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ANOMALIES and CURIOSITIES of MEDICINE
Being an encyclopedic collection of rare and extraordinary cases, and
of the most striking instances of abnormality in all branches of
medicine and surgery, derived from an exhaustive research of medical
literature from its origin to the present day, abstracted, classified,
annotated, and indexed.
by GEORGE M. GOULD, A.M., M.D. and WALTER L. PYLE, A.M., M.D.
PREFATORY AND INTRODUCTORY.
----
Since the time when man's mind first busied itself with subjects beyond
his own self-preservation and the satisfaction of his bodily appetites,
the anomalous and curious have been of exceptional and persistent
fascination to him; and especially is this true of the construction and
functions of the human body. Possibly, indeed, it was the anomalous
that was largely instrumental in arousing in the savage the attention,
thought, and investigation that were finally to develop into the body
of organized truth which we now call Science. As by the aid of
collected experience and careful inference we to-day endeavor to pass
our vision into the dim twilight whence has emerged our civilization,
we find abundant hint and even evidence of this truth. To the highest
type of philosophic minds it is the usual and the ordinary that demand
investigation and explanation. But even to such, no less than to the
most naive-minded, the strange and exceptional is of absorbing
interest, and it is often through the extraordinary that the
philosopher gets the most searching glimpses into the heart of the
mystery of the ordinary. Truly it has been said, facts are stranger
than fiction. In monstrosities and dermoid cysts, for example, we seem
to catch forbidden sight of the secret work-room of Nature, and drag
out into the light the evidences of her clumsiness, and proofs of her
lapses of skill,--evidences and proofs, moreover, that tell us much of
the methods and means used by the vital artisan of Life,--the loom, and
even the silent weaver at work upon the mysterious garment of
corporeality.
"La premiere chose qui s'offre a l' Homme quand il se regarde, c'est
son corps," says Pascal, and looking at the matter more closely we find
that it was the strange and mysterious things of his body that occupied
man's earliest as well as much of his later attention. In the
beginning, the organs and functions of generation, the mysteries of
sex, not the routine of digestion or of locomotion, stimulated his
curiosity, and in them he recognized, as it were, an unseen hand
reaching down into the world of matter and the workings of bodily
organization, and reining them to impersonal service and far-off ends.
All ethnologists and students of primitive religion well know the role
that has been played in primitive society by the genetic instincts.
Among the older naturalists, such as Pliny and Aristotle, and even in
the older historians, whose scope included natural as well as civil and
political history, the atypic and bizarre, and especially the
aberrations of form or function of the generative organs, caught the
eye most quickly. Judging from the records of early writers, when
Medicine began to struggle toward self-consciousness, it was again the
same order of facts that was singled out by the attention. The very
names applied by the early anatomists to many structures so widely
separated from the organs of generation as were those of the brain,
give testimony of the state of mind that led to and dominated the
practice of dissection.
In the literature of the past centuries the predominance of the
interest in the curious is exemplified in the almost ludicrously
monotonous iteration of titles, in which the conspicuous words are
curiosa, rara, monstruosa, memorabilia, prodigiosa, selecta, exotica,
miraculi, lusibus naturae, occultis naturae, etc., etc. Even when
medical science became more strict, it was largely the curious and rare
that were thought worthy of chronicling, and not the establishment or
illustration of the common, or of general principles. With all his
sovereign sound sense, Ambrose Pare has loaded his book with references
to impossibly strange, and even mythologic cases.
In our day the taste seems to be insatiable, and hardly any medical
journal is without its rare or "unique" case, or one noteworthy chiefly
by reason of its anomalous features. A curious case is invariably
reported, and the insertion of such a report is generally productive of
correspondence and discussion with the object of finding a parallel for
it.
In view of all this it seems itself a curious fact that there has never
been any systematic gathering of medical curiosities. It would have
been most natural that numerous encyclopedias should spring into
existence in response to such a persistently dominant interest. The
forelying volume appears to be the first thorough attempt to classify
and epitomize the literature of this nature. It has been our purpose
to briefly summarize and to arrange in order the records of the most
curious, bizarre, and abnormal cases that are found in medical
literature of all ages and all languages--a thaumatographia medica. It
will be readily seen that such a collection must have a function far
beyond the satisfaction of mere curiosity, even if that be stigmatized
with the word "idle." If, as we believe, reference may here be found to
all such cases in the literature of Medicine (including Anatomy,
Physiology, Surgery, Obstetrics, etc.) as show the most extreme and
exceptional departures from the ordinary, it follows that the future
clinician and investigator must have use for a handbook that decides
whether his own strange case has already been paralleled or excelled.
He will thus be aided in determining the truth of his statements and
the accuracy of his diagnoses. Moreover, to know extremes gives
directly some knowledge of means, and by implication and inference it
frequently does more. Remarkable injuries illustrate to what extent
tissues and organs may be damaged without resultant death, and thus the
surgeon is encouraged to proceed to his operation with greater
confidence and more definite knowledge as to the issue. If a mad cow
may blindly play the part of a successful obstetrician with her horns,
certainly a skilled surgeon may hazard entering the womb with his
knife. If large portions of an organ,--the lung, a kidney, parts of the
liver, or the brain itself,--may be lost by accident, and the patient
still live, the physician is taught the lesson of nil desperandum, and
that if possible to arrest disease of these organs before their total
destruction, the prognosis and treatment thereby acquire new and more
hopeful phases.
Directly or indirectly many similar examples have also clear
medicolegal bearings or suggestions; in fact, it must be acknowledged
that much of the importance of medical jurisprudence lies in a thorough
comprehension of the anomalous and rare cases in Medicine. Expert
medical testimony has its chief value in showing the possibilities of
the occurrence of alleged extreme cases, and extraordinary deviations
from the natural. Every expert witness should be able to maintain his
argument by a full citation of parallels to any remarkable theory or
hypothesis advanced by his clients; and it is only by an exhaustive
knowledge of extremes and anomalies that an authority on medical
jurisprudence can hope to substantiate his testimony beyond question.
In every poisoning case he is closely questioned as to the largest dose
of the drug in question that has been taken with impunity, and the
smallest dose that has killed, and he is expected to have the cases of
reported idiosyncrasies and tolerance at his immediate command. A widow
with a child of ten months' gestation may be saved the loss of
reputation by mention of the authentic cases in which pregnancy has
exceeded nine months' duration; the proof of the viability of a seven
months' child may alter the disposition of an estate; the proof of
death by a blow on the epigastrium without external marks of violence
may convict a murderer; and so it is with many other cases of a
medicolegal nature.
It is noteworthy that in old-time medical literature--sadly and
unjustly neglected in our rage for the new--should so often be found
parallels of our most wonderful and peculiar modern cases. We wish,
also, to enter a mild protest against the modern egotism that would set
aside with a sneer as myth and fancy the testimonies and reports of
philosophers and physicians, only because they lived hundreds of years
ago. We are keenly appreciative of the power exercised by the
myth-making faculty in the past, but as applied to early physicians, we
suggest that the suspicion may easily be too active. When Pare, for
example, pictures a monster, we may distrust his art, his artist, or
his engraver, and make all due allowance for his primitive knowledge of
teratology, coupled with the exaggerations and inventions of the
wonder-lover; but when he describes in his own writing what he or his
confreres have seen on the battle-field or in the dissecting room, we
think, within moderate limits, we owe him credence. For the rest, we
doubt not that the modern reporter is, to be mild, quite as much of a
myth-maker as his elder brother, especially if we find modern instances
that are essentially like the older cases reported in reputable
journals or books, and by men presumably honest. In our collection we
have endeavored, so far as possible, to cite similar cases from the
older and from the more recent literature.
This connection suggests the question of credibility in general. It
need hardly be said that the lay-journalist and newspaper reporter have
usually been ignored by us, simply because experience and investigation
have many times proved that a scientific fact, by presentation in most
lay-journals, becomes in some mysterious manner, ipso facto, a
scientific caricature (or worse!), and if it is so with facts, what
must be the effect upon reports based upon no fact whatsoever? It is
manifestly impossible for us to guarantee the credibility of chronicles
given. If we have been reasonably certain of unreliability, we may not
even have mentioned the marvelous statement. Obviously, we could do no
more with apparently credible cases, reported by reputable medical men,
than to cite author and source and leave the matter there, where our
responsibility must end.
But where our proper responsibility seemed likely never to end was in
carrying out the enormous labor requisite for a reasonable certainty
that we had omitted no searching that might lead to undiscovered facts,
ancient or modern. Choice in selection is always, of course, an affair
de gustibus, and especially when, like the present, there is
considerable embarrassment of riches, coupled with the purpose of
compressing our results in one handy volume. In brief, it may be said
that several years of exhaustive research have been spent by us in the
great medical libraries of the United States and Europe in collecting
the material herewith presented. If, despite of this, omissions and
errors are to be found, we shall be grateful to have them pointed out.
It must be remembered that limits of space have forbidden satisfactory
discussion of the cases, and the prime object of the whole work has
been to carefully collect and group the anomalies and curiosities, and
allow the reader to form his own conclusions and make his own
deductions.
As the entire labor in the preparation of the forelying volume, from
the inception of the idea to the completion of the index, has been
exclusively the personal work of the authors, it is with full
confidence of the authenticity of the reports quoted that the material
is presented.
Complete references are given to those facts that are comparatively
unknown or unique, or that are worthy of particular interest or further
investigation. To prevent unnecessary loading of the book with
foot-notes, in those instances in which there are a number of cases of
the same nature, and a description has not been thought necessary, mere
citation being sufficient, references are but briefly given or omitted
altogether. For the same reason a bibliographic index has been added at
the end of the text. This contains the most important sources of
information used, and each journal or book therein has its own number,
which is used in its stead all through the book (thus, 476 signifies
The Lancet, London; 597, the New York Medical Journal; etc.). These
bibliographic numbers begin at 100.
Notwithstanding that every effort has been made to conveniently and
satisfactorily group the thousands of cases contained in the book (a
labor of no small proportions in itself), a complete general index is a
practical necessity for the full success of what is essentially a
reference-volume, and consequently one has been added, in which may be
found not only the subjects under consideration and numerous
cross-references, but also the names of the authors of the most
important reports. A table of contents follows this preface.
We assume the responsibility for innovations in orthography, certain
abbreviations, and the occasional substitution of figures for large
numerals, fractions, and decimals, made necessary by limited space, and
in some cases to more lucidly show tables and statistics. From the
variety of the reports, uniformity of nomenclature and numeration is
almost impossible.
As we contemplate constantly increasing our data, we shall be glad to
receive information of any unpublished anomalous or curious cases,
either of the past or in the future.
