. Accordingly the two match up well. BY THE COURT:- Q.- In what sense do you use morphological in this context? A.- Merely to mean the appearance of the thing as distinct from any question of a function as the physiologist might use it, we are looking at fixed tissues, morphologically we use to mean appearance of the thing as one might make a drawing of it. EXAMINATION CONTINUED:- Q.- Were you from your examination in a position to form any opinion as to the age of the individual at which the testis was likely to have ceased to descend? A.-I think this is more than one could normally do. BY THE COURT:- Q.- Even within a wide range? A.- All one could say is that it was likely to be a mal-descended testis typical of the appearances seen in mal- descended testes in the normal adult. Q.- Would you tell me the date when you received these specimens from Dr. Stalker? A.- I received them on the 6th. Q.- Of what? A.- The 6th of May. Q.- You brought them back to Edinburgh with you? A.- Yes. Q.- What did you do with them when you brought them back to Edinburgh? A.- I was given to understand that I should talk to Dr. McClean, I took them - do you want to go into detail? original, p. 132, 133, 134 68 Q.- I want to know what happened to them? A.- I was given to understand that I should contact Dr. Neil McClean whom I knew as a pathologist at the Western. I rang him up on the telephone, he said he had not heard of this and advised that I should contact Professor Strong which I did, since Professor Strong and I happened to be examining that self same morning in the College of Surgeons. Professor Strong informed me Dr. McClean was to be approached and I transferred the slides to Professor Strong. Q.- So where they are now you have no idea? A.- No idea. I have a receipt from Professor Strong. Q.- And no doubt if they were available you would be able to identify them again? A.- Yes. Q.- Have you had any experience in examination of hermaphrodites? A.- I think not. I may at some time have examined material from such an individual without specific knowledge that, that was so. Q.- Do I understand then that you are not in a position to give an opinion as to where in hermaphrodites testes are likely to be found? A.- Oh well, in common with those in my profession I am familiar through reading and meeting colleague pathologists who have personal knowledge of these cases what the general situation is, it is a rare condition, and only a few people are likely to meet the situation. The situation is with such individuals - you are speaking, of course, of the true hermaphrodite - they may have a testis on one side of the body and an ovary on the other, or they may have a combined organ, so called ovotestis on both sides. This organ may be situated either superficially where it is accessible to touch in the inguinal canal or inter-abdominally where they are not accessible to touch. My impression is that in the ovotestis which is the combined ovarian and testicular organ the testicular elements are very poorly formed. Q.- Were you able to form any impression from the specimens which you examined whether they came from a testis or an ovotestis? A.- No ovarian tissue was identifiable, and to that extent the material I examined is not consistent or shall we say is unlikely to be derived from an ovotestis. CROSS-EXAMINED:- Q.- I suppose the specimen which you examined was a pretty little bit of material? A.- The first specimen was what we would call a reasonable biopsy, the second specimen was what I think most people would call rather a small biopsy. Q.- Can you exclude in such a specimen, particularly the second, the possibility of there being ovarian tissue in the same organ as the specimen was taken from? A.- I think one could not altogether exclude it, but it is highly improbable from the point of view that an excretory duct would be most unlikely in an ovotestis. Q.- Were both specimens which you examined capable of being original, p. 134, 135, 136 69 described as consisting of abnormal testicular tissue? A.- I think that, that description could fairly be applied. Q.- I understand from what we have been told that they were in an early stage of maturation? A.