cataplasms or fomentations, to be followed by the discharge of the pus by means of the lancet or bistoury. Few women can be found who have moral courage enough to allow them to expose such a cause of alarm and distress in the early stages. Their modesty leads them to conceal their pain until it becomes insupportable, and then it is too late to expect that any measures whatever shall be able to effect a cure by resolution. The only thing then to be done, is to soothe the pain by emollient and opiated dressings, and to discharge the pus as soon as its fluctuation is made manifest. The incision is to be made on the mucous surface, and not on the outer aspect.

There is great liability to make a mistake in the diagnosis of these labial abscesses, which ought not to be confounded with a disease of the excretory duct of a Duverney's gland. But, as this is not the proper place to speak at length on that case, I shall postpone any further consideration of it to a future page.

The superior angle of the vulva is its anterior commissure, and the lower or posterior one its posterior commissure. The symphysis is one and a half inches long at least, and yet the posterior commissure is to be found about on the level of the arch of the pubis, not below that level; so that, when a child's head or trunk is coming out under the arch and is distending the vulva to the utmost, this posterior commissure is thrust away from the arch to a distance equal to the diameter of the plane of the distending head, which is generally not less than ten, and sometimes fourteen inches in circumference. obtain this degree of dilatation, the labia must become greatly strained and elongated, so that they sometimes break short off near the lower end, whereupon the child is instantly and violently ejected. The proper way to eschew so considerable a misfortune, is to support the perineum, and oppose the escape, while exhorting the woman to desist from all voluntary efforts to drive the child from her womb.

To

The Nymphæ, which are called labia minora and labia interna, lesser lips and inner lips, are seen to be two folds of the inner mucous membrane, like two flaps or valves. Near to, but a quarter of an inch below the superior commissure, the nymphæ meet, and after covering the clitoris like a hood, whence the part is called prepuce of the clitoris, they descend, each in an outward direction to about three-fourths of the whole length of the labium, where they are lost in the general plane of the surfaces. They are excessively vascular bodies, and are by some persons supposed to be erectile, which I do not admit to be true. They have been supposed to have the office of furnishing material for the ampliation of the orifice when undergoing the distension

usual in childbirth, an idea which is as unfounded as the former one. I have, on many occasions, touched the ridge of the nymphæ when the head was passing out, and found it firm and undeployed. Probably the real function or office of the nymphæ is to draw the glans of the clitoris downwards, and force it into strong contact with the dorsum penis in coitû, which, by increasing the friction of the glans or tentigo, must greatly increase the sexual feeling or orgasm of the congress. Such orgasm, probably, is one of the indispensable agents of fecundation, since without it the oviducts or Fallopian tubes would lie flaccid and relaxed within the pelvis; whereas, when highly wrought up by the sexual orgasm, they are known to erect themselves, and apply their fimbria or ingluvies to the ovaries for receiving any ova that may chance to be ready to enter their orifices.

Vestibule. As the nymphæ divaricate in descending along the inner aspects of the labia, they leave a triangular space, terminated below by the crown of the arch just beneath the meatus urinæ or orifice of the urethra. It is the duty of the Student to study this vestibulum upon the subject, and to learn that it is to serve as his director in the operation of catheterism. It has a sort of raphe or raised line in the middle. If the index finger of the left hand is first applied to the crown of the arch, and then slid upwards, it will separate the nymphæ and go up near to the top of the triangle. If the pulp of the finger is now slowly moved downwards again towards the crown of the arch, it will feel the little dimple made by the urethra's orifice, and then the point of the catheter may be immediately introduced into the urinary passage without vexing the woman with vain oft-repeated trials, and without being obliged to call for lamp or candle, as I have witnessed, to the mortification and humbling of the patient, and the great scandal of medical skill and proficiency.

Cohesion of the Labia.-In young children, it not unfrequently happens that the inner face of the labia pudendorum becomes irritated, which produces an adhesive inflammation, uniting the surfaces that are in mutual contact. The inevitable evacuation of the bladder will, of course, always prevent a union of the whole extent of the labia.

In all the instances of this kind that have fallen under my notice, I have found it sufficient to separate the cohering surfaces by forcing them apart with the fore and middle fingers of the left hand, while, with the end of a probe, drawn down directly upon the line of union, the adhesions are readily destroyed, and that without occasioning the least bleeding. The scalpel has never been required. In performing

this operation in a good light, it will be seen that the union of the surfaces has taken place by the mutual interlocking of very delicate villi, much in the same way as the placenta and cotyledon of the sheep or cow are interlocked: the villi that are pulled apart in this process are exceedingly delicate. I have been struck with this resemblance on several occasions. I have no doubt, however, that a case might occur, in which, by long neglect, the union should acquire so great a degree of solidity as to yield only to the knife.

When the labia shall have been separated, in these instances of cohesion, they may be carefully kept from coming in contact by a pledget covered with cerate, as the adhesive tendency is renewed by the very violence which is required to obviate the consequences of a preceding irritation.

M. Colombat, in his Treatise on the Diseases of Females, advises us to touch one, not both, of the recently separated surfaces, with a nitrateof silver pencil, in order to produce on that surface a state of vital action different from that existing on the uncauterized surface; which he supposes must effectually obviate the tendency to cohesion. His idea is, that, to adhere, both surfaces must possess the same adhesive temper. For my part, I have found it, in all instances, sufficient to direct the nurse to draw the point of the little finger, dipped in oil, strongly downwards, from the anterior to the posterior commissure. Such a process, daily repeated, effectually sets aside all possibility of re-establishing the cohesion of the labia.