For many courtesies most generously extended in aiding our
research-work we wish, among others, to acknowledge our especial
gratitude and indebtedness to the officers and assistants of the
Surgeon-General's Library at Washington, D.C., the Library of the Royal
College of Surgeons of London, the Library of the British Museum, the
Library of the British Medical Association, the Bibliotheque de Faculte
de Medecine de Paris, the Bibliotheque Nationale, and the Library of
the College of Physicians of Philadelphia.
GEORGE M. GOULD.
PHILADELPHIA, October, 1896. WALTER L. PYLE.
TABLE OF CONTENTS.
CHAPTER PAGES
I. GENETIC ANOMALIES . . . . . . . . . . . . . . . . . 17-49
II. PRENATAL ANOMALIES . . . . . . . . . . . . . . . . 50-112
III. OBSTETRIC ANOMALIES . . . . . . . . . . . . . . . 113-143
IV. PROLIFICITY . . . . . . . . . . . . . . . . . . . 144-160
V. MAJOR TERATA . . . . . . . . . . . . . . . . . . . 161-212
VI. MINOR TERATA . . . . . . . . . . . . . . . . . . . 213-323
VII. ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT . . . 324-364
VIII. LONGEVITY . . . . . . . . . . . . . . . . . . . 365-382
IX. PHYSIOLOGIC AND FUNCTIONAL ANOMALIES . . . . . . . 383-526
X. SURGICAL ANOMALIES OF THE HEAD AND NECK . . . . . . 527-587
XI. SURGICAL ANOMALIES OF THE EXTREMITIES . . . . . . 588-605
XII. SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN . . 606-666
XIII. SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM . 667-696
XIV. MISCELLANEOUS SURGICAL ANOMALIES . . . . . . . . 697-758
XV. ANOMALOUS TYPES AND INSTANCES OF DISEASE . . . . . 759-822
XVI. ANOMALOUS SKIN-DISEASES . . . . . . . . . . . . . 823-851
XVII. ANOMALOUS NERVOUS AND MENTAL DISEASES . . . . . 852-890
XVIII. HISTORIC EPIDEMICS . . . . . . . . . . . . . . 891-914
ANOMALIES AND CURIOSITIES OF MEDICINE.
CHAPTER I.
GENETIC ANOMALIES.
Menstruation has always been of interest, not only to the student of
medicine, but to the lay-observer as well. In olden times there were
many opinions concerning its causation, all of which, until the era of
physiologic investigation, were of superstitious derivation. Believing
menstruation to be the natural means of exit of the feminine bodily
impurities, the ancients always thought a menstruating woman was to be
shunned; her very presence was deleterious to the whole animal economy,
as, for instance, among the older writers we find that Pliny remarks:
"On the approach of a woman in this state, must will become sour, seeds
which are touched by her become sterile, grass withers away, garden
plants are parched up, and the fruit will fall from the tree beneath
which she sits." He also says that the menstruating women in Cappadocia
were perambulated about the fields to preserve the vegetation from
worms and caterpillars. According to Flemming, menstrual blood was
believed to be so powerful that the mere touch of a menstruating woman
would render vines and all kinds of fruit-trees sterile. Among the
indigenous Australians, menstrual superstition was so intense that one
of the native blacks, who discovered his wife lying on his blanket
during her menstrual period, killed her, and died of terror himself in
a fortnight. Hence, Australian women during this season are forbidden
to touch anything that men use. Aristotle said that the very look of a
menstruating woman would take the polish out of a mirror, and the next
person looking in it would be bewitched. Frommann mentions a man who
said he saw a tree in Goa which withered because a catamenial napkin
was hung on it. Bourke remarks that the dread felt by the American
Indians in this respect corresponds with the particulars recited by
Pliny. Squaws at the time of menstrual purgation are obliged to seclude
themselves, and in most instances to occupy isolated lodges, and in all
tribes are forbidden to prepare food for anyone save themselves. It was
believed that, were a menstruating woman to step astride a rifle, a
bow, or a lance, the weapon would have no utility. Medicine men are in
the habit of making a "protective" clause whenever they concoct a
"medicine," which is to the effect that the "medicine" will be
effective provided that no woman in this condition is allowed to
approach the tent of the official in charge.
Empiricism had doubtless taught the ancient husbands the dangers of
sexual intercourse during this period, and the after-results of many
such connections were looked upon as manifestations of the
contagiousness of the evil excretions issuing at this period. Hence at
one time menstruation was held in much awe and abhorrence.
On the other hand, in some of the eastern countries menstruation was
regarded as sacred, and the first menstrual discharge was considered so
valuable that premenstrual marriages were inaugurated in order that the
first ovum might not be wasted, but fertilized, because it was supposed
to be the purest and best for the purpose. Such customs are extant at
the present day in some parts of India, despite the efforts of the
British Government to suppress them, and descriptions of
child-marriages and their evil results have often been given by
missionaries.
As the advances of physiology enlightened the mind as to the true
nature of the menstrual period, and the age of superstition gradually
disappeared, the intense interest in menstruation vanished, and now,
rather than being held in fear and awe, the physicians of to-day
constantly see the results of copulation during this period. The
uncontrollable desire of the husband and the mercenary aims of the
prostitute furnish examples of modern disregard.
The anomalies of menstruation must naturally have attracted much
attention, and we find medical literature of all times replete with
examples. While some are simply examples of vicarious or compensatory
menstruation, and were so explained even by the older writers, there
are many that are physiologic curiosities of considerable interest.
Lheritier furnishes the oft-quoted history of the case of a young girl
who suffered from suppression of menses, which, instead of flowing
through the natural channels, issued periodically from vesicles on the
leg for a period of six months, when the seat of the discharge changed
to an eruption on the left arm, and continued in this location for one
year; then the discharge shifted to a sore on the thumb, and at the end
of another six months again changed, the next location being on the
upper eyelid; here it continued for a period of two years. Brierre de
Boismont and Meisner describe a case apparently identical with the
foregoing, though not quoting the source.
Haller, in a collection of physiologic curiosities covering a period of
a century and a half, cites 18 instances of menstruation from the skin.
Parrot has also mentioned several cases of this nature. Chambers speaks
of bloody sweat occurring periodically in a woman of twenty-seven; the
intervals, however, were occasionally but a week or a fortnight, and
the exudation was not confined to any one locality. Van Swieten quotes
the history of a case of suppression of the menstrual function in which
there were convulsive contractions of the body, followed by paralysis
of the right arm. Later on, the patient received a blow on the left eye
causing amaurosis; swelling of this organ followed, and one month later
blood issued from it, and subsequently blood oozed from the skin of the
nose, and ran in jets from the skin of the fingers and from the nails.
D'Andrade cites an account of a healthy Parsee lady, eighteen years of
age, who menstruated regularly from thirteen to fifteen and a half
years; the catamenia then became irregular and she suffered occasional
hemorrhages from the gums and nose, together with attacks of
hematemesis. The menstruation returned, but she never became pregnant,
and, later, blood issued from the healthy skin of the left breast and
right forearm, recurring every month or two, and finally additional
dermal hemorrhage developed on the forehead. Microscopic examination of
the exuded blood showed usual constituents present. There are two
somewhat similar cases spoken of in French literature. The first was
that of a young lady, who, after ten years' suppression of the
menstrual discharge, exhibited the flow from a vesicular eruption on
the finger. The other case was quite peculiar, the woman being a
prostitute, who menstruated from time to time through spots, the size
of a five-franc piece, developing on the breasts, buttocks, back,
axilla, and epigastrium. Barham records a case similar to the
foregoing, in which the menstruation assumed the character of periodic
purpura. Duchesne mentions an instance of complete amenorrhea, in which
the ordinary flow was replaced by periodic sweats.
Parrot speaks of a woman who, when seven months old, suffered from
strumous ulcers, which left cicatrices on the right hand, from whence,
at the age of six years, issued a sanguineous discharge with associate
convulsions. One day, while in violent grief, she shed bloody tears.
She menstruated at the age of eleven, and was temporarily improved in
her condition; but after any strong emotion the hemorrhages returned.
The subsidence of the bleeding followed her first pregnancy, but
subsequently on one occasion, when the menses were a few days in
arrears, she exhibited a blood-like exudation from the forehead,
eyelids, and scalp. As in the case under D'Andrade's observation, the
exudation was found by microscopic examination to consist of the true
constituents of blood. An additional element of complication in this
case was the occurrence of occasional attacks of hematemesis.
Menstruation from the Breasts.--Being in close sympathy with the
generative function, we would naturally expect to find the female
mammae involved in cases of anomalous menstruation, and the truth of
this supposition is substantiated in the abundance of such cases on
record. Schenck reports instances of menstruation from the nipple; and
Richter, de Fontechia, Laurentius, Marcellus Donatus, Amatus Lusitanus,
and Bierling are some of the older writers who have observed this
anomaly. Pare says the wife of Pierre de Feure, an iron merchant,
living at Chasteaudun, menstruated such quantities from the breasts
each month that several serviettes were necessary to receive the
discharge. Cazenave details the history of a case in which the mammary
menstruation was associated with a similar exudation from the face, and
Wolff saw an example associated with hemorrhage from the fauces. In the
Lancet (1840-1841) is an instance of monthly discharge from beneath the
left mamma. Finley also writes of an example of mammary hemorrhage
simulating menstruation. Barnes saw a case in St. George's Hospital,
London, 1876, in which the young girl menstruated vicariously from the
nipple and stomach. In a London discussion there was mentioned the case
of a healthy woman of fifty who never was pregnant, and whose
menstruation had ceased two years previously, but who for twelve months
had menstruated regularly from the nipples, the hemorrhage being so
profuse as to require constant change of napkins. The mammae were large
and painful, and the accompanying symptoms were those of ordinary
menstruation. Boulger mentions an instance of periodic menstrual
discharge from beneath the left mamma. Jacobson speaks of habitual
menstruation by both breasts. Rouxeau describes amenorrhea in a girl of
seventeen, who menstruated from the breast; and Teufard reports a case
in which there was reestablishment of menstruation by the mammae at the
age of fifty-six. Baker details in full the description of a case of
vicarious menstruation from an ulcer on the right mamma of a woman of
twenty. At the time he was called to see her she was suffering with
what was called "green-sickness." The girl had never menstruated
regularly or freely. The right mamma was quite well developed, flaccid,
the nipple prominent, and the superficial veins larger and more
tortuous than usual. The patient stated that the right mamma had always
been larger than the left. The areola was large and well marked, and
1/4 inch from its outer edge, immediately under the nipple, there was
an ulcer with slightly elevated edges measuring about 1 1/4 inches
across the base, and having an opening in its center 1/4 inch in
diameter, covered with a thin scab. By removing the scab and making
pressure at the base of the ulcer, drops of thick, mucopurulent matter
were made to exude. This discharge, however, was not offensive to the
smell. On March 17, 1846, the breast became much enlarged and
congested, as portrayed in Plate 1. The ulcer was much inflamed and
painful, the veins corded and deep colored, and there was a free
discharge of sanguineous yellowish matter. When the girl's general
health improved and menstruation became more natural, the vicarious
discharge diminished in proportion, and the ulcer healed shortly
afterward. Every month this breast had enlarged, the ulcer became
inflamed and discharged vicariously, continuing in this manner for a
few days, with all the accompanying menstrual symptoms, and then dried
up gradually. It was stated that the ulcer was the result of the girl's
stooping over some bushes to take an egg from a hen's nest, when the
point of a palmetto stuck in her breast and broke off. The ulcer
subsequently formed, and ultimately discharged a piece of palmetto.