- The use of the term "early" implies an ability to say exactly what the sequence of events has been, which I think might be a little difficult to sustain. There was less spermatogenesis than in a normal testis, but I think it would be difficult to say categorically whether the spermatogenesis was proceeding or reversing. Q.- You cannot express a view one way or the other, is that the position? A.- I would not like to say one way or the other, one does not in the normal way see a testis removed at the progressive stage since generally a surgical endeavour is made to draw these down into the scrotum in children. Q.- Are you able to say whether this taken from a child or an adult? A.- I think it would be difficult to say with certainty. The appearances however are certainly such that if the age of the individual from whom the biopsy is taken is known, and it normally is known, the appearances are typical of those we see in the reversing testis. I don't think that my own experience of the mal-descended testis in childhood would be sufficient to say categorically that this could not have been such a testis. Q.- When you say reversing stage do you mean the situation where development has proceeded so far then stopped then started to go back? A.- It might very well mean that, the point really is this, that in undescended testes the extent of maturation obtained is very variable, and individuals with bilateral mal-descended testes are not by any means invariably sterile, so again one has to allow for a considerable range of biological variation in this matter. Q.- Whether this was a person who had bilateral mal-descended testicles you do not know? A.- No, I had no information on that. Q.- And no means of forming a view on it from what you saw? A.- No. Q.- You said to me that the second specimen was I think smaller than you would normally expect. Was it sufficient for your purposes? A.- Quite sufficient, it included an adequate representation of the tissue. One is dealing with a tissue consisting of tubules, I think I am right in saying there was something like perhaps four or five well formed and complete tubules of this kind, and I would not have had the slightest hesitation about accepting it from what I have described. RE-EXAMINED:- Q.- When you say you were not quite sure whether spermatogenesis was proceeding or reversing do you mean by that, that you were not able to tell whether the maximum output of sperm production had not yet been reached or had been reached and was diminishing? original, p. 136, 137, 138 70 A.- That is so. Q.- Lest there be any doubt about that I take it that when you use the word proceeding you mean increasing, and when you use the word reversing you mean output reducing? A.- Yes, or maturing on the one hand and indicating atrophy on the other. Q.- And am I right in thinking that is the condition which happens to everybody? A.- Ultimately, yes. BY THE COURT:- Q.- What do you mean by that? A.- Well, many do not survive sufficiently long for this to become an element. Q.- When would you expect it to become an element in a normal male? A.- In substantial old age. Q.- More than three score years and ten? A.- Yes, one point I should have added in this connection is that quite often in mal-descended testes there is a substantial thickening of the basement membrane of the tubules. Had that been present it would have been possible to say quite categorically this was regression indicating atrophy, but in fact it was not present which means it is as I have said not possible to say precisely whether the thing is progressing or regressing. I do not know that much has been written on this , but for what it is worth it means that this particular testis is substantially nearer to normal than the average run of mal-descended testes. DR. A. A. SHIVAS recalled FURTHER EXAMINED:- Q.- Look at No. 56 of Process which is two slides. Can you tell me whether those were the two slides which were handed to you by Dr. Stalker on the 6th May, 1967? A.- They are so. Q.- And do those slides relate to the opinion which you expressed as to a specimen coming from the body of the testes? A.- They do. Q.- Would you look please now at No. 57 and tell me whether those three slides were handed to you by Dr. Stalker on the same occasion? A.- They were. Q.- Do those three slides relate to the opinion which you have expressed as to the tissue having come from the ductus deferens? A.-They do. Q.