U.S. NATIONAL LIBRARY OF MEDICINE ' *w^ < <. WOMAN; HER DISEASES AND REMEDIES. A SERIES OF TO HIS CLASS, BY/ ...^ CHARLES D/jjjjJGS, M.D., Professor of Midwifery, and the Diseases of Women and Children, in the Jefferson Medical College at Philadelphia; Member of the American Medical Association; of the American Philosophical Society, and of the Council; Vice-President of the College of Physicians of Philadelphia; late one of the Physicians to the Lying-in Department of the Pennsylvania Hospital; &c. &c> SECOND EDITION REVISED AND ENLARGED. PHILADELPHIA: LEA AND BLANCHARD. 1851. 5-' CP v\> ETTERS 4 V" wp 1251 Entered according to the Act of Congress, in the year 1850, by LEA AND BLANCHARD, In the Clerk's Office of the District Court for the Eastern District of Pennsylvania. PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS. 0 TO THE STUDENTS OF MY CLASS, IN THE SESSION OF 1846--7, THIS VOLUME IS RESPECTFULLY AND AFFECTIONATELY ueMcatcti, BY THEIR GRATEFUL FRIEND, THE AUTHOR. PREFACE TO THE SECOND EDITION. I am happy to offer to my Class an enlarged and amended Edition of my Letters on the Diseases of Women; and I avail myself of the occasion to return my heartfelt thanks to them, and to our brethren generally, for the nattering manner in which they have accepted this fruit of my labors. The numerous criticisms with which the work has been honored have furnished me with hints as to its improvement—of which I have not been wholly unmindful, I am obliged to the reviewers for praise as well as for correction. If any portion of the former is really deserved, I may, by the aid of the latter, hope in the course of time to fulfil an anxious wish of my heart, that of placing on the shelves a useful and original American medical work. CHARLES D. MEIGvS. November, 1850. AN INTRODUCTORY LETTER TO A FRIEND. Dear Sir : I send you a new Medical book, which I beg you to accept as a testimonial of my respect and affection. I have not dedicated it to you, because it belongs to the Gentlemen to whom I addressed the Letters of which the volume consists. I shall be obliged to you if you will look at it, and tell me whether you think I have committed an unpardonable breach of the forms of our Science, in writing with such a freedom and abandon as you shall here find; for I may say with Juvenal— " Quicquid agunt homines, votum, timor, ira voluptas, Gaudia, discursus, nostri est farrago libelli." Dr. Forbes, in his farewell article, in the British and Foreign Medi- cal Review, tells us it is a lamentable truth that the eminent practi- tioners of England neither read nor buy medical books; and I fear a chief reason of it is to be found in the dulness and jargon Avhich characterize so many medical writings. I am sure that, exclusive of such as treat of the Physiology of Man, many of them are very tiresome and disgusting; for the Doctors seem not to have heeded the lines of Horace, who says:— "Omne tulit punctum qui miscuit utile dulci, Lectorem delectando pariterque monendo." According to my poor ability, I have endeavored in these Letters, while telling the truth about our Science and Art, to avoid the dul- ness ; and, in doing so, I thought the honestest way for a man to speak is to'speak what he thinks, in his own tone and manner, and not to come before the public under a false disguise. The young gentlemen who composed my Class were accustomed, all winter, to hear me say Vlll INTRODUCTORY LETTER TO A FRIEND. just whatever the occasion prompted me to say to them, without any reservation of mine, from distrust of them; for I went into the Lecture-room with my heart in my hand open before them, and it is in the same fashion that I have sent them these Letters. Indeed, when on the spur of an occasion I promised to write for them, I engaged to adopt the most familiar style, saying, " I will write in the same language I should address to any one of you, whom I might be instructing, in my library here at home." You will see that I have kept my promise. Whether such a mode of writing might prove agreeable to the brethren, so as to meet their approbation, remained to be seen. If I should fail in this attempt, I may still hope that some one else will invent a new and happier method than mine to get rid of our medical dulness, and our time-honored clergyableness. To judge of the medical student of the present day, by comparing my own student- life with his, I cannot but think he must daily find the books as tedious and uninteresting as they used to be when you and I were young men like them. As to the doctrine and the precept of these Letters, I might well suppose I have a right, at this stage of my life, to be heard upon them—and having felt it an occasion of self-reproach that I could never find time, in the winter curriculum, to fulfill my duties as Lecturer on Diseases of Women and Children, I have taken occasion by speaking to my Class through the press to supply the deficiency. In doing so, I could not but stand before the public. Flaccus says, " Scribendi recte, sapere est et principium et fons." You will be able to judge whether I have said that which is naught as to the diseases treated of herein. Certainly, I have had much opportunity to see the things spoken of, and if the book turns out useless or disagreeable, mine is the fault. You, who have seen so much, may well become my competent and dispassionate judge. Let me tell you, though, my dear Hodge, that the whole of these 684 pages have been begun and finished since the month of May last. They, therefore, have no claim to the nonum prematur in annum merit; and I wish you to understand that I have been obliged to do the whole of the work in addition to my diurno- nocturnal task of visiting the sick. I cannot, under these circum- stances, expect for it the same consideration as might be due to essays carefully revised and finished; and I have a just right to make this .apology. But, shall people, who desire to make a contribution to the art INTRODUCTORY LETTER TO A FRIEND. ix that has absorbed their whole existence, refrain from doing so from a fear of offending in the matter of their manner ? Would that be American-like ? And shall everybody go out of the world making no sign ? Beaufort was asked but to hold up his hand, but " he died and made no sign." I wish you would make a sign for us; we all wish so. I have made this apology to you, because I look upon you as a chief representative of Medicine, on this topic, in the United States: and, as I desired to say a few words to the Brethren, in general, in addition to all I have said in these Letters to my Students, I trust that in saying these things to you, in whom they have con- fidence, I am, towards them, absolved as to apologies. As to my personal feelings towards you—did we not sit on the same benches at the lectures ?—and have we not interchangeably assisted us with counsel and with dexterity, in our vocation these thirty years ?— What more! I pray God to prosper you long; and to allow the City, and the Country, to enjoy, for many years, the advantages of your skill, the honor of your well-earned reputation, and the benefit of your public instruction, as well as your private example as a minister of your philanthropic calling. Farewell, dear doctor, and believe me very faithfully Your affectionate friend, CHARLES D. MEIGS. November, 1847. To Hugh L. Hodge, M. D., Professor of Midwifery and Diseases of Women and Children, in the University of Pennsylvania. CONTENTS. PAGE DEDICATION,........m LETTER TO A FRIEND, ..---- vii LETTER I. Motives for writing, ------- 25—26 LETTER II. General remarks on conduct—The Doctor—Sir Thomas Brown's opinion of the practice of medicine, ------ 26—38 LETTER III. Sex—The ovum—Vitellus—The corpus luteum, - - - 38—45 LETTER IT. The female—Her distinctive characteristics, - - - 45—61 LETTER V. Sexual organs—Relaxed symphyses—Seton in pubal pains—Vulva—Labia pudendorum—CEdema laborium, ----- 61 72 LETTER VI. Wounds and laceration of the labia—Labial thrombus, - - 72—76 LETTER VII. Ruptured labium—Ruptured labium and perineum—Uncured laceration of peri- neum with procidentia uteri—Labial cysts—Warts of the vulva—Dr. Brain- erd's letter to J. F. Meigs—Pruritus of the vulva—Cicatrices, - 76—88 xii CONTENTS. LETTER VIII. PAGE Nymphae—Cohesion of the nymphge, - °° LETTER IX. Vagina—Its structure and relations—Absence of the vagina—Operation by Dr. Randolph for absence of vagina—Congenital narrowness of the vagina—Dila- tation of the vagina as a cure—Imperforation or atresia—Cases—Cohesion of vaginal walls after labor—Case of the same—Ulceration of the vagina— Vaginitis—Inversion of the vagina—Vaginal fistula—Vaginal rectocele— Vaginal enterocele—Vaginal cystocele—Double vagina, - - 92 124 LETTER X. Cohesion of labia and nymphae—Ulcerated nymphae—Excision of nymphas, by Mauriceau, ------- 124—129 LETTER XI. Clitoris—Hermaphrodism—Free Martin—Nymphomania—Inversion of the bladder—Mr. Crosse's case, ----- 129—137 LETTER XII. Displacements of the womb—Prolapsus uteri—Lamotte's account of it—Prolap- sus, with abdominal neuralgia—Case—Levatores ani in prolapsus—Diagnosis —Carus' curve—Dr. J. H. Bennet—Causes of prolapsus—Pessaries—Gynae- ciorum of Spach—Simulative prolapsus—Miss Helen Blanque's case, and dialogue with her, ------ 137—177 LETTER XIII. Diagnostics of prolapsus—Bad training of girls—Quevenne's metallic iron— Powers of medicines—Dr. Cerise on neurosity, - - 177—184 LETTER XIV. Pessaries—Mr. Joseph Warner and his instruments—Dr. Physick's pessary— Suffita—Sachet—Sponge—Cork—Caoutchouc—Whalebone-ring—BlundelFs pessary, ------- 184—197 LETTER XV. Prolapsus in the unmarried—Case—Immobility of the womb—Case—Cautions as to pessaries—Utero-abdominal supporters, - - 197__204 CONTENTS. xiii LETTER XVI. PAGE Retroversion of the womb—Wood-cut of retroversion—Dr. Amussat's pamphlet —Wm. Hunter and Dr. Wall—Dialogue with a patient—Cases—Treatment- Chronic retroversion—Pregnancy as a cause of retroversion—Dr. Weir—Mr. Mayor's case—Instrument for the repositing of the womb, - 205—233 LETTER XVII. Anteversion of the womb—Flexion of the womb, - - 233—240 LETTER XVIII. Inversion of the womb—Mr. Crosse, of Norwich, in England - 240—255 LETTER XIX. Inflammation of the non-gravid womb, - • - 255—272 LETTER XX. Dr. Betton's case of inversion—Polypus of the womb—Dr. Safford Lee cited— Anne Rvder's case—Dialogue with a patient^A case of polypus—Adherent , J .... 272—289 polypus, - LETTER XXI. Polypus—Hasty diagnostics—Nascent polypus, - - 289—294 LETTER XXII. Fibrous tumors of the womb—M. Serres' Anatomie Transcendente quoted LETTER XXIII. **i. v, - 307—316 Cancer of the womb, LETTER XXIV. 317__325 Phvsometra—Tympanitis, Hydrometra—Hydatids, LETTER XXV. 325—328 xiv CONTENTS. LETTER XXVI. PAGE Ovarian diseases—Ovariotomy, ----- 328—344. LETTER XXVII. Diseases of the Fallopian tubes—Tubal pregnancy—Cases—Ovarian pregnancy —M. Pouchet's opinion, ----- 344—351 LETTER XXVIII. Puberty,.......351—395 LETTER XXIX. The menstrua—Periods of eruption—Climatic influences—Nature—Causes— Extract froniBurdach—Germ-production in vegetables and in animals—Migra- tion of animals, birds, and fishes, ... - 396—407 LETTER XXX. Periodicity of germ-production, or ovulation—Secretions—Prof. Huschke— Martin Barry and Gerber—Negrier, Gendrin, Lee, Bischoff, and Pouchet— M. Pouchet's "Theorie Positive—Rapid evolution of a Graafian cell, 407—414 LETTER XXXI. ' Corpus luteum—Author's opinion—Opinion of authors, as Henle", Carpenter, Huschke, Flourens, Velpeau, Jacquemier, Chailly, Bernhardt, Von Baer, Bischoff, Coste—Experiments: constitution and uses of the corpus luteum, 414—424 LETTER XXXII. Menstrua—Brierre de Boismont's tables—Analysis of menstrual fluid—Roussel, 424—438 LETTER XXXIII. Emmenagogues, ----.. 