als is called
the skisma. The nymphe or the murton are the names
applied to that pendulous fleshy body in the midline;
others call it the hypodermis; while some prefer to call it
the clitoris. Titillation of this structure for lascivious
purposes is design a ted as clitorising.
Soranus (An Ephesian physician who worked in Rome
during the period 98-138 AD) described the vagina and
the external genitalia. He wrote of the hymen and the
difference between that of the virgin and that of the
non-virgin. Galen’s (130-199 AD, physician and anato-
mist) fame in gynaecology was based on his anatomical
dissections and descriptions of the female genitalia.
Galen mentions the use of a “scalpellus” in incising an
imperforate hymen [14].
During the Byzantine period (fourth to seventh century
AD) Vindicianus, an African born Latin physician [14]
wrote a “Gynaecia” dealing with anatomy, embryology
and physiology of the female genitalia. Aetius of Amida
(700 AD, Mesopotamian physician) was the first eminent
Christian physician and writer of texts. In his writings
“Diseases of the External Genitalia” he described a Bar-
tholin’s cyst recognising its location and the possibility
of it being bilateral. He also described hypertrophic
changes of the clitoris and “various ulcerations of the
pudenda and labia which may assume a malignant nature
and bleed freely, especially after coitus, exercise or fol-
lowing a speculum examination.” [14] (p. 185). Paulus
Aegineta (625-690 AD, Greek the last of the Byzantine
medical writers and surgeon) wrote on pudendal ulcers,
condylomata, haemorrhoids about the female genitalia
and hermaphrodites recommending excision of the su-
perfluous parts and treating the raw surfaces like an or-
dinary wound [14].
Ricci summarises the gynaecological data in the Ara-
bian medical manuscripts (800-1200) as being “scanty
and reflective of the views of the Greeks with gynaeco-
logy being neglected even more than obstetrics with the
practice of both specialties being left to midwives.” [14]
(p. 221). He suggested that this occurred because their
physicians and the population as a whole had a “profound
Copyright © 2012 SciRes. OPEN ACCESS
I. S. C. Jones / Open Journal of Obstetrics and Gynecology 2 (2012) 223-226 225
aversion to both gynaecology and obstetrics based on a
mistaken sense of values and prudery.”
4. THE ADVENT OF ANATOMICAL
DISSECTION
Further progress in understanding anatomy was delayed
until the sixteenth century when anatomical dissection of
the human body was permitted and the findings obtained
were recorded with accurate drawings. However, at this
stage in time there was still considerable confusion on
the function of the Fallopian tubes and the number of
compartments in the uterine cavity. This confusion had
arisen as a result of the extrapolation of findings from
animal dissections to the human. Even the records of
Vesalius (1514-1564, anatomist and military surgeon)
demonstrated the influence of Galen’s teachings as shown
in his drawing of the uterine cavity which indicated a
fundal septum protruding into it. Apart from this possible
error (questioned because a uterus subseptus of minor
degree can have this appearance), he accurately de-
scribed each organ within the whole g enital tract with the
anatomical illustrations attributed to John de Calcar and
published in 1543 as his “De Corporis Humani Fabrica”.
Fallopio (1523-1562, professor of anatomy, surgery and
botany at Padua) of fallopian tube fame was the first to
mention the clitoris as a muscular structure and rede-
scribed the hymen as a definite structure [14]. Fabricius
(1537-1619, anatomist), wrote in his textbook of sur-
gery “Opera Chirurgica” brief chapters on the imperfo-
rate hymen and adherent labia in addition to other gy-
naecologi c al pr o b le ms.
In the seventeenth century a more detailed assessment
of anatomical structures became possible with the de-
velopment of preserving anatomical specimens and in-
jecting blood vessels [14]. Seventeenth century texts
solely devoted to gynaecology are few. In 1618 the post-
humous “Opuscula Medica” of Ronsseus (1525-1596,
Flemish physician) was published and contained a sec-
tion on diseases of women. De Gr aaf (1641-1673, Dutch
anatomist) accurately described not only the ovary and
its follicles, but the entire genital tract. His text on the
female genital tract contains chapters on the pudendum,
the clitoris, clitoral crura and its blood supply, the mons,
the hymen, the urinary meatus [14].
At about this time Leeuwenhoek (1632-1723, Dutch
microscopist) and Hooke (1635-1703, English micro-
scopist and curator of the Royal Society of London) de-
veloped the prototype of the microscope. Further devel-
opment of this instrument was to advance the study of
vulvar pathology cons iderably but that was still two hun-
dred years in the future. In 1693, Vater-Schondorff re-
corded a case of carcinoma of the labia majora in his
Wittenberg thesis, and the lymphatic drainage of the
genitalia was correctly detailed in Anton Nuck’s (1650-
1692, Dutch anatomist) textbook of anatomy which was
published in 1722. The way was now clear for further
meaningful studi es of v ul va r m a l ignancy.
Gynaecology and gynaecological surgery as a distinct
specialty did not occur in the eighteenth century. How-
ever, by the eighteenth century obstetrics was well on the
way to becoming a definite speciality [14]. Smellie
(1697-1763, Scottish obstetrician who practiced in Lon-
don) gave a description of the vulva in his chapter enti-
tled “Of the external and internal Parts of Generation
proper to women” [14] and provided a detailed illustra-
tion in Plate IV [15] published in 1783.
The concept of pre malignant lesions developed nearly
150 years later when Schwimmer (1877, German) re-
ported white lesions in the mouth and tongue describing
them as leukoplakia. It was then recognised that similar
lesions could occur at other sites on the body. In 1885
kraurosis vulvae was described by Breisky (1832-1889,
Czech gynaecologist) and two years later in 1887 Hallo-
peau (1842-1919, French dermatologist) described what
is now known as lichen sclerosus. These were conditions
considered to be premalignant lesions of the vulva.
The use of histology for the stu dy of vulvar conditions
gained momentum. Webster (1863-1950, Canadian gy-
naecologist) in 1891 and Sanger (German gynaecologist)
in 1894 studied vulvar tissue excised from patients with
intractable pruritus vulvae. They reported upon an in-
flammatory affection of the corium and noted excision
cured the symptoms. Since that time many authors have
added to the literature on vulvar disease, its causes and
treatments. However this more recent history is beyond
the current study’s time period.
Distance and modes of transport have played an im-
portant part in how once isolated communities were ab le
to literally expand their horizons and share knowledge.
Initially Europe, England, Egypt, Middle East and India
were isolated from each other but adventurers broke
down the barrier of distance and expanded their know-
ledge. However the Australian Aborigines remained iso-
lated because of distance and the lack of long distance
transport which in turn slowed their progress in th e study
of medicine and its diseases as we now know it. How-
ever isolation did bring the benefit of isolating them from
western diseases until they were introduced by the colo-
nists.
5. CONCLUSION
History shows how culture, religion and social attitudes
(together with natural and man made disasters and the
laws of the times), influenced the subsequent rate of
progress in the study of medicine and its diseases. This is
nowhere more apparent than with the study of the vulva
Copyright © 2012 SciRes. OPEN ACCESS
I. S. C. Jones / Open Journal of Obstetrics and Gynecology 2 (2012) 223-226
Copyright © 2012 SciRes. OPEN ACCESS
226
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I acknowledge the work of Professor James Ricci from the Department
of Gynaecology and Obstetrics at the City Hospital New York and his
Genealogy of Gynaecology.
[9] Soong, F.S. (1983) Role of the margidjbu (traditional
healer) in Western Arnhem Land. Medical Journal of
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Health, The University of Queensland for his encouragement and ad-
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