Samuel David Gross.

was considered the greatest American surgeon of his time. Among his many writings was a treatise on the genito-urinary organs (1851) containing the first account of the distribution of urinary calculi. He was immortalized in the monumental (8 ft by 6 ft, 6 in) painting by Thomas Eakins known as The Gross Clinic which now hangs in the Jefferson Medical College. Fielding Garrison, in his authoritative History of Medicine, states that "His works were crowned, as the inscription of his funeral urn reads, by the milk white flower of a stainless life." In this short case report Gross struggles with a new problem, that of the med-icalization of sex. He is confronted with issues of what we now recognize as at the intersection of sex, gender, and sexuality, but he was groping for a better understanding that was not available in his time. In the nineteenth century, physicians were called upon by the courts to "assign sex" for legal purposes. This assignment took on even more significance when one recalls that women could not vote, were subject to discriminatory property rights, and limited in many other legal and extra-legal ways. As the philosopher Michel Foucault noted in his influential History of Sexuality, the late Nineteenth Century was a period when matters of sexuality were contested between the legal system and the medical system. Thus, Dr. Gross used the now unfamiliar term "juridical medicine" to classify this case report. The fundamental assumption underlying mid-Nineteenth Century understanding of sexuality was that sexuality was determined by anatomy. In this era before the discovery of sex hormones , psychological understanding of libido, and anthropological appreciation of the diversity of sexual practices, anatomy ruled: "normalize" the anatomy and you will "normalize" the sexuality. Gross realized the difficulties he faced. He carefully recounts his consultation with a respected and prudent colleague , and he even reaches back to classical antiquity for guidance. That his conclusions and subsequent management of his patient were not universally accepted, however, is made clear by the note appended to this article by the Editor of the American Journal of Medical Sciences. The Editor compares the treatment of this patient to euthanasia of cancer patients with hydrogen cyanide (prussic acid).