438__446 LETTER XXXIV. Menorrhagia, ------- 446—456 LETTER XXXV. Dysmenorrhoea, ------- 455__4.55 CONTENTS. XT LETTER XXXVI. PAGE Change of life,.......465—476 LETTER XXXVII. Hysteria,.......476—492 LETTER XXXVIII. Disorders of pregnancy—Fecundation and conception—Early changes of the womb—Uterine intrusion—Ovum grows by vis insita—Sympathy with uterus in the mammary glands, the stomach, &c.—Missing the return—Quickening —Rational signs and sensible signs—Some of the signs, as diseases of preg- nancy—Salivations and vomitings—Bruit desouffle ut6rin—Sounds of foetal heart—Dr. J. A. H. De Paul, of Paris, and his work on Auscultation—Early detection of foetal heart—Evory Kennedy and others—OMema gravidarum —Constipation—Compression of the great vessels by womb—Duration of gestation—Incipient phlebitis from varix. - - - 493—521 LETTER XXXIX. Disorders of pregnancy continued—Cost of pregnancy to the blood-membrane —Anaemia—A case—Palpitation—Endocarditis—Dropsy of chest—Sprain of the symphyses—Dr. Moreau's case detailed, - - 522—53 9 LETTER XL. Abortion—Dr. Merriman's table of duration of pregnancy—Causes of abortion —Take care of the pregnancy!—Hemorrhage—Prophylaxis, 539—568 LETTER XLI. Lying-in diseases—Fainting after delivery—Concealed hemorrhage—Turn out the clots—Binder and compress—Keep the head down—Ergot—Opium- After-pains— Rheumatismus uteri—Neuralgia of womb and abdomen—Lochia —Dr. Lee of London—Asdrubali on bandaging the accouchee—Retention of urine_Medicines for the accouchee—Diet—Dies nondinae—Vaccination of pregnant women, - - , - - - " 568—597 Puerperal fever, LETTER XLII. 598—646 XV1 CONTENTS. LETTER XLIII. PAGE Phlegmasia-dolens, or crural phlebitis, - 647—653 LETTER XLIV. Puerperal convulsions, - - - - - - 653—666 LETTER XLV. The female breast, ------ 666—683 WOMAN: DISEASES AND REMEDIES. LETTER I. MOTIVES FOR WRITING. Gentlemen :—When I took leave of you, at the close of the session of our Lectures on the last of February, 1847, I engaged to address to you a series of Letters, in which I should endeavor to lay before you my views upon some of the disorders of women; and you may remember that, on the same occasion, I requested each one of you to consider these letters as addressed to himself. I felt that I had not fully discharged the obligations of my professorship as re- lates to disquisitions upon the sexual maladies; and explained to you that the time allowed for a course of lectures on obstetrics and diseases of women, a period of only four months, is too short to permit any one fully to describe the many diseases to which females are liable. Notwithstanding I had taken advantage of every open occasion to describe the phenomena and treatment of the disorders and acci- dents of the various structures which it was my province to demon- strate, still there was much incumbent on me to say, which the 9 shortness of your sojourn here would not allow me leisure to say. When I enjoyed the satisfaction of meeting you in the Lecture- room, I felt that my happiness was to be esteemed great, in the privilege I had of addressing so great a number of gentlemen, all patiently and politely receiving the instruction I was able to convey upon very important points of a business, which is related to some of the most delicate and hazardous periods of female existence. The labor of the task was always alleviated by the reflection that I was 3 26 THE D0CT0K. endeavoring to do good, and win, at the same time, your kind regards. Lucretius allows this sentiment to be proper by admitting it as his own consolation, in the lines "Sed tua me virtus tamen et sperata voluptas Suavis amicitiae, quern vis efferre laborem Suadet." I need not repeat the assurances I gave at parting with you, that I was filled with painful emotions in bidding you farewell, for I could not be insensible to the goodness you had so steadily mani- fested towards me, nor to the admirable conduct of the whole Class, which reflects the highest credit upon them, as demonstrative of their fine sense of what is due both to themselves and to their teachers, whom they highly distinguish and greatly honor by such consistent and admirable deportment. To address these letters to you again, seems to renew our late delightful intercourse; and should I be permitted in the course of them to assist you, and strengthen your hands in your great mission of usefulness and benevolence, I shall be thankful to Him by whose Providence I have been allowed these now many years, to observe and contemplate the affections of which I am about to treat. Fare- well. C. D. M. LETTER II. GENERAL REMARKS ON CONDUCT. The relations between the sexes are of so delicate a character, that the duties of a medical practitioner are necessarily more diffi- cult when he comes to take charge of a patient laboring under any one of the great host of female complaints, than where he is called upon to treat the more general disorders, such as fevers, inflamma- tions, the exanthemata, &c, to which the gentler, like the ruder sex is liable. So great, indeed, is the embarrassment arising from fastidiousness on the part either of the female herself, or of the prac- titioner, or both, that, I am persuaded, much of the ill success of Treatment may be justly charged thereto. It is to be confessed that a very current opinion exists as to the difficulty of effectually curing many of the diseases of women; and THE DOCTOR. 27 it is as mortifying as it is true, that we see the cases 6*f these dis- orders going the whole round of the profession, in any village, town, or city, and falling, at last, into the hands of the quack; gither ending in some surprising cure, or leading the victim, by gradual lapses of health and strength, down to the grave, the last refuge of the incurable, or rather the uncured: I say uncured, for it is a clear and well-known truth, that many of these cases are, in their be- ginning, of light or trifling importance—cases where the constitution takes no part in affections of tissues or organs, which, when slightly modified- by disease, may long continue to be so without provoking any disturbance in the harmony of the other great organs; as, for example, the organs of the circulation, nutrition, respiration, and in- nervation. Yet, by neglecting such affections in their rise, on the one hand, or by imprudently treating them by violent and disturbing therapeutical or hygienical methods on the other, the whole consti- tution may at length come into sympathy with the deranged member of it; and the health, the usefulness, and so, the happiness or life of the mismanaged and misinformed female, are sacrificed. All these evils of medical practice spring not, in the main, from any want of competency in medicines or in medical men, but from the delicacy of the relations existing between the sexes of which I spoke; and, in a good degree also from want of information among the population in general, as to the import, meaning, and tendency of disorders, manifested by a certain train of symptoms. It is, perhaps, best, upon the whole, that this great degree of modesty should exist, even though it go to the extent of putting a bar to early researches, without which no very clear and under- standable notions can be obtained of the sexual disorders. I confess I am proud to say, that, in this country generally, certainly in many parts of it, there are women who prefer to suffer the extre- mity of danger and pain rather than waive those scruples of delicacy which prevent their maladies from being fully explored. I say it is an evidence of the dominion of a fine morality in our society; but nevertheless, it is true that a greater candor on the part of the patient, and a more resolute and careful inquiry on that of the prac- titioner, would scarcely fail to bring to light, in their early stages, the curable maladies, which, by faults on both sides, are now misun- derstood, because concealed, and, consequently, mismanaged and rendered at last incurable. What in fact, is it, in the human body, that can become disordered so secretly as to elude the exploratory powers of a well-educated medical man, allowed to make the neces- 28 THE DOCTOR. sary inquiries; or what is the disorder that may not, in its forming stages, be made to yield to the prescriptions of a learned and wise physician ? Can anything be done to obviate the perpetuity of this evil—one that has existed for ages ? Is there any recourse by means of which the amount of suffering endured by women affected with peculiar complaints may be greatly lessened? I am of opinion that the answer ought to be affirmative, and I believe that the fault is chargeable to us; and that our fault consists in the concealment within our own breasts of a great amount of communi- cable information which it is our duty to pour forth into the public mind, and which we should certainly diffuse, spread abroad and make vulgar or common but for our clerkly or clergyable pride. The doctors have an idea that their knowledge can not be imparted to the world, and that it is better, in fact, that the world should not be possessed of such recondite information as theirs. The people too, are in gene- ral afraid of doctors—distrust, and eschew them except when they cannot help themselves. I believe, that if any medical practitioner knows how to obtain the entire confidence of the class of persons who habitually consult him; if he be endowed with a clear perceptive power, a sound judgment, a real probity, and a proper degree of intel- ligence, and a familiarity with the doctrines of a good medical school, he will, as far as to the extent of his particular sphere of action, be found capable of greatly lessening the evils of which complaint is here made; and if these qualities are generally attached to physi- cians, then it is in their power to abate the evil throughout the popu- lation in general. Can there exist any reasonable doubt that the country is abundantly supplied with such well-informed physicians; seeing that the land is filled with members of the profession, who have enjoyed the best possi- ble opportunities of storing the mind with all the lines and precepts of medicine, delivered down through a succession of ages, continually pro- ductive of ameliorations in the doctrines and the arts of curing dis- ease ? But such persons as these are worthy of the public confi- dence, both as to their morals and their understanding. They are in general, worthy representatives of the style and character of the gentleman, and, therefore, capable of attracting the confidence of such as are under suffering. I met, April 9th, 1847, with a case which shows how far the fas- tidious delicacy existing in the relation betwixt the sexes may be carried on the part of the physician. A lady, 40 years of a^e con- THE DOCTOR. 