Teaching today’s medical students is oftentimes a challenge. Of course, being a medical student is probably a challenge of equal or greater proportions, but faculty members rarely view this perspective with the same gravity held by students. The complexity of effective teaching and learning requires balancing information output from the faculty member with information uptake and retention by the student. Students are quick to identify information output presented in formats unsuitable for uptake, such as the poorly prepared or obtuse lectures, or information nearly impossible to retain, such as the truly obtuse topics or topics with little apparent applicability for a future practicing physician. Therefore, effective teaching remains a constant challenge of reviewing new material, preparing new ways to present material, and seeking new connections between different disciplines to underscore the impact of the information.

This is an account of such a challenge that resulted in several unexpected associations between the genetics of gender development and the importance of childcare decisions. A review of hermaphroditism provided several insights into childcare and the impact of family symbolism to raising children that I failed previously to notice in presenting this material to students. The learning objectives for students were gender differentiation and development that provided fundamentals for subsequent objectives on steroidogenic disorders affecting gender.

Searching the Internet
The Internet is a wonderful resource for preparing lectures and providing resource material for students. Anything and everything can be found on the Internet and is often available for teaching without additional permission; however, during the past year I have never been refused permissions requested to use material found on the Internet for publication and/or dissemination to the public. Examples of materials I have used include text, figures, diagrams, algorithms, and photos. Many authors volunteer to send original material for better resolution.

To begin updating material on hermaphrodites, I began at my web browser. At this point, I strongly suggest no one search under the words “hermaphrodite” or “hermaphroditism.” DO NOT open anything that comes up for these words – believe me on this. You may find that, in doing so inadvertently, getting rid of emails that begin filling your inbox is difficult for a long time afterwards. You may even have to change your email address to get rid of unwanted emails.

Using Background to Enhance Teaching
I decided to give students some background on hermaphrodites with the hope that this would enhance their learning experience and reduce the snickering sidebars that accompany this topic. So I went to Greek mythology. My story begins here, but it is really two stories: one about Hermes, the father of Hermaphroditus, and the other about Hermaphroditus, the son. Both stories are important to understanding the culture of Hermaphroditus’ family and the Greeks who ultimately influenced the association of Hermaphroditus’ name with a genetic anomaly of gonadal development.

Either a male and female gonad in one individual, or the presence of male and female gonad tissue in a single gonad (a presentation known as an ovotestis) characterizes the genetic anomaly. Hermaphrodites are referred to as individuals with intersex. Hermaphroditism is not a psychosocial disorder, though psychosocial events will definitely influence the child’s development. It is an error in development that may occur on one or both sides of the body. Both male and female genotypes occur in the same individual.

Hermes (The Father)
The story begins with Hermes, most commonly recognized as the Messenger of the Gods. Hermes had many, many assignments. As Protector of the Roads, he did a lot of ferrying of messages and cargo for the Gods. As the God of Speed, Hermes delivered messages for the Gods, who wanted their messages delivered in a timely manner. Obviously, Hermes could also be considered the forefather of FedEx, an association overlooked by the FedEx corporate directors. Hermes was the son of Zeus and Maia, daughter of Atlas and one of the Pleiades. Not only was Hermes the offspring of an illegitimate affair, he was one of several gods who had one-night stands with Aphrodite, the Goddess of Love, and with other minor goddesses. Such one-night affairs may have been an occupational hazard, but my review of the literature revealed that fidelity was not a high priority among many mortals and gods, as well as Hermes and his father.

The name Hermes is associated with the Greek term herma – a rectangular stone pillar used to mark roads for safe passage. These pillars also became popular markers at the entrance of homes to ward off evil spirits. Unlike today’s rectangular pillars that often support large flower urns, hermai (plural for herma) in early Greece were topped by a sculpture of Hermes’ head. Located at, or near, the base of the pillar were sculptures of Hermes’ genitals. During an unpopular period of the Peloponnesian War, in about 415 BC, citizens of Athens did not favor sending their young men off on ships to wage war in Syracuse (the older one). Rather than picketing against this unfavorable war, hermai were defaced; thus, only their description remains. However, the description seems to elicit appropriate imagery. Several thoughts come to mind when considering these hermai. First, outdoor landscaping was apparently a man’s responsibility. What woman would mark the entrance of her home with stone genitals? I wonder if the location of the genitals, which when in a higher position may have been broken, was a compromise by sculptors to appease women complaining of bruised hips and thighs. Second, when did pet dogs enter Grecian life? [Think male pets!] Third, I suspect that hermai were defaced at the top and bottom, since pillars and other types of hermai have been found at many archeological sites. Finally, I also suspect that women, not the men going to war, defaced hermai.