- And were those the five slides which you handed to Professor Strong? A.- They are. (No cross examination) original, p. 138, 139, 140 71 WILLIAM GEORGE CAMBELL MANSON (42) EXAMINED:- I am a medical practitioner in practice at Alford since 1955 as a Principle. Before that I was the second Petitioner, Dr. Forbes-Sempill's Assistant in the practice there. Q.- Since that time when you took over the practice has the Second Petitioner Dr. Forbes-Sempill been your patient? A.- Yes. Q.- And of course you have known Dr. Forbes-Sempill for longer than that no doubt? A.- Yes. Q.- How long were you his assistant? A.- From December, 1951, until March, 1955. Q.- Some three years and four months? A.- Yes. BY THE COURT:- Q.- Had you known the Second Petitioner before that or was 1951 your first acquaintance? A.- I had known him casually before that. EXAMINATION CONTINUED:- Q.- Since you have known the Second Petitioner have you as a result of your dealings with him both in business and socially come to any view as to what his sex appeared to you to be? A.- Yes, I think so, to my mind I consider him as a male. To me he has always appeared to be a male, yes. Q.- Can you elaborate that a little, in what respect did he appear to you to be a male? A.- I thought generally when I was Assistant to Dr. Forbes-Sempill, and latterly our conversation has always been as male to male, and that his interests to my mind are wholly male. I shot with him, and we have walked up in very hilly rough country, and to my mind his stamina on the hill was beyond any female, and all his interests and pursuits and the way he followed them were to me male. Q.- Can you describe briefly the sort of life which the Doctor lives now? A.- Yes, Dr. Forbes_Sempill is an active farmer, he goes about his duties as any farmer in our part of the world, any working farmer, he takes his part in all duties, cleaning out byres, looking after his dairy herd and doing all the manual tasks that are necessary, driving a combine harvester, lifting bales, doing all the manual tasks on the farm. Also hill cattle, and carrying feed up during the winter through hilly and difficult country requiring a lot of stamina. Q.- Is this a purely low ground farm he operates or is it low ground and hill or marginal? A.- I would say a mixture of the three, low ground, marginal and three, and he runs quite a number of cattle. Q.- How long to your knowledge has Dr. Forbes-Sempill been conducting these farming operations? A.- Certainly since he left the practice in Alford in 1955, and before that partly for two or three years. original, p. 140, 141, 142 72 Q.- Has the Doctor been a whole time farmer since he gave up practice? A.- Yes. Q.- Did you receive a telephone call from Dr. Forbes-Sempill on the 3rd March, 1967? A.- Yes. Q.- What did that call relate to? A.- That Dr. Forbes-Sempill asked if he could send to the Pathology Department at Aberdeen University biopsy tissue for examination and identification under my name. Q.- Why do you think he wanted to do it under your name? A.- I feel he was no longer actually engaged in the practice of medicine in the county and no longer was sending specimen samples etc, to the University of Aberdeen for examination, and I thought that the idea was that he would do it through his practitioner, and a person who was in the habit of sending material etc, to this Department in Aberdeen. Q.- What did you do in response to his request? A.- I agreed that he could do this and the result would then naturally come to me, and then he did send the specimen to Aberdeen. Q.- Can we have the mechanism in detail, did he actually parcel it up and post the specimen or did or did you? A.- He did, I did not. Q.- Did you provide some authentication to go with the specimen? A.- No, I gave authority he could send the specimen to the Department in Aberdeen under the name of Dr. Manson. Q.- Look at No. 54 of process. Is that prepared by you? A.- No. Q.- Do I understand then the purpose of the telephone call was to obtain your authority to send a specimen in under your name? A.- Yes. Q.- Following upon the telephone conversation did you receive any sort of Report from Aberdeen University? A.- Yes. Q.- Would you look please at No. 12. Is that the Report or a copy of the Report which you received? A.- Yes. Q.- Was this the normal drill when you send in a specimen to be examined? A.