29 suited me as to a painful menstruation she has had for twenty years. She experiences severe pain and disagreeable weight and pressure in the loins and hypogaster, and pain in the head for five or six entire days before each menstrual period; all which symptoms dis- appear with the first gushings of the evacuation. She represents her health to be the same now as for twenty years past. Hence, I presume, there has occurred but little change in the physical condi- tion of the parts, else there would be some change in the sensations arising from the malady. She has been repeatedly subjected to the taxis; but no one ever examined the os uteri with the speculum until to-day. Well, that examination reveals a certain state of the cervix and os uteri, and glands of Naboth, &c, which it was indispensable to know, in order to found a rational treatment. The delicacy existed, not on the part of the lady, but on that of the medical advisers; for I have her assurance that her sufferings, both bodily and mental, have been so great, that she sho>uld long ago have sub- mitted to any means of even a probable cure; and was, indeed, always desirous to have everything done that was possible in her behalf. I doubt not this lady might have been cured long ago, had her malady been thoroughly understood. I have mentioned this case to show that the physician is in fault when he does not do his whole duty; for it is incumbent on him to leave nothing undone that may aid and comfort his patient. But let us return to our remarks upon the qualities that ought to dis- tinguish the medical man. I think that, in order to be a physician one ought to enjoy strong perceptive faculties; he should be able to make nice discrimina- tions—quickly perceiving the slightest shades of difference in all material forms, superficies, colors, weights, and resistance. The faculty of judging between the relations and differences of things should be of the primest quality; not sudden, hasty, and impatient in its operations, but slow, dispassionate, and attentive. The mind and heart of the practitioner ought1 to be the shrine of truth and probity: his mind should not deceive itself, and his heart should not suffer itself to be deceived and misled, by any earthly temptation, from the narrow and rugged way of duty and conscien- tiousness. His intelligence ought to be vast, as acquainted, very generally, with what is called knowledge and science by mankind. Particularly should he be fully informed as to the nature of the Life-force, as displayed in the various tissues and organs of any animal economy; 30 THE DOCTOR. not in that of man alone, but in.the whole zoological series, as well as in the vegetable kingdom of nature. There ought to be no function of the economy, or of its parts, whose healthy rate he could not estimate, as well as all its devia- tions in sickness. But this is not all—he ought to be able to dis- cern, not the signs only of maladies, but the tendencies of these maladies; as whether they possess a certain tendency towards recovery, or a tendency towards destruction; so as to enable him to say, as he does of a vaccine inoculation, let it alone, it requires no remedy, it carries the cure in its own nature, it will have dis- appeared, with all its phenomena, on the eighteenth day. Or, on the other hand, take care of that headache; she is pregnant, and near term; know that such a headache is but a step removed from an eclampsia; and that an eclampsia is often the penultimate phe- nomenon of life. Let that case alone—cure this one. Do you not perceive; young gentlemen, that such a physician is not of necessity a doser, a druggist; and that in a great moiety of the cases in which he is consulted, the patient will escape all physic and be cured by wise counsel—and likewise, that when therapeuti- cal interference is required, he will know what to do, what medi- cines are required, and when, and how much ? It is often dangerous to ask a physician the question, what shall we do, because habit, custom, routinism, almost always compel him to say take—take. Let me influence you to form early, the resolution to give only the physic and the counsel that may be really required in the case. If you will form and live up to such a resolution, you will early triumph over your difficulties. You will early learn, that a large variety of the complaints made to physicians are complaints of pains, of disabilities, of fevers that require for their removal only that the patient should know their nature, causes and tendencies. The Homoeopaths treat multitudes of people, in thus giving them not the least particle, but only the name of a drug; and all those that recover under their guidance, give evidence of the great abundance of spontaneous cures. You ought to be familiar with the doctrines of a good Medical School; by which I mean, not the doctrines of the University of Pennsylvania, or that of New York, or Maryland, or London or Paris, nor the Jefferson College, but a school whi^h has taught you a demonstrative anatomy, a real eclectic physiology, a sound and philosophical chemistry, &c. A school, in short, which has set THE DOCTOR. 31 before you, in full array, the results of man's achievements in medical investigation, experience, and art; leaving him, out of his own clear, sound, honest, and capacious intellect, to become capable of saying, as to any case of disorder presented for his opinion, such is the malady, its tendencies are thus, or so, its treatment requires such and such methods. You should judge the case by the case, and by no other law or evidence. Be not methodists—on the contrary, be men of principles in medi- cine ; principles, which like the genii of the Persian fable, come at your bidding and do your bidding, for no one can be taught to cure diseases by a method. Method in medicine is beneath contempt; because, owing to the infinite variety and differences existing among the living molecules that are the subjects of the vital forces, there never were, nor can be, two absolutely similar cases. Each instance of disease is an integer, and should, in strictness, be so deemed, and studied, and understood, and managed upon a reference to it, and riot to another integer. It is true that the patient who is under care to-day may be like "him who died o' Wednesday," but is not him. Hence, you perceive that I am no admirer of statistics, except for the Government, where statistical returns of Agriculture, Commerce, Manufactures, Crime, Population, &c, are useful to the statesman for making his assessments, his calculations, and his levies. When I treat a case of pleurisy, I do not care how you treated your ca^s of pleurisy; I shall bleed my patient on account of his fever, pain, cough, dyspnoea, &c, and not because you bled your patient, who had similar symptoms, of the gravity of which I am no judge, not having been present to judge. So, if I treat a female with certain pain about the middle of the sacral bone, with dysuria, or retention of urine, &c, by methods calculated to take the strain off from her ligamenta rotunda, and thus cure her of retroversio uteri, what is it to me that you adopted some other mode? That which interests me is, to be sure that a woman who has ligamenta rotunda not more than two inches and a half long, cannot have her womb turned topsy-turvy. That is the principle which I ought to apprehend, and I shall carry it out in my practice. Do you get some other principle, if you can, and come to prove my error by your statistics; I should be strongly inclined to take after Mr. Dennis Bulgruddery, in the play, who, if bothered with statis- tics, bv his friend Bull, would have been apt to say, " To the divil I pitch you and your statistics, Mr. Bull!" If you had the statistical report of the weather at sunrise, for 32 THE DOCTOR. the last six thousand years, it could not tell you whether to-morrow morning will be clear or cloudy. Let a man, therefore, make himself so thoroughly learned in medicine that he can detect the lesion of structure or function wherever it may hide, and then he is the sole judge of the action required in the case. Not because twenty other cases were, but because this case is. But I stated that one great cause of unsuccess is in the absence of information among the population generally. This absence of information is the fruitful source of Homoeopathy, Hydropathy, Thompsonianism, Panaceaism, and all the Catholicons, Infallible worm-destroying lozenges, Balms of Gilead, and that shocking ab- surdity—the Vegetable pill, which, like a sort of epidemic diarrhoea, has tormented the intestinal canal of thousands and tens of thou- sands of our far-seeing compatriots, until the American population have become hardened in purgations. If Horace were here, he would not think the dura messorum ilia the toughest things in creation. Do you suppose, my dear young gentlemen, that if the community at large should be as well acquainted with physiology and therapeu- tics as you and I, the Ledger and the Gazette would occupy nearly one-half of their columns with those horrid descriptions and un- blushing confessions of piles and itch, and other dreadful disorders, which the sufferers under them love to parade for the public gratifi- cation and improvement, under their own signs manual in the Gazette ? You, who know the sceleton humanum, and the attitude of the uterus within the pelvis, do you think that Mrs. a. to x. .would, out of a missionary zeal, suffer her name to appear as one of the wonder- worked cures of a shameless procidentia, by what is, at our daily breakfast-table, brought up in the morning paper, to stare the ladies out of countenance, under the modest title of a utero-abdominal supporter. Who wants to know, or ought to know that the ladies have abdomens and wombs but us doctors ? When I was young, a woman had no legs even, but only feet, and possibly ankles ; now, forsooth, they have wtero-abdominal supporters, not in fact only, but in the very newspapers. They are, surely, not fit subjects for newspaper advertisements, nor would they be advertised but out of our own stupidity or remissness. I say, confidently, out of our remissness, and here are my reasons for saying so. THE DOCTOR. 