This happened just at the time of the beginning of the menstrual epoch.
The accompanying figures, Plate 1, show the breast in the ordinary
state and at the time of the anomalous discharge.
Hancock relates an instance of menstruation from the left breast in a
large, otherwise healthy, Englishwoman of thirty-one, who one and a
half years after the birth of the youngest child (now ten years old)
commenced to have a discharge of fluid from the left breast three days
before the time of the regular period. As the fluid escaped from the
nipple it became changed in character, passing from a whitish to a
bloody and to a yellowish color respectively, and suddenly terminating
at the beginning of the real flow from the uterus, to reappear again at
the breast at the close of the flow, and then lasting two or three days
longer. Some pain of a lancinating type occurred in the breast at this
time. The patient first discovered her peculiar condition by a stain of
blood upon the night-gown on awakening in the morning, and this she
traced to the breast. From an examination it appeared that a neglected
lacerated cervix during the birth of the last child had given rise to
endometritis, and for a year the patient had suffered from severe
menorrhagia, for which she was subsequently treated. At this time the
menses became scanty, and then supervened the discharge of bloody fluid
from the left breast, as heretofore mentioned. The right breast
remained always entirely passive. A remarkable feature of the case was
that some escape of fluid occurred from the left breast during coitus.
As a possible means of throwing light on this subject it may be added
that the patient was unusually vigorous, and during the nursing of her
two children she had more than the ordinary amount of milk
(galactorrhea), which poured from the breast constantly. Since this
time the breasts had been quite normal, except for the tendency
manifested in the left one under the conditions given.
Cases of menstruation through the eyes are frequently mentioned by the
older writers. Bellini, Hellwig, and Dodonaeus all speak of
menstruation from the eye. Jonston quotes an example of ocular
menstruation in a young Saxon girl, and Bartholinus an instance
associated with bloody discharge of the foot. Guepin has an example in
a case of a girl of eighteen, who commenced to menstruate when three
years old. The menstruation was tolerably regular, occurring every
thirty-two or thirty-three days, and lasting from one to six days. At
the cessation of the menstrual flow, she generally had a supplementary
epistaxis, and on one occasion, when this was omitted, she suffered a
sudden effusion into the anterior chamber of the eye. The discharge had
only lasted two hours on this occasion. He also relates an example of
hemorrhage into the vitreous humor in a case of amenorrhea.
Conjunctival hemorrhage has been noticed as a manifestation of
vicarious menstruation by several American observers. Liebreich found
examples of retinal hemorrhage in suppressed menstruation, and Sir
James Paget says that he has seen a young girl at Moorfields who had a
small effusion of blood into the anterior chamber of the eye at the
menstrual period, which became absorbed during the intervals of
menstruation. Blair relates the history of a case of vicarious
menstruation attended with conjunctivitis and opacity of the cornea.
Law speaks of a plethoric woman of thirty who bled freely from the
eyes, though menstruating regularly.
Relative to menstruation from the ear, Spindler, Paullini, and Alibert
furnish examples. In Paullini's case the discharge is spoken of as very
foul, which makes it quite possible that this was a case of middle-ear
disease associated with some menstrual disturbance, and not one of true
vicarious menstruation. Alibert's case was consequent upon suppression
of the menses. Law cites an instance in a woman of twenty-three, in
whom the menstrual discharge was suspended several months. She
experienced fulness of the head and bleeding (largely from the ears),
which subsequently occurred periodically, being preceded by much
throbbing; but the patient finally made a good recovery. Barnes,
Stepanoff, and Field adduce examples of this anomaly. Jouilleton
relates an instance of menstruation from the right ear for five years,
following a miscarriage.
Hemorrhage from the mouth of a vicarious nature has been frequently
observed associated with menstrual disorders. The Ephemerides,
Meibomius, and Rhodius mention instances. The case of Meibomius was
that of an infant, and the case mentioned by Rhodius was associated
with hemorrhages from the lungs, umbilicus, thigh, and tooth-cavity.
Allport reports the history of a case in which there was recession of
the gingival margins and alveolar processes, the consequence of
amenorrhea. Caso has an instance of menstruation from the gums, and
there is on record the description of a woman, aged thirty-two, who had
bleeding from the throat preceding menstruation; later the menstruation
ceased to be regular, and four years previously, after an unfortunate
and violent connection, the menses ceased, and the woman soon developed
hemorrhoids and hemoptysis. Henry speaks of a woman who menstruated
from the mouth; at the necropsy 207 stones were found in the
gall-bladder. Krishaber speaks of a case of lingual menstruation at the
epoch of menstruation.
Descriptions of menstruation from the extremities are quite numerous.
Pechlin offers an example from the foot; Boerhaave from the skin of the
hand; Ephemerides from the knee; Albertus from the foot; Zacutus
Lusitanus from the left thumb; Bartholinus a curious instance from the
hand; and the Ephemerides another during pregnancy from the ankle.
Post speaks of a very peculiar case of edema of the arm alternating
with the menstrual discharge. Sennert writes of menstruation from the
groin associated with hemorrhage from the umbilicus and gums. Moses
offers an example of hemorrhage from the umbilicus, doubtless
vicarious. Verduc details the history of two cases from the top of the
head, and Kerokring cites three similar instances, one of which was
associated with hemorrhage from the hand.
A peculiar mode is vicarious menstrual hemorrhage through old ulcers,
wounds, or cicatrices, and many examples are on record, a few of which
will be described. Calder gives an excellent account of menstruation at
an ankle-ulcer, and Brincken says he has seen periodical bleeding from
the cicatrix of a leprous ulcer. In the Lancet is an account of a case
in the Vienna Hospital of simulated stigmata; the scar opened each
month and a menstrual flow proceeded therefrom; but by placing a
plaster-of-Paris bandage about the wound, sealing it so that tampering
with the wound could be easily detected, healing soon ensued, and the
imposture was thus exposed. Such would likely be the result of the
investigation of most cases of "bleeding wounds" which are exhibited to
the ignorant and superstitious for religious purposes.
Hogg publishes a report describing a young lady who injured her leg
with the broken steel of her crinoline. The wound healed nicely, but
always burst out afresh the day preceding the regular period. Forster
speaks of a menstrual ulcer of the face, and Moses two of the head.
White, quoted by Barnes, cites an instance of vicarious hemorrhage from
five deep fissures of the lips in a girl of fourteen; the hemorrhage
was periodical and could not be checked. At the advent of each
menstrual period the lips became much congested, and the
recently-healed menstrual scars burst open anew.
Knaggs relates an interesting account of a sequel to an operation for
ovarian disease. Following the operation, there was a regular, painless
menstruation every month, at which time the lower part of the wound
re-opened, and blood issued forth during the three days of the
catamenia. McGraw illustrates vicarious menstruation by an example, the
discharge issuing from an ovariotomy-scar, and Hooper cites an instance
in which the vicarious function was performed by a sloughing ulcer.
Buchanan and Simpson describe "amenorrheal ulcers." Dupuytren speaks of
denudation of the skin from a burn, with the subsequent development of
vicarious catamenia from the seat of the injury.
There are cases on record in which the menstruation occurs by the
rectum or the urinary tract. Barbee illustrates this by a case in which
cholera morbus occurred monthly in lieu of the regular menstrual
discharge. Barrett speaks of a case of vicarious menstruation by the
rectum. Astbury says he has seen a case of menstruation by the
hemorrhoidal vessels, and instances of relief from plethora by
vicarious menstruation in this manner are quite common. Rosenbladt
cites an instance of menstruation by the bladder, and Salmuth speaks of
a pregnant woman who had her monthly flow by the urinary tract. Ford
illustrates this anomaly by the case of a woman of thirty-two, who
began normal menstruation at fourteen; for quite a period she had
vicarious menstruation from the urinary tract, which ceased after the
birth of her last child. The coexistence of a floating kidney in this
case may have been responsible for this hemorrhage, and in reading
reports of so-called menstruation due consideration must be given to
the existence of any other than menstrual derangement before we can
accept the cases as true vicarious hemorrhage. Tarnier cites an
instance of a girl without a uterus, in whom menstruation proceeded
from the vagina. Zacutus Lusitanus relates the history of a case of
uterine occlusion, with the flow from the lips of the cervix. There is
mentioned an instance of menstruation from the labia.
The occurrence of menstruation after removal of the uterus or ovaries
is frequently reported. Storer, Clay, Tait, and the British and Foreign
Medico-Chirurgical Review report cases in which menstruation took place
with neither uterus nor ovary. Doubtless many authentic instances like
the preceding could be found to-day. Menstruation after hysterectomy
and ovariotomy has been attributed to the incomplete removal of the
organs in question, yet upon postmortem examination of some cases no
vestige of the functional organs in question has been found.
Hematemesis is a means of anomalous menstruation, and several instances
are recorded. Marcellus Donatus and Benivenius exemplify this with
cases. Instances of vicarious and compensatory epistaxis and hemoptysis
are so common that any examples would be superfluous. There is recorded
an inexplicable case of menstruation from the region of the sternum,
and among the curious anomalies of menstruation must be mentioned that
reported by Parvin seen in a woman, who, at the menstrual epoch,
suffered hemoptysis and oozing of blood from the lips and tongue.
Occasionally there was a substitution of a great swelling of the
tongue, rendering mastication and articulation very difficult for four
or five days. Parvin gives portraits showing the venous congestion and
discoloration of the lips.
Instances of migratory menstruation, the flow moving periodically from
the ordinary passage to the breasts and mammae, are found in the older
writers. Salmuth speaks of a woman on whose hands appeared spots
immediately before the establishment of the menses. Cases of
semimonthly menstruation and many similar anomalies of periodicity are
spoken of.
The Ephemerides contains an instance of the simulation of menstruation
after death, and Testa speaks of menstruation lasting through a long
sleep. Instances of black menstruation are to be found, described in
full, in the Ephemerides, by Paullini and by Schurig, and in some of
the later works; it is possible that an excess of iron, administered
for some menstrual disorder, may cause such an alteration in the color
of the menstrual fluid.