- Yes. Q.- Did Dr. Forbes-Sempill attend your Surgery on the 28th March, 1967? A.- Yes. Q.- The telephone call was the 3rd March? A.- Yes. Q.- Did he attend alone or was somebody else there? A.- He attended with the Rev; Reid. Q.- What was the purpose of Dr.Forbes-Sempill's call on you on the 28th March? A.- That I might take a small biopsy from a mass in the left groin and give this to the Rev; Reid to take into Dr. Klopper in Aberdeen. Q.- At this date had you received a Report, No. 12 of Process? original, p. 142,143, 144 73 A.- No. Q.- Did you in fact proceed to carry out this biopsy? A.- Yes. Q.- With regard to the position of this mass which you have mentioned? A.- The left iliac fossa. Q.- Is that anywhere near the left inguinal canal? A.- Yes, the left groin. BY THE COURT:- Q.- Can you describe how you take a biopsy of this sort? A.- The part is anaesthetized with a local anaesthetic and an incision is made, and the mass to be biopsied is brought forward and a small piece of tissue nicked off with a scalpel. EXAMINATION CONTINUED:- Q.- What is done with the piece of tissue? A.- I took the piece of tissue and put it into a little stoppered glass bottle which I handed to the Rev; Reid, and on the bottle was a label and he named it and sealed it up and then took it in to Dr. Klopper. Q.- Would you describe first of all the mass from which this biopsy was taken by you? A.-Yes, a small rounded mass about the size of a small walnut in the left groin in the area of the external inguinal ring, the left inguinal ring. Q.- Was there anything of significance about this mass when you first looked at it on the 28th March, 1967? A.- Sorry? Q.- Was there anything of significance to you? A.- No, this was a mass which could have been a gland or it could have been perhaps an undescended testicle, the purpose of the biopsy was to find out what it was. Q.- Were there any marks on this mass? A.- No, not in my field of vision. There was on the skin an incision just above, there were marks of an incision on the skin just above where I went to take my biopsy. Q.- Did you form any impression as to the likely cause of those marks? A.- That this was a mark of an incision, a recently healed incision. Q.- What made you come to that conclusion? A.- The general appearance of the scar, the scar was of an incision which had healed fairly recently, the coloration of the scar and the general look of the thing. Q.- Do I understand then that after you had performed your biopsy that so far as you know the specimen which you removed was never in the possession of the Second Petitioner? A.- Yes, as far as I know it was never in his possession. Q.- You handed the specimen to Mr Reid, did you give him anything else to take to Dr. Klopper? A.- I gave him a short covering note stating that this was a small portion of tissue which I had removed and was sending that morning, via Mr Reid to him. Q.- Did you see Dr. Forbes-Sempill on the 4th May, 1967? original, p. 144, 145, 74 A.- Yes. Q.- For what purpose? A.- That was to take a blood sample. Q.- How much blood did you take? A.- 20 cc's. Q.- Where from? A.- I took it from the vein in the front of the forearm, the elbow. BY THE COURT:- Q.- That is on the inside of the elbow joint? A.- Yes, the inside of the joint. Q.- On the right arm? A.- The right arm, yes. EXAMINATION CONTINUED:- Q.- What did you do with that sample of blood? A.- I had previously obtained two heparinized tubes. Q.- What did you do with the blood in the tubes? A.- I put 10 cc's into each and then sent them to Professor Dewhurst at Sheffield. Q.- Would you tell us what a heparinized tube is? A.- It is just a tube to which a little heparin has been added, heparin being a drug which improves clotting of the blood. CROSS-EXAMINED:- Q.- I am not sure that I quite understand what happened with regard to these two specimens. Do I understand the position to be that on the 3rd of March you received a telephone call from Dr. Forbes-Sempill? A.- Yes. Q.- Asking if in fact you could lend your name to a sample being sent to Aberdeen University? A.- Yes. Q.- Were you told what the sample was? A.- I was told this was a biopsy from the left inguinal region. Q.- Were you told who made it? A.- No. Q.- And you never saw it? A.- No. Q.- And although No. 54 of Process appears to be a letter in your name it was not a letter which is written by you? A.