A Letter from Mr. John Bonnet, Surgeon at Fowye in Cornwall, to Claudius Amyand, Esq; Serjeant-Surgeon to His Majesty, F. R. S. concerning the Preternatural Structure of the Pudenda in a Woman, Describ'd in Phil. Transact. No 379

VI. A Letter from Mr. John Bonnet, Surgeon at Fowye in Cornwall, to Claudius Amyand, Esq; Serjeant-Surgeon to his Majesty, F. R. S. concerning the preternatural Structure of the Pudenda in a Woman, describ'd in Phil. Transact. No 379. As there appears to be some Difference in the Accounts of the remarkable Structure of the Pudenda, &c. of the Woman of Lanteglass, near Fowye, publish'd in the Philosophical Transactions No 379. I take the Liberty of giving you a particular Account of what I observ'd, with respect to this Matter. This I am the rather embolden'd to do, as I repeatedly observ'd the wonderful Structure of the Parts, before the Birth approach'd, and before I was oblig'd to make the Incision. This Woman was about 23 Years old when she was married, and some time after conceiv'd. As she was conscious of the preternatural Structure of the Parts, and her Mother apprehensive of the Danger that wou'd attend the Delivery under such unhappy Circumstances; they apply'd to me about the 7th Month, in order to engage my Assistance. On viewing the Abdomen, I made the following Observations; There was no Sign of the Umbilicus; but about three Inches lower, than that is regularly plac'd in Persons naturally form'd, there was a spongy, fleshy Exuberance, nearly of the Shape and Bignets of an Hen-Egg: Not, as is said in Mr. O ... 's Account, compos'd of many Lobules involv'd by distinct Membranes, but but entirely resembling that luxuriant Flesh which is thrown forth in ill-digested Wounds, and is therefore commonly call'd proud Flesh. This was exceeding tender, and on it she cou'd not bear the least Touch. On the lower Part of this Excrecence, I perceiv'd two small Orifices, the one distant from the other about an Inch. Thro' these the Urine drops continually, nor is she able to retain it; but by violent Efforts can make it spout out near a Foot. What is laid in Mr. O....'s Account of its being render'd multis rivulis, is certainly erroneous: The two Orifices, by which it is indeed discharg'd, being now very evident, and will easily admit a small Probe. About $\frac{1}{4}$ Inch below this Protuberance, was a transverse Orifice, much resembling the Anus of a Cock. Through this the Menstrua regularly flow'd: By this she was impregnated. 'Twas with some Difficulty I thrust my Finger into this Orifice, in order to reach the Os Tince, which, however, I could by no means feel, it lay so deep; but I plainly felt a thick transverse Membrane separating this Passage from an Orifice, which is situated about two Inches below that already describ'd. This lower Orifice seem'd to be situated, exactly where the Symphysis of the Offa Pubis is, in Women regularly form'd, somewhat above the Place where the natural Hiatus shou'd have been. I cou'd but just enter the Tip of my Finger into this. There were a few Hairs scatter'd up and down irregularly about this Orifice. The Anus terminated as usual, with a Sphincter, about two Inches below this lower Orifice, much more forward than usual. So that the upper Orifice, which may be properly call'd the Orifice of the Vagina, was about $\frac{1}{4}$ Inch below the umbilical Excrecence: The lower oblong Orifice (or another Passage to the Womb) was about two Inches. Inches below that of the *Vagina*: Contrary to what is said in Mr. O....'s Account, who makes the superior Orifice to be near four Inches below the Excrecence, and the lower Orifice four Inches from the superior; and then says, the *Anus*, which he (rightly enough) makes to usurp the Place of the *Fossa magna* in Women naturally conformed, was five or six Inches below this. According to this Proportion, the Woman must be really gigantick; whereas she is a short, little Woman: But however, Worthy Sir, you may depend upon the Account and Measure I have given; nor do Mr. O....'s Cuts any way represent the Case. This Woman had no *Os*, or *Os Pubis*; indeed there was an *Apophysis* jutting out from the lower Part of each *Os Ilium*, but they were far from being join'd, as usual, by *Synchondrosis*. *July 18. 1722.* I was sent for late at Night. I found the Woman with true Travail-Pains upon her. The Throws were excessive violent, and the continued Agony had almost quite exhausted the poor Woman's Spirits; but the Orifice of the *Vagina* was no way sensibly dilated, tho' the *Anus*, thro' the Violence of the Throws, open'd extremely wide. In vain were all Endeavours to relieve her, by thrusting up the Child, and putting the Mother in a proper Posture. Vain were her own Throws and Agonies. Convulsions now had seiz'd her, and Nature seem'd to have deny'd a longer Life to the Mother, or an Entrance into it to the Child. I was in the utmost Perplexity what to do under these Circumstances. On the one Hand I consider'd, that if there was not a Passage made for the Child, and that by Incision, both Mother and Child must speedily perish. On the other Hand I foresaw the Danger and Hazard of an Incision, and the unavoidable Censure of having kill'd the Woman, if she should die under the Operation. Operation. At last Humanity so far prevail'd with me, as to try a doubtful Method of preserving Life, rather than none. I told her Mother, and the other Persons in the Room, that Death was inevitable, without making the Passages wider by Incision, and so attempting a Delivery; withal apprising them of the Uncertainty of the Event of the Operation. When they saw her (as they thought) just expiring, they deliver'd her into my Hands, to do with her what I thought fit. I immediately thrust my Scalpel into the inferior oblong Orifice, and directly cut into the Orifice of the Vagina; so brought them into one: Then presently with my Scissors, snipp'd the transverse Membrane. This being done, I easily introduced my Hand, felt the Head of the Child, and with my Finger thrust into its Mouth, drew forth a Female Infant, living and well form'd, to my own Surprize and Admiration of all. Thus was this Gordian Knot, at last, happily cut, that cou'd not be unty'd. Ever since she was deliver'd, in the Manner recited, she hath suffer'd a Prolapsus uteri, upon the least standing or walking. I propos'd to remedy this by a Suture, as is practis'd in the Case of the Vulva breaking into the Anus; but she wou'd by no means admit of it: So that she almost continually labours under a Procidentia uteri, and the Body of the Womb and Vagina are so corroded by the Acrimony of the Urine, that there are four or five Ulcers form'd upon them. Besides this Inconvenience, some of the thinner Parts of the Excrement are discharg'd at the Bottom of this large Cleft, and by introducing my Finger at the Bottom of the Cleft, I can easily thrust the Top of it thro' the Anus: which is an Argument that there cou'd not be 5 or 6 Inches between the oblong Orifice and the Anus, as is affert- ed by Mr. O...., the Distance being scarce above two Inches. Fowey, June 23. 1724. FIGURARUM EXPLANATIO. FIGURA Octava. A. Epigastrium. B. Regio umbilicalis. C. Hypogastrium. D. Regio pubis. E E. Spongiosa offa. F F. Meatus urinarii, a partu satis visu faciles. G. Orificium transversale. H. Oblongum orificium. II. Cicatrices duæ, ex Urinae, ut videtur, acrimoniae. K. Anus, paululum anteriùs locatus. FIGURA Nona. P P. Fissura magna quatuor pollices oblonga. L. Procidentia uteri. M. Os Tincæ. VII. Casus