Suppression of menstruation is brought about in many peculiar ways, and
sometimes by the slightest of causes, some authentic instances being so
strange as to seem mythical. Through the Ephemerides we constantly read
of such causes as contact with a corpse, the sight of a serpent or
mouse, the sight of monsters, etc. Lightning stroke and curious
neuroses have been reported as causes. Many of the older books on
obstetric subjects are full of such instances, and modern illustrations
are constantly reported.
Menstruation in Man.--Periodic discharges of blood in man, constituting
what is called "male menstruation," have been frequently noticed and
are particularly interesting when the discharge is from the penis or
urethra, furnishing a striking analogy to the female function of
menstruation. The older authors quoted several such instances, and
Mehliss says that in the ancient days certain writers remarked that
catamenial lustration from the penis was inflicted on the Jews as a
divine punishment. Bartholinus mentions a case in a youth; the
Ephemerides several instances; Zacutus Lusitanus, Salmuth, Hngedorn,
Fabricius Hildanus, Vesalius, Mead, and Acta Eruditorum all mention
instances. Forel saw menstruation in a man. Gloninger tells of a man of
thirty-six, who, since the age of seventeen years and five months, had
had lunar manifestations of menstruation. Each attack was accompanied
by pains in the back and hypogastric region, febrile disturbance, and a
sanguineous discharge from the urethra, which resembled in color,
consistency, etc., the menstrual flux. King relates that while
attending a course of medical lectures at the University of Louisiana
he formed the acquaintance of a young student who possessed the normal
male generative organs, but in whom the simulated function of
menstruation was periodically performed. The cause was inexplicable,
and the unfortunate victim was the subject of deep chagrin, and was
afflicted with melancholia. He had menstruated for three years in this
manner: a fluid exuded from the sebaceous glands of the deep fossa
behind the corona glandis; this fluid was of the same appearance as the
menstrual flux. The quantity was from one to two ounces, and the
discharge lasted from three to six days. At this time the student was
twenty-two years of age, of a lymphatic temperament, not particularly
lustful, and was never the victim of any venereal disease. The author
gives no account of the after-life of this man, his whereabouts being,
unfortunately, unknown or omitted.
Vicarious Menstruation in the Male.--This simulation of menstruation by
the male assumes a vicarious nature as well as in the female. Van
Swieten, quoting from Benivenius, relates a case of a man who once a
month sweated great quantities of blood from his right flank. Pinel
mentions a case of a captain in the army (M. Regis), who was wounded by
a bullet in the body and who afterward had a monthly discharge from the
urethra. Pinel calls attention particularly to the analogy in this case
by mentioning that if the captain were exposed to fatigue, privation,
cold, etc., he exhibited the ordinary symptoms of amenorrhea or
suppression. Fournier speaks of a man over thirty years old, who had
been the subject of a menstrual evacuation since puberty, or shortly
after his first sexual intercourse. He would experience pains of the
premenstrual type, about twenty-four hours before the appearance of the
flow, which subsided when the menstruation began. He was of an
intensely voluptuous nature, and constantly gave himself up to sexual
excesses. The flow was abundant on the first day, diminished on the
second, and ceased on the third. Halliburton, Jouilleton, and Rayman
also record male menstruation.
Cases of menstruation during pregnancy and lactation are not rare. It
is not uncommon to find pregnancy, lactation, and menstruation
coexisting. No careful obstetrician will deny pregnancy solely on the
regular occurrence of the menstrual periods, any more than he would
make the diagnosis of pregnancy from the fact of the suppression of
menses. Blake reports an instance of catamenia and mammary secretion
during pregnancy. Denaux de Breyne mentions a similar case. The child
was born by a face-presentation. De Saint-Moulin cites an instance of
the persistence of menstruation during pregnancy in a woman of
twenty-four, who had never been regular; the child was born at term.
Gelly speaks of a case in which menstruation continued until the third
month of pregnancy, when abortion occurred. Post, in describing the
birth of a two-pound child, mentions that menstruation had persisted
during the mother's pregnancy. Rousset reports a peculiar case in which
menstruation appeared during the last four months of pregnancy.
There are some cases on record of child-bearing after the menopause,
as, for instance, that of Pearson, of a woman who had given birth to
nine children up to September, 1836; after this the menses appeared
only slightly until July, 1838, when they ceased entirely. A year and a
half after this she was delivered of her tenth child. Other cases,
somewhat similar, will be found under the discussion of late conception.
Precocious menstruation is seen from birth to nine or ten years. Of
course, menstruation before the third or fourth year is extremely rare,
most of the cases reported before this age being merely accidental
sanguineous discharges from the genitals, not regularly periodical, and
not true catamenia. However, there are many authentic cases of
infantile menstruation on record, which were generally associated with
precocious development in other parts as well. Billard says that the
source of infantile menstruation is the lining membrane of the uterus;
but Camerer explains it as due to ligature of the umbilical cord before
the circulation in the pulmonary vessels is thoroughly established. In
the consideration of this subject, we must bear in mind the influence
of climate and locality on the time of the appearance of menstruation.
In the southern countries, girls arrive at maturity at an earlier age
than their sisters of the north. Medical reports from India show early
puberty of the females of that country. Campbell remarks that girls
attain the age of puberty at twelve in Siam, while, on the contrary,
some observers report the fact that menstruation does not appear in the
Esquimaux women until the age of twenty-three, and then is very scanty,
and is only present in the summer months.
Cases of menstruation commencing within a few days after birth and
exhibiting periodical recurrence are spoken of by Penada, Neues
Hannoverisehes Magazin, Drummond, Buxtorf, Arnold, The Lancet, and the
British Medical Journal.
Cecil relates an instance of menstruation on the sixth day, continuing
for five days, in which six or eight drams of blood were lost. Peeples
cites an instance in Texas in an infant at the age of five days, which
was associated with a remarkable development of the genital organs and
breasts. Van Swieten offers an example at the first month; the British
Medical Journal at the second month; Conarmond at the third month.
Ysabel, a young slave girl belonging to Don Carlos Pedro of Havana,
began to menstruate soon after birth, and at the first year was regular
in this function. At birth her mamma were well developed and her
axillae were slightly covered with hair. At the age of thirty-two
months she was three feet ten inches tall, and her genitals and mammae
resembled those of a girl of thirteen. Her voice was grave and
sonorous; her moral inclinations were not known. Deever records an
instance of a child two years and seven months old who, with the
exception of three months only, had menstruated regularly since the
fourth month. Harle speaks of a child, the youngest of three girls, who
had a bloody discharge at the age of five months which lasted three
days and recurred every month until the child was weaned at the tenth
month. At the eleventh month it returned and continued periodically
until death, occasioned by diarrhea at the fourteenth month. The
necropsy showed a uterus 1 5/8 inches long, the lips of which were
congested; the left ovary was twice the size of the right, but
displayed nothing strikingly abnormal. Baillot and the British Medical
Journal cite instances of menstruation at the fourth month. A case is
on record of an infant who menstruated at the age of six months, and
whose menses returned on the twenty-eighth day exactly. Clark, Wall,
and the Lancet give descriptions of cases at the ninth month. Naegele
has seen a case at the eighteenth month, and Schmidt and Colly in the
second year. Another case is that of a child, nineteen months old,
whose breasts and external genitals were fully developed, although the
child had shown no sexual desire, and did not exceed other children of
the same age in intellectual development. This prodigy was
symmetrically formed and of pleasant appearance. Warner speaks of
Sophie Gantz, of Jewish parentage, born in Cincinnati, July 27, 1865,
whose menses began at the twenty-third month and had continued
regularly up to the time of reporting. At the age of three years and
six months she was 38 inches tall, 38 pounds in weight, and her girth
at the hip was 33 1/2 inches. The pelvis was broad and well shaped, and
measured 10 1/2 inches from the anterior surface of the spinous process
of one ilium to that of the other, being a little more than the
standard pelvis of Churchill, and, in consequence of this pelvic
development, her legs were bowed. The mammae and labia had all the
appearance of established puberty, and the pubes and axillae were
covered with hair. She was lady-like and maidenly in her demeanor,
without unnatural constraint or effrontery. A case somewhat similar,
though the patient had the appearance of a little old woman, was a
child of three whose breasts were as well developed as in a girl of
twenty, and whose sexual organs resembled those of a girl at puberty.
She had menstruated regularly since the age of two years. Woodruff
describes a child who began to menstruate at two years of age and
continued regularly thereafter. At the age of six years she was still
menstruating, and exhibited beginning signs of puberty. She was 118 cm.
tall, her breasts were developed, and she had hair on the mons veneris.
Van der Veer mentions an infant who began menstruating at the early age
of four months and had continued regularly for over two years. She had
the features and development of a child ten or twelve years old. The
external labia and the vulva in all its parts were well formed, and the
mons veneris was covered with a full growth of hair. Sir Astley Cooper,
Mandelshof, the Ephemerides, Rause, Geoffroy-Saint-Hilaire, and several
others a report instances of menstruation occurring at three years of
age. Le Beau describes an infant prodigy who was born with the mammae
well formed and as much hair on the mons veneris as a girl of thirteen
or fourteen. She menstruated at three and continued to do so
regularly, the flow lasting four days and being copious. At the age of
four years and five months she was 42 1/2 inches tall; her features
were regular, the complexion rosy, the hair chestnut, the eyes
blue-gray, her mamma the size of a large orange, and indications that
she would be able to bear children at the age of eight. Prideaux cites
a case at five, and Gaugirau Casals, a doctor of Agde, has seen a girl
of six years who suffered abdominal colic, hemorrhage from the nose,
migraine, and neuralgia, all periodically, which, with the association
of pruritus of the genitals and engorged mammae, led him to suspect
amenorrhea. He ordered baths, and shortly the menstruation appeared and
became regular thereafter. Brierre de Boismont records cases of
catamenia at five, seven, and eight years; and Skene mentions a girl
who menstruated at ten years and five months. She was in the lowest
grade of society, living with a drunken father in a tenement house, and
was of wretched physical constitution, quite ignorant, and of low moral
character, as evinced by her specific vaginitis. Occurring from nine
years to the ordinary time of puberty, many cases are recorded.
Instances of protracted menstruation are, as a rule, reliable, the
individuals themselves being cognizant of the nature of true
menstruation, and themselves furnishing the requisite information as to
the nature and periodicity of the discharge in question. Such cases
range even past the century-mark. Many elaborate statistics on this
subject have been gathered by men of ability. Dr. Meyer of Berlin
quotes the following:--
28 at 50 years of age,
3 at 57 years of age,
18 " 51 " " "
3 " 58 " " "
18 " 52 " " "
1 " 59 " " "
11 " 53 " " "
4 " 60 " " "
13 " 54 " " "
4 " 62 " " "
5 " 55 " " "
3 " 63 " " "
4 " 56 " " "
These statistics were from examination of 6000 cases of menstruating
women. The last seven were found to be in women in the highest class of
society.
