Dr Morris descants on the evils of preputial adhesions

About eighty per cent of all Aryan American women  have adhesions which bind together the glans of the clitoris and its prepuce, in part or wholly, and which cause little or much disturbance. The condition very evidently represents a degenerative process that goes with higher civilization. It dates back to the embryonic life of the individual, and consists anatomically in a failure of the genital eminence to develop its epithelial surfaces perfectly enough for complete cleavage between the opposed surfaces of the prepuce and the glans of the clitoris. ...

Preputial adhesions in women are similar in character to those which occur less frequently in men, and the resulting disturbances are alike in both sexes, but greater in degree in women because of the more impressionable nervous system of the gentler sex.

Baker Brown was very near the subject of clitoris adhesions when he published his work On the curability of various forms of insanity, epilepsy, catalepsy and hysteria, but his method consisted, not in separation of adhesions, but in bodily removal of the offending clitoris; and he found so many cures resulting from the treatment that he was led astray, as many pioneers are, and amputated the clitoris so often that he was expelled from the London Obstetrical Society in 1867.  If he had observed the role that clitoris adhesions play, he would not have fallen into disrepute, because his work, where useless, would certainly have been harmless.

It is strange that the subject has been overlooked by so many sharp-eyed gynecologists; but the clitoris is small, and they were after larger game. I doubt if there is a man in this audience who knows if there is a large hole in his left-hand trouser pocket. ...

[A review of the literature shows that little has been written on this subject.]

Dr Merrill Ricketts, in his noteworthy paper on Circumcision, says, referring to preputial adhesions: "Hystero-epilepsy is a result found in boys and girls alike. No girl or boy should be allowed to become one month old without a thorough examination of the genitals having been made. In many of these cases in girls, or even in women, adhesions, growths, or malformations are the source of the irritation, and should receive immediate and radical attention."

Dr N.C. Jones, of Brooklyn, in one of his osteotomy reports, states incidentally that all the patients with bow-legs and knock-knees had preputial adhesions – a coincidence in sings of degeneration probably, and not a relation of cause and effect.

Remondino, in his History of Circumcision, says: "The idea of masturbation or of irritation of the genitals ending in reflex neurosis is always, as a rule, associated with  the male, and that it has not been associated with the female has deprived her of the same benefit that the prosecution of the study in this regard has been to the male sex."

Dr M.F. Price, in a paper read before the American Medical Association in 1874, incidentally refers to the case of a young girl, illy developed [sic], who had neither walked nor talked, and who, on examination by Dr L.A. Sayre, was found to have preputial adhesions with retained secretion. This, Dr Sayre thought, accounted for the child's condition.

The above quotations and references are all that I could find upon the subject through the aid of the two great bibliographies, and yet there are thousands upon thousands of women in this country who are suffering from reflex neuroses that are directly and solely dependent upon preputial adhesions. It has now been determined that many of the schoolboys who are known to be bright and yet who cannot study have errors of refraction or heterophoria, and that they are repulsed by print without knowing why. The boy who finally becomes the expert baseball-pitcher might become an Alexander von Humboldt if his eyes were only properly cared for. As a parallel we can now learn that the girl who becomes irritable, disagreeable and hysterical may become charming, interesting and possessed of all feminine graces when her prepuce is forcibly peeled away from the glans of the clitoris, and we have made a distinct step forward in civilization when this fact is generally appreciated by the profession.

The importance of preputial adhesions in the female will be doubted by some observers and overestimated by others, just as is the case with heterophoria; but those of us who try to take an intermediate position will know that while some patients are strong enough to withstand one or both of these conditions for a lifetime, there are countless numbers who sink beneath the load that seats itself so insidiously that the patient herself does not realize  what she is carrying until neurasthenia untunes her resisting power.

Summary

1.  The prepuce and the glans clitoridis are bound together by adhesions, partly or completely, in about eighty per cent of all Aryan American women.

2.  Preputial adhesions are rare among Negresses, and seem to occur in only a few of the individuals possessing a large admixture of white blood.

3.  Highly developed domesticated animals do not present examples of the degeneration, so far as the author's observation has gone.

4.  When preputial adhesions are extensive, the glans clitoridis and the imprisoned mucous glands remain undeveloped, but they may develop later when the physician has separated adhesions.

5.  The failure of the embryonic genital eminence to properly develop the prepuce and the glans clitoridis for perfect cleavage undoubtedly means that nature is trying to abolish the clitoris as civilization advances.

6.  The degenerative process represented by preputial adhesions is characteristic of the civilized type of homo sapiens, in which we find decaying teeth, early falling hair, and imperfect mammae and eye muscles.

7.  Preputial adhesions which involve small portions of the glans clitoridis are of interest simply as anatomical curiosities.

8.  Preputial adhesions involving a large part or the whole of the glans clitoridis may cause profound disturbance, and they are among the most pronounced of the peripheral irritators. They cause desire for masturbation which leads to neurasthenia, and they are responsible for grave reflex neuroses.

9.  Preputial adhesions for a very common factor in invalidism in young women.

10.  The clitoris is a little electric button which, pressed by adhesions, rings up the whole nervous system.

Discussion

Dr A.H. Corder

A few years ago Dr Sayre advanced view similar to those Dr Morris has propounded, and reported a number of cases, but his experience was confined principally to boys with adherent and inflamed foreskins. He specified early the class of cases in which benefit from circumcision could be expected, and surgeons who select their cases according to Dr Sayre's views are not often disappointed in the results following operative procedures. That a constant state of genital excitement produced by any cause in the male or female may produce structural changes in the [spinal] cord and other remote organs is, in my mind, a settled fact. We all know that a stone in the bladder can produce pain in the glans penis; also that an irritation applied to the periphery may and often is manifested in remote organs – a prolonged reflex irritation will produce structural changes in the organs involved; especially is this true of the genito-urinary organs. I have in more than once instance relieved reflex nervous symptoms and thwarted permanent injury to remote organs by an early circumcision.

I see no reason why the same truths should not be applied to the female sexual organs.

Dr Morris (closing the discussion)

For the sake of brevity I presented this subject in abstract, but my paper when examined in full in the Transactions will answer all the points brought out in the discussion. ... I think Baker Brown was almost on the right track. If he had separated adhesions instead of amputating the clitoris he would not have been expelled from the London Obstetrical Society. He found such profound relief resulting from removing the clitoris that he tried to cure all kinds of reflex neuroses by doing it.

Robert T. Morris MD, "Is evolution trying to do away with the clitoris?", Transactions of the American Association of Obstetricians and Gynecologists, Vol. 5, 1892, pp. 288-302