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Circumcision of Women.

[From Caledonian Medical Journal, July, 1904.)

The inhabitants of Egypt are circumcised. Religion prescribes it to the Mahometans, and the Copts, or Catholics, willing to double their claims to paradise, are circumcised as well as baptised. Circumcision was practised among the ancient Egyptians, and some have gone so far as to find it necessary in the climate of that country.

In almost every other region, men alone are circumcised, and the mode of operation is universally known, but in Egypt women likewise submit to the operation, or to an operation somewhat similar, and one which has obtained the same name. The circumcision of women was likewise practised by the ancient Egyptians. It is at present confined to women who are properly Egyptians; the women of other countries, who are brought thither, having no occasion for the operation.

Sonnini justly remarks that it is by no means easy to treat of this subject with any degree of perspicuity, and, at the same time, to avoid such expressions as may offend the ear of modesty. The subject, however, is of importance in the history of man. To pass it over would be improper. It will be necessary, therefore, in discussing this subject to make use of the scientific terms which, though they may not be so universally understood, are certainly less offensive to delicacy.

That the women of Egypt undergo an operation denominated circumcision has long been known, but writers remain ignorant of the nature of the operation. Many affirmed that it consisted in retrenching the nymphæ, which were supposed to grow to an uncommon size. Bruce distinguished the operation by the name of excision, and affirmed that it consisted in shortening the clitoris. Niebuhr seems to have adopted an opinion compounded of these two notions, and such was the idea of Sonnini himself, till he had an opportunity of procuring more exact information.

That the nymphæ and clitoris are frequently retrenched seems to Sonnini, after the enquiries he made, to be sufficiently certain; but this is not all that is understood by the circumcision of women. Sonnini had long been of opinion that the ideas entertained of this operation were not correct. He wished to examine the matter more accurately, and he formed a project which, in Egypt, was not a little arduous—he resolved to witness the circumcision of a girl.

Forneti, the interpreter, lent his aid in this affair, which it was by no means easy to accomplish. The impropriety of exposing to the profane eyes of a Frank a Mahometan girl was strongly urged. Besides, it was winter, and deep-rooted prejudice had fixed the commencement of the rise of the Nile as the only auspicious period for the performance of the operation. The only argument in opposition to such objections was money, and this was so well applied that Sonnini at length had an opportunity, not only of seeing the operation performed, but also of examining a case which had been operated upon some years previously. When he examined her person, Sonnini perceived a fleshy excrescence hang from the os pubis, immediately above the labia. Its length was about half an inch, and the removal of this excrescence was what constituted female circumcision. The operator made the girl sit down on the ground before her, and, with a bad razor, immediately cut off the part mentioned. Though a good deal of blood issued from it, nothing was applied except a small quantity of ashes. Neither the nymphæ nor the clitoris were touched, and, indeed they were not visible in this girl or in her who had formerly been circumcised.

Circumcision in the women of Egypt, if this operation can be properly called by that name, is the effect rather of necessity than of choice. The excrescence is enlarged in proportion to the age of the woman, the operator assuring Sonnini that, if it is suffered to remain untouched, at the age of 25 it would be 1 inches in length. The operation is always performed, however, before the girls arrive at maturity, generally about the age of

or 8. The operators, who are, for the most part, women, are commonly natives of Upper Egypt. At the season reckoned most proper for the performance, which has already been mentioned to be the commencement of the increase of the Nile, they go from village to village proclaiming their occupation.

The excrescence which renders circumcision necessary is peculiar to women of Egyptian origin—to women descended from the ancient race of inhabitants. Females brought from another country, or females descended from parents who at some period, however remote, have arrived from another country, never exhibit any such excrescence. If we compare this circumstance with the accounts of the women in other parts of Africa, it may tend to render descriptions, formerly much suspected, if not wholly true, at least partly true. The preternatural apron of the Hottentot females was long considered as a fable, and Vaillant himself, who had traversed many parts of the country, strenuously contradicted the supposition of any such appearance. The same traveler, however, at a great distance from the Cape of Good Hope, met with women with a lengthened excrescence, similar to that belonging to the Egyptian women, except that at the lower extremity it was divided into two parts. The latter circumstance he considers as the effect of art.

Should the dubious authority of Vaillant be reckoned insufficient to establish the reality of any such conformation existing among the Hottentot females, his assertion may be confirmed by the authority of one whose veracity has not been suspected. Barron, in his travels near the Cape, mentions the same circumstance. It is evident, therefore, that at the tipo extremities of Africa, are found women who from nature have received suchi an excrescence.

Female circumcision, at the same time, is known to be practised in Abyssinia, and, though the nature of that circumcision has not been precisely determined, it may be presumed to be owing to a conformation similar to that of the Egyptian women, especially when we consider that those who perform circumcision in Egypt come from that part of the country which is nearest Abyssinia. Among the African negroes, no such conformation has ever been observed. Upon the whole, therefore, it may be concluded with some degree of probability, that the peculiarity in question is confined to the tawny women in Africa, and that a race of them extends, perhaps with a few interruptions, from Egypt in the north to the Cape of Good Hope in the south. It is probable, likewise, that it is peculiar to a race of women, without being under the influence of climate, since no length of residence in Egypt seems to bestow such a mark on females not belonging to the original inhabitants. It would be curious to know whether the original Egyptians preserve the same conformation after a residence of successive generations in a different country. Should this appear to be the case, it would afford a very powerful argument in favor of those who contend for the existence of different species of human beings.

