Imatges de pàgina
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of an inflamed part restores the action of its capilliaries *, that is, by increasing the quantity of the natural stimulus, viz. of the fluids impelled into them by the vis a tergo. The retained excrementitious matter is thus thrown off, and the preternatural action of the heart and larger vessels subsides. But, if the debilitating power has been considerable, on the removal of the preternatural stimulus, (the retained excrementitious matter), the debility of the vital system recurs, and the same phenomena are renewed. Thus, when the fatigue of the animal organs has been excessive, a series of febrile paroxysms is the consequence. When we see other debilitating causes affecting the vital organs, and producing the same train of symptoms, is it not a fair inference, that they operate in the same way?

I have wished to give this concise statement of my opinion respecting the nature of fever, that it may not be misunderstood, as I have already found it to be; and that, if it is discussed, the attention may be directed to its leading features, and not to circumstances which tend to illustrate, but are not essential to it. It has been stated, that it differs little, but in words, from Dr Cullen's opinion. Dr Cullen's opinion rests wholly on the supposed operations of the vis medicatrix naturæ. In that I propose, the effects, referred by him to that agent, are explained on the known laws of the animal œconomy. Dr Cullen attributes nothing to the excrementitious matter retained in consequence of the debility of the excreting organs, on which, if my opinion be just, a great part of the phenomena of fever depends.

Those who write on the nature of fever, labour under peculiar disadvantages. It seems, at present, to be the general opinion, that its phenomena cannot be explained; any attempt to explain them is, therefore, treated with neglect, and its author hardly escapes the imputation of presumption. Several years, wholly devoted to a painfully minute study of the various species of fever, will, at least, defend me from the accusation of precipitancy, or of attempting an investigation of the nature of this disease, without having previously acquired a knowledge of the long, and, in many instances, uninteresting train of facts, on which such an inquiry must be founded. My opinion is now before the public, who will judge whether I am deceived in regarding it as a necessary inference from the phenomena of fever.

Permit me, before closing this letter, to vindicate myself from an accusation of plagiarism, brought against me in the last number of the Edinburgh Medical and Surgical Journal. I not only never saw Dr Rush's work on the proximate cause of fever, and the work of Bichât, to which the critic alludes, but did not even know that such books existed. Worcester, 8th Oct. 1807.

III.

See the experiments, made with a view to ascertain the nature of inflam mation, related in the third volume of my Treatise on Febrile Diseases.

III.

Case of Malconformation in the Genitals, with an Engraving. By Mr JOHN SMITH SODEN, Member of the Royal College of Surgeons, London.

THE organs of generation have always excited attention, apportionate to their importance in the animal economy. To the savage, the voluptuary and the philosopher, they form a subject of equal interest. When Omai was in Dr Hunter's museum, he was very inquisitive concerning the hymen; and, I believe, more polished, and better informed visitors, frequently manifest a similar curiosity.

In malformations of the genitals, the physiologist has found a theme for much ingenious speculation; and, though deviations from the ordinary arrangement of these parts do not often lead to practical improvement in the medical art, yet they tend to enlarge our knowledge of laws which govern the human system, and teach us to admire the wisdom employed by nature, in correcting those errors, or accidents, which may have impeded her usual course of operation. Considerable information has been accumulated in this Journal. Extraordinary cases are recorded by Mr Cooper, and Mr Coates; a very learned and entertaining essay has issued from the pen of Dr Duncan junior; and some valuable and judicious remarks are blended with the review of Professor Ackermann's work on hermaphrodites.

To add to the facts already collected, an instance that recently fell under my notice, is the intention of the present paper.

As the subject of the following case bears the name, and appears in the attire of a female, I shall speak of her in that character; though it will be evident, that she ought to be considered as belonging to the opposite sex.

Sarah L-e, aged 24, a thin spare person, extremely awkward in her figure and gait, with masculine features, manly voice, and a strong beard, has flat breasts, and straight hips like a man, and hair upon her body and thighs.

A brief description of the annexed plate, will convey a clear idea of the peculiarities in the sexual organs. My friend, Dr Terry, an eminent physician in this place, and Mr Hodgson, an ingenious pupil of Mr Freer, surgeon, of Birmingham, were present

at

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at the examination. The latter gentleman was so obliging as to take the drawings.

The first figure shews a clitoris, or imperforated penis, and scrotum containing testicles.

The penis is about two inches long, and a depression upon the glans marks the place where the urethra generally opens. The testes are somewhat less than common. The scrotum is divided, and bears a resemblance to labia.

In the second figure, the penis is lifted up as high as a strong and short frænum will permit, and the labia, or sides of the scrotum are separated.

Within the labia, are observed small protuberances, resembling nymphæ; and between them the meatus urinarius. A probe passed easily into the bladder, as is represented in the plate. The rapha perinæi is conspicuous, and commences at the termination of the frænum. The fossa navicularis is deeper than usual from the fourchette being more forward. Within the fossa, and concealed by the fourchette, that it cannot be seen in the plate, is a blind aperture, with a small excrescence at its entrance, something like a caruncula myrtiformis. This opening deserves not the name of vagina, though it occupies the situation. It admitted the end of the probe with difficulty, and would not receive more than half an inch of it. The excrescence was painful, and bled upon being touched by the probe.

This person, as will be supposed, has never menstruated, nor suffered inconvenience on that account. She is shy in conversing upon her sexual appetite, and disclaims all partiality for either sex. Her passions, probably, are not very strong; but, from intelligence gained from one of her female friends, I have no doubt that she sometimes evinces desire for a woman; though the frænum, I think, is too contracted to allow of complete erec

tion.

She is attacked periodically with asthma; but her general health enables her to pursue the occupation of a servant, in which capacity she resides in this city.

Upon a superficial view of the genitals, it appears impossible, that she ever could have been considered as a girl; but, I suppose, at her birth the testes had not descended from the abdomen, the empty scrotum looked like tumefied labia, the imperforated penis resembled an enlarged clitoris, and the urine flowing from between the labia, no suspicion of ambiguous sex was entertained by her parents or friends.

The term hermaphrodite, which has frequently been applied to these cases, is not so generally used by medical writers as formerly. It is believed, that no real hermaphrodite, or a person possessing the organs, propensities, and powers of both sexes, ever VOL. IV. NO. 13.

existed.

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