33 We live in a land and an age of common schools and common sense. This is a country of general knowledge among the popula- tion. It is impossible that any system of science or art can stand in this country, flooded as it is with intellectual light, if sustained by any but real claims to the respect and confidence of the public. We doctors claim this confidence and respect; and we deserve it, doubtless ; but we claim it imperiously and as a vested right, as a right descended to us by inheritance, from our avos et proavos, the founders of our order. But we ought to remember that our pri- vileges, those we received in a commission proceeding from the Legislature, under the Great Seal of the Commonwealth, are not of the nature of the privilegium clericale, as the lawyers term it. There are too many persons in this country that can read and write, to allow us to claim a clergyable exemption from the general practice here of explaining one's self. What is the right, therefore, by which we assume, in the present day, to clothe all our pro- , ceedings in mystery, and to expect our patients to kneel down while we (not confess, but) cut them with bistouries and knives, or put arsenic and prussic acid down their gullets ? They will not submit to our clerical manners ; and they say, that if we will persist to hide our art under an impenetrable veil of mystery and jargon, they must continue incapable of discriminating betwixt the true physician and the quack-salver, since both agree upon one course, that of demanding an implicit faith and obedience without recourse to reasoning. When Meg Merrilies offered her Devil's broth to honest Dominie ^arnpson and he feared to take the dose, what said the witch to him? She said what we doctors say to the sick lady or gentleman, " Gape, sinner, and swallow." Is not this representation a fair one? Even your early and noviciate experience must, we think, have furnished you the materials for judging whether I speak fairly or not. I say then, it is our stupidity and remissness that work evil to the people, and redound to our own hurt also; for there is no person, endowed with a good share of common sense, to whom we could not address, through that common sense, a reasonable and plain statement of the facts of his case, the probabilities as to its course, duration, and end ; with an enumeration of the safest, most convenient, and certain processes for its cure. Imagine such a person, well-informed, and you have the idea of a patient the most docile, the most exact in therapeutic and hygienic obedience; the most confiding in your skill, and the most grateful for your inter- 34 THE DOCTOR. vention in his behalf. Would that all our brethren in this land might adopt views like these. With their united force of intellect, of character, of beneficence and of social station, it would be but a short time ere the diminished head of charlatanism, under whatever disguise, would be found only to lift itself up among the most ignorant and abject portions of the population, instead of riding, as it does to-day, with chariots and with horsemen, a shame to the intelligence of the age, and a perpetual eye-sore to the lover of truth and contemner of every species of imposture. Let us explain ourselves then to the people. I hope it will not be deemed impertinent in me to say to you that I have enjoyed a large share of professional business for some years past, and that, in the main, I have had reason to suppose I received very unbounded confidence, and a general obedience to my medical directions, from those persons and families who called me. This good fortuue I have long attribute'd, in a considerable measure, to the entire frankness of my explanations as to any diagnostic, prog- nostic, therapeutic, and hygienic views in my cases; as well as the pathology of them. Some of the brethren, chiefly I presume those who have not very clear and concise views of their own on medical topics, are bitterly opposed to all such explanation, on the ground that the principles of our science are too recondite for the vulgar, who are not able to appreciate either them or the facts on which they rest. I have oc- casionally met with difficulties in consultations from the opposition of some of the brethren to these my desires to let the patient fully into my opinions. If a man really have any opinions, that are honest and clear, and well founded, why should he conceal them ? I pro- fess my belief that where a physician forms perfectly transparent views of his cases, there is no need for the powdered wig and the gold-headed cane, the mysterious nod and all the apparatus of de- ception that we might look for rather in old Felix Plater, or Horace Augenius, than in a modern physician, who is or rather ought to be a modern gentleman and man of honor; and as such, above all false pretences—open, candid, and manly. Now I sincerely believe, that where you desire to effect a cure, yet meet with obstruction through the timidity, the doubts, or apprehensions of the patient, you will only have to speak common sense, and to take out your pencil, and on a sheet of paper make a few well-sketched diagrams of parts, organs, and relations of parts and organs, in order to bring the recusant back to a truer and THE DOCTOR. 35 firmer faith than before, by convincing his judgment and winning his inclination. Yea, verily, you shall sustain the fainting hope and the dying faith of the sick girl, for days and for weeks, and through months of pain, if you speak the truth and explain the truth; if you show the hope and have the hope; if you explain the power and really possess it. If you have not the confidence of your patients, it is because you either do not merit it by your science, your skill, and your temper; or because, possessing all these, you are destitute of, what I beg you to excuse me for calling in a grave book by a slight term, gumption. Depend upon it, my dear young gentlemen, there are plenty of peo- ple, "plenty as blackberries," who seem very learned and very shining except when you come to a rub with them, but who lose all their shining qualities because they have not and cannot take a real polish. The celebrated Dr. Clarke, of London, from whose lectures that capital little midwifery book, called the London Practice of Mid- wifery, was pirated, says, somewhere in its pages, that one Doctor, by his good sense, shall retain the entire confidence of the woman in labor through the most painful protractedness of labor, while another would lose her confidence, in a very short time, of hope deferred; and that, not because he hath not ability as a presenber equal to the other, but from some fault of manner, expression, or conversation. If you would be learned men, it is well; but it is better to" be wise men. A man may be wise without being learned; but it is not un- common to be learned and yet to be a perfect ass in all that relates to what I might term administration, or action. Let your light, therefore, shine among men: set it on a hill, and do not conceal it under a bushel of gawkeyness, or some stupid conceit of your per- sonal dignity; or, what is still more asinine, the dignity of your calling. Dignity is you, not physic, nor the practice thereof. Did you never hear that « Worth makes the man, the want of it the fellow, And all the rest is leather and prunella?" I have seen dignified shoemakers, carters, butchers, and even a very dignified tailor, and I have known philosophers and very learned men without the least dignity. Believe me, there is true dignity in great virtue, great information, and great power to diffuse, apply, and make that information useful to our fellow men. Such is the dignity you should strive to attain. Such is the dignity of the "" THE DOCTOR. scholar. He is not the scholar who knows most, but rather he in whom scholarship begets the fruits of wisdom both as to conver- sation and conduct. If I could give you the best piece of advice in my power, I think I should give you this advice; namely, in all your dealings with man- kind as physicians, and in all your life-doings, strive, first, to increase the boundaries of your knowledge; and, second, strive to make that knowledge as vulgar, as popular as possible. Be a reformer in this particular, and you will, should you succeed, become the real founder of a Sect in medicine, and that sect you may baptize as the Young Physic that Dr. Forbes advocates. That will be the true young physic, which succeeds in bringing down Old Physic to the level of this common sense aire. I say again, therefore, wherever you place" yourself, be sure to have no concealment, no mystery, no pretence; but endeavor, in the clearest manner, not to assert, but to show your claims to superior power in that great utilitarian avocation of curing the sick and the wounded; an avocation which is almost, I say it with reverence, next in goodness to the mission of Christ, who went about clothed with power and authority,—(ey«p«„ tovs vlxPovS xai faortouiv.) In order fully to discharge the duties of this great mission, is it not indispensable that you should prepare yourselves for its offices by suitable preparation of the mind and person ? Of the mind, by arming it with knowledge and wisdom; with prudence and patience; with firmness to encounter all vexation and responsibility; with charity and liberality, and with all that armature of the soul that alone can render men worthy to be called ^p*', or freemen, for none are so but those whose condition has raised them above the grossness and sensuality of the corporeal nature, rendering the body the ser- vant and the minister, not the tyrant of the soul and the heart; not as crushing, but adorning the intellect with noble sentiments. It is difficult to say how a man, in forming his manners, should proceed. Indeed, there is, probably, no art so great to form the manners as that which teaches us to keep the temper and the desires of the soul within the just bounds within which they are restrained among all true followers of the Christ. To be a Le and a Lorn plished gentleman one should "do justly, love mercy, andTaTk humbly before God." Any person, under such guidance cannot fail to have manners acceptable in all forms and ranks of society, "her business may present him. ,y' wnere A special regard to one's personal appearance is also a very in. THE DOCTOR. 37 dispensable means of success, not in making money, but in curing the sick. The sick are affected by the presence of the physician. One well dressed, of good manners, of agreeable conversation, neither too grave nor too gay, would, cceteris paribus, inspire more confi- dence, infuse larger courage, longer patience, and greater hope, and therein succeed more surely in curing his patient, than another of equal information on medical science, but careless and negligent of. his behavior and appearance. Let every scholar, also, become really a freeman of the republic of letters, not a servant or slave. Let him be assured that St. Augustin spoke the truth in saying quod scimus debcmus rationi, quod credimus auctoritati. Be ye therefore men that know, and not merely people that believe of a doctrine whether it be good or bad, true or false. I cannot advise that you always should carry about with you an air, and, indeed, a habit of boasting, and an appearance of self-suffi- ciency, which, wherever they are observed, generally are taken to be signs of weakness. But that which you do know, I would have you conscious of knowing, so that you may be enabled to speak with due boldness and decision on all proper occasions. What you do know you ought to know well; and you should not forget that your training and education, that have made you familiar with many deep things in science, can not prevent you from being troubled with professional opinions by non-professional people. Despise them not; remembering that one man can not know all things even in his own art—and that even if he could, the remark of Mirabeau is a good one, that " To succeed in the world it is necessary to submit " to be taught many things which you understand, by persons who "know nothing about them." But, I fear I am uselessly consuming your time and exhausting your patience. I shall close this letter, therefore, by recommend- ing you to observe the rules of conduct laid down by your professor of the Institutes on commencement day. Should you remember and follow out the plan he then pointed out, you will become what I desire ardently that you should become, useful and successful in your calling, which will redound not only to your own honor and profit, but to the credit of your Alma Mater. Before I close this letter, pray allow me to cite for your perusal a passage from Sir Thomas Browne's Religio Medici, p. 139, who, if you imitate him in the sentiments and conduct here pointed out, will be your sufficient model. •I feel not in me," says Sir Thomas Browne, "those sordid and BEX. 