- No. Q.- How does it read? A.- It reads "From Dr. W.G.C. Manson, Coreen, Alford. Patient's name - Forbes Ewan. Biopsy from inguinal region. Please identify tissue and state if any malignancy present". Q.- Was that not read to you before the sample was sent? A.- No, not it's content, this was a biopsy of the inguinal region and Dr. Forbes-Sempill asked me if he could send this in for identification of tissue and to ask if there was any malignancy. Q.- Was that not written at your dictation, or had you seen it before? original, p. 145, 146, 147 75 A.- No I had not seen it before, this was the gist of the conversation we had. Q.- But in fact despite what the note says the sample did not come from you? A.- No, it did not come from me, it was sent under my name. Q.- And it was not from a person called Ewan Forbes? A.- Yes. Q.- It was from Dr. Ewan Forbes-Sempill? A.- Yes. Q.- Assuming that is the sample you were told was being sent and it had reached Aberdeen University was that the sample you understood Dr. Stalker had reported on? A.- Yes. BY THE COURT:- Q.- When did you receive Dr Stalker's Report? A.- I can't remember the exact date, it was into April. CROSS-EXAMINATION CONTINUED:- Q.- The second was one which I understand you took yourself? A.- Yes. Q.- In your surgery? A.- Yes. Q.- In what circumstances was that taken, what were you asked to do? A.- I was asked if I could take a little biopsy of a swelling in the left groin. Q.- Were you told where to take it from? A.- No. Q.- What were you asked to do with regard to finding the position as to where it was to be taken from? A.- There was a little swelling in the left groin. Q.- Were you able to identify that in any way at the time? A.- No. Q.- You say I think you saw some evidence of an incision near where you made your incision? A.- Yes. Q.- Is the sort of operation which you performed a sort of operation which somebody could perform on themselves? A.- Yes, I think so. Q.- With ease or with difficulty? A.- With a reasonable degree of difficulty, not extreme difficulty and not extremely easy, one could put it in between. BY THE COURT:- Q.- What size was the incision which you observed? A.- About three inches long and almost two finger breadths above the inguinal ligament. Q.- On the left? A.- On the left. CROSS-EXAMINATION CONTINUED:- Q.- And your incision was made on the left too? A.- Yes. Q.- What length was your incision? A.- Approximately the same. original, p. 147, 148, 149 76 BY THE COURT:- Q.- And below, I understand, a little below? A.- A little below. Q.- How far below? A.- Possibly half an inch. CROSS-EXAMINATION CONTINUED:- Q.- And was it your specimen which was handed to the Rev; Reid, and so far as you know for whom it was destined, who was going to examine it? A.- Dr Klopper was going to examine. Q.- Who told you that? A.- Aberdeen University. Dr. Forbes-Sempill told me. Q.- How do you know Dr. Klopper was going to examine it? A.- Dr. Forbes-Sempill told me that the Rev; Reid was going to take it into Dr. Klopper. Q.- You understood the Rev; Reid was going to take it to Dr. Klopper? A.- Yes, for examination. Q.- Did that go in your name? A.- Yes, I wrote a little note with it. Q.- You were Dr, Forbes-Sempill's partner, I understand, for some four years? A.- Assistant. Q.- And you became the Doctor's Assistant in December, 1951? A.- Yes. Q.- At that time was the Doctor known as Dr. Elizabeth Forbes-Sempill? A.- Yes. Q.- And was to all intents and purposes a woman? A.- Yes. Q.- And carrying on practice as a woman doctor? A.- Yes, under the name of Dr. Elizabeth Forbes-Sempill. Q.- Locally the Doctor was a woman doctor. Is that right? A.- Yes and no, I think if I can put it that way, I don't think generally the patient's looked on Dr Forbes-Sempill at that time as a woman doctor, you know, completely as one would compare with a woman doctor elsewhere. Q.- Did she dress as a woman? A.- No, mostly in a suit or in a kilt. BY THE COURT:- Q.- What do you mean by a suit? A.- I beg your pardon, sorry, in a gents suit or in the kilt with a kilt jacket. CROSS-EXAMINATION CONTINUED:- Q.- Would it be fair to say that she was a woman who appeared to have ceratin masculine interests? A.