Hermaphroditus (The Illegitimate Son)
Hermes and Aphrodite had a son named Hermaphroditus who was raised by a group of nymphs¹. In my opinion, nymphs may not have been the best choice for childcare since they were constantly the target of satyrs’ lust. These nymphs resided in a place called Phrygia² (frij'e-?), which seems a bit oxymoronic. Other half-siblings of Hermaphroditus were Priapus and Eros. Hermaphroditus was a very handsome young man. As a teenager he decided to leave home because his parents were constantly having affairs with the neighboring gods and goddesses, his father’s head and genitals were displayed at every door, and his nannies and tutors were nymphs.

Hermaphroditus was traveling the country when he encountered a reflecting pond that beautifully mirrored the nearby forests and meadows. In this particularly beautiful pond was a nymph named Salmacis – probably a water nymph. She was at once attracted to this handsome young god and invited him into the pool. However, Hermaphroditus was in deep thought about his life and the nature around him and ignored the nymph. After all, he had been around nymphs his whole life. As he walked along the pool, the nymph continued her solicitations. Hermaphroditus paid no attention to the nymph, but he was very much attracted to the pool. He decided to disrobe and enter the pool for relief from the searing, late afternoon sun. The nymph, as was true of most nymphs, did not appreciate a blatant rebuff. She sought a more direct approach. She swam to Hermaphroditus, embraced him tightly and began to wildly kiss and fondle him. Hermaphroditus fought vigorously to free himself from this unexpected attack but was unable to release her hold. Salmacis continued her sensuous pleasures and cried out to the gods that their bodies never be separated, even as Hermaphroditus was fighting to release her hold. The gods, who may not have been paying close attention to the events in this small remote pool (perhaps they were enjoying their own godly delights), granted Salmacis’ wish. The bodies of Salmacis and Hermaphroditus became one – half male and half female. In his horror of what happened, Hermaphroditus cried out to the gods with all the air his lungs could expel and begged them to punish any man who entered this pond by taking his virility. The birds and animals were quiet as the winds began to move from every direction. The gods heard Hermaphroditus’ cry and considered the terrible thing they had done. Then they granted his wish.

Unexpected Lessons
As I contemplated this story for medical students, several aspects seemed clearer than previously. First, the story might be better suited for behavioral science discussions, but interdisciplinary approaches for teaching often enhance learning. Hermaphroditus was a tragic figure, whose destiny was shaped not by genetics, but by his parents’ behavior and his own random wanderings that took him by the pond where Salmacis was bathing. Family counseling and individual counseling were indicated for both Hermes and Aphrodite before their affair, as well as during Hermaphroditus’ childhood. Second, even the names Aphrodite chose for her children did not consider the difficulties these gods would have to live with as they matured. Third, Hermes and Aphrodite were not involved in their child’s life. They should have paid closer attention to the childcare workers’ résumés. Just as no one today wants a landscaper from Leavenworth, nymphs from Phrygia should have been given a little more scrutiny. Fourth, Hermaphroditus’ curriculum would have benefited from a more adequate physical fitness program. Finally, teenagers shouldn’t roam the country in search of an inner self and meaning of life without a traveling companion. This tragedy points out only too clearly that mothers of handsome sons must teach them to beware of nymphs in ponds.

Conclusion
The students wildly received this information with great enthusiasm. They demonstrated great retention of this and related material about hermaphrodites on the evaluation – which was my goal. On a final note, I considered briefly the idea of requesting volunteers for dramatization of this material as it was being presented; however, after further consideration, I refrained from the temptation.

Linda Adkison, PhD
Mercer University School of Medicine
ELAM 1999-2000

Reference: Publius Ovidius Naso, Ovid IV, 288

1)A minor nature goddess usually depicted as a beautiful maiden among the ancient Greeks believed to inhabit forests and bodies of water. Today’s connotation of the word nymph may be closer to insect-like than maiden-like, or an issue of regional dialect.
2)An ancient country in western and central Asia Minor that is modern day central Turkey.