'unchristian desires of my profession; I do not secretly implore 'and wish for plagues, rejoice at famines, revolve ephemendes and 'almanacks, in expectation of malignant aspects, fatal conjunctions 'and eclipses : I rejoice not at unwholesome springs, or unseason- able winters; my prayer goes with the husbandman's; I desire 'everything in its proper season, that neither men nor the times be 'put out of temper. Let me be sick myself, if sometimes the mala, 40 SEX. germ-producing and the fecundating powers upon the same creature —in others, she has provided two independent forms of being for the carrying on of the office. In the lower orders of beings, as the earthworm, for example, both the germiferous and the fecundative attributes are comprised within the same individual body. So that the creature can fecundate its own female constitution by the act of its male constitution; and this simple but effectual mode of keeping up the genus or species is admirably adapted to the inactive and aperceptive nature of the being itself. In higher forms, two separate individuals are provided, one with the male, or fecundating nature, and the other with the female, or germinating nature. "Male and female created he them," unto the end that they might increase and multiply, and fill the earth with sentient beings, wonderfully endowed with life-faculties, and there- fore with the means of enjoyment, in other words, of happiness. To procure happiness and establish it, must be regarded as one of the highest attributes of Divine power and beneficence. The important, the indispensable ovum, could not be left without protection—it could not be developed without a machinery. The ovum is, therefore, protected with an ovisac, or capsule, which is what is called a Graafian vesicle, or Graafian follicle, or Graafian cell, from Regnier de Graaf, a Dutch physician, who, in his Treatise de Mulierum Organis Generationi Inservientibus, published in 1672, gave the first clear account of those small pellucid vesicles that you have so often seen in the ovaries I exhibited to you. A Graafian vesicle consists of a double-coated capsule, of which the outer one lies in contact with the stroma, and contains the inner one within its own sphere; not loose and unattached, but connected to it by means probably of a very delicate laminated cellular tela. This interposed and connecting cellular tela may become filled with secretions; and as the outer one is, like a mineral in its gangue, pressed against the stroma, it is clear that any interstitial deposit must have two contrary results, one to enlarge the outer concentric and throw it back against the stroma, displacing and distending it, and the other to press the ovisac inwards towards its contents to compress them, and to render the inner aspect of the ovisac uneven wrinkled, or convoluted; and, in fact, I have shown you on several occasions both these different results. I Pray you call to mind, not only the human ovaries in which I showed you the convoluted or wrinkled appearance of the inner sex. 41 aspect of the ovisac, but the more striking samples of the same effect in the ovary of the cow. In this latter case, the interstitial deposit was so enormous that the outer coat of the ovisac had grown to a size nearly equal to half the mass of the whole ovary, and was of an orange hue, derived from the deposit of a vast quantity of vitel- lary matter betwixt the two laminae; the outer one being greatly expanded or extended, and the inner one being crumpled, convoluted, or wrinkled. This great orange-colored mass was the corpus luteum. Before the corpus luteum had begun to be formed, the ovary had been occupied in furnishing vitellary matter for the constitution of the yelk-ball; but that ball, having become complete in all its parts, and incapable of any further accretion, as contrary to its generic law, the ovarian stroma, whose office it is to produce germs and vitellus, could not at once withhold its villiferous power, and the deposit went on upon the outside of the ovisac. Hence, you perceive that within a perfectly mature Graafian folli- cle there is a yelk-ball with its germinal vesicle and its germinal spot inside of it; some fluid of the ovisac filled with granules; while on the outer surface of the ovisac, between it and the external capsule or coat, is a yellow deposit, which begins to appear there about the time when the yelk is quite ripe, and continues to augment in quantity for some time after the yelk has been discharged. Let me repeat, that this yellow body is the famous corpus luteum, and that such a yellow mass is deposited with the maturation and discharge of every yelk. Sometimes, perhaps, in pregnancy, the corpus luteum is larger than at other times, but whether large or small, it is a real corpus luteum; for there are not, as some writers pretend, true and false, but only true corpora lutea. But this gradual evolution of the luteal deposit has the effect of lifting the germ, with its vesicle and its yelk-ball, nearer and nearer to the superficies of the stroma; to press outwards the tunica albu- ginea; and, finally, to press it so forcibly that absorption commences at the weakest and most distended point of its surface, until, a pore being formed, the yelk and the fluid about it escape from their imprisonment in the ovary and fall into the belly, or are received within the infundibular orifice of the oviduct, which you call the Fallopian tube, and thence conveyed to the womb. Its mesenteric attachment to the womb, as I before said, constitutes a conception, which pregnancy follows. I have made the foregoing observations in order to fortify my 4 42 SEX. assertion, that for the female stroma is sex. But you will find, if you will read the good authors, that this is not my doctrine. It is the doctrine of the highest authorities. The British and Foreign Medico-Chirurgical Review for Jan. 1849, ridicules me for saying that stroma is sex. I have not that vain-glorious pride that can lead me to suppose that truth is mine. Truth is God's, and his alone. Truth belongs to no mortal. He may see it and feel conscious of it. I am conscious that I speak the truth when I say that stroma is the sexual concrete, and that it alone is so, as alone being a villiferous organ. "La difference sexuelle ne repose done pas sur une polarisation complete, sur une scission en deux facteurs qui s'excluent l'un et l'autre ; l'ovaire reste, jusqu'a un certain point, la chose primordiale, indifferente, procreatrice de son propre fonds, et il n'y a antagonisme de polarity entre lui et le testicale qu'en egard a l'achevement de ses produits par conse- quence de l'intensite de ses forces."—(Burdach, i. 360.) Do you think that if a creature should be born with the external genitalia .perfectly well formed, with a perfect uterus, and vagina, and tubes, but without the trace of any ovarium, such a creature could be a female ? Or, if she should have two perfect ovaria, and be born without womb, or vagina, or external organs, would she be anything else than a female ? I am sure you will agree with me that she would not, in the former case, be female, and that, in the latter, she would be truly female—because, though unhappily deprived of any gestative organ, or organ of copulation, she is endowed with the germiferous through her vitelliferous faculty, which resides essentially and exclusively in the substance called stroma. No germ could she evolve in the spleen or liver, in the kidney or brain, in the heart or lungs, nor, indeed, anywhere, save in the stroma, which is the true sexual concrete, and is, therefore, itself sex; for liver, heart, brain, lung, nor digestive canal, is not sex, but stroma is sex for the female—nothing else is sex. Oken says "Already in the course of the heavenly bodies has the highest act of the animal, that of copulation, been preindicated or portrayed. The creation of the universe or world is itself nothing but an act of impregnation. The sex is prognosticated from the beginning, and pursues its course like a holy and conservative bond throughout the whole of nature," &c. (Oken, Physio.-Philosophy, q98.) But, after all, what is sex? Methinks you ask the question which is a very difficult one. Perhaps I should best answer it in a SEX. 43 few words, by saying it is reproductive power, whether male power or female power. It is a matter of indifference whether the philo- logists derive the word from secus, aliter, otherwise, after another manner; or from secare, to cut, to divide one from another. We have, in physic, less to do with philology than with facts. I consider that we are hitherto unacquainted with any facts that give convincing proof of a sexual nature in the germ. There is an embryonal stage of life in which it is utterly impossi- ble to determine the sex of the embryo; and it is not known whether the female embryo proceeds from a germ originally female, or whether the germ, being in its inchoate state, neither male nor female, assumes the female nature in the progress of its evolution, or takes on the nature of the male under some law as yet unknown to us. It is very certain, however, that for the human race, the propor- tion of the sexes, as to their number on the globe, is maintained from age to age. The law that ordains this equable rate of produc- tion, operates so as to bring into the world about 104 males to 100 females; a proportion which keeps the sexes nearly equal in number; it being supposed that the temperament and exposure of the male render him more liable to premature death than the female, on which account the excess of males is ordained. If we refer to what is known to occur as to the non-sexual nature of the larva of the bee, hereafter to be mentioned, we may find arguments for the opinion that the germ, originally, is non-sexual, but becomes male or female under some unknown law of develop- ment, in its earliest embryonal life. If such a sentiment may be rightfully entertained, you will, per- haps, agree with me that the sex is something superimposed upon the mere living nature of a creature; and you will more readily admit of it if you contemplate two children, one male and the other female, of the same stature, weight, and temperament, born at the same hour, and brought up at the same breast. You cannot report to the mother of what sex they be, without referring to the pelvic extremity of the trunk. They are pleased with the same rattle, tickled with the same straw. They play at the same toys, and are alike in moral and physical attributes, until