LETTER V.

SEXUAL ORGANS.

GENTLEMEN:-In my Letters I have set before you some general ideas on the nature of sex in the female; and have also pointed out some of the more distinctive characteristics of that best half of our race. In this letter, I shall speak to you of the reproductive organs; begging you to accompany me in the disagreeable task of this investigation with minds purified by the love of truth, and by that decent self-respect, which ought to guard every physician. when he comes to study, as a part of his professional obligations, this department of anatomy; a department we cannot omit to learn, without leaving ourselves incompetent to the safe discharge of many important medical and chirurgical duties; and which we cannot study without feeling that we are engaged in inquiries that ought not to be exposed to the public gaze.

Instead of treating in this letter, of the private parts in question, I might perhaps as well have referred you to the anatomical treatises already published; but, by so doing I feel that I should leave this volume less complete than it ought to be.

In a recent report of testimony given before one of our courts of justice, where a person was in question for having published an obscene book, pretending to be a medical work, a witness characterized it as "fit to be seen only in a Doctor's shop."

Let us take a lesson from this undesigned reproof of the medical faculty; and while we acknowledge that our ministry calls upon us to know all that can be learned as to the anatomy and physiology of the reproductive organs, let us admit also that it behoves us out of a feeling of self-respect, and respect to our calling, to treat these subjects with all decency, and with a just deference to our friends not of the profession; who, having no claims to acquire the knowledge we are compelled to obtain, must not be offended by any unavoidable indelicacy of expression in our writings. Such persons being to us entirely esoterical, ought not to suffer themselves to pry into those particular mysteries of

the medical profession, which it is better for them not to learn than to know. If they look into our books and blush, they are like eaves-droppers, who generally hear no good of themselves. As for us, let us remember that the President of the Board of Trustees, who, in the name, and by authority of the State of Pennsylvania, admitted you to the rank and quality of Doctors in Medicine, declared you vested with the powers exercendi, docendi et scribendi, ubi rite vocati fueritis; and that this commission allows us a great privilege of discussion; which being needful for our art and the security of the people, is decent and proper in our hands, but vile and contra bonos mores in the hands of other people. Fantoni, as cited by Dr. Asdrubali, in the Trattato Générale di Ostetricia, &c., p. 68, t. l., says, "Honesta quantum potero, muliebria examinando; honeste, inquam si potero; nam fieri vix posse puto, ut honestis, appellationibus res vulgo obscænas designamus, quæ facile pudicas aures offendunt. Sed vobis nullus. sit pudor integris auribus ea excipere quæ divina sapientia creare non erubuit," &c.

The reproductive organs of the female are external, and internal. The former being situated upon the outer face of the pelvis, and the latter concealed within its bony cavity.

A sense of modesty induced the ancients to give the denomination of pudenda to the external or visible privities of the female; and this word, which is a plural noun, applies to the whole of the external genitalia.

The pudenda, therefore, comprise the mons veneris; the labia externa, also called labia majora; the labia interna or minora, called also nymphæ; the clitoris; the præputium clitoridis; the vestibulum; the os magnum; the caruncula; the hymen; the fossa navicularis; the fourchette, and the perineum.

The internal genitals are the vagina, or vulvo-uterine canal, as the Frenchmen call it; the uterus or womb; the Fallopian tubes; the ovaries; the round ligaments, and the broad ligaments. The word vulva applies to the sexual fissure, rima, or sulcus, that is observed between the two opposite labia majora.

Now, as to the mons veneris (le Penil,) it is an elevated portion of skin, that is lifted above the general level of the lower part of the belly, partly because it is on the share-bone or os pubis, and partly because it is underlaid by a considerable quantity of adipose tissue filled with fat.

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This part of the skin is of a darker color than that which is above and about it; for it contains a portion of pigmentary membrane which deposits on the exterior surface of its corpus mucothe same sort of dark matter as is known to color the axilla, the aureole of the mamma, the perineum, &c. It is also covered abundantly with hair, which begins to make its appearance under the critical efforts of the constitution when those efforts are being employed to convert the creature from childhood to puberty;—or, in other words, when she is about obtaining such a degree of development as may consist with the power of germ-production. It is not unworthy of your observation, that when the power of germ-production is lost at the change of life, that of producing the pudendal hair is diminished very sensibly, and in old age, not unfrequently goes to the extent of a complete depilation.

Women also, who from feebler health, cease to bear children, as they advance in age, but who have not wholly lost the faculty of germ-production, often find that the pudendal hairs are lessened in abundance during the suspension of the child-bearing faculty; and that the crop is greatly increased as soon as they find themselves again pregnant after many years have passed since any former gestation of theirs. This I have learned from several cases observed and inquired of in my clinical experience, for I have many times had charge of labors in women, who being as it is called getting old, and not bearing children for eight, ten or twelve years, were yet surprised and vexed to find themselves so wonderfully young again.