Mehliss has made the following collection of statistics of a somewhat
similar nature--
Late Dentition. Late Late
Male. Female. Lactation. Menstruation.
Between 40 and 50 0 4 0 0
" 50 " 60 1 4 2 1
" 60 " 70 3 2 1 0
" 70 " 80 3 2 0 7
" 80 " 90 6 2 0 0
" 90 " 100 1 1 0 1
Above 100 ..... 6 1 0 1
-- -- -- --
20 16 3 10
These statistics seem to have been made with the idea of illustrating
the marvelous rather than to give the usual prolongation of these
functions. It hardly seems possible that ordinary investigation would
show no cases of menstruation between sixty and seventy, and seven
cases between seventy and eighty; however, in searching literature for
such a collection, we must bear in mind that the more extraordinary the
instance, the more likely it is that it would be spoken of, as the
natural tendency of medical men is to overlook the important ordinary
and report the nonimportant extraordinary. Dewees mentions an example
of menstruation at sixty-five, and others at fifty-four and fifty-five
years. Motte speaks of a case at sixty-one; Ryan and others, at
fifty-five, sixty, and sixty-five; Parry, from sixty-six to seventy
seven; Desormeux, from sixty to seventy-five; Semple, at seventy and
eighty seven; Higgins, at seventy-six; Whitehead, at seventy-seven;
Bernstein, at seventy-eight; Beyrat, at eighty-seven; Haller, at one
hundred; and highest of all is Blancardi's case, in which menstruation
was present at one hundred and six years. In the London Medical and
Surgical Journal, 1831, are reported cases at eighty and ninety-five
years. In Good's System of Nosology there are instances occurring at
seventy-one, eighty, and ninety years. There was a woman in Italy
whose menstrual function continued from twenty-four to ninety years.
Emmet cites an instance of menstruation at seventy, and Brierre de
Boismont one of a woman who menstruated regularly from her
twenty-fourth year to the time of her death at ninety-two.
Strasberger of Beeskow describes a woman who ceased menstruating at
forty-two, who remained in good health up to eighty, suffering slight
attacks of rheumatism only, and at this late age was seized with
abdominal pains, followed by menstruation, which continued for three
years; the woman died the next year. This late menstruation had all the
sensible characters of the early one. Kennard mentions a negress, aged
ninety-one, who menstruated at fourteen, ceased at forty-nine, and at
eighty-two commenced again, and was regular for four years, but had had
no return since. On the return of her menstruation, believing that her
procreative powers were returning, she married a vigorous negro of
thirty-five and experienced little difficulty in satisfying his
desires. Du Peyrou de Cheyssiole and Bonhoure speak of an aged peasant
woman, past ninety-one years of age, who menstruated regularly.
Petersen describes a woman of seventy-nine, who on March 26th was
seized with uterine pains lasting a few days and terminating with
hemorrhagic discharge. On April 23d she was seized again, and a
discharge commenced on the 25th, continuing four days. Up to the time
of the report, one year after, this menstruation had been regular.
There is an instance on record of a female who menstruated every three
months during the period from her fiftieth to her seventy-fourth year,
the discharge, however, being very slight. Thomas cites an instance of
a woman of sixty-nine who had had no menstruation since her forty-ninth
year, but who commenced again the year he saw her. Her mother and
sister were similarly affected at the age of sixty, in the first case
attributable to grief over the death of a son, in the second ascribed
to fright. It seemed to be a peculiar family idiosyncrasy. Velasquez of
Tarentum says that the Abbess of Monvicaro at the very advanced age of
one hundred had a recurrence of catamenia after a severe illness, and
subsequently a new set of teeth and a new growth of hair.
Late Establishment of Menstruation.--In some cases menstruation never
appears until late in life, presenting the same phenomena as normal
menstruation. Perfect relates the history of a woman who had been
married many years, and whose menstruation did not appear until her
forty-seventh year. She was a widow at the time, and had never been
pregnant. Up to the time of her death, which was occasioned by a
convulsive colic, in her fifty-seventh year, she had the usual
prodromes of menstruation followed by the usual discharge. Rodsewitch
speaks of a widow of a peasant who menstruated for the first time at
the age of thirty-six. Her first coitus took place at the age of
fifteen, before any signs of menstruation had appeared, and from this
time all through her married life she was either pregnant or suckling.
Her husband died when thirty-six years old, and ever since the
catamenial flow had shown itself with great regularity. She had borne
twins in her second, fourth, and eighth confinement, and altogether had
16 children. Holdefrund in 1836 mentions a case in which menstruation
did not commence until the seventieth year, and Hoyer mentions one
delayed to the seventy-sixth year. Marx of Krakau speaks of a woman,
aged forty-eight, who had never menstruated; until forty-two years old
she had felt no symptoms, but at this time pain began, and at
forty-eight regular menstruation ensued. At the time of report, four
years after, she was free from pain and amenorrhea, and her flow was
regular, though scant. She had been married since she was twenty-eight
years of age. A somewhat similar case is mentioned by Gregory of a
mother of 7 children who had never had her menstrual flow. There are
two instances of delayed menstruation quoted: the first, a woman of
thirty, well formed, healthy, of good social position, and with all the
signs of puberty except menstruation, which had never appeared; the
second, a married woman of forty-two, who throughout a healthy
connubial life had never menstruated. An instance is known to the
authors of a woman of forty who has never menstruated, though she is of
exceptional vigor and development. She has been married many years
without pregnancy.
The medical literature relative to precocious impregnation is full of
marvelous instances. Individually, many of the cases would be beyond
credibility, but when instance after instance is reported by reliable
authorities we must accept the possibility of their occurrence, even if
we doubt the statements of some of the authorities. No less a medical
celebrity than the illustrious Sir Astley Cooper remarks that on one
occasion he saw a girl in Scotland, seven years old, whose pelvis was
so fully developed that he was sure she could easily give birth to a
child; and Warner's case of the Jewish girl three and a half years old,
with a pelvis of normal width, more than substantiates this
supposition. Similar examples of precocious pelvic and sexual
development are on record in abundance, and nearly every medical man of
experience has seen cases of infantile masturbation.
The ordinary period of female maturity is astonishingly late when
compared with the lower animals of the same size, particularly when
viewed with cases of animal precocity on record. Berthold speaks of a
kid fourteen days old which was impregnated by an adult goat, and at
the usual period of gestation bore a kid, which was mature but weak, to
which it gave milk in abundance, and both the mother and kid grew up
strong. Compared with the above, child-bearing by women of eight is not
extraordinary.
The earliest case of conception that has come to the authors' notice is
a quotation in one of the last century books from von Mandelslo of
impregnation at six; but a careful search in the British Museum failed
to confirm this statement, and, for the present, we must accept the
statement as hearsay and without authority available for
reference-purposes.
Molitor gives an instance of precocious pregnancy in a child of eight.
It was probably the same case spoken of by Lefebvre and reported to the
Belgium Academy: A girl, born in Luxemborg, well developed sexually,
having hair on the pubis at birth, who menstruated at four, and at the
age of eight was impregnated by a cousin of thirty-seven, who was
sentenced to five years' imprisonment for seduction. The pregnancy
terminated by the expulsion of a mole containing a well-characterized
human embryo. Schmidt's case in 1779 was in a child who had
menstruated at two, and bore a dead fetus when she was but eight years
and ten months old. She had all the appearance and development of a
girl of seventeen. Kussmaul gives an example of conception at eight.
Dodd speaks of a child who menstruated early and continued up to the
time of impregnation. She was a hard worker and did all her mother's
washing. Her labor pains did not continue over six hours, from first to
the last. The child was a large one, weighing 7 pounds, and afterward
died in convulsions. The infant's left foot had but 3 toes. The young
mother at the time of delivery was only nine years and eight months
old, and consequently must have been impregnated before the age of
nine. Meyer gives an astonishing instance of birth in a Swiss girl at
nine. Carn describes a case of a child who menstruated at two, became
pregnant at eight, and lived to an advanced age. Ruttel reports
conception in a girl of nine, and as far north as St. Petersburg a
girl has become a mother before nine years. The Journal de Scavans,
1684, contains the report of the case of a boy, who survived, being
born to a mother of nine years.
Beck has reported an instance of delivery in a girl a little over ten
years of age. There are instances of fecundity at nine years recorded
by Ephemerides, Wolffius, Savonarola, and others. Gleaves reports from
Wytheville, Va., the history of what he calls the case of the youngest
mother in Virginia--Annie H.--who was born in Bland County, July 15,
1885, and, on September 10, 1895, was delivered of a well-formed child
weighing 5 pounds. The girl had not the development of a woman,
although she had menstruated regularly since her fifth year. The labor
was short and uneventful, and, two hours afterward, the child-mother
wanted to arise and dress and would have done so had she been
permitted. There were no developments of the mammae nor secretion of
milk. The baby was nourished through its short existence (as it only
lived a week) by its grandmother, who had a child only a few months
old. The parents of this child were prosperous, intelligent, and worthy
people, and there was no doubt of the child's age. "Annie is now well
and plays about with the other children as if nothing had happened."
Harris refers to a Kentucky woman, a mother at ten years, one in
Massachusetts a mother at ten years, eight months, and seventeen days,
and one in Philadelphia at eleven years and three months. The first
case was one of infantile precocity, the other belonging to a much
later period, the menstrual function having been established but a few
months prior to conception. All these girls had well-developed pelves,
large mammae, and the general marks of womanhood, and bore living
children. It has been remarked of 3 very markedly precocious cases of
pregnancy that one was the daughter of very humble parents, one born in
an almshouse, and the other raised by her mother in a house of
prostitution. The only significance of this statement is the greater
amount of vice and opportunity for precocious sexual intercourse to
which they were exposed; doubtless similar cases under more favorable
conditions would never be recognized as such.
The instance in the Journal decavans is reiterated in 1775, which is
but such a repetition as is found all through medical literature--"new
friends with old faces," as it were. Haller observed a case of
impregnation in a girl of nine, who had menstruated several years, and
others who had become pregnant at nine, ten, and twelve years
respectively. Rowlett, whose case is mentioned by Harris, saw a child
who had menstruated the first year and regularly thereafter, and gave
birth to a child weighing 7 3/4 pounds when she was only ten years and
thirteen days old. At the time of delivery she measured 4 feet 7
inches in height and weighed 100 pounds. Curtis, who is also quoted by
Harris, relates the history of Elizabeth Drayton, who became pregnant
before she was ten, and was delivered of a full-grown, living male
child weighing 8 pounds. She had menstruated once or twice before
conception, was fairly healthy during gestation, and had a rather
lingering but natural labor. To complete the story, the father of this
child was a boy of fifteen. One of the faculty of Montpellier has
reported an instance at New Orleans of a young girl of eleven, who
became impregnated by a youth who was not yet sixteen. Maygrier says
that he knew a girl of twelve, living in the Faubourg Saint-Germain,
who was confined.