the sexual endowment comes to be granted to them. Upon that instant they divaricate ; their whole physical and intellectual, and moral forces become dif- ferent, and they pursue, so to speak, a separate walk of life, until the exhaustion of the sexual attribute, in the one and in the other, 44 SEX. causes their paths to converge again, until they are seen sleeping " thegither at the fit" of the hill of life, over which they had toiled in distinct tracks from the puberic until the critical age. What can be more like an old woman than an old man ? or what can be more like a girl than a perfectly ingenuous boy ? Where is the likeness of men and women ? Is it not true, then, that the sexual nature is something superadded to the mere living corporeal nature, which, on being taken away, reduces the sexual individuals back again to their original sameness of life-nature. You have heard, I presume, of a circumstance that may tend to illustrate this view, in the history of the honey-bee. The community requires a queen—which means a vitelliferous, and so a germiferous creature—and it also requires a considerable number of drones— males, or fecundating members of the society; which being provided for the hive in question, nothing more is wanting but a sufficient number of mules, or working bees, or creatures capable, first of enjoyment, and second, of providing for the conservation of the species by collecting food—1, for the germiferous; 2, for the fecun- dating ; and 3, for the providing part of the species. Now all these males and workers are alike in the ovular state; but if the males die, by some epidemic, a battle or accident, the community know how to convert the larvae into males by administering to them cer- tain sorts of food, or to leave them mere workers by withholding that kind of aliment. So that, in fact, you discover here that the mere corporeal life of the larva possesses no sexual nature, and that a sexual nature may be superadded by a certain economy of the hive, an economy that can cause the ovum so to develop itself as to be- come fitly provided with the fecundating apparatus and material, or to become a queen bee or germiferous bee. When a queen dies, after having deposited many thousand eggs in the mule bee cell, the alarm and confusion in the hive are very extraordinary; but it subsides after the tumult of the first excitement, and the mules or workers select some one egg, for which they enlarge the cell by converting three common ones into a single royal cell. By feeding the grub with an aliment called royal jelly, they cause it to pass into the female state, and thus the lost queen is succeeded by a queen produced from the egg of a mule or worker-bee; an egg that could only have developed a non-sexual creature but for the special influences brought to bear upon it from a state necessity. I ask you again, if this be true, whether it does not show that the sexual SEX. 45 nature is not an original nature, but a nature superimposed upon a mere animal or living nature. And, if true of the bee, does not that truth, established, likewise establish the law for all possible animal and even vegetable existences? M. G. Cuvier, in the Regne Ani- mal, vol. vi. 314, is of opinion that the mule bee is but an undeve- loped female; but even this view confirms the one I have taken above. I see not how a better proof, or at least illustration, could be given of my idea that the sexual nature is a climax. It is a culmi- nating life-force that evolves it. It ought not to excite our astonishment that the female sexual nature gives to her physical intellectual and moral attributes a bias different from that of the male. In woman, the sexual organs are different—they are subject to fluctuations as to the tide of life within them that those of the male are by no means exposed to. They are always about to menstruate or menstruating, or ceasing to menstruate. The womb is gravid or going to become so, or it is recovering from the parturient state: her organs have never an even steady tenor of life. They require a different and more complex system of innervations, more expensive to the nerve centres than those of the male; more delicate, sensitive, impressible than his. These are circumstances implying a depend- ence and physical debility as compared with him; a reliance upon and a trusting to his power; and, in fact, all the peculiarities that mark her as a creature of the feminine and gentle sex. I shall in my next letter occupy your attention with some re- marks on the distinctive characteristics of the female, to which I shall beg to invite your attention, not with a view that you may learn of me what those distinctive characteristics are—for & volume would not suffice fully to relate them—but that I may, perhaps, be able to turn your attention in that direction, in the hope that your young and vigorous strength may be incited to a more consistent and energetic pursuit of whatever literature and science ought to be garnered up by a physician, as the ornaments and aids of his career of usefulness and dignity. Farewell. C. D. M. *d SEXUAL PECULIARITIES. LETTER IV. SEXUAL PECULIARITIES. Gentlemen :—Before I proceed to the consideration of those topics that are to engage our attention in the main, I wish to take advantage of this occasion to say some.words to you on the Distinct- ive Characteristics of the Female—or rather, I should say, on some of those characteristics—for to describe them all would require ra- ther a series of letters than a single discourse. I shall, therefore, in the present letter, only attempt to indicate a few points of contrast betwixt the male and female, with a view to turn your attention that way. I could readily fill a volume upon the different texts that I am about to present to your consideration. I believe it is proper that I should fulfill this design, for I have long thought, as I now do, that without some prefatory remarks in this direction, you might be less fully prepared to receive those views of the disorders to which the woman is subject, and which it behooves you as medical men to acquire; and less capable than you should be to appreciate those modifications of therapeutical indication and process that are demanded by the moral, the intellec- tual, and the physical qualities of the female; for her mere human or generk; nature is modified by her sexual or female nature, to such a degree, that in certain of the great crises of her life she de- mands a' treatment adapted to the specialties of her own constitu- tion, as a moral, a sexual, germiferous, gestative, and parturient creature. I do not suppose you could acquire just views on these points in the dissecting-room, or the theatre of anatomy alone. Nor can I give them to you here in one letter; the time is too short. There, it is true, you might explore the items of her physical structure, in order to compare them with those of the hardier sex. You might there learn that though she be a part of mankind, a truer Zygo- zoaire than those of M. de Blainville's classification, she yet differs from men in her stature, which is lower; in her weight, which is less ; in her form, which is more gracile and beautiful; in her re- sexual peculiarities. 47 productive organs, that are peculiar to her; and in her intellectual and moral perceptivity and powers, which are feminine as her organs are. Beyond all these, you shall have to explore the history of those wonderful functions and destinies which her sexual nature enables her to fulfill, and the strange and secret influences which her organs, by their nervous constitution, and their functions, by their relation to her whole life-force, whether in sickness or health, are capable of exerting, not on the body alone, but on the heart, the mind, and the very soul of woman. The medical practitioner has, then, much to study, as to the fe- male, that is not purely medical—but psychological and moral rather: such aasearches will be a future obligation lying heavily upon you, upon all of you. Every well-educated medical man ought to know something more of women than is contained in the volumes of a medical library. Her history and literature, in all ages and countries, ought to be gathered as the garlands with which to adorn his triumphant career as a physician; but these insignia of his power he can only gather by the careful and tasteful study of his subject among the rich stores of learning that are gained in the belles-lettres collections, whether archaiological, mediaeval, or modern. The medical man, surely, of all men, ought to be best able to appreciate the influence of the sex in the social compact; because he, more than other men, is by his vocation in habits of closer observation upon the operation of the influences that bind together the members of families which compose the social compact. He more clearly than others can recognize the power of woman in the family—and thus in all society, which he sees to be controlled by the gentler sex. But for the power of that influence, which one of you would doubt the rapid relapse of society into the violence and chaos of the earliest barbarism ? Are you not aware that the elegance and the polish of the Christ- ian nations are due to the presence of the Sex in society—not in the Zenana! Do you not perceive that Music, Poetry, Painting, all the arts of elegance: Luxury, Fashion, (that potent spell!) are of her, and through her, and to her ? Versailles and Marli, and the Trianons, had never been built for men. The loom blends and sets forth the dyes that add richer reflections to her bloom; the wheel flies for polishing the diamond that is to flash in impotent rivalry above her beautiful eyes; sea and land are ransacked of their trea- 48 sexual peculiarities. sures for her; and the very air yields its egrets, and marabouts, and paradise-birds, that they may add piquancy to her style, and grace to her gesture. Even literature and the sciences are in a good mea- sure due to her patronage and approbation, which is the motive power to all manly endeavor. This is true, since, but for her ap- proving smile, and her rewarding caress, what is there should stir man from the sole, the dire, unremitted compulsion to act that he may live? With woman for his companion, man acts not only that he may live, but that he may live like a Christian and like a Gen- tleman. Dr. Johnson says, that " to be happy at home is the ulti- " mate result of all ambition, the end to which every enterprise and " labor tends, and of which every desire prompts the prosecution." " Blest as the immortal Gods is he, The youth who fondly sits by thee, And hears and sees thee all the while, Softly speak, and sweetly smile !" The great stage of the world, we are informed by the inspired writers, was prepared as the scene of a grand moral drama. The earth and all that it inherit is for man, his use, his delight, his trial! But, this mankind—this genus man—what is it ? It is an imperishable unit—it commenced at the beginning—it touches the middle and the end of time. It is a vast wave rolling down the tide of time, ever rolling, ever descending. Its spray and its foam are lost in the sands or melted in the air, as the fragments of mor- tality are broken off and swallowed up in the grave ; but the unit is unbroken ; the great majestic wave rolls onward, onward for ever; perdurable; and shall not be swallowed up till the last trump shall sound, and the last end be come. The sun himself "grows dim with years," but the unit, the Genus man, springs ever fresh in immortal youth and vigor, like Antaeus of old, foreshowing the immortality of that spiritual part to which Adrian the pagan addressed his speech, as it was leaving the imperial possessor a mere dust-fragment of the vast, ever-living unit man. Animula vagula blandula Hospes comesque corporis Quae nunc, abibis, in locis. Ael. Spartiancs.