- To my mind dressed in the kilt, a pair of legs in the kilt, it did not look like a feminine person below the kilt, a pair of legs, it looked to me like a good man in a kilt. Q.- You were asked to describe why you considered her to be a male, and I think you put it, it was because of the fact that she appeared to have male interests? A.- Yes. original, p. 149, 150, 151 77 Q.- And she appeared to have some considerable strength which you would have associated with a man more than with a woman? A.- Yes. Q.- But the Doctor was still for I think some eighteen months or so when first you went as her Assistant outwardly in the sense of her name a woman? A.- Yes. Q.- Has it been within your experience that there are some women who have strength in excess of what is associated with a normal woman and masculine interests, but are nonetheless accepted as women? A.- I think one could say that. Q.- It is not an uncommon feature of our civilisation? A.- No. Q.- And if Dr. Forbes-Sempill had chosen to continue to call herself Dr. Elizabeth Forbes- Sempill would you not just have accepted her as one of those persons who although woman appear to have certain masculine interests and certain masculine attributes like quite a lot of women do have? A.- My experience in the country, we have a lot of ladies, farmers wives, etc, and daughters of the farm who one might say did a lot of male work about the farm and they have male interests, etc, about the farm but to me these women did not appear as Dr. Forbes-Sempill appeared, to me much more masculine than the masculinized women I see about the farm in the country district. Q.- Did the fact that Dr. Forbes-Sempill in fact adopted the kilt and wore a man's suit affect your view? A.- I don't think so. Q.- Did Dr. Forbes-Sempill ever in your experience wear women's clothes? A.- I have never seen Dr. Forbes-Sempill dressed in women's clothes. Q.- How long before December, 1951, did you know Dr. Forbes- Sempill? A.- Possibly casually about a year before that. Q.- In what circumstances? A.- I had seen her at odd meetings of practitioners in the area, with a concert party, and dancing Highland Dancing on the stage. BY THE COURT:- Q.- Were you in another practice at that time? A.- Yes, I was at Huntly at that time. Q.- That was about a year prior to your going in as an Assistant? A.- Yes. Q.- With the Second Petitioner? A.- Yes. CROSS-EXAMINATION CONTINUED:- Q.- Has Dr. Forbes-Sempill changed the mode of dress adopted by the Doctor since becoming known as Dr. Ewan Forbes-Sempill? A.- No. Q.- That is to say within the limit of your knowledge of the person? original, p. 150, 151 152 78 A.- Yes, exactly. RE-EXAMINED:- Q.- So far as the biopsy of which you saw signs you said it would be neither extremely difficult nor extremely easy to perform this? A.- Yes. Q.- For an individual? A.- Yes. Q.- But I take it, it would be easier for somebody qualified in medicine to do this than somebody unqualified? A.- Yes, I think so. BY THE COURT:- Q.- Was your previous evidence related to a medical practitioner or just to a lay man when giving evidence that it was neither extremely easy nor extremely difficult? A.- I think if I could say, we have heard of people having to take out their own appendix, I think one can see the area,and therefore it is reasonably easy, it is an area that lends itself to doing a little self surgery. Q.- Yes, but there is all the difference in the world between a lay man taking a biopsy and a doctor taking one? A.- Yes. Q.- I had assumed when you were giving your evidence earlier that you had in mind that it was a doctor who was performing the self operation? A.- Certainly for a lay man it would be technically difficult to do, still be possible. There is a difference if you have an idea what you are doing or if you don't know what you are doing. RE-EXAMINATION CONTINUED:- Q.- You say it would be technically possible but difficult for a lay man, how would you describe it for a doctor? A.- I would say relatively easy. BY THE COURT:- Q.- From that position? A.- Yes. RE-EXAMINATION CONTINUED:- Q.- You were asked whether Dr. Forbes-Sempill had changed his mode of dress since he became Dr. Ewan? A.- Yes. Q.- And your answer I think was no. Has Dr. Forbes-Sempill in any way changed his mode of life since re-registration in 1952 to your knowledge? A.- No, he is now farming full time. Q.- Instead of practising medicine? A.- Yes.