As to the disorders to which the structure called the mons veneris is liable; you will be sensible that they must be of the nature of the exanthematic and phlegmonous inflammations, contusions, and wounds; and that such affections have not and cannot have any special relation to what is properly called midwifery. Perhaps, indeed, we may except some rare samples of pain, neuralgia or inflammation of the textures connected with strains, or violence done to the symphysis pubis; either by the protracted influence of continued pressure and weight on the pubes by a heavy womb; or by injurious tension and even disruption of the symphysis or of the bone, under the transit of an overgrown fœtus, or a badly managed forceps operation; where great violence is sometimes done to the bony structures, either by the power of the womb in its expulsive efforts, forcing too large a child

through too small a pelvis; or where, by the additional power of the forceps, such a child is drawn through such a pelvis, the articulation of the pubis, which lies underneath the mons veneris, becoming so strained as to inflame after the labor is over: or the bone itself may be broken asunder, as in some instances related by Madame Lachapelle in her admirable Treatise on Midwifery.

In any such cases, where pain is felt in the lower part of the mons, as I have heard many persons complain, it appears obvious that the same chirurgical treatment ought to be adopted as is known to be most suitable to the articular maladies in general.

Professor Mütter has doubtless taught you that, in the treatment of articular inflammations, rest is of the primest force; and that in the movable joints, when inflamed, the splint is the first and greatest of remedies. Hence, in the instances where your patients after childbirth, shall complain of pain in the mons, in walking, or in turning in bed, you ought to direct your attention to the condition of the symphysis of the pubis.

I have met with many instances wherein the ligaments that bind the ossa pubis together have become so relaxed, probably under the infiltrative influences of pressure and tension, continually exerted by the gravid womb, as to allow of a very perceptible play of the opposite ends of the ossa pubis upon one another; the right pubis moving upwards when the woman stood upon the right foot, and the left one rising above it again as she stood upon the left foot. I leave you to imagine the pain, the discomfort, the uncertainty and the feebleness of gait, attending so large, or even the least motion of this important joint. You fully know that the pubal bones cannot pass and repass each other, without, in some degree, disturbing the repose of the sacroiliac junctions; and I have shown you what sort of a cartilage that is, that we used to study under the denomination of the auricular cartilage of the sacrum and ileum. A cartilage so firm and resisting as that, could not become the subject of motion without the greatest inconvenience. It could not be treated by means of internal medicines; nor could any counter-irritants, liniments, lotions, or plasters, or ointments, have a very useful effect in the treatment.

Hence, you perceive, my friends, that, for your patients complaining of such movableness of the joint, there is but one chi

rurgical principle; and that is, the joint must be allowed to rest. She must not make it move by walking about—for she can never transfer the weight of her body from one foot to the other, without transferring it from one acetabulum to the other; and you remember that the pubis owns one-fifth of the acetabulum, and you ought to know, that an inflamed joint is nearly as little apt to be cured while motion is allowed in it, as a broken bone. They equally demand the use of the splint. This is the treatment suggested and used for half a century by our illustrious compatriot Dr. Physic. In Europe, it is becoming understood within a few years past.

I have tried various bandages, springs, and compresses, to relieve certain of my patients thus affected; but such bandages are intolerable, because they cannot be kept in adjustment. Some women have soon spontaneously recovered by means of rest, which permits the joint again to become firm; while others have continued to suffer more or less through successive pregnancies.Rest is the cure.

I will not say, that where the disturbance of the joint has caused an attack of inflammatory congestion, rest alone is indicated-for, in such a state of things the patient might very reasonably expect that you should seek to relieve her, further, by means of leeches; by counter-irritant applications; by stupes and cataplasms, and by anodyne liniments; for the selection of which remedies in particular, I must refer you to the indications of the special case and time-as well as to your memory, for what Professor Mütter has counselled on such topics. These remedies are not dependable.-Rest is the cure.

I hope you will come to the conclusion, that wherever the symphyses of the pelvis are found loose and relaxed after gestation, that effect has been produced by a maladive condition. I am fully of Dr. Dewees' opinion on this point, and he used to scout at the notion of the bones naturally yielding in order to let the child escape more easily.

Dr. Moreau of Paris, whose excellent work on midwifery is in the hands of many of you, seems to think that the relaxation of the ligaments of the pelvis is not an unusual or unhealthful occurrence; his remarks on the subject are at page 46, tom. i. I should be glad if you would read attentively his relation of a case at page 47, as well as a most interesting one at page 51. The