—Adrian. Caesar. Now are not these great considerations ? and yet from what mean- ness do they spring, even the germiferous tissue of the female ! It is from her stroma that issues the generic as well as the genetic force ! What a wondrous law ! what a wondrous power is that which SEXUAL PECULIARITIES. 49 maintains each genus and species pure and unalloyed as when it issued from the Creator's hand ! So strange, so powerful, that each of them is set, as it were, within a magic circle, out of whose charmed round it can never stray ; so that no wild and horrid passion, no brutal lust, no insane desire can break, much less change or abro- gate the law that set forth the primordial models, " each after his kind," of the species of the globe. For notwithstanding the count- less myriads of generations that from the remotest ages have repro- duced individuals more numerous than the sands of the shore or the stars in the firmament, each blade of grass still obedient to its ge- neric law, still imitates exactly its primitive pattern ; and every ele- phant or worm ; every eagle that soars to the sun, or sparrow that chirps in the hedge; every man, and every woman go steadily, like the current of a river, down Time's flowing stream, ever ending, ever beginning, always changing, yet immutably the same ! I repeat it, the generic power is launched from the ovarian stroma: that is, the sole animal concrete that is capable of produc- ing yelk matter. Yelk matter is germinal or generic matter; I should rather say reproductive matter. The male tissues are no- where endowed with the power of this yelk production, and the sole elaboration of the stroma of ovaries is germ-elaboration. See, then, in this unobvious, apparently vile lump of animal texture in the inner court of the temple of the body, the ark that contains the law which keeps the genera unmixed from age to age. How can you study this subject sufficiently ? But let us pass to other views. Let us go to look upon woman in the phases of her intellectual nature. If we scan her position amidst the ornate circle of a Christian civilization, it is easy to per- ceive that her intellectual force is different from that of her master and lord. I say her master and lord ; and it is true to say so, since even in that society she is still in a manner in bonds, and the manacles of custom, of politics, or of bienseance, not yet struck from her hands. She has nowhere been admitted to the political rights, franchises and powers that man arrogates to men alone. The Crown, when it rests on the brow of a woman, is always a political accident, grievous and deprecable ; and even then, where woman reigns, man governs. The great administrative faculties are not hers. She plans no sublime campaigns, nor leads armies to battle, or fleets to victory. The Forum is no theatre for her silver voice, full of tenderness and sensibility. She discerns not the courses of the planets. Orion 50 SEXUAL peculiarities. with his belt, and Arcturus with his Suns are naught to her but pretty baubles set up in the sky. She guides no ship through night and tempest across the trackless sea to some far-off haven half round the world. She composes no Iliad, no iEneid. The strength of Mil- ton's poetic vision was far beyond her fine and delicate perceptions. She would have been affrighted at the idea of that fiery sea on whose flaming billows Satan, " With head uplift above the waves, and eyes That sparkling blazed------------- extended long and large, Lay floating many a rood: in bulk as huge As whom the fables name of monstrous size; -----------or that sea-beast Leviathan, which God of all his works Created hugest that swim the ocean stream." Do you think that a woman, who can produce a race and modify the whole fabric of society, could have developed, in the tender soil of her intellect, the strong idea of a Hamlet, or a Macbeth? Could her voice, like the accents of Hortensius, or Tully, or Chatham's, or Burke's, command the bent ear of listening senates, or move like leaves whirled in a tornado, the agitated masses of a people tossed in the tempest of its own vehemence; and then, like a gentle west wind, soothe and calm them down again by the influences of its rea- soning and prayerful suasion ? " Hie regit dictis animos, et pectora mulcet." ^Eneid, I. Such is not woman's province, nature, power, nor mission. She reigns in the heart; her seat and throne are by the hearth-stone. The household altar is her place of worship and service. The Fo- rum is too angry for her. The Curia is too grave and high, and the Commitia too boisterous and rude. Home is her place, except when, like the star of day, she deigns to issue forth to the world, to exhibit her beauty and her -grace, and scatter her smiles upon all that are worthy to receive so rich a boon—and then she goes back to her home, like as the sun sinks in the west, and the memory of her presence is like the sunlight that lingers long behind a bright departed day. Her voiee is not for brawling. Its tender tones are for soothings and caressings. The sweetest lute is in her vocal organs; and with its music she stifles the passion, assuages the rage of her master and reduces back to the gentlest flowing, the furious tide that boils SEXUAL peculiarities. 51 in his veins. It is by the mere contrast of her gentleness, her doci- lity, her submissiveness and patience, that she makes herself the queen and the arbitress of the fate of whom she loves, and whose best rewards for the pains, hazards and toils of existence, are ever to be found within the narrow circle of her domestic reign. It is true that we meet in the pages of History and Biography the relations of strange phenomena in the lives and actions of cer- tain women. There are Julias and Messalinas, that are monsters. Fredegonde and Brunehaut terrify us by their atrocities. There is even somewhat questionable in the nature of such ladies as Elizabeth, or Mary of Medici. We have the male powers of a Dacier and a Stael. We find the gentle and feminine Hemans sometimes bursting forth with a wild, impetuous and martial enthusiasm. Yet these are exceptions, and not rules; exceptions that fill us with surprise, as of things out of or beyond the common course of nature. Among the wonderful exceptions of power in women, there is per- haps none on record so extraordinary as that of the actress Rachel. The power of that woman's eloquence seems superhuman, and I much doubt whether the most splendid orators of antiquity, or the most powerful senators of modern times, could vie with the potent and spell-weaving accents and gestures of that extraordinary crea- ture. A word, a look, a sign, a pleno rotundoque, an effusion of thoughts that breathed and words that burned, overbore me that I could no longer look at her face and figure, but compelled me to avert my eyes from the intolerable blaze of genius that flashed like a glory all about the pretended daughter of Virginius. Although I believe that Rachel is the most eloquent human being that has lived, she is mainly so in the use of others' thoughts and others' words. As to her own power of imagination, reasoning or judgment, I presume they are those of a play actress. The bibliographical lists are full of the prettinesses of the ladies. —No Mdcanique Celeste—no Principia—no Treatise de Senectute —no annals of Tacitus belong to them; but Canzonetti, Fairy tales, Stories of the heart, Mysteries of Udolpho, and Ccelebs in search of a Wife. Such are their works. So that it is easy, by a slight glance at history, and by the facts that surround us, to conclude that the intellectual and moral force of the female are different from those of the stronger or ruder sex. Who could imagine such an intellectual fairy as Felicia Hemans joining a charging squadron of crusading chivalry, knee to knee, with Godfrey de Bouillon, or Coeur de Lion, and glorying in the com- 52 SEXUAL PECULIARITIES. mingling of the spears? Yet, though timid herself, her very tender- ness gives her the keenest perception of the nature of courage, and the deepest sympathy with the feelings of her gallant knight. See, gentlemen, in the following lines by Mrs. Hemans, her touch- ing sympathy with a captive Crusader in some lofty Pagan tower, perched above a deep craggy wady in Palestine. Worn and wearied with a long and lone captivity, his valiant heart, though broken, still pants, in its solitude and hopelessness, for the freedom and action of the field. Suddenly he starts at the wild scream of a bugle, which rises to the topmost height of his lonely tower, penetrates its embattled walls, and thrills in every fibre as he listens. 'Twas a trumpet's pealing sound! And the Knight look'd down from the Paynim tower As a Christian host, in its pride and power, Through the pass beneath him wound. Cease awhile, Clarion—Clarion loud and shrill— Cease ; let them hear the Captive's voice.—Be still, be still. I knew 'twas a trumpet's note; And I see my brethren's lances gleam, And their pennons wave by the mountain stream, And their plumes on the glad wind float. Cease awhile, &c. I am here in my heavy chain! And I look on the torrent sweeping by, And an eagle rushing to the sky, And a host to its battle plain! Cease awhile, &c. Must I pine in my fetters here, With the wild wave's foam And the free bird's flight, And the tall spears glancing in my sight, And the trumpet in my ear? Cease awhile, Clarion, &c. &c. Now, for my part, I cannot but see in these verses of that most sweet poetess, proofs of her liveliest sensibility to both the nature and the intenseness of those male passions, which, however they may be fitted to enkindle her admiration, and enslave her heart, as forming a perfect antithesis to her own gentle nature, would, as ex- isting in her own breast, demoralize and deform it. The military pennons and plumes floating on the glad wind, and the tall spears glancing in her mental sight, are not for her to wear or wield. But SEXUAL PECULIARITIES. 