The Fourchette.-The dermal portion of the labia is partly lost in the perineum, and in part becomes fused or connected with its opposite fellow, and where the inner dermal edges of the two labia unite, there is a sort of edge or frænum, resembling the inner edge of a crescent, the horns of which are turned upwards like a fork, whence the part is termed furcilla, little fork, or, to use a now technical English word taken from the French, the fourchette. Inside of this fourchette, or furcilla, is a sort of depression pit, or cavity, which is concealed until the fourchette is pulled forwards and depressed. This is the fossa navicularis, or boat-shaped pit, behind which, at a greater depth within the orifice, is the front surface of the virginal valve, membrane, or fold, known as the hymen, the mark and sign of chastity and virgin purity, as is supposed by most people.

The Hymen is merely a crescent shaped duplicature of the mucous membrane of the orificium vagine which varies much in different individuals. In some women, like a new moon with sharp and

curved horns it half surrounds the orifice, being hidden within and only visible when the labia have been separated or pressed open. In some, the horns ascend but a little way, in others they go across the opening above until they almost meet, and in others they do meet, and thus make a circular diaphragm or plane with a hole near its top, or even exactly in its centre. In some girls it constitutes a complete diaphragm without any the least aperture, and I saw one woman in whom the opening was not larger than a common bristle, and wholly undiscoverable except while she was menstruating. In that state she forced the mensual blood through the little orifice where I saw it like a fine dark point, certainly not bigger than the diameter of a bristle. This woman had been several years married. I cut open the diaphragm for her, and so removed the cause of her reproach of barrenness, for after her return to her own distant State she recovered from the operation, and becoming pregnant, had the happiness to be a mother, a thing that all women naturally long to become, or ought to.

It is by no means the rarest of occurrences for girls to be affected with such malformation of the hymen as to be quite shut up, the hymen forming itself into a complete diaphragm like a small tambourine. In this case, nothing wrong is suspected until the age of puberty, when the poor child is observed not to change as usual with girls of her age. The health now begins to fail. Pain in the belly, constipation, and uneasy urination come on, and she grows pale and weakly. Being affected with complete atresia of the orifice, which is shut up by this unnatural hymen, she is all this time swallowing physic, and undergoing a system of dieting, and is treated medically by the process of guessing at her ailments instead of by a method founded upon a physical diagnostication. The existence of this obturating membrane has nothing to do with her power to menstruate, and she does menstruate regularly, but the sanguineous discharge, unable to escape from its prison, accumulates within the now distended walls of the vagina, and when that becomes too much filled to hold any more, the accumulation goes on within the womb's cavity. The uterus enlarges more and more with each successive menstruation, and now from the evident growth of the lower belly, the poor girl is very likely to be suspected of indiscretion. It is a dreadful thing to accuse a sick virgin of the greatest woman's shame, when her pregnancy exists only in the imagination of her ignorant accusers. At length resort is had to the only possible method of diagnosis, and it is found that she labors under atresia from imperforate hymen. The womb will be discovered by placing the hand on the lower belly where its fundus is found rising upwards above the plane of the supe

rior strait; the hymen is found to make a convex tumor at the orifice, and if the index finger is passed upwards along the canal of the rectum, the vagina is discovered to be distended with a mass that fluctuates under the touch. Now that the truth is made known, there is nothing left but to open the hymen by means of a bistoury, taking care before making the incision, to empty the bladder by means of the catheter, and while using the lancet or bistoury to have one finger vithin the bowel so as to make sure of doing no injury.

As soon as the cavity is opened, the accumulated products of all her antecedent menstruations begins to gush forth in color and consistence resembling molasses or thin currant jelly. If the womb should have been much distended by the collection, that organ immediately tends to contractions, that are felt in the same manner as women's after-pains.

It would be but a prudent precaution, before doing this operation, simple as it is, to announce not only its indispensability, but the no little risk that waits upon it, for it does sometimes happen that the abnormal state of the womb forces it into a state of inflammation subsequently to the operation; and such inflammation may very readily assume the characteristics of mortal metro-peritonitis. I have done this operation for several different persons, and have had cause of serious concern during a few days subsequent to the drawing off of the long retained products, on account of a following inflammatory disposition in the woman.

I ought to add a word concerning the Hymen as a sign of virginity. It is torn in the sexual act, and if the debris of the crescent should be examined soon after the rupture, one might feel no hesitation in speaking as to the facts. Still the question recurs, and we are compelled to say whether or no it is always ruptured if it does exist, and next, whether it does always exist in the virgin. Now, I am entirely convinced that it is not always ruptured in the sexual congress, and I do further know that it may escape destruction even in the acts of parturition, for I have attended in all her confinements (and she has several children) a woman in this city, whose hymen is still perfect, and which never was torn, even in her labors. If this statement is to be relied upon, then it ought to prove that a sexual union may have been perfected in a woman in whom the hymen still remains whole. Further, I have had a very extensive medical practice during many years, in the course of which I have had occasions in numerous instances to examine unmarried women, and the result of my great experience is to convince me that there are thousands of perfectly pure, chaste, and not to be suspected unmarried women in whom no