Harris relates the particulars of the case of a white girl who began to
menstruate at eleven years and four months, and who gave birth to an
over-sized male child on January 21, 1872, when she was twelve years
and nine months old. She had an abundance of milk and nursed the child;
the labor was of about eighteen hours' duration, and laceration was
avoided. He also speaks of a mulatto girl, born in 1848, who began to
menstruate at eleven years and nine months, and gave birth to a female
child before she reached thirteen, and bore a second child when
fourteen years and seven months old. The child's father was a white boy
of seventeen.
The following are some Indian statistics: 1 pregnancy at ten, 6 at
eleven, 2 at eighteen, 1 at nineteen. Chevers speaks of a mother at ten
and others at eleven and twelve; and Green, at Dacca, performed
craniotomy upon the fetus of a girl of twelve. Wilson gives an account
of a girl thirteen years old, who gave birth to a full-grown female
child after three hours' labor. She made a speedy convalescence, but
the child died four weeks afterward from bad nursing. The lad who
acknowledged paternity was nineteen years old. King reports a
well-verified case of confinement in a girl of eleven. Both the mother
and child did well.
Robertson of Manchester describes a girl, working in a cotton factory,
who was a mother at twelve; de La Motte mentions pregnancy before
twelve; Kilpatrick in a negress, at eleven years and six months; Fox,
at twelve; Hall, at twelve; Kinney, at twelve years, ten months, and
sixteen days; Herrick, at thirteen years and nine months; Murillo, at
thirteen years; Philippart, at fourteen years; Stallcup, at eleven
years and nine months; Stoakley, at thirteen years; Walker, at the age
of twelve years and eight months; another case, at twelve years and six
months; and Williams, at eleven.
An editorial article in the Indian Medical Gazette of Sept., 1890,
says:--
"The appearance of menstruation is held by the great majority of
natives of India to be evidence and proof of marriageability, but among
the Hindu community it is considered disgraceful that a girl should
remain unmarried until this function is established. The consequence
is that girls are married at the age of nine or ten years, but it is
understood or professed that the consummation of the marriage is
delayed until after the first menstrual period. There is, however, too
much reason to believe that the earlier ceremony is very frequently,
perhaps commonly, taken to warrant resort to sexual intercourse before
the menstrual flux has occurred: it may be accepted as true that
premenstrual copulation is largely practised under the cover of
marriage in this country.
"From this practice it results that girls become mothers at the
earliest possible period of their lives. A native medical witness
testified that in about 20 per cent of marriages children were born by
wives of from twelve to thirteen years of age. Cases of death caused by
the first act of sexual intercourse are by no means rare. They are
naturally concealed, but ever and anon they come to light. Dr. Chevers
mentioned some 14 cases of this sort in the last edition of his
'Handbook of Medical Jurisprudence for India,' and Dr. Harvey found 5
in the medicolegal returns submitted by the Civil Surgeons of the
Bengal Presidency during the years 1870-71-72.
"Reform must come from conviction and effort, as in every other case,
but meantime the strong arm of the law should be put forth for the
protection of female children from the degradation and hurt entailed by
premature sexual intercourse. This can easily be done by raising the
age of punishable intercourse, which is now fixed at the absurd limit
of ten years. Menstruation very seldom appears in native girls before
the completed age of twelve years, and if the 'age of consent' were
raised to that limit, it would not interfere with the prejudices and
customs which insist on marriage before menstruation."
In 1816 some girls were admitted to the Paris Maternite as young as
thirteen, and during the Revolution several at eleven, and even
younger. Smith speaks of a legal case in which a girl, eleven years
old, being safely delivered of a living child, charged her uncle with
rape. Allen speaks of a girl who became pregnant at twelve years and
nine months, and was delivered of a healthy, 9-pound boy before the
physician's arrival; the placenta came away afterward, and the mother
made a speedy recovery. She was thought to have had "dropsy of the
abdomen," as the parents had lost a girl of about the same age who was
tapped for ascites. The father of the child was a boy only fourteen
years of age.
Marvelous to relate, there are on record several cases of twins being
born to a child mother. Kay reports a case of twins in a girl of
thirteen; Montgomery, at fourteen; and Meigs reports the case of a
young girl, of Spanish blood, at Maracaibo, who gave birth to a child
before she was twelve and to twins before reaching fourteen years.
In the older works, the following authors have reported cases of
pregnancy before the appearance of menstruation: Ballonius, Vogel,
Morgagni, the anatomist of the kidney, Schenck, Bartholinus, Bierling,
Zacchias, Charleton, Mauriceau, Ephemerides, and Fabricius Hildanus.
In some cases this precocity seems to be hereditary, being transmitted
from mother to daughter, bringing about an almost incredible state of
affairs, in which a girl is a grandmother about the ordinary age of
maternity. Kay says that he had reported to him, on "pretty good"
authority, an instance of a Damascus Jewess who became a grandmother at
twenty-one years. In France they record a young grandmother of
twenty-eight. Ketchum speaks of a negress, aged thirteen, who gave
birth to a well-developed child which began to menstruate at ten years
and nine months and at thirteen became pregnant; hence the negress was
a grandmother at twenty-five years and nine months. She had a second
child before she was sixteen, who began to menstruate at seven years
and six months, thus proving the inheritance of this precocity, and
leaving us at sea to figure what degree of grandmother she may be if
she lives to an advanced age. Another interesting case of this nature
is that of Mrs. C., born 1854, married in 1867, and who had a daughter
ten months after. This daughter married in 1882, and in March, 1883,
gave birth to a 9-pound boy. The youthful grandmother, not twenty-nine,
was present at the birth. This case was remarkable, as the children
were both legitimate.
Fecundity in the old seems to have attracted fully as much attention
among the older observers as precocity. Pliny speaks of Cornelia, of
the family of Serpios, who bore a son at sixty, who was named Volusius
Saturnius; and Marsa, a physician of Venice, was deceived in a
pregnancy in a woman of sixty, his diagnosis being "dropsy." Tarenta
records the history of the case of a woman who menstruated and bore
children when past the age of sixty. Among the older reports are those
of Blanchard of a woman who bore a child at sixty years; Fielitz, one
at sixty; Ephemerides, one at sixty-two; Rush, one at sixty; Bernstein,
one at sixty years; Schoepfer, at seventy years; and, almost beyond
belief, Debes cites an instance as taking place at the very advanced
age of one hundred and three. Wallace speaks of a woman in the Isle of
Orkney bearing children when past the age of sixty. We would naturally
expect to find the age of child-bearing prolonged in the northern
countries where the age of maturity is later. Capuron cites an example
of child-birth in a woman of sixty; Haller, cases at fifty-eight,
sixty-three, and seventy; Dewees, at sixty-one; and Thibaut de
Chauvalon, in a woman of Martinique aged ninety years. There was a
woman delivered in Germany, in 1723, at the age of fifty-five; one at
fifty-one in Kentucky; and one in Russia at fifty. Depasse speaks of a
woman of fifty-nine years and five months old who was delivered of a
healthy male child, which she suckled, weaning it on her sixtieth
birthday. She had been a widow for twenty years, and had ceased to
menstruate nearly ten years before. In St. Peter's Church, in East
Oxford, is a monument bearing an inscription recording the death in
child-birth of a woman sixty-two years old. Cachot relates the case of
a woman of fifty-three, who was delivered of a living child by means of
the forceps, and a year after bore a second child without instrumental
interference. She had no milk in her breasts at the time and no signs
of secretion. This aged mother had been married at fifty-two, five
years after the cessation of her menstruation, and her husband was a
young man, only twenty-four years old.
Kennedy reports a delivery at sixty-two years, and the Cincinnati
Enquirer, January, 1863, says: "Dr. W. McCarthy was in attendance on a
lady of sixty-nine years, on Thursday night last, who gave birth to a
fine boy. The father of the child is seventy-four years old, and the
mother and child are doing well." Quite recently there died in Great
Britain a Mrs. Henry of Gortree at the age of one hundred and twelve,
leaving a daughter of nine years.
Mayham saw a woman seventy-three years old who recovered after delivery
of a child. A most peculiar case is that of a widow, seventy years old,
a native of Garches. She had been in the habit of indulging freely in
wine, and, during the last six months, to decided excess. After an
unusually prolonged libation she found herself unable to walk home; she
sat down by the roadside waiting until she could proceed, and was so
found by a young man who knew her and who proposed helping her home. By
the time her house was reached night was well advanced, and she invited
him to stop over night; finding her more than affable, he stopped at
her house over four nights, and the result of his visits was an ensuing
pregnancy for Madame.
Multiple births in the aged have been reported from authentic sources.
The Lancet quotes a rather fabulous account of a lady over sixty-two
years of age who gave birth to triplets, making her total number of
children 13. Montgomery, Colomb, and Knehel, each, have recorded the
birth of twins in women beyond the usual age of the menopause, and
there is a case recorded of a woman of fifty-two who was delivered of
twins.
Impregnation without completion of the copulative act by reason of some
malformation, such as occlusion of the vagina or uterus, fibrous and
unruptured hymen, etc., has been a subject of discussion in the works
of medical jurisprudence of all ages; and cases of conception without
entrance of the penis are found in abundance throughout medical
literature, and may have an important medicolegal bearing. There is
little doubt of the possibility of spermatozoa deposited on the
genitalia making progress to the seat of fertilization, as their power
of motility and tenacity of life have been well demonstrated. Percy
reports an instance in which semen was found issuing from the os uteri
eight and one-half days after the last intercourse; and a microscopic
examination of this semen revealed the presence of living as well as
dead spermatozoa. We have occasional instances of impregnation by
rectal coitus, the semen finding its way into an occluded vaginal canal
by a fistulous communication.