PROGRESS IN MEDICAL SCIENCE.

Pediatrics.
Conducted by MAUD J. FRYE, M. D., Buffalo, N. Y.

INFECTIONS OF THE NEWBORN. HAMILL AND NICHOLSON (Archives of Pediatrics, September, 1903,) report a series of cases of hemorrhagic disease of the newborn ending fatally, in which the postmortem findings warrant the following conclusions :

Etiology:—Hemorrhagic conditions in the newborn may, in certain instances, be due to some of the causes formerly held accountable for all such manifestations. In the majority of instances, however, hemorrhages may be considered as symptoms of an infectious condition.

Strong evidence in favor of the infectious nature of all such conditions as melena, Winckel's disease, and the like, rests in the fact that they are observed almost exclusively in institutions and not unconimonly in epidemic form. One peculiar feature of this last observation is that bacteriological studies, while proving the cases infectious, have commonly failed to demonstrate the pressence of the same microorganisms in all of the cases, a result which suggests that these infections are more often dependent upon the deficient technique of a poorly trained nurse than upon defective conditions in the ward.

The nature of the infecting organism varies widely. In the 6 cases recorded, 6 different microorganisms were isolated, viz. : the bacillus pyocyaneus, the bacillus lactis aerogenes, the colon bacillus, the staphylococcus aureus, the bacillus coli immobilis and a streptococcus. The literature contains instances of infection by the pneumococcus, Pfeiffer's bacillus, the bacillus of Babés, the bacillus hemorrhagica of Kolb, the bacillus of Gaertner, the encapsulated bacillus of Dungern, and the pneumococcus. The streptococcus, the bacillus coli commune and the staphylococcus are the ones which have been most commonly encountered.

Origin of Infection.-Air infections may sometimes occur. The mother's milk may be responsible for a small number of cases. A source of infection may be the bath water, but probably the most common medium is the poorly trained or careless nurse.

It is impossible to definitely fix upon the port of entry. The buccal cavity, the tonsils, pharynx and the remainder of the alimentary tract, are probably the most common ; next in order the lungs. The authors believe that the cord has been given too great prominence as the point of entrance and that the other avenues named—the skin, conjunctiva, nose, ears and urogenital tract—are rarely responsible.

Symptoms.—The symptoms have no definite order of occurrence. Fever is usually early manifested, and may vary from a slight elevation to a hyperpyrexia. Diarrhea with malodorous, undigested, greenish, mucus stools, is present in the majority of cases. Icterus may occur and is sometimes intense. Skin eruptions of almost every description have been noted. Apathy, rapid and persistent emaciation and inability or disinclination to nurse are always noted. Hemorrhage of varying degree, from either the skin, umbilical cord, eyes, ears, nose, mouth, vagina, bladder, stomach and bowels, usually happens at some time during the course of the disease. Nervous phenomena are varied; they consist mainly of convulsions, retraction of the head, nystagmus, twitching of the muscles, tetanic and tonic spasms, strabismus, changes in the pupils, and sometimes paralysis. Cyanosis anul rapid, labored and irregular respirations, usually toxic in origin, may occur early or, more frequently, late in the disease. Any decided elevation of temperature, notwithstanding the frequency of fever at this age, should arouse suspicion. It may be the only evidence of the condition for several days. In most of the cases enteritis is an early symptom, and next in order, perhaps, is the occurrence of the papular or papulovesicular eruption involving the skin of the face, neck, shoulders and forearms. If, therefore, one observes this combination-fever, greenish, mucus stools, a skin eruption of the character described, and rapid emaciationone is justified, from the therapeutic standpoint, in considering the condition infectious. If to these manifestations are added hemorrhage, nervous phenomena, cyanosis, and rapid, irregular or labored respiration, the evidences of an infectious condition are complete. Confirmatory data and definite information as to the character of the infection can be obtained by cultures made from the blood.

Treatment.—Measures should be directed toward improving the general aseptic technic of maternity hospitals. The routine measure of cleaning the infant's mouth is not advisable. The nurse who has handled the bedding of a patient, treated a fissured breast, emptied a bed pan or changed a napkin, unless she be most careful in preparing her hands, will readily infect the mouth of the infant. The condition of the breasts of the mother should be carefully studied. The recognition of erosions, fissures, or any other pathological condition, should result in the immediate withdrawal of the infant. Infection once established, comparatively little can be done. Isolation in bright, sunny rooms has a good effect. The withdrawal of from 15 to 20 c.cm. of blood, immediately injecting subcutaneously 20 to 30 c.cm. of artificial serum is claimed by Delestre to have a very beneficial effect. Otherwise symptomatic treatment is to be followed.

The prognosis of these infections is distinctly bad. Mild infections do occur and, in some instances, the patients recover When the condition seems hopeless. It is a not uncommon occurrence, in private practice, to see mild cases of so-called melena recover, but in institutions the mortality from infections of any type is extraordinarily high.

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