53 she may well glory in the hero who is both able to wield and to wear them. As to the more strictly moral attributes and propensities of the female, what are the facts ? Is not her heart, in general, the seat of tenderer and gentler emotions than those of her mate? Her suscep- tible soul is acutely alive to the human charities and trembling sym- pathies that spring spontaneously in the delicate moral perceptions and somatic innervations of her feminine constitution. She cannot unmoved look on scenes of woe. She melts at the spectacle of human distress—a maiden sheltering a wounded dove in her bosom is an eidolon of the sex. Mungo Park in the Sahara, and Ledyard among the wildest Sa- moiedes, always received good, and not evil entreaty at the hands of women, whose husbands had hearts like the nether millstone. Notwithstanding the poet has characterized her as being, " in our hours of ease, Uncertain, coy, and hard to please, And variable as the shade By the light trembling aspen made," she is faithful and true. She follows the fortunes of her mate, who has gained her affections. Yea, she adheres to the promise at the altar, which was for better for worse, for richer for poorer, in sick* ness and health—even unto death; so that the same rhymer apos- trophizes her with " When pain and anguish wring the brow, A ministering angel thou!"' What a beautiful picture is that engraving of the " Intemperate," which you see everywhere in the print-shops! What touching, what immortal fidelity is depicted by the artist in the face of that woman! A face beautiful in its expression of resignation, and of pride in her own faithfulness and truthfulness, as she bears on her bosom the youngest child, while she leads a sick boy by the hand, and is clutched by a timid older girl, all of them barefooted, houseless, hopeless, homeless, for they leave behind in the distance the pretty cottage where they were born, to pursue, along a rugged way, the uncertain, drunken footsteps of the husband and the father, who leads them miserable far away, deserting the homestead she had brought as her dower, in that blessed morn when in the village church she gave herself away for Mm. Now here is her reward! But she will cling to him until the death of the drunkard shall have 54 SEXUAL PECULIARITIES. broken the bond; and after that, go weep on his discreditable grave, and forgive him too. Such pictures are from life. There are thou- sands of such. The female is naturally prone to be religious. Hers is a pious mind. Her confiding nature leads her more readily than men to accept the proffered grace of the Gospel. If an undevout astrono- mer is mad, what shall we say of an irreligious woman? See how the temples of the Christian worship are filled with women. They flock thither with their young children, and endeavor to implant in their souls the seeds of virtue and piety, to be reared in that pure soil and by their watchful nurture, into plants that shall blossom like the immortal amaranth among the stars. See, then, what and how great is the influence that women exert on the morals of society, of whole nations, of the whole world! Wherever there is a true civiliza- tion, woman reigns in society. It is not until she comes to sit beside him, in view of all the people, that man ceases to be barbarous, or semi-barbarous, and cruel, and ignorant. She spreads abroad the light of civilization and improvement as soon as she issues from the prison of the Harem or Zenana, to live with him in the world. Who made us human? Whose were the hands that led us to kneel down, and whose the lips that taught our infant voices the earliest invocations to Heaven ? Is it not so, that after the world and fortune have done their best, or their worst by us, we, in late years, and early, forget not those pious mothers, who so steadfastly strove to bias our young minds in favor of whatsoever is true, whatsoever is pure, whatsoever is of good report!! How can we forget the rewards we received at her hands for all our good, and her gentle, and sometimes tearful reprovings of our evil inclinations and practices? She was not only our teacher and pattern, but our companion and playfellow, for, of a truth, she was of a child-like temper—and that was the secret of the bond that united us so long and so closely. Hear what an eloquent French- man says of her :— "Source feconde et sacree de la vie, la mere est la creature la plus respectable de la , " nature ; c'est d'elle que decoulent les generations sur la terre ; c'est Eve ou letre vivi- "fiant, qui nous rechauffe dans son sein, qui nous allaite de ses mammelW, nous re- "cueille entre ses bras et protege notre enfance dans le giron de son inepuisable tendresse. "Femme! mere! honneur de la creation! quels hommages (kernels ne vous sont pas " dus dans tout l'univers ?" ViRKr.—La Femme. The male is less versatile than the woman.- His mission is more SEXUAL PECULIARITIES. 55 adventurous and dangerous. He enters on the path of ambition, that dark and dangerous, or broad and shining road. He pursues the devious track of politics with a resolute will; reach- ing ever onwards to the possession of fame and patronage, and rank and wealth and power. She sits at home to adorn the tent or the cottage with wreaths of flowers, or to guide the tendrils that give shade to his bower. She plies the busy loom—and the sweet sounds of her singing—how often have I listened as they accompany the hum and buzz of her wheel, as she gracefully advances and retires by turns, forming the threads about to be woven into garments for her husband or child! Her nimble fingers, all day long, ply the shining needle, to fashion the robe for her spouse—or to arrange the more elegant embellish- ments of her person, that they may engage his admiration, and augment the flame of his love. For woman, man's love is the mov- ing spring of all her actions. This is at the foundation even of her vanity. Lais herself is said to have sacrificed even her rage for wealth, at times, to the gratification of her vanity ; and the lioness tearing a ram to pieces, which was sculptured upon her tomb, was the emblem of her insatiable avarice. Yet Lais lived more for love than for gain. What say you of the fortitude of woman? She bears the evils of life without repining or complaining against the providence of God. Is she evil entreated, prevented, injured ? That which sets a man on fire with an insane rage kindles in her bosom, perhaps, only a virtuous feeling of indignation. She bears the greatest crosses. How beautifully does Shakspeare say so in the words, " She never told her love, But let Concealment, like a worm i* the bud, Feed on her damask cheek; And sate, like Patience on a monument, Smiling at grief." She dies a willing martyr for religion, for country—for her chil- dren. Who can number the Lucretias and Portias ? How many are like the charming Roland? Think of the calm features of Charlotte Corday! Did you read of the deeds and the death of La Pacelle ? Women possess a peculiar trait—which is modesty—and is one of the most charming of their attributes; springing probably from their natural timidity and sense of dependence. All rude, boisterous, and immodest speech or action unsexes and disgraces woman. This 56 SEXUAL PECULIARITIES. modesty is one of the strongest of her attractions; and she some- times, perhaps, affects to possess it for the purpose of riveting her chains on the conqueror man. Malo me Galatea petit, lasciva puella, Et fugit ad salices et se cupit ante videri. The attribute of modesty certainly lends the most powerful aid to the charms of a woman. It is one of the qualities given to her in order to be a strong fence for her children; it binds her to the domestic altar—her children could not but endure damage and loss, should she leave them at home to plunge into the torrent of public affairs, or mingle freely with the distracting world! Her modesty, gentleness and timidity assimilate her to the characters- of children, whose best playfellow, nurse, and instructress she is. Come out from the world, and be separate from it, is peculiarly a command for her. There is in the Museo Pio-Clementino, at Rome, an antique statue, which the learned Visconti asserts to be a statue of Modesty, and, as I am informed, is among the most beautiful of the works of ancient art now remaining in the world. It is completely clothed from head to foot, and veiled. It seems to me that such a work is proof enough of the ancient admiration of the quality in question; for the artist who could produce, and the people who" could appreci- ate such an exquisite specimen of taste and right feeling, must have had a keen perception of the charm. By her physical form and proportion, she is still more trenchantly divided from the male. Look at two statues, male and female. Take the Venus de Medici as the consummate exposition—the very eidolon of the female form, just as Praxiteles in the greatest verve, fervor and enthusiasm of his genius, and he alone of all mankind could conceive the idea of the Queen of the Loves. Compare her with the Apollo of the Belvidere—she has a head almost too small for intellect, but just big enough for love. His magnificent forehead, calm as heaven, and almost as high as it, rises above those eyes that are following the shaft he has sped with his clanging silver bow. The front of Jove himself, An eye like Mars, to threaten and command; A station, like a feathered Mercury, new-lighted on Some Heaven-kissing hill. Her thorax seems built as the sanctuary of that beautiful bosom whence is destined to flow the sweet nutriment of the winged boy. SEXUAL PECULIARITIES. 57 His vast chest is for breathing, and for eloquence and command. From its capacious stores of oxygen he draws the elements of the most strenuous, the most protracted exertions. He breathes deep, that he may ascend the highest hills and the sharpest crags in pursuit of his game or his prey, and that his loud harmonious voice may command his armies in the midst of the conflict, or sway the forum with its tones. Like Virgil's wild horse, he is equal to the longest career—nothing can stay him in his race. Non Scopuli, rupesque cava?, atque objecta retardant Flumina, conreptos unda torquentia montes.—Georg. III. See his loins how they are narrowed down, as they approach the hips, that he may balance himself, as it were, on the point of an inverted cone, ready for the promptest motion. His pelvis contains no variable organs, requiring ample space for extraordinary deve- lopments ; but its depth and solidity afford origin and insertion to the powerful muscles, by whose immense strength he can act well in the wild, rude, and adventurous life to which he is ordained. The cone, on the other hand, is reversed in the female. The apex is above, and the base is at the hips. It is within that bony cell that are hidden those miraculous organs that out of nothing can evolve the wondrous work of reproduction. Her pelvis is broad and shallow, lighter in substance, its excavation ampler, and its pubic arch round or Roman; while his is Gothic or lanceolate. From under this arch a child could not go; the other gives it easy utter- ance. The organs of the male are permanent—hers are mutable. The uterus—no bigger than a thumb—comes in gestation to be twelve inches high and nine in width. Its invisible vessels and nerves come to be great cords and tubes, and its uncognoscible muscles acquire a force to rend itself in pieces in its rage, and, what seems still more miraculous, to expel a full-grown foetus from its parietes, against the enormous resistance of flesh and bone. She is a germiparous and villiferous creature. She—the female—possesses that strange compound or concrete which you call stroma, ovarian stroma, of which I already have spoken, but must again speak. Now, that stroma lives by the blood it receives out of a common endan