Guillemeau, the surgeon of the French king, tells of a girl of
eighteen, who was brought before the French officials in Paris, in
1607, on the citation of her husband of her inability to allow him
completion of the marital function. He alleged that he had made several
unsuccessful attempts to enter her, and in doing so had caused
paraphimosis. On examination by the surgeons she was found to have a
dense membrane, of a fibrous nature, entirely occluding the vagina,
which they incised. Immediately afterward the woman exhibited morning
sickness and the usual signs of pregnancy, and was delivered in four
months of a full-term child, the results of an impregnation occasioned
by one of the unsuccessful attempts at entrance. Such instances are
numerous in the older literature, and a mere citation of a few is
considered sufficient here. Zacchias, Amand, Fabricius Hildanus, Graaf,
the discoverer of the follicles that bear his name, Borellus, Blegny,
Blanchard, Diemerbroeck, Duddell, Mauriceau, a Reyes, Riolan, Harvey,
the discoverer of the circulation of the blood, Wolfius, Walther,
Rongier, Ruysch, Forestus, Ephemerides, and Schurig all mention cases
of conception with intact hymen, and in which there was no entrance of
the penis. Tolberg has an example of hymen integrum after the birth of
a fetus five months old, and there is recorded a case of tubal
pregnancy in which the hymen was intact.
Gilbert gives an account of a case of pregnancy in an unmarried woman,
who successfully resisted an attempt at criminal connection and yet
became impregnated and gave birth to a perfectly formed female child.
The hymen was not ruptured, and the impregnation could not have
preceded the birth more than thirty-six weeks. Unfortunately, this poor
woman was infected with gonorrhea after the attempted assault. Simmons
of St. Louis gives a curious peculiarity of conception, in which there
was complete closure of the vagina, subsequent conception, and delivery
at term. He made the patient's acquaintance from her application to him
in regard to a malcondition of her sexual apparatus, causing much
domestic infelicity.
Lawson speaks of a woman of thirty-five, who had been married ten
months, and whose husband could never effect an entrance; yet she
became pregnant and had a normal labor, despite the fact that, in
addition to a tough and unruptured hymen, she had an occluding vaginal
cyst. Hickinbotham of Birmingham reports the history of two cases of
labor at term in females whose hymens were immensely thickened. H. Grey
Edwards has seen a case of imperforate hymen which had to be torn
through in labor; yet one single act of copulation, even with this
obstacle to entrance, sufficed to impregnate. Champion speaks of a
woman who became pregnant although her hymen was intact. She had been
in the habit of having coitus by the urethra, and all through her
pregnancy continued this practice.
Houghton speaks of a girl of twenty-five into whose vagina it was
impossible to pass the tip of the first finger on account of the dense
cicatricial membrane in the orifice, but who gave birth, with
comparative ease, to a child at full term, the only interference
necessary being a few slight incisions to permit the passage of the
head. Tweedie saw an Irish girl of twenty-three, with an imperforate os
uteri, who had menstruated only scantily since fourteen and not since
her marriage. She became pregnant and went to term, and required some
operative interference. He incised at the point of usual location of
the os, and one of his incisions was followed by the flow of liquor
amnii, and the head fell upon the artificial opening, the diameter of
which proved to be one and a half or two inches; the birth then
progressed promptly, the child being born alive.
Guerard notes an instance in which the opening barely admitted a hair;
yet the patient reached the third month of pregnancy, at which time she
induced abortion in a manner that could not be ascertained. Roe gives a
case of conception in an imperforate uterus, and Duncan relates the
history of a case of pregnancy in an unruptured hymen, characterized by
an extraordinary ascent of the uterus. Among many, the following modern
observers have also reported instances of pregnancy with hymen
integrum: Braun, 3 cases; Francis, Horton, Oakman, Brill, 2 cases;
Burgess, Haig, Hay, and Smith.
Instances in which the presence of an unruptured hymen has complicated
or retarded actual labor are quite common, and until the membrane is
ruptured by external means the labor is often effectually obstructed.
Among others reporting cases of this nature are Beale, Carey, Davis,
Emond Fetherston, Leisenring, Mackinlay, Martinelli, Palmer, Rousseau,
Ware, and Yale.
There are many cases of stricture or complete occlusion of the vagina,
congenital or acquired from cicatricial contraction, obstructing
delivery, and in some the impregnation seems more marvelous than cases
in which the obstruction is only a thin membranous hymen. Often the
obstruction is so dense as to require a large bistoury to divide it,
and even that is not always sufficient, and the Cesarean operation only
can terminate the obstructed delivery; we cannot surmise how conception
could have been possible. Staples records a case of pregnancy and
parturition with congenital stricture of the vagina. Maisonneuve
mentions the successful practice of a Cesarean operation in a case of
congenital occlusion of the vagina forming a complete obstruction to
delivery. Verdile records an instance of imperforate vagina in which
rectovaginal wall was divided and the delivery effected through the
rectum and anus. Lombard mentions an observation of complete occlusion
of the vagina in a woman, the mother of 4 living children and pregnant
for the fifth time. Thus, almost incredible to relate, it is possible
for a woman to become a mother of a living child and yet preserve all
the vaginal evidences of virginity. Cole describes a woman of
twenty-four who was delivered without the rupture of the hymen, and
Meek remarks on a similar case. We can readily see that, in a case like
that of Verdile, in which rectal delivery is effected, the hymen could
be left intact and the product of conception be born alive.
A natural sequence to the subject of impregnation without entrance is
that of artificial impregnation. From being a matter of wonder and
hearsay, it has been demonstrated as a practical and useful method in
those cases in which, by reason of some unfortunate anatomic
malformation on either the male or the female side, the marriage is
unfruitful. There are many cases constantly occurring in which the
birth of an heir is a most desirable thing in a person's life. The
historic instance of Queen Mary of England, whose anxiety and efforts
to bear a child were the subject of public comment and prayers, is but
an example of a fact that is occurring every day, and doubtless some of
these cases could be righted by the pursuance of some of the methods
suggested.
There have been rumors from the beginning of the century of women being
impregnated in a bath, from contact with cloths containing semen, etc.,
and some authorities in medical jurisprudence have accepted the
possibility of such an occurrence. It is not in the province of this
work to speculate on what may be, but to give authoritative facts, from
which the reader may draw his own deductions. Fertilization of plants
has been thought to have been known in the oldest times, and there are
some who believe that the library at Alexandria must have contained
some information relative to it. The first authentic account that we
have of artificial impregnation is that of Schwammerdam, who in 1680
attempted it without success by the fecundation of the eggs of fish.
Roesel, his scholar, made an attempt in 1690, but also failed; and to
Jacobi, in 1700, belongs the honor of success. In 1780, Abbe
Spallanzani, following up the success of Jacobi, artificially
impregnated a bitch, who brought forth in sixty-two days 3 puppies, all
resembling the male. The illustrious John Hunter advised a man
afflicted with hypospadias to impregnate his wife by vaginal injections
of semen in water with an ordinary syringe, and, in spite of the
simplicity of this method, the attempt was followed by a successful
issue. Since this time, Nicholas of Nancy and Lesueur have practised
the simple vaginal method; while Gigon, d'Angouleme (14 cases), Girault
(10 cases), Marion Sims, Thomas, Salmon, Pajot, Gallard, Courty,
Roubaud, Dehaut, and others have used the more modern uterine method
with success.
A dog-breeder, by syringing the uterus of a bitch, has succeeded in
impregnating her. Those who are desirous of full information on this
subject, as regards the modus operandi, etc., are referred to Girault;
this author reports in full several examples. One case was that of a
woman, aged twenty-five, afflicted with blenorrhea, who, chagrined at
not having issue, made repeated forcible injections of semen in water
for two months, and finally succeeded in impregnating herself, and was
delivered of a living child. Another case was that of a female, aged
twenty-three, who had an extra long vaginal canal, probably accounting
for the absence of pregnancy. She made injections of semen, and was
finally delivered of a child. He also reports the case of a
distinguished musician who, by reason of hypospadias, had never
impregnated his wife, and had resorted to injections of semen with a
favorable result. This latter case seems hardly warranted when we
consider that men afflicted with hypospadias and epispadias have become
fathers. Percy gives the instance of a gentleman whom he had known for
some time, whose urethra terminated a little below the frenum, as in
other persons, but whose glans bulged quite prominently beyond it,
rendering urination in the forward direction impossible. Despite the
fact that this man could not perform the ejaculatory function, he was
the father of three children, two of them inheriting his penile
formation.
The fundamental condition of fecundity being the union of a
spermatozoid and an ovum, the object of artificial impregnation is to
further this union by introducing semen directly to the fundus of the
uterus. The operation is quite simple and as follows: The husband,
having been found perfectly healthy, is directed to cohabit with his
wife, using a condom. The semen ejaculated is sucked up by an
intrauterine syringe which has been properly disinfected and kept warm.
The os uteri is now exposed and wiped off with some cotton which has
been dipped in an antiseptic fluid; introduced to the fundus of the
uterus, and some drops of the fluid slowly expressed into the uterus.
The woman is then kept in bed on her back. This operation is best
carried out immediately before or immediately after the menstrual
epoch, and if not successful at the first attempt should be repeated
for several months. At the present day artificial impregnation in
pisciculture is extensively used with great success.
{footnote} The following extraordinary incident of accidental
impregnation, quoted from the American Medical Weekly by the Lancet, is
given in brief, not because it bears any semblance of possibility, but
as a curious example from the realms of imagination in medicine.
L. G. Capers of Vicksburg, Miss., relates an incident during the late
Civil War, as follows: A matron and her two daughters, aged fifteen and
seventeen years, filled with the enthusiasm of patriotism, stood ready
to minister to the wounds of their countrymen in their fine residence
near the scene of the battle of R----, May 12, 1863, between a portion
of Grant's army and some Confederates. During the fray a gallant and
noble young friend of the narrator staggered and fell to the earth; at
the same time a piercing cry was heard in the house near by.
Examination of the wounded soldier showed that a bullet had passed
through the scrotum and carried away the left testicle. The same
bullet had apparently penetrated the left side of the abdomen of the
elder young lady, midway between the umbilicus and the anterior
superior spinous process of the ilium, and had become lost in the
abdomen. This daughter suffered an attack of peritonitis, but recovered
in two months under the treatment administered.
Marvelous to relate, just two hundred and seventy-eight days after the
reception of the minie-ball, she was delivered of a fine boy, weighing
8 pounds, to the surprise of herself and the mortification of her
parents and friends. The hymen was intact, and the young mother
strenuously insisted on her virginity and innocence. About three weeks
after this remarkable birth Dr. Capers was called to see the infant,
and the grandmother insisted that there was something wrong with the
child's genitals. Examination showed a rough, swollen, and sensitive
scrotum, containing some hard substance. He operated, and extracted a
smashed and battered minie-ball. The doctor, after some meditation,
theorized in this manner: He concluded that this was the same ball that
had carried away the testicle of his young friend, that had penetrated
the ovary of the young lady, and, with some spermatozoa upon it, had
impregnated her. With this conviction he approached the young man and
told him the circumstances; the soldier appeared skeptical at first,
but consented to visit the young mother; a friendship ensued which soon
ripened into a happy marriage, and the pair had three children, none
resembling, in the same degree as the first, the heroic pater familias.
Interesting as are all the anomalies of conception, none are more so
than those of unconscious impregnation; and some well-authenticated
cases can be mentioned. Instances of violation in sleep, with
subsequent pregnancy as a result, have been reported in the last
century by Valentini, Genselius, and Schurig. Reports by modern
authorities seem to be quite scarce, though there are several cases on
record of rape during anesthesia, followed by impregnation. Capuron
relates a curious instance of a woman who was raped during lethargy,
and who subsequently became pregnant, though her condition was not
ascertained until the fourth month, the peculiar abdominal sensation
exciting suspicion of the true nature of the case, which had previously
been thought impossible.
There is a record of a case of a young girl of great moral purity who
became pregnant without the slightest knowledge of the source;
although, it might be remarked, such cases must be taken "cum grano
salis." Cases of conception without the slightest sexual desire or
pleasure, either from fright, as in rape, or naturally deficient
constitution, have been recorded; as well as conception during
intoxication and in a hypnotic trance, which latter has recently
assumed a much mooted legal aspect. As far back as 1680, Duverney
speaks of conception without the slightest sense of desire or pleasure
on the part of the female.
Conception with Deficient Organs.--Having spoken of conception with
some obstructive interference, conception with some natural or acquired
deficiency of the functional, organic, or genital apparatus must be
considered. It is a well-known fact that women exhibiting rudimentary
development of the uterus or vagina are still liable to become
pregnant, and many such cases have been recorded; but the most peculiar
cases are those in which pregnancy has appeared after removal of some
of the sexual apparatus.
Pregnancy going to term with a successful delivery frequently follows
the performance of ovariotomy with astonishing rapidity. Olier cites
an instance of ovariotomy with a pregnancy of twins three months
afterward, and accouchement at term of two well-developed boys.
Polaillon speaks of a pregnancy consecutive to ovariotomy, the
accouchement being normal at term. Crouch reports a case of successful
parturition in a patient who had previously undergone ovariotomy by a
large incision. Parsons mentions a case of twin pregnancy two years
after ovariotomy attended with abnormal development of one of the
children. Cutter speaks of a case in which a woman bore a child one
year after the performance of ovariotomy, and Pippingskold of two cases
of pregnancy after ovariotomy in which the stump as well as the
remaining ovary were cauterized. Brown relates a similar instance with
successful delivery. Bixby, Harding, Walker (1878-9), and Mears all
report cases, and others are not at all rare. In the cases following
shortly after operation, it has been suggested that they may be
explained by the long retention of the ova in the uterus, deposited
them prior to operation. In the presence of such facts one can but
wonder if artificial fecundation of an ovum derived from another woman
may ever be brought about in the uterus of a sterile woman!
Conception Soon After a Preceding Pregnancy.--Conception sometimes
follows birth (or abortion) with astonishing rapidity, and some women
seem for a period of their lives either always pregnant or with infants
at their breasts. This prolificity is often alluded to, and is not
confined to the lower classes, as often stated, but is common even
among the nobility. Illustrative of this, we have examples in some of
the reigning families in Europe to-day. A peculiar instance is given by
Sparkman in which a woman conceived just forty hours after abortion.
Rice mentions the case of a woman who was confined with her first
child, a boy, on July 31, 1870, and was again delivered of another
child on June 4, 1871. She had become pregnant twenty-eight days after
delivery. He also mentions another case of a Mrs. C., who, at the age
of twenty-three, gave birth to a child on September 13, 1880, and bore
a second child on July 2, 1881. She must have become pregnant
twenty-one days after the delivery of her first child.
Superfetation has been known for many centuries; the Romans had laws
prescribing the laws of succession in such cases, and many medical
writers have mentioned it. Hippocrates and Aristotle wrote of it, the
former at some length. Pliny speaks of a slave who bore two infants,
one resembling the master, the other a man with whom she had
intercourse, and cites the case as one of superfetation. Schenck
relates instances, and Zacchias, Velchius, and Sinibaldus mention
eases. Pare seemed to be well conversant with the possibility as well
as the actuality of superfetation; and Harvey reports that a certain
maid, gotten with child by her master, in order to hide her knavery
came to London in September, where she lay in by stealth, and being
recovered, returned home. In December of the same year she was
unexpectedly delivered of another child, a product of superfetation,
which proclaimed the crime that she had so cunningly concealed before.
Marcellus Donatus, Goret, Schacher, and Mauriceau mention
superfetation. In the Academie des Sciences, at Paris, in 1702, there
was mentioned the case of a woman who was delivered of a boy; in the
placenta was discovered a sort of bladder which was found to contain a
female fetus of the age of from four to five months; and in 1729,
before the same society, there was an instance in which two fetuses
were born a day apart, one aged forty days and the other at full term.
From the description, it does not seem possible that either of these
were blighted twin pregnancies. Ruysch gives an account of a surgeon's
wife at Amsterdam, in 1686, who was delivered of a strong child which
survived, and, six hours after, of a small embryo, the funis of which
was full of hydatids and the placenta as large and thick as one of
three months. Ruysch accompanies his description with an illustrative
figure. At Lyons, in 1782, Benoite Franquet was unexpectedly delivered
of a child seven months old; three weeks later she experienced symptoms
indicative of the existence of another fetus, and after five months and
sixteen days she was delivered of a remarkably strong and healthy child.
Baudeloque speaks of a case of superfetation observed by Desgranges in
Lyons in 1780. After the birth of the first infant the lochia failed to
flow, no milk appeared in the breasts, and the belly remained large. In
about three weeks after the accouchement she had connection with her
husband, and in a few days felt fetal movements. A second child was
born at term, sixty-eight days after the first; and in 1782 both
children were living. A woman of Arles was delivered on November 11,
1796, of a child at term; she had connection with her husband four days
after; the lochia stopped, and the milk did not flow after this
intercourse. About one and a half months after this she felt quickening
again, and naturally supposed that she had become impregnated by the
first intercourse after confinement; but five months after the first
accouchement she was delivered of another child at term, the result of
a superfetation. Milk in abundance made its appearance, and she was
amply able to nourish both children from the breasts. Lachausse speaks
of a woman of thirty who bore one child on April 30, 1748, and another
on September 16th in the same year. Her breasts were full enough to
nourish both of the children. It might be remarked in comment on this
case that, according to a French authority, the woman died in 1755, and
on dissection was found to have had a double uterus.
A peculiar instance of superfetation was reported by Langmore in which
there was an abortion of a fetus between the third and fourth months,
apparently dead some time, and thirteen hours later a second fetus; an
ovum of about four weeks and of perfect formation was found adherent
near the fundus. Tyler Smith mentions a lady pregnant for the first
time who miscarried at five months and some time afterward discharged a
small clot containing a perfectly fresh and healthy ovum of about four
weeks' formation. There was no sign of a double uterus, and the patient
menstruated regularly during pregnancy, being unwell three weeks before
the abortion. Harley and Tanner speak of a woman of thirty-eight who
never had borne twins, and who aborted a fetus of four months'
gestation; serious hemorrhage accompanied the removal of the placenta,
and on placing the hand in the uterine cavity an embryo of five or six
weeks was found inclosed in a sac and floating in clear liquor amnii.
The patient was the mother of nine children, the youngest of which was
three years old.
Young speaks of a woman who three months previously had aborted a three
months' fetus, but a tumor still remained in the abdomen, the
auscultation of which gave evidence of a fetal heart-beat. Vaginal
examination revealed a dilatation of the os uteri of at least one inch
and a fetal head pressing out; subsequently a living fetus of about six
months of age was delivered. Severe hemorrhage complicated the case,
but was controlled, and convalescence speedily ensued. Huse cites an
instance of a mother bearing a boy on November 4, 1834, and a girl on
August 3, 1835. At birth the boy looked premature, about seven months
old, which being the case, the girl must have been either a
superfetation or a seven months' child also. Van Bibber of Baltimore
says he met a young lady who was born five months after her sister, and
who was still living.
The most curious and convincing examples of superfetation are those in
which children of different colors, either twins or near the same age,
are born to the same woman,--similar to that exemplified in the case of
the mare who was covered first by a stallion and a quarter of an hour
later by an ass, and gave birth at one parturition to a horse and a
mule. Parsons speaks of a case at Charleston, S.C., in 1714, of a white
woman who gave birth to twins, one a mulatto and the other white. She
confessed that after her husband left her a negro servant came to her
and forced her to comply with his wishes by threatening her life.
Smellie mentions the case of a black woman who had twins, one child
black and the other almost white. She confessed having had intercourse
with a white overseer immediately after her husband left her bed.
Dewees reports a similar case. Newlin of Nashville speaks of a negress
who bore twins, one distinctly black with the typical African features,
while the other was a pretty mulatto exhibiting the distinct characters
of the Caucasian race. Both the parents were perfect types of the black
African negro. The mother, on being questioned, frankly acknowledged
that shortly after being with her husband she had lain a night with a
white man. In this case each child had its own distinct cord and
placenta.
Archer gives facts illustrating and observations showing: "that a white
woman, by intercourse with a white man and negro, may conceive twins,
one of which shall be white and the other a mulatto; and that, vice
versa, a black woman, by intercourse with a negro and a white man, may
conceive twins, one of which shall be a negro and the other a mulatto."
Wight narrates that he was called to see a woman, the wife of an East
Indian laborer on the Isle of Trinidad, who had been delivered of a
fetus 6 inches long, about four months old, and having a cord of about
18 inches in length. He removed the placenta, and in about half an hour
the woman was delivered of a full-term white female child. The first
child was dark, like the mother and father, and the mother denied any
possibility of its being a white man's child; but this was only natural
on her part, as East Indian husbands are so intensely jealous that they
would even kill an unfaithful wife. Both the mother and the mysterious
white baby are doing well. Bouillon speaks of a negress in Guadeloupe
who bore twins, one a negro and the other a mulatto. She had sexual
congress with both a negro and a white man.
Delmas, a surgeon of Rouen, tells of a woman of thirty-six who was
delivered in the hospital of his city on February 26, 1806, of two
children, one black and the other a mulatto. She had been pregnant
eight months, and had had intercourse with a negro twice about her
fourth month of pregnancy, though living with the white man who first
impregnated her. Two placentae were expelled some time after the twins,
and showed a membranous junction. The children died shortly after birth.
Pregnancy often takes place in a unicorn or bicorn uterus, leading to
similar anomalous conditions. Galle, Hoffman, Massen, and Sanger give
interesting accounts of this occurrence, and Ross relates an instance
of triple pregnancy in a double uterus. Cleveland describes a
discharge of an anomalous deciduous membrane during pregnancy which was
probably from